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Great Clients are Made, Not Born (Part 1 of 3)

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Professional skin care in the 21st Century has never been so exciting, technical, scientific, profitable and yes, extremely competitive. Open up a fashion magazine today and you will find no less than 30+ non-professional skin care brands claiming to reduce lines and wrinkles, improve skin, restore elasticity, replace Botox tm and on and on and on.
These companies also promise simulated “professional peels” and “microdermabrasion” in do-it-yourself at home product kits. Think about it, if you are reading these ads, it’s inevitable your clients are reading them too!

Remember, this expensive advertising is designed to attract, tempt, and convince individuals to buy their skin care in less than a 10 second decision making process. Is this really professional skin care and how does your client know the professional difference?

To help you acquire the most out of this edutorial, analyze the following points of reference, which will be found through the length of the series, while reading along to assist you in answering the final questions.

- The aesthetician’s first point of difference to make a great client.

- The backbone of your professional services proceeding skin treatments and product dispensing

- Photo-dermatology skin analysis

- Photo-dermatology analysis two-step approach

- Analyzing the skin for Photo-dermatology analysis

- Educating your client about the enemies of the skin

- Nutrition and Photo-dermatology skin assessment

- Circadian rhythms

- The New Skin of Color

- Pets and your client’s skin

- The Second professional point of difference to make a great client

- Best aesthetic treatments achieved

- The “Mac Facial” attitude of yesteryear.

- The clinical treatment room.

- The third point of professional difference to make a great client.

- Education and sales


Department stores have entered into the aesthetic world by staffing their skin care sections with aestheticians and nurses, in an effort to improve the “counter culture” image and send a message to the consumer they are equal to that of a professional skin care environment. Can an individual who suffers from acne, pigmentation and aging skin really find professional solutions at a counter and how does your client know the professional difference?

Shopping channels insert their spin on skin care into your clients living space repeating the same chant with outrageous claims that border deception, convincing “your client” the skin care they sell equals that of a spa, medical, and aesthetic environment. Many of these products are cheap and bank on sales volume, void of efficacy for the clients skin, never revealing they have up to a 40 percent return on these goods. It’s just a numbers game for them, not a professional commitment. So how do you compete with these false powerful promises and how does your client really know the professional difference?

Skin care infomercials staffed with actresses, medical, and self-proclaimed skin experts are too numerous to count on TV now. They rely on someone famous championing testimonials too good to believe to sell these inferior skin care products. The majority of infomercials misinforms the public and in addition, sells so-called peels and microdermabrasion goods claiming the customer will acquire the same results as in a skin care clinic, with only a fraction of the cost. How can you compete economically with these misleading advertisements and how does your client really know the professional difference?

Physicians have entered into professional aesthetic skin care and with medical license backing, how do you compete and how does your client know the difference?

If professional skin care were not so real, licensed aestheticians would not be faced with the blizzard of competitors currently in the same race for client’s dollars, loyalty, and commitment to their products and services. It is the personal commitment of this author and magazine to provide an educational edge for the professional aesthetician and assist you in making choices and help you achieve success in your skin care business by developing a great client for life.

So how do you develop a successful relationship with a client to ensure they are loyal to you and not a department store, shopping channel or infomercial? The answers lie in these series of articles to help you assemble a winning code of practice that will make a customer for life because great clients are made, not born.

Every day a new generation of aestheticians enter the professional world of skin care with hopes and dreams of building a successful business and a solid, loyal clientele. With so much competition and deep pocket companies spending millions of dollars competing for the same customer, the aesthetician must establish the point of difference to create a great client. In other words, there is no room for lazy aesthetics, only professional commitment to the customer and the health of their skin. Ask yourself, are you an aesthetician who fails to research the client’s skin and rushes into a treatment without first establishing a client/skin relationship?

Clients are the backbone of your business. Clients drive the success or failure of your business and without a client you are out of business. What do you think would separate you from the mainstream of other professionals and why would a client continue to come back to your spa, clinic or salon for your services?

You! Yes, you are the main point of difference for your client and simply put, nothing takes the place of a genuine professional treatment and clinical skin care available only through a licensed aesthetician. With that said, making a great client is not about lazy aesthetics or a quick fix. It is vis-à-vis, developing a strong relationship with your customer by means of your professional services, thoroughly educating them on their specific skin conditions, providing clinical treatments with results, and selling professional products that really work.

The formula for making a great client is straightforward and your first point of difference begins with a thorough skin health check-up. As important as a physical assessment conducted by a doctor prior to any medical procedure or Rx dispensing, this individualized skin examination is suitably named Photo-dermatology skin analysis and is no less significant.

Photo-dermatology analysis is the backbone of your professional services and precedes all skin treatments and product dispensing; pinpointing concealed histological manifestations of health related changes not yet clinically evident on the skin. Evaluation of wrinkles, acne, pigmentation, and other skin conditions provide the intimate insight for the aesthetician to make an accurate verdict for clinical skin treatments and professional products. Because aestheticians must be great detectives, this skin investigation cannot be done via an advertisement, TV, talk show, infomercial, shopping channel, or department store. Thus making photo-dermatology analysis the main point of difference for professional skin care, giving the aesthetician a significant advantage and edge to treat the client according to their personal skin needs.

Photo-dermatology skin analysis evaluates this complicated immune organ for cosmetic effects directly impacted by sun, smoking, sleep, intrinsic/extrinsic aging, antibiotics, prescription drugs, hormones, menopause, birth control, vitamin supplements, cosmetic/reconstructive surgery, stress, weight loss, nutrition, skin care habits, etc. to assist in establishing the “true age” of your client’s skin.

Regardless of age, sex, color, condition, and problem, all skins have one thing in common and that is aging. No matter what professional skin care treatment or product is selected for the client, maintaining a preventative aging protocol will always support the health of the skin.

Although skin in itself is a protection against radiation, this shield brings with it consequences of it own, leading to a “perceived age” that could be greater than one’s actual age. The appearance of an individual’s face and hands are often used as a rapid measure of skin maturity. Comparing the appearance of the face and forearms with that of less exposed areas demonstrates the differences between intrinsic (internal) and extrinsic (external) or “photo-aged” skin. Conclusive findings from a Photo-dermatology analysis are the first step to establish the skin goal for the client and devise a purpose with a professional plan of action: peels, acne treatments, ultrasound, etc.

I can guarantee your client will not receive Photo-dermatology analysis from anyone but an aesthetician who has been trained in this exclusive method of professional skin examination. The value of this consultation not only furnishes critical skin history data, it also provides an excellent time to educate your client specific to their skin needs based on solid information gathered and not driven by what a cosmetic company advertises or dictates. Photo-dermatology analysis eliminates one-size fits all professional treatment and skin care protocol and provides you the expert tools to customize to each of your clients skin needs.

Photo-dermatology analysis is the cosmetic assessment and treatment of photo-aged skin that requires a two-step approach: prevention for the health related conditions of the skin and correction directed to the cosmetic appearance of the skin. Clinical assessment is critical before any treatment is recommended. Your tools should consist of a thorough client questionnaire, proper instrumentation using a woods lamp and 5-diaptor derma scope. Instrumentation has become a legitimate way to evaluate your client’s skin prior to professional treatments and skin care providing insight to damage not yet visible to the naked eye.

A woods lamp indicates skin conditions through color impact:

White spots: Normal healthy skin

Blue white: Non-nucleated cornefied epithelium

Purple: Thin, sensitive skin lacking hydration

Light violet: Dehydrated skin

Orange/pink: Comedones, oil activity and or oily skin

Black brown: Pigmentation/oxidation injuries.

Before you begin treatment and select a home skin care protocol, always take before and after pictures and secure a consent form for both pictures and treatment. Clients forget how bad their skin really was and pictures speak a thousand words you are not able to verbalize. I have found even after years of treatment, my clients loved to look at the before pictures. Pictures validate how healthy and young the skin has remained with professional products and treatments even after a decade! This is a great way to maintain a visual record and reinforce to your client why they are committed to your exclusive program. It is also an amazing way to build a testimonial image archive you can share with new clients to relate with concerning the results of your professional skin treatments.

When analyzing the skin for Photo-dermatology analysis, aging assessment is the most relevant across geographical and cultural boundaries with seven common points connecting the dots of extrinsic photo-aged skin:

-Fine lines and wrinkles

-Rough skin texture

-Uneven skin tone

-Skin dullness

-Large, visible pores

-Oxidation damage i.e.; pigmentation/age spots

-Skin dryness

Charting photo-aged mature changing skin coupled with questions on your client’s ancestor history that pertains to aging furnishes information concerning family patterns beyond your control. Sometimes client expectations are off the richter scale with the perception of their reality. Arm yourself with the knowledge that each of your clients possess aging skin “genes” they inherited over which you have little control no matter what you do. These are the hereditary patterns in their family lineage that predetermine how their face and body respond to the aging process.

If you are fortunate enough to be acquainted with information about the older generations of your clients family members, you may note patterns of aging skin in their faces and bodies. These can include:

* Furrows in the brow or forehead

* Tiny lines or crinkles around the eyes

* Deep creases along the sides of the nose to the mouth

* Drooping eyelids

* Loose skin along the jaw line

· A “tired” look

Chart all visual heredity patterns and if requested, your client may ask you to be referred to a plastic or cosmetic surgeon for surgical age management to help control aging concerns aesthetic treatments cannot provide short or long-term. Having an established relationship with a competent medical doctor is another valuable asset to establish trust to build a great client for the future. Also important is to recognize what you are able to do within the scope of your practice and never promise anything you cannot deliver or are not experienced enough to perform.

To measure aging of your clients face, an important question for photo-dermatology analysis concerns any weight gain or loss. Rapid weight loss is part of your charting to determine if skin sagging is attributed to UVR or weight. If weight loss occurs too rapidly, the volume of fat cells responsible to cushion the face are decreased before chemicals in the skin can react. This not only makes a person look gaunt, but can cause the skin to sag. Be sure to chart these sagging patterns and make notes.

The process of aging differs in male and female skin. There is a gradual thinning of male skin with increasing age of approximately 1 percent a year. Here a relationship between skin thickness and collagen content exists in men of all ages. In adult skin, regardless of gender, the features of aging are closely related to the total collagen content, which in both sexes decreases with increasing age, but at different rates. Another reason for the gender difference in skin collagen content may be the difference in male hormone (androgen) production between men and women.

These aging facts are significant to your masculine clientele and establish an important reason to offer a clinical point of difference with a specialized professional skin care line to your male clients. Educating your male customers on this fact will elevate their confidence level in your aesthetic aptitude and will establish a masculine client for life. Since men’s skin care is growing at a faster pace than women’s, this also makes sound business sense for the growth and success of your business now and for the future.

Always determine the approximate “skin age” (extrinsic) in addition to the actual chronological age (true years) of your client. In later life women may look older than men of the same age with similar sun exposure, partly because their skin contains lower collagen content to start with.

In women, estrogen and androgen output from the ovaries and adrenal glands falls after menopause, resulting in decreased collagen synthesis and repair. Aging related to the failure of estrogen production at menopause accentuates intrinsic aging, and together with photo-aging may dramatically increase the apparent age of a menopausal woman.

Estrogen deficiency particularly affects the fibroblast cell of the dermis, and thinning of the skin is primarily related to a decrease in the production of collagen. Obtain measurements of the skin thickness and maintain accurate documentation. Many professional treatments, such as non-invasive ultrasound and aha peels, help re-establish significant collagen deposition and knowing what works best should be part of your record keeping process.

Sunlight damages collagen fibers (the major structural protein in the skin) and causes accumulation of abnormal elastin (the protein that causes tissue to stretch).

In response to this sun-induced elastin accumulation and disorganization, identified as elastosis, large amounts of enzymes called metalloproteinase’s are significantly produced. (One study indicated that when people with light to moderate skin color (SPT 1-3) is exposed to sunlight for five to 15 minutes, metalloproteinase’s remain elevated for about a week.) This valuable information is essential for a client who needs more than just a warning to stay out of the sun to avoid aging acceleration. Education is the key for a positive attitude towards a client’s treatment and validates their treatment program.

The normal function of these metalloproteinase’s is generally positive, to remodel the sun-injured connective tissue by manufacturing and reforming collagen. Unfortunately, this is an imperfect process and some of metalloproteinase’s produced by sunlight actually degrade collagen producing a negative effect. The result is an uneven formation (matrix) of disorganized collagen fibers called solar scars. Repetition of this imperfect skin rebuilding over and over again is one of the main causes of deep wrinkles. Educating your client to avoid wrinkle-causing conditions should be an integral part of your relationship building process to make a great client for life, as there is not a skin care client born who wants a wrinkle!

An important event in the wrinkle process is the over-production of oxidants, also known as free radicals. These “oxidants” are unstable molecules normally produced by chemical processes in the body, a process called oxidation. When environmental assaults from sunlight are produced in excessive amounts they damage the body's cells altering their genetic material. Oxidation may specifically contribute to wrinkling by activating the specific metalloproteinase’s that degrade connective tissue.

The array of clinical and histological findings characterizing aging skin damaged by cumulative radiation from the sun’s free radical assaults to be evaluated are:

Melanogenesis – pigment-oxidation changes: hypo/hyper

Rhytids – deep lines and wrinkle pattern

Elastosis – sagging by elastin degradation

Collagen degradation – loss of tugor, firmness, hydration & facial foundation

Basal & squamous carcinomas, melanomas – dangerous skin changes

Chart these and all other skin findings on a facial map, making notations for your records to select the appropriate professional skin care products and treatments. In the case of dangerous skin changes, you are not a doctor and cannot “diagnose”, however establish the sense of urgency and encourage your client have any suspicious lesion checked out immediately.

Some individuals will develop more blood vessels, known as telangiectasias or “broken” blood vessels caused from UVR exposure. If damage is severe, thinning of the skin and bruising may be seen particularly on the hands and forearms. Be sure to chart all of these indications and use these as your base when assessing the progress of your treatments.

Educate your client about the deadly UVR enemies of the skin; UVA, UVB, and UVC. These hazardous energies are generated from the most dangerous environmental free radical, the sun. Many clients still bake their skin by lying in the sun or “microwave” their skin by exposing it to a suntan bed. Either way, educate your client on the dangers of both manmade and natural UVR damage. Neither is healthy to the skin when it is overexposed to radiation damage.

UVA initiates a photo-toxicity signaling free radical reaction in the epidermis and dermis affecting the Langerhans cell, an important cellular immune protector for long term health of the skin. This long UVA wavelength radiation free radical is a major danger. UVA initiates inflammatory response and is extremely hazardous because it reaches the dermis where the fibroblast cell responsible for collagen and elastin resides.

UVB has a shorter energy wavelength, however is no less dangerous than it’s cousins, UVA and UVC. UVB triggers the erythemic reactions (sunburn, polymorphic, etc.) and destroys major skin compartments responsible for building skin, which include keratinocytes, melanocytes and Langerhans cells. If your client exhibits significant melaoncyte damage, do not lose site of the fact the Langerhans cells are depleted too. These important immune protector cells are now in a weakened state unable to completely protect the skin from impending dangers that include, but are not limited to disease and cancer. Langerhans cells are especially sensitive to UVA and UVB and are the key cells in association with the ketatinocytes of the epidermis. During aging, particularly photo aging, this system deteriorates. (For more information on these cells, refer back to July, August, and September 2005 DERMASCOPE educational series on cell science.)

UVC is the least thought of wavelength and very rarely factored in as a potential suspect linked to sun damage in the skin. The shortest, but most deadly and carcinogenic wavelength, UVC is able to cause severe damage only when the ozone layer is deficient and the ecosystem is out of balance in our atmosphere. UVC is still emitted onto the skin by many commercial suntan beds, another reason to avoid this suntan appliance.

Always educate your client about the dangers when their skin is left unprotected in our natural environment and ensure they always wear sun block with the minimum skin security of SPF 15. Sunscreens are not only used for cosmetic purposes to protect the skin from wrinkles and pigmentation they are important for the health of the skin and it’s host, your client. This is a major educational point of difference.

Another UVR related state, found only in light skin, is Polymorphic light eruption, a condition of the skin which is abnormally sensitive to sunlight producing an itchy rash, papules, pustules, or blisters. Prevalent in northern European skin, this problem is not to be confused with Rosacea or a grade I acne.

Specifically, your objective for photo-dermatology analysis is assembling all the pieces of the puzzle with respect to the skin’s response to the daily life of its host. This, of course includes identifying all drug or nutritional supplements your client is taking. Ingestion of any substance influences the skin for good or bad. Once consumed, chemicals or nutrients are assimilated into the blood stream and travel to their final destination, the skin. These constituents can trigger sensitivities, inflammation, acne, pigmentation, and many other unwelcome circumstances.

Because you do not have daily interaction to the nutritional and supplemental habits of your clients, it is probably safe to assume that most individuals you see are taking some form of medication (over the counter or Rx), aspirin, vitamins, or supplements and it is important you ask your client questions to the type of nutrients and drugs they consume on a daily, weekly, and monthly basis.

Medications that react with the skin and cause redness are termed photo sensitizers. Physicians and pharmacists often advise individuals to avoid prolonged exposure to sunlight while taking certain medications without telling them why. Do not follow this example; learn more about the interaction skin has with drugs and vitamins and educate your client. Regardless of your level of drug and supplement knowledge, always warn your client of the UVR dangers. Those clients who do not heed this warning may later find a red itchy rash or sunburn in areas left unprotected from sunlight or the light emitted by tanning beds. No one is ever safe with tanning beds and I would advise all of your clients to stay away from them, period.

This is significant information with regards to the treatments you perform on the skin that includes peels, microdermabrasion, ultra sound, IPL, enzymes, etc. These professional therapies are intended to remove micro thin injured skin and promote healthier cellular function, however by their exfoliating nature, these products condense the volume of the Stratum Corneum (SC.) 30 percent or more. Although the results are strictly for positive skin effects, this basic information should signal the aesthetician to increase UVR protection and boost the SPF environmental security to no less than 30 after a treatment has been performed. UVR defense is even more important as these unwanted conditions can be made worse when the skin comes in contact with the sun.

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