Facial plastic surgeons seeking information about establishing and maintaining a first-rate skin care program and practice in their office will learn practice management tips and business advice. This content begins with presenting steps in patient evaluation and continues through development of a care plan. Discussion includes approach to skin care products, sunscreen, and related preventive and restorative methods. Detailed discussion is included of developing a personalized skin care plan. The content concludes with essential business tips and marketing advice for the facial plastic surgeon to include skin care in the surgical practice, including the way in which these are handled in the author’s practice.
Facial plastic surgery practices should provide excellent skin care programs for their patients. Patients, whether they are preoperative, postoperative, or potential surgical candidates, require skin rejuvenation and restoration as well as preventative maintenance. It is vital for the practitioner to be knowledgeable regarding not only effective skin care products, but also basic dermatologic recognition, diagnosis, and treatment.
Patient evaluation
As surgeons, patient skin health is of paramount importance preoperatively and postoperatively. The facial plastic surgeon must have a thorough understanding of how to diagnose, evaluate, and treat skin issues.
In evaluating a new patient’s skin, the surgeon should obtain a complete skin history and perform an appropriate skin physical examination. Questions to be included in obtaining the history are listed in Box 1 .
What bothers you most about your skin?
Have you had problems with acne at any time?
Have you had any hormonal problems?
Are you currently on birth control pills?
Are you prone to skin allergies or contact dermatitis?
Do you have problems with seborrheic dermatitis?
Do you regularly use sunscreen with a sun protection factor (SPF) of 30?
Have you in the past or do you currently use retinoids?
Have you had any skin cancers involving the face, head, or neck?
Have you ever used bleaching agents on your skin?
Do you have a T zone or any other problems with excessive oil or dryness?
Have you had any laser resurfacing, IPL, or chemical peeling?
Do you have a problem with enlarged pores?
Have you in the past or are you currently taking isotretinoin (Accutane)?
Have you had pigmentation problems in the past?
Have you ever had radiation treatments to your face, head, or neck?
After obtaining the skin history, execute a methodical, physical examination of the skin of the face, head, neck, and anterior chest. Examine these areas in natural lighting and evaluate
Skin color
TexturePresence or absence of acne or acne scarsAbnormal lesions
Vascularity
Photo damage and associated stigmata.
Evaluate the pilosebaceous apparatus by pore size and presence or absence of vellus hairs.
It is anticipated that, following the skin history and physical examination, one has fully established rapport with the patient. It is wise at this point to explain to the patient how photo damage and other environmental factors (eg, smoking, alcohol use, and diet) can cause the skin to lose its luster and vitality. Also, make clear the effects of hormones on the skin. This is the time to emphasize how critical a high-quality, basic skin care program is to overall skin health, as well as its role in prevention of further skin damage.
Developing a patient’s personalized skin care program
It is essential for each patient to understand that the facial plastic surgeon personally designs the skin care program (ie, each product selected is individualized for a particular diagnosis or problem). To have a successful skin care practice, the surgeon and his or her skin care program must be inseparable. Duties of patient education, product selection, and problem solving must be physician-directed with the assistance of staff. After the physician reviews the diagnosis and examination with the patient, he or she then explains what responsibilities will be necessary in home care. The physician should also disclose that 50% of the treatment regimen involves home treatments, and the remainder consists of monthly office peels performed by the physician.
In the author’s practice, general product selection is done by the physician with the assistance of his staff. Each year, many products are clinically tested within the practice, and only the most efficacious are selected. All of the staff use our skin care products and thus feel very comfortable in answering patients’ questions or concerns.
The author never recommends or uses complete lines of products; rather, he reinforces the aspect of individualization. It is imperative for patients to understand that no line of products could possibly fulfill every patient’s needs or skin type; certain products are recommended to all of patients including retinoids, hydrators, and topical vitamin C. All recommended skin care products are available at the office so as to accommodate patients; in doing so, they can have the products available at their consultation and at future visits, which proves both beneficial to the patient and the office. If samples are available from vendors, patients are encouraged to try the samples before purchasing the product. It is the author’s firm philosophy that if any patient dislikes a product or has an untoward reaction, the product may be returned or payment refunded.
Following the summary of diagnosis and treatment recommendations, the physician spends a considerable amount of time reviewing appropriate use of sunscreens. All patients are prescribed a daily sunscreen; a special-use, outdoor activity sunscreen is highly recommended. Typically, patients think that for sun-intense outdoor activities, such as swimming, jogging, skiing, working in the yard, a one-time sunscreen application will protect them for the day.
Currently, the author emphasizes the relevance of applying the appropriate SPF sunscreen 30 minutes before starting a sun-intense activity and reapplying it every 1.5 to 2 hours, depending on water exposure and perspiration.
At this juncture, the patient is transferred to the care of the practice’s skin care registered nurse, who spends approximately 30 minutes reviewing each product prescribed, including instructions for the amount of product to be used and the timing of application in relation to other products. During this educational period with with the registered nurse, the patient is given a personalized road map (see samples of the Cortez Skin Care Management Program, Figs. 1 and 2 ), which describes in detail the morning and evening regimens, sequentially. The skin care registered nurse then numbers each product container for order of application to help ensure patient compliance.
