LNE & Spa - February 2014

LNE & Spa—the magazine for skin care and spa professionals February 2014 $7.50

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an award-winning organic skin care line, call 1-888-747-4787an award-winning organic skin care line, call 1-888-747-4787

or visit www.eminenceorganics.com.or visit www.eminenceorganics.com.

Thanks a Bunch!A sincere thank you from all of us at Éminence Organic Skin Care for voting us your Favorite Body Lotion in LNE & Spa Magazine’s Best of the Best awards! Thank you to all our loyal customers and spa partners for your support.


The Beyond Organic Collection from Éminence The Beyond Organic Collection from Éminence

Organic Skin Care features Demeter Certified Organic Skin Care features Demeter Certified

Biodynamic® ingredients and is the first and onlyingredients and is the first and only

Demeter International Globally CertifiedDemeter International Globally Certified

Organic Skin and Body Care line from Hungary. Organic Skin and Body Care line from Hungary.

Biodynamic® farming is one of the most sustainable

forms of agriculture that will take you to a new world

of natural! Discover the highest quality ingredients

skin care has ever seen. To read more about this

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Page 4 • LNEONLINE.com Les Nouvelles Esthétiques & Spa • February 2014

businessMedical Spa Service 75 Med Spa Owner Concerns 76Expanding Services,

Business and Revenue 80Device Rules and Regulations 84 Med Spa Marketing and PR Strategies 88Biz News 92

spaIt’s not a Stretch—Beautiful Skin can be Yours! 51 LNE & Spa’s Best Product 2014 52Aromatherapy 60

SOAP Charting 66Visual Stress 70Spa News 73

skin“Facelift” for the Décolleté 19 The Bridge Between Clinicians and Physicians 22

Photodynamic Therapy and Blue Light for Acne 30Medications and the Skin 34The Next Generation of Peptides 38The Changing Face of Beauty 44Skin News 50

The Bridge Between Clinicians and Physicians page 22

Aromatherapy more than just a pleasant scent page 60

Med Spa Owner Concerns

top five considerationspage 76

organic & wellnessAvoiding Irritation in the Nasolabial Folds 93Marma Points 94Of all the Nerve! 98Ah-Choo! 102Organic & Wellness News 105

imageDark Circle Coverage 107Medical Pedicures 108Pedicure Problems 112Safety Sells 115

Perfect Lash & Brow Tinting 118Image News 123

Medical Pedicures page 108

Covercourtesy of Dior

extrasFrom the Editor 6Spa of the Month: Skin Essentials MediSpa & Boutique 9Calendar of Events 124Advertisers’ Index 130

Marma Pointspage 94

Les Nouvelles Esthétiques & Spa, American Edition, (USPS 003-687) (ISSN 1043-9641) is published monthly, 12 times per year and is sold exclusively by subscription. Publisher’s Name: Jean Jacques Legrand, M.D., 3929 Ponce De Leon Blvd., Coral Gables, FL, 33134. Periodical postage paid at Miami, Florida, with additional mailing offices. Postmaster: Send address changes to: Les Nouvelles Esthétiques & Spa, American Edition, 3929 Ponce De Leon Blvd., Coral Gables, Florida 33134, United States Subscription: Annual Rate $45.00 Canada Subscription: $55.00 (American) 1st Class Postage Overseas Subscription: Two years for $140.00 (U.S.) Air Mail Postage

CONTENTSFEBRUARY 2013 VOLUME 29 NUMBER 2

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Say you saw it in LNE & Spa and circle #109


WHETHER YOU WORK IN A MEDICAL environment or not, as a spa professional it is imperative to have a clear understanding of the

latest technology, medical advancements and ingredients to best serve your clients. As spa goers now have access to many medical procedures for beauty and wellness, their knowledge base has grown. Hence, we need to stay one step ahead of them in order to provide guidance and an-swers to their questions.

The February edition of LNE & Spa is about cutting-edge developments at medical spas, pre- and post-operative tech-niques and medical breakthroughs! Glean critical insight into how to have a collaborative relationship with a physician, dermatologist, surgeon or podiatrist in your community. This is guaranteed to enrich and enhance your own practice!

Learn the science behind medical esthetics. If your desire is to be able to offer corrective treatments and truly make an impact on the health of your clients’ skin, re-ignite your passion and enhance your skill set to create a dynamic and thriving facility by reading and attending advanced train-ings. More knowledge brings more opportunities.

No matter what service or treatment your facility offers, from the front desk to the therapists, make sure your busi-ness is a true provider of specialized services, outstanding customer care and quality. Your guests deserve the very best of your therapeutic touch and attention.

At the end of 2013, you went online and selected your favorite products, equipment and spa apparel. Your choic-es earned the coveted recognition of being named LNE & Spa’s BEST for 2014! Congratulations to all of the out-standing nominees and winners, featured on pages 52-59!

Wishing each and every one of you the very best suc-cess in your business and practice! n

—Denise R. Fuller, [email protected]

from the EDITOR

Naturally Balanced Skincare™

THANK YOULes NouvellesEsthétiques

& Spa Magazine & Readers

for nominating ourGlossy Lip Treatment

Best of 2014Lip Treatment!

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3929 PONCE DE LEON BLVD. CORAL GABLES, FLORIDA 33134

800.471.0229 (USA)

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e-mail: [email protected] [email protected]

Publisher Dr. Jean Jacques Legrand

Chief exeCutive OffiCer Rodolphe Legrand [email protected]

editOr in Chief Denise R. Fuller [email protected]

Art direCtOr Sacha Smith [email protected]

AssistAnt editOr Amanda Clinton Winter [email protected]

direCtOr Of sAles Aché Fougere [email protected]

MArketing direCtOr Christèle de La Haye [email protected]

COnferenCe COOrdinAtOr Laura G. Bazo [email protected]

exhibitOr OPerAtiOns MAnAger Mayli Tenorio [email protected]

internAtiOnAl editOr Michele de Lattre-Pierantoni 7 Avenue Stephane-Mallarme, 75017

Paris, France - 43 80 06 47

ADVISORY BOARD Lydia Sarfati • Ben Johnson, M.D. • Lake Louise • Nina Curtis

Diane Buccola • Camille Hoheb • Joseph Mandato

Contributors

Printed with 100% soy-based ink. This magazine is recyclable.

Please recycle where facilities exist.

Patti BiroGoldie BonnellKris CampbellLaura CookseyRenee Elise CooverKaren HodgesJenny HoganBarry M. Kay, O.D.

Jennifer Linder, M.D.Dubi Luxman, M.D.Janet McCormickAngela O’MaraLarry OskinTeri PearmanIvar E. Roth, D.P.M., M.P.H.Melanie Sachs

Robert SachsSusanne SchmalingAmanda ShackletonLouis SilbermanDori SoukupDavid SuzukiIvana Veljkovic, Ph.D.Ruth WernerAnne C. Willis


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February 2014 • Les Nouvelles Esthétiques & Spa LNEONLINE.com • Page 9

SPA OF THE MONTH

by Dori Soukup

SPECIALIZED SERVICES AND PROVIDERS SKIN ESSENTIALS MEDISPA & BOUTIQUE LITTLETON, CO

SKIN ESSENTIALS MEDISPA IS NOTED FOR its charm, delivering outstanding experiences and achieving milestones. The road to becom-ing the prosperous, growing business it is today has been a truly inspirational journey!

Founder Beth Pestotnik has transformed Skin Essentials from a small, one-person skin care clinic into a beautiful medi-spa located in the heart of historic downtown Littleton, CO. From a very young age, she was obsessed with skin care! Her mother would send her out to shop for new back-to-school clothes, and instead she would come home with the latest skin care product from a cosmetic counter! After college, Pestotnik started working for a day spa as an continues

accountant. That is when she decided to return to school to become an esthetician.

Pestotnik started her business in 1999 with a small loan of $5,000 from her father. At that time, she had to work two other jobs to make ends meet. But she had a vision and the passion to make her dream a reality.

Currently, Skin Essentials MediSpa & Boutique encompasses over 2,300 square feet in a histori-cal building that was restored from the 1800s. Some of the original brick can be seen through-out the spa and within the treatment rooms. The spa has a simple and calming design. Guests feel relaxed from the moment they walk in. Beth Pestotnik

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The tall Birchwood sticks and river rocks give the relaxation area an organic feel. The mixture of warm, natural colors and distinctive textures gives off the comfortable feeling of home in con-trast to the modern cutting-edge treatments and services. Abstract canvas artwork is displayed in each treatment room.

The facility offers special amenities such as a beautiful boutique, treatment suites, a steam shower, a changing lounge featuring personal-ized guest lockers with their names hand painted on them, and a relaxation lounge with a water-fall seven feet tall. The soothing sound from the waterfall sets the spa mood as guests relax by the fireplace and cozy up with a signature throw.

The spa has a beautiful boutique offering a wide range of merchandise. Pestotnik is dedi-cated to offering great products and gener-ating revenue from retail. She practices the consultative approach in designing the guest experience. Every guest experiences a detailed consultation and receives a customized program that includes treatment options and appropri-ate home care recommendations on their first

continues

visit. This approach educates each guest on the importance of home care. One of the key factors is tracking the guests’ progress, which leads to a high level of guest retention. Many of Skin Essentials’ clients have been visiting them for over 10 years.

Pestotnik is continually searching for new and exciting results-driven products. She loves researching and discovering new ingredients, and determining ways to offer them to her guests. Home care equates to 60 percent of revenue for Skin Essentials. Retail revenue is a very impor-tant segment of a business’ prosperity. Guests also benefit greatly from using great products. Pestotnik is very passionate about providing her clients with the best options available.

Keen attention to detail is very apparent upon entering Skin Essentials. The entire team is trained on what to say and how to say it, and they are skilled in the type of treatments they offer.

Pestotnik believes that delivering a great guest experience results in business growth! She recalls being in that one-room skin clinic practicing solo, and how she built her business by treating each client with respect, delivering the visual results they were looking for.

She grew her business gradually as she went from one room to two rooms to five rooms, add-ing more and more team members, eventually bringing a dermatologist onboard as well.

When asked what contributed to her success, she responds, “Drive, patience, passion, business planning and continued education.” Pestotnik never stopped investing in her own education and that of her staff, who she keeps up-to-date and inspired each month with team meetings.

spa of the month

Every guest experiences a

detailed consultation and receives a

customized program that includes

treatment options and appropriate

home care recommendations on their first visit.



continues

She belongs to a coaching program to help her continually fine-tune her business model. She consistently attends trade shows as well.

The menu at Skin Essentials offers a wide range of treatments. Even though Pestotnik start-ed by offering facials only, she added new items to the menu as her business grew. Her clients can choose massage, body contouring wraps, scrubs, anti-aging treatments, acne treatments, LED light therapy and hydrafacials.

“I do not jump the gun and bring on new equipment without proper research and the patience to see if they stand the test of time,” she emphasizes. “The spa industry is constantly coming out with new equipment and products, and some are not as good as others.”

For years, Pestotnik would refer her clients to a dermatologist who happened to generate a large amount of income. She and her coach later decided she would benefit greatly if she teamed up with a physician who would visit her spa and take care of her clients. That turned out to be a great move for her!

Pestotnik teamed up with Riley Greene, M.D., a board certified dermatologist and as-sociate clinical professor at the University of

Colorado. Skin Essentials now offers many medi-cal treatments to help their clients look younger!

The anti-aging menu includes solutions such as Botox, dermal fillers and peels. Dr. Greene visits the spa frequently to assist guests with anti-aging solutions. “This relationship is ideal for both businesses,” says Pestotnik.

Dr. Greene’s office is right up the street from Skin Essentials. Even though Pestotnik and Greene were neighbors, the relationship began when Dr. Greene’s sister, who is a client of Skin Essentials, gave Pestotnik his business card and recommended that she connect with her brother. Pestotnik had al-ways wanted to work side by side with a dermatolo-gist, and her dream became a reality upon meeting

spa of the month|skin essentials medispa & boutique

The anti-aging menu includes solutions

such as Botox, dermal fillers and peels. Dr.

Greene visits the spa frequently to assist

guests with anti-aging solutions. “This

relationship is ideal for both businesses,”

says Pestotnik.

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Dr. Greene. They send each other many referrals, and they both benefit from servicing Skin Essentials clients. Dr. Greene respects what estheticians do, and is a big believer in skin care. “While delivering the highest quality esthetic services, Skin Essentials helps screen clients for medically necessary care as well. This partnership has allowed my dermatology practice to grow exponentially,” he says.

“Being able to add medical anti-aging solu-tions to the menu has proved to be a very good move for us financially,” Pestotnik agrees. “I highly recommend this arrangement to any spa owner who wishes to tap into new revenue streams. Our pricing is competitive. We charge $13 per unit for Botox, and Juvederm is $500 per syringe. We offer first-time specials and other promotions

from time to time. This was a great move for us. Our clients love the convenience of being able to come to a place they know and trust. Overall, having an actual dermatologist has helped Skin Essentials become a true medi-spa, and this gives us a big competitive advantage over day spas in the area.”

Pestotnik now spends a fair amount of time on marketing. “I am obsessed with marketing! I love to experiment and see what our guests are interested in,” she says. “Skin Essentials mar-keting is geared toward building relationships and offering value to the client base. One of the best things we did is create an e-newsletter, which goes out on the first of every month. In it, we have consumer articles, spa cuisine reci-pes, special promotions and the opportunity for people to engage with us via “Ask a Therapist.” They also offer spa memberships, loyalty and referral programs, monthly specials and events hosted at the spa.

spa of the month

continues

Dr. Greene respects what estheticians do, and is a big believer in skin care. “While

delivering the highest quality esthetic services, Skin Essentials helps screen clients for medically

necessary care as well. This partnership has allowed my

dermatology practice to grow exponentially,” he says.



POPULAR EVENTS HOSTED AT SKIN ESSENTIALS MEDISPA:• Let’s Talk About Hormones: End Your Menopause Misery,

with special guest and author Stephanie Bender • 30-Day Health and Wellness Challenge• Makeup Lessons for all Ages• Sample Treatment Nights• Birthday Parties • Bridal Showers

All of this success is only possible when you have a great team to help you! Having a great team has allowed Pestotnik to be a successful entrepreneur, wife and mother. Skin Essentials would not be what it is today without a solid, loyal support system.

“I have learned over the years to trust my intuition and protect the energy of what I have worked so hard to create,” she says. “If the energy or attitude is off, it will affect the entire spa. I have an amazing team! I am blessed to work with won-derful people who take pride in making Skin Essentials the best. We have team meetings on a regular basis to ensure that quality and sharpen our skills. We have a spa business success library of CDs that we refer to, which helps us stay sharp and on the cutting-edge of business techniques that produce profit. To me, edu-cation is very important, and we make it fun. We often have contests and give the team the opportunity to win trade show admission with accommodations and airline tickets. We also have a compensation model that rewards top performers!”

Pestotnik shares that the biggest revenue driver within her business is her VIP membership. It allows the guests to receive monthly spa treatments at a discounted price. Not only has it been a steady income source, but it also brings the guests in for treatments every month. This has been a win-win for the guests and the therapists, because the schedules are full and the guests enjoy amazing results!

With focus and direction, Skin Essentials MediSpa in Littleton, CO is growing bigger and getting better each step of the way in their ever evolving journey! n

Photography by Kathleen Peachey, courtesy of Skin Essentials MediSpa

Dori Soukup is an executive coach, author, professional speaker and the founder of InSPAration Management. She speaks at conventions all over the world and hosts public and private seminars. Her Spa BizTools and strategies have helped thousands of spa profession-als experience exponential growth and profits. She can be reached at [email protected].

spa of the month



rejuvenation procedure developed by Dr. Brennan, patients are excited to wear flattering dresses once again. Upper chest rejuvenation is a short, simple and painless procedure, performed in an out-patient setting.

According to Dr. Brennan, a small, in-conspicuous incision is made close to the armpit and hidden by a bra or clothing straps. The skin on the chest is tightened in a way similar to a facelift, and heals quickly and inconspicuously. The size of the incision varies, and is dependent upon the degree of skin tissue to be tightened.

Just as in a facelift, the skin is released after the incision is made, all the way to the midline of the front of the chest. The excess skin is advanced to the inci-sion site, and the overlapping skin is then marked. The excess tissue is removed so that there is an even redistribution of the skin from the midline of the chest to the area of the incision. Then a series of tiny sutures are placed to close the incision.

“YOU CAN ALWAYS TELL A WOM-an’s age by the condition of her hands and her neck,” says Newport Beach cos-metic surgeon H. George Brennan, M.D., F.A.C.S. “However, many women also show severe signs of aging in the upper chest or décolleté due to sun dam-age, collagen loss, tissue dehydration and loose skin.”

It doesn’t matter how smooth and unlined their faces are—or how plump their hands are. If the skin on their chest is crispy and wrinkly looking, the only thing for women to do is hide it. The décol-leté, the triangle between the shoulders and the breast cleavage (the V neck), is an area that women tend to cover with clothing as they age, as the tissue often becomes crepe-like and wrinkled.

The word “décolletage” is French. It is derived from “decolleter,” meaning to reveal the neck. The term was first used in English literature sometime before 1831. Strictly speaking, the décolletage is the neckline, extending about two hand-breadths from the base of the neck down, front and back. From at least the 11th cen-tury until the Victorian period in the 19th century, evening gowns that exposed a woman’s neck and the top of the chest were very common and noncontroversial in Europe. Many gowns during those times were designed to display and emphasize the cleavage. Wearing low-cut dresses that exposed breasts was considered more ac-ceptable than it is today. A woman’s bared legs, ankles or shoulders were viewed as being more risqué than exposed breasts.

Modern women tend to cover the décolleté with clothing, and are discour-aged from wearing jewelry or evening dresses that would generally enhance the chest area, as they did in the day of Marie Antoinette. With the upper chest

After surgery, a compression dress-ing is placed around the chest. After a short recovery period, the patient is dis-charged. By the evening of surgery, they can have dinner and enjoy a normal night of sleep. The day after surgery, the com-pression dressings are removed, and the patient is free to wear her normal bra. Then she can resume all non-strenuous activities, continue with her normal daily hygiene and not have to deal with any diet restrictions. Patients can engage in cardiovascular exercises the day af-ter surgery, and even use light weights within one week.

In addition to excess skin, there are commonly signs of sun damage on these patients. Such issues can be referred to the services of an esthetician, who can recommend a combination of a home skin rejuvenation regimen, and offer laser resurfacing and/or chemical resurfacing. Healing is rapid. Surgical fees can range from $5,000 to $10,000 depending on a number of variables. The price is based on the amount of loose skin and sun dam-age, as well as follow up laser treatments and/or chemical treatments, which may or may not be necessary depending on each individual patient. The fee includes sur-gery, post op care and also anesthesia. n

Angela O’Mara is a freelance writer and the author of several books. She is also the president of The Professional Image, Inc., a public relations agency. O’Mara is founder of BIG Medicine Magazine—The Magazine for BIG Thinkers, which is distributed in doctor’s offices na-tionwide. O’Mara can be reached at [email protected] or 949.768.1522.

by Angela O’Mara

skin “facelift” for the décolleté

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actual patient of Dr. H. George Brennan, before and after chest lift procedure

THE INTERNATIONAL CONGRESSOF ESTHETICS AND SPA

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PRESENTED BY


ENDORSED BY:

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• General Session Lectures and Demos• Wellness Seminar• NASN-National Aesthetics Spa Network• Medical Esthetics Seminar• Spa Director Symposium• Image Seminars

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• AIA-Aesthetics International Association

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stoc

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skin

ALTHOUGH THERE ARE VAST DIF-ferences between the training and li-censing of physicians and estheticians, these are two disciplines that have a unique connection in the arena of skin health. Since each has distinct proficien-cies and limitations, the physician and clinician working together complement one another to maximize patient rela-tionships and outcomes.

The relationship between the physi-cian and the esthetician has not always been symbiotic. In the 1990s, before physicians became deeply involved in the dispensing of skin care, they often viewed estheticians as overstepping their boundaries and encroaching on the medical realm by providing results-oriented treatments and topical prod-ucts to their clients. As physicians and clinicians have become more deeply in-volved and invested in the esthetic treat-ment of the skin, this issue has been put

to rest for the most part. Additionally, states have taken a more vested interest in clarifying their esthetic license param-eters. Many physicians have become increasingly aware of the benefits an esthetician can bring to their practice, and licensed skin health professionals embrace the importance of having a physician they can refer their clients to when the need or desire for medical treatment or more invasive cosmetic procedures arises. By working together, continues

BY JENNIFER LINDER, M.D.

these two specialties can produce ex-ceedingly positive and beneficial out-comes for patients.

Proficiencies and limitationsThe physician is clearly trained and li-censed to diagnose diseases and treat living tissue, while the esthetician’s li-cense is limited to the treatment of only dead cells on the surface, and does not allow for the diagnosis or treatment of diseases. Additionally, skin health cli-nicians are extensively trained in per-forming many other types of facial treat-ments, such as massage and lymphatic drainage, as well as the creation of ben-eficial home care product regimens, and understanding the bedside manner expected from patients seeking esthetic treatments. Because there is immense pressure on physicians to see a large number of patients in a day, oftentimes

The esthetician that has a working business relationship with a

physician is valuable to their clients, as they can quickly refer them to a physician for a diagnosis or support.

clinicians and physiciansTHE BRIDGE BETWEEN



physicians find themselves pressed for time. Having a licensed skin health professional on their practice team to whom they can refer their patients for peels, facials and a number of other more time consuming esthetic treatments is a benefit to all involved.

Conversely, the esthetician that has a working business relationship with a physician is valuable to their clients, as they can quickly refer them to a physician for a diagnosis or support, should an unintended complication occur during treatment.

There are additional benefits to the esthetician working within a medical practice. Many of the devices available to-day are only sold to physicians’ practices. That is not to say that the esthetician cannot perform these procedures, but because they are not part of a medical practice, they may not have access to these machines to treat their clients. Some of these devices include:

• Ablativeornon-ablativelaser(including fractionatedCO,erbiumresurfacing, ND:YAG,Q-SwitchedYAG,hairreduction, veinreduction,skintightening)

• IPL/Photofacial• Ultrasound• Dermalneedles/rollersof1mmormore(some

statesallowestheticianstousedermal needlesat.25mmor.5mm)

skin|the bridge between clinician and physician

continues

This mutually beneficial relationship, if organized properly, supports the needs of the physician, the esthetician and the patient

• Radiofrequency• Cellulitereduction(CoolSculpting®,

laserliposuction)

Working togetherThere are multiple ways that this relationship can be maxi-mized. The esthetician can be employed by the physician and work within the physical practice; the esthetician can be an independent business located within a medical practice; or the esthetician may work independently in a different loca-tion from the physician. There are pros and cons to each of these arrangements, and these decisions are unique to each physician and esthetician. Probably the most efficient and symbiotic arrangement is for the esthetician to be a medical practice staff member, so the skin health clinician has access to all of the training that is brought into the practice and can work as an expert in the arena of skin care topicals and treat-ments. This is beneficial to the physician, who may not have time to apply the due diligence on skin care lines or devices that the practice may bring in. Additionally, as an employee of the medical practice, protocols can be put in place to help facilitate the work of both the physician and the esthetician.

Maximizing timeThis mutually beneficial relationship, if organized properly, supports the needs of the physician, the esthetician and the patient. Every new patient that comes into the practice for a consultation with the physician should be introduced

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to the esthetician. This initiates a trust relationship between the patient and clinician that will increase the likelihood that the patient will come back to the practice for esthetic treatments. The physician’s introduction and support of the esthetician then paves the way for patients to be shifted off of the phy-sician’s schedule for procedures that may not require the expertise of the physician, but rather the training of an esthetician.

Conversely, a client that comes to the practice initially looking only for treatments with the esthetician can be referred to the physician when they are ready to consider treatments such as injectables or surgical procedures.

Gaining the trust of the patientToday’s world of social media with “friends” and “followers” leaves many yearning for true connections. People

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have become more cynical and suspi-cious of marketing efforts by companies and professionals that feign personal-ization, when really it is just another mass mailing. Making the effort to cre-ate an environment in your practice that is truly honest, ethical and work-ing toward the best outcome for your patients will go a long way in building trust between your practice and your patients. Having a practice that offers many different types of care with indi-viduals that are well-educated, have a thirst for helping others and truly take pride in what they do speaks volumes to potential patients. Once they have decided to put their trust in the prac-tice, the likelihood that they will come back for multiple types of treatments, to purchase retail products, and refer their friends and family to you increases exponentially.

The key to getting the most out of the business relationship between the physician and the esthetician is mutual respect and trust. The field of skin health is ever-expanding, and the number of people seeking treatment to fight the process of aging is exploding. Maximizing this disciplinary symbiosis leads not only to satisfied patients, but also to a successful and thriving long-term business. n

Jennifer Linder, M.D. is a dermatologist and Mohs micrographic skin surgeon. She serves as chief scientific officer for PCA SKIN® and runs a private practice out of Scottsdale, AZ. Dr. Linder holds a clinical faculty position in the department of dermatology at the University of California, San Francisco. She is a spokesperson for The Skin Cancer Foundation and a member of the American Academy of Dermatology, the American Society for Dermatologic Surgery and the American College of Mohs Surgery.

skin|the bridge between clinician and physician

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MIAMI BEACH, FLORIDAMiami Beach Convention Center

April 5-7, 2014

PHRCPHRCProfessional Hair Removal Conference

ARLINGTON, TEXASSheraton Arlington Hotel

May 3-5, 2014

Pre-Registration Recommended www.phrconline.com or 800-961-3777

The Professional Hair Removal Conference has expanded to

two events in 2014!

Brought to you by:

Sponsored by:

All hair removal professionals welcome!15 live continuing education hours are being offered at each event.

Lectures on:• IndustryEthics• HIVandOtherBloodbornePathogens• UpsaleOpportunitiesandRetailSales• AppointingaLaserSafetyOfficer• EndocrineSystem:Facts,FunctionsandDiseases• HairRemovalonEthnicSkin• SpecializedInsurancefortheLaserHairRemoval

andElectrologyIndustries• LaserandElectrolysisUpdates

To see the complete schedule for each event, visit www.phrconline.com.

3-Day all-inclusive admission for each event:$325

Professional Hair Removal Conference General Assembly

Two-Day Ticket to The International Congress of Esthetics & Spa

$350forregistrationsafterMarch12thforMiamiandafterApril14thforDallas.

MIAMI BEACH, FLORIDAMiami Beach Convention Center

April 5-7, 2014

PHRCPHRCProfessional Hair Removal Conference

ARLINGTON, TEXASSheraton Arlington Hotel

May 3-5, 2014

Pre-Registration Recommended www.phrconline.com or 800-961-3777

The Professional Hair Removal Conference has expanded to

two events in 2014!

Brought to you by:

Sponsored by:

All hair removal professionals welcome!15 live continuing education hours are being offered at each event.

Lectures on:• IndustryEthics• HIVandOtherBloodbornePathogens• UpsaleOpportunitiesandRetailSales• AppointingaLaserSafetyOfficer• EndocrineSystem:Facts,FunctionsandDiseases• HairRemovalonEthnicSkin• SpecializedInsurancefortheLaserHairRemoval

andElectrologyIndustries• LaserandElectrolysisUpdates

To see the complete schedule for each event, visit www.phrconline.com.

3-Day all-inclusive admission for each event:$325

Professional Hair Removal Conference General Assembly

Two-Day Ticket to The International Congress of Esthetics & Spa

$350forregistrationsafterMarch12thforMiamiandafterApril14thforDallas.


SUNLIGHT HAS LONG BEEN THOUGHT TO IMPROVE acne. Although the accuracy of this belief is debatable, it has been attributed to antibacterial effects of the ultraviolet spectrum. However, we all know that sunlight cannot be used as a treatment in the long term because of the likelihood of skin damage and/or skin cancer. It was discovered that some of the visible violet light present in sunlight (in the range of 405-420 nm) activates a group of organic compounds in the bacterium called porphyrins. When activated by light, these porphyrins kill the bacteria from the inside out. This discovery ultimately led to the development of both in-patient proce-dures and handheld devices for use at home.

Photodynamic therapyThe in-patient procedure called photodynamic therapy (PDT) uses either intense pulsed laser (IPL) or concentrated blue light with a photosensitizer. The photosensitizer increases the skin’s sensitivity to light, thereby creating more of the bacteria killing porphyrins inside the pore. For this procedure, the photosensi-

tizer called aminolevulinic acid (ALA) is applied to the skin, and is absorbed by the hair follicles, oil glands, bacteria and rapidly growing cells. ALA makes the skin more sensitive to light, and may help produce more porphyrins within bacteria. Then the patient sits in front of a light source, either blue light or IPL for several minutes. This is repeated several times each week for about six weeks. The mode of action is as follows: the sensitizing agent penetrates the skin, and when activated with the light source, it absorbs the energy from the light and excites the porphyrin. The porphyrins damage the bacteria wall, effectively killing the bacteria and shrinking the sebaceous glands.

The initial data for the in-office treatment has been very encouraging. In October 2002, the American Academy of Dermatology reported the following: “A low intensity blue light source (405 nm to 420 nm) has been studied for the treat-ment of mild to moderate inflammatory acne. In the study, two 15-minute exposures a week for a period of four weeks produced a 60 percent reduction in acne in 80 percent of pa-tients.” Also, a study published in March 2009 by The Journal

BY LAURA COOKSEY

PHOTODYNAMIC THERAPY AND BLUE LIGHT FOR ACNE

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of Clinical and Aesthetic Dermatology entitled “The clinical efficacy of self-applied bluelight for mild-moderate acne” suggested that overall improvements on average showed a decrease of up to 40 percent in the number of lesions by Day 28 of the treatment.

These numbers sound pretty convincing. So what’s the other side? First, the cost and time factor is relatively high. Ongoing treatments will likely be needed to keep skin clear. With an average treatment cost of $200 to $300, an entire course can cost $2,000 or more.

Secondly, many studies (as well as anecdotal evidence) suggest that the therapy worked well for those suffering from inflamed acne and abnormally high oil production. It failed to show significant improvement in non-inflamed acne suf-ferers who had moderate oil production. Up to 40 percent of all acne sufferers have non-inflamed acne. This means that photodynamic therapies basically fail to address these clients’ needs at all.

Third, the treatments can be quite painful, and may have other side effects. The most common side effects of photody-namic therapy for acne are moderate to severe pain, erythema (redness, typically lasting three to five days), edema (swelling, usually occurring one to four days after treatment) and hyper-pigmentation, which can persist up to four weeks after a treat-ment. Pain typically begins within a minute of light exposure, peaks within several minutes, subsides as photobleaching of the porphyrin occurs, and ceases when the light is turned off.

Finally, the consensus among researchers is that results are temporary, since colonies of acne bacteria grow back quickly. In fact, in October 2008, Dusa Pharmaceuticals an-nounced that it was no longer developing Levulan (ALA) for the treatment of acne, after the Phase II results failed to show statistical significance.

Handheld LED devicesThe handheld blue light units are composed of neatly ar-ranged light emitting diodes (LEDs). Basically, these diodes are tiny light bulbs that fit easily into an electrical circuit. But unlike ordinary incandescent bulbs, they don’t burn out or get very warm. They are illuminated solely by the movement of electrons within a material that conducts electricity. When blue light reaches the sebaceous glands in the skin, it helps excite porphyrins and obliterates the P. acnes bacteria within the pore. It thereby reduces inflammation, but certainly not nearly to the extent of the in-office procedure. Handheld devices can be loaned or sold to a client to include in their home care routine. Check state guidelines regarding scope of practice for working with LED devices.

Having a multi-faceted approach with modalities, profes-sional treatment and home care is the only way to address the sebum and bacteria, which are secondary symptoms of

acne, not the cause. A device alone is not enough. Clients need long term assistance, guidance and coaching to get clear, not an overnight quick fix promise. For most people, acne is an inherited condition of the pores. There are about five layers of skin cells inside each pore. Healthy pores shed a layer of these skin cells each day; however, the pores of an acne-prone person can shed up to five layers per day. When the cells shed more quickly than the pore can expel them, it is called retention hyperkeratosis. The dead skin cells accumu-late inside the pore and form a plug called a microcomedone, which is essentially the precursor to all acne.

Hormonal fluctuations may trigger more oil production in-side the pore. In normal skin, this is not a problem because the dead cells do not get trapped. There are many people with oily skin who do not have acne. With acne-prone skin, however, the excess sebum combines with the blockage from the dead cells to create the perfect environment for acne bacteria to flourish.

Because acne is primarily a dead skin cell problem, the solution lies in keratolytic products that penetrate the pore and prevent dead skin cells from building up in the first place. It’s all about preventing microcomedones from forming.

The key ingredients to include in treatments and home care regimens are: exfoliant and keratolytic serums like man-delic acid, glycolic acid and/or vitamin A propionate. When used in combination with benzoyl peroxide, all of these ad-dress the retention hyperkeratosis aspect of acne, targeting acne at the root cause. It also addresses it on an ongoing basis—preventing the retention hyperkeratosis.

Photodynamic therapy and/or blue light is not a replace-ment for in-office treatments and home care regimens. A combination approach of equipment, treatment and man-aged home care will offer successful, long-term results. n

Laura Cooksey is a licensed estheti-cian, acne expert, educator, speaker and owner of Face Reality Acne Clinic in the San Francisco Bay area. She has over 20 years of experience in helping people get clear skin. Cooksey certi-fies skin care professionals around the country to create successful practices with her comprehensive training DVD,

Proven Strategies for Treating Acne. For more information, visit facerealityacneclinic.com.

skin

Handheld devices can be loaned or sold to a client to include in their home care routine. Check state guidelines regarding scope of practice for working with LED devices.


DALLAS, TXArlington Convention CenterMAY 4 & 5, 2014


PRESENTED BY


ENDORSED BY:

Grow with your industryLearn, Network, Embrace

• General Session Lectures and Demos• Wellness Seminar• Medical facilities, Aesthetic and Wellness Center Track• NASN-National Aesthetics Spa Network• Medical Esthetics Seminar

• Image Seminars• Cutting Edge Salon/Spa Business Seminar• AIA-Aesthetics International Association• All Manufacturers’ Workshops• Exhibit Hall flooded with hundreds of exhibitors

NEWNEW


DALLAS, TXArlington Convention CenterMAY 4 & 5, 2014


PRESENTED BY


ENDORSED BY:

Grow with your industryLearn, Network, Embrace

• General Session Lectures and Demos• Wellness Seminar• Medical facilities, Aesthetic and Wellness Center Track• NASN-National Aesthetics Spa Network• Medical Esthetics Seminar

• Image Seminars• Cutting Edge Salon/Spa Business Seminar• AIA-Aesthetics International Association• All Manufacturers’ Workshops• Exhibit Hall flooded with hundreds of exhibitors

NEWNEW


IT IS HARD TO BELIEVE, BUT THERE are approximately 500,000 different types of prescription medications avail-able in the United States alone! In 2011, doctors wrote 4.02 billion prescriptions; which translates roughly to 13 prescrip-tions for each man, woman and child!

As professional skin therapists, we need to have a general understanding of many health conditions and how medications can affect the client’s skin. Remember to always practice within the scope of your professional license and the board regulations that apply to the state you are practicing in.

We begin each service or treatment with an in-depth consultation. It is im-portant to always keep your consulta-tion cards up to date, as it is a vital legal record of whether or not the client has accurately disclosed any medical relat-

3. What is the purpose of this medication?

*Note that some clients are not aware of the reason they are taking specific medication(s); they only know that their physician has prescribed it for them.4. How has it affected your skin?

Their answer to this question will reveal what their concerns are and how they view their skin.

1. Heart diseaseThis is one of the leading causes of death in the United States for both men and women. Heart disease is a broad term that refers to several diseases that affect the heart. Our main concerns are blocked or narrowed blood vessels, and other heart conditions that affect the valves and beat-ing rhythm.

ed condition. Sadly, this is normally the most neglected part of the consultation. Prior to starting your treatment, always make sure that the client has signed the consultation card each and every time, as this is your professional protection!

This article is a review of a few health issues that currently afflict our clients, and how their prescriptions are impacting their skin. Our main objective is to thoroughly educate our clients and create a plan of action to help them.

Ask your clients the following four key questions and chart their answers on your consultation card.1. How long have you been

on this prescription?2. How much longer

do you have to take it?

MEDICATIONS

BE AWARE OF CONTRAINDICATIONS

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Contraindications: Due to the com-promised vascular system, we cannot incorporate anything that will increase blood circulation—no stimulating fa-cials, body massages, body treatments or wraps, and no steam towels, infra-red light, direct steam, heating pads or electrical modalities (galvanic, indirect high frequency, ultrasound, etc.). It is also important to inquire about pace-makers. If your client has one, you will notice a small scar above their heart area. Do not work over this area.

Medications or combinations of:Diuretics (water pills). These cause se-vere dehydration and deplete all essen-tial minerals, especially calcium, mag-nesium and potassium. This leads to cramping in the lower legs and feet while lying down. Make sure your client’s feet are elevated during treatment, and that their head is always positioned higher.

Antiarrythmics (control irregular heartbeat) will cause fluid retention (es-pecially in the legs) and headaches, as continues

BYGOLDIEBONNELL well as increase sensitivity to sunlight. Make sure to cover the eyes during the skin analysis, and do not place a mag lamp directly over the client. Keep it off to the side.

Beta blockers, which lower blood pressure and heart rate, will cause weight gain, cold hands and feet and dryness, especially in and around the mouth area. Always ensure that the client is comfort-able. The mummy wrap is too claustro-phobic for this client; their hands should be outside the sheet, and they should be able to move their feet. Cover them with a light blanket and adjust it as nec-essary throughout the treatment.

Clot busters/anticoagulants such as Coumadin, which prevent thrombo-sis, will cause excess bleeding due to blood thinning. Therefore, absolutely no extractions should be done on the client who is taking these mediations (espe-cially with the use of a comedone ex-tractor or lancets), as they have compro-mised healing abilities, and will bruise and bleed for an extended amount of time. Clients taking clot busters/antico-agulants are prone to nosebleeds, so make sure that their head is elevated and tissues are available.

Statins such as Crestor, Zocor, Lisin-opril and Lipitor lower bad cholesterol (low-density lipoprotein or LDL) and tri-glycerides while increasing good cho-lesterol (high–density lipoprotein or HDL). They are prescribed to reduce the risk of dieabetes, stroke, heart at-tack and other heart complications.

As you perform a skin analysis on clients taking these medications, you should expect to find very dehydrated skin and uneven skin texture; especially around the forehead, dilated capillar-ies, blotchy milia around the eye area, severe congestion and sensitive skin.

Treatment plan: Apply the “less” rule. Less time, less heat, less pressure or friction and less product—meaning no layering of products.

2. DiabetesThere are two types of diabetes.

Type 1 diabetes. The pancreas un-dergoes an autoimmune attack from its

own body (may be hereditary or due to illness or trauma); meaning it is inca-pable of producing insulin. This client has to rely on insulin medication for survival; they need insulin therapy daily.

Treat clients that have heart disease and Type 1 diabetes with similar proto-cols. These clients will be on a long-term prescription of medications, therefore the less rule is your best plan of ac-tion. Recommend and use products for sensitive and sensitized skin, and abso-lutely no detoxification body treatments! Avoid products with high levels of sea-weed or algae, as they are detoxifying and will interfere with insulin production.

Remember, we can give these cli-ents treatments and do so much more by simply touching and nurturing them. Never underestimate the healing pow-ers of human touch!

Type 2 diabetes. The pancreas can produce insulin, but not the right amount to meet the body’s needs. In many cases, the pancreas produces larger amounts than needed (hyperglycemia), and causes a severe lack of sensitivity, particularly in fat and muscle cells. Therefore the client cannot detect too much pressure or rise in temperature. They will rely on you for that.

Type 2 diabetes is the most com-mon form of diabetes, as the body can-not properly utilize insulin, which results in “insulin resistance.” Treat the skin according to findings during the skin analysis. Clients will have injections to stimulate the release of insulin such as Exenatide (Byetta) and Liraglutide (Victoza). Or take oral medications to stimulate insulin such as Prandin, Starlix,

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DiaBeta or Glynase. Precaution: The cli-ent can have elevated corticosteroids, due to either elevated glucose levels or lower blood sugar levels, caused by insufficient calorie intake or excessive physical exertion. This causes dehydra-tion and dryness. If not attended to, this can lead to a seizure. The best way to quickly raise glucose levels is to drink a small glass of orange juice or a regular (not diet) soft drink, ideally cola.

3. CancerAll cancer begins in our cells, the basic unit of life. Normally, when cells become old or damaged, they die and are re-placed with new cells. However, when the DNA is changed or damaged, this can start the production of mutations that affect normal cell growth and division.

Cancer is not just one disease but many; there are 100 different types of cancer. Most cancers are named for the type of cell or organ they originate in. The most common cancer for men is prostate cancer; for women it is breast cancer.

All clients undergoing chemothera-py and/or radiations will have a compro-mised immune system. Sanitation is the most important aspect of dealing with a cancer patient. A client going through cancer treatments will have a reduc-tion in sebum production (sometimes onset by menopausal skin), chemically induced acne, red/irritated skin, flaking, peeling, hyper and hypo pigmentation, blotchy, visible burns and lymphedema in the arms and legs. Skin is extremely fragile and dry during chemotherapy and radiation, and stress levels are el-evated to the extreme. During che-motherapy, women may experience irregular menstrual cycles or none at all. Some medications may damage the ovaries, thus resulting in menopausal symptoms or menopause.

Thankfully, the approach to han-dling cancer clients in spa settings has changed through many years of re-search and updated education. Cancer clients used to be completely contra-indicated to any spa service, but not anymore! Receiving a skin treatment

and/or scalp treatment is just what the client needs to bring hydration, relax-ation and human touch to promote self healing. Focus on treatments for sensitive skin (LED and oxygen treat-ments), and avoid chemical exfoliation, extractions with comedone extractors and direct steam. During the treatment, elevate the client’s feet and hands, utilize the less rule for the skin service and ap-ply cool gel packs to hands and feet. It is also recommended to utilize ice packs or cool packs, alternating off and on for no longer than 15 minutes.

How does chemo affect the client‘s skin? The goal of chemo is to destroy can-cer cells and kill cells that divide rapidly, which unfortunately also destroys healthy cells. Sadly, hair root cells are rapidly di-viding cells, hence the loss of hair that occurs during chemotherapy. This even includes hair in pubic areas, eyelashes, eyebrows and underarms. Clients also lose their sense of smell due to the lack of nose hairs. The most vital benefit for a cancer patient is that you touch them and give them a sense of feeling “normal” for a period of time. The guidelines apply the less rule and incorporate a scalp and lymph drainage massage for the arms. Recommend products for sensitized skin and advise the client to book services on a regular basis.

4. DepressionThis condition is currently one of the top five health concerns in the U.S. While everyone feels blue or sad on occasion, true depression interferes with daily life, and causes pain for the individuals who suffer from it as well as those who care about them. It is believed to be caused

by a combination of genetic, biological, environmental and psychological factors. Depression is a serious illness.

Abilify is the most prescribed medi-cation for depression in the U.S. It is an antipsychotic drug that works by chang-ing the chemical reactions in the brain. It is widely prescribed to treat mood swings, aggression and irritability in adults.

Cymbalta is an antidepressant that affects the chemistry in the brain by pro-ducing serotonin, helping the user to feel better. It is also prescribed to treat anxiety, major depression, chronic pain, osteoarthritis, fibromyalgia and severe damage from diabetes. There are no known specific contraindications to Abilify and Cymbalta for spa services. If you have concerns, refer to a physician.

Remember, all medications height-en nerve activity as they raise the pH of the blood, making it more alkaline, thus creating more sensitivity, dryness and dehydration. As spa professionals, we need to have an overall understanding of this variety of prescription medica-tions. There is no way to thoroughly cover all of the numerous medications on the market in this article. When in doubt, always refer to a physician. Also consider offering a treatment specific for sensitive skin that will be soothing and nurturing for any guest. n

Goldie Bonnell has more than 20 years of ex-perience in the skin care and wellness indus-tries. She has designed pro-grams and cli-ent treatments for many spas. Bonnell has been involved in the building of training centers for The International Dermal Institute and Dermalogica. Teaching is Bonnell’s passion, and she has been a featured speaker on nu-merous topics at industry trade shows throughout the U.S. and Germany.

skin|medications and the skin

Remember, all medications heighten nerve activity as they raise the pH of the

blood, making it more alkaline, thus creating

more sensitivity, dryness and dehydration.

Biochemist and founder, Gül Zone and Dr. Robert Zone.

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THE NEXT GENERATION OF PEPTIDESBY IVANA VELJKOVIC, PH.D.

CLINICIANS AND PATIENTS ALIKE ARE ON A CONSTANT search for corrective products that can deliver visible results and keep their age a mystery. Of the most groundbreaking

and scientifically advanced ingredients available on the market, pep-tides are arguably the most fascinating. With countless peptides to consider, palmitoyl tripeptide-38 and palmitoyl tripeptide-5 are among the newest next-generation peptides used in cosmeceutical products today. Understanding these particular peptides’ mechanisms of action and how they mitigate the various visible signs of aging will assist any skin health professional in their endeavor to provide their patients with youthful, healthy skin.

Peptides definedBy definition, a peptide is a chain of amino acids connected by peptide bonds. The molecular structure of these organic substances resembles that of proteins, though they are much smaller in size. Many of these cosmetically and pharmaceutically used signaling peptides do not occur in nature and are synthesized in a lab, while others occur naturally in the body. The prefix of the peptide defines the number of amino acids in that particular chain. For example, a dipeptide is made up of two amino acids, while a tetrapeptide contains four amino acids. As a standard, oli-gopeptides contain 10 or fewer amino acids; a chain of 10-20 amino acids is referred to as a peptide; polypeptides contain 20-30 amino acids; and a chain of 50 or more amino acids is considered a protein.

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skin|the next generation peptides

Cosmeticpeptidescanperformawidevarietyoffunctionswithintheskin, allfallingintothreemajorcategories:• Neurotransmitter-affecting peptides

communicate specific messages in the body; relaxing repetitive facial expressions to minimize fine lines and wrinkles is a specific signal that a neurotransmitter-affecting peptide might transmit within the skin.

• Carrierpeptides are involved in the novel delivery systems of collagen deposition, glycosaminoglycan synthesis and adhesive protein production.

• Signalingpeptides initiate specific actions within the skin, such as stimulation of colla-gen, enhancing glycosaminoglycan synthe-sis (hyaluronic acid in particular), boosting skin firmness and elasticity and decreasing inflammation.

continues

The science and technology behind the de-velopment and advancement of the category of topically applied peptides represent the cutting-edge in skin health. This compelling group of ingredients is highly beneficial to a wide demo-graphic fighting myriad skin concerns. Some of these raw materials can be costly, yet if properly formulated into topicals with excellent delivery systems, they deliver on their promises. You will typically find peptides only in products that are left on the skin, not in cleansers, exfoliants or other products that are washed off or removed. Peptides are an exceptionally valuable addition to any practice.

Next generation peptides

PALMITOYL TRIPEPTIDE-38 is one of the most compelling matrix-building peptides available today. This messenger peptide was developed using a different thought process than previous peptides used in skin care topicals. Rather than being used to exert one specific function in the skin, it has demonstrated the ability to increase the production of the following exceedingly important dermal and epidermal components:

COLLAGEN I is the most abundant form of collagen in humans. Present in scar tissue due to healing and repair, collagen I is thought to com-prise over 90 percent of all collagen found in the human body. Not only is collagen I found in the skin, but also in tendons and organs, and it is a major component of bones.

COLLAGEN III is often referred to as the col-lagen “of youth,” produced by young fibroblasts and during the early phases of wound healing. It is also thought to be responsible for the overall smoothness of the skin, and decreases with the natural aging process.

COLLAGEN IV is responsible for forming the base of cell membranes and works closely with lam-inin-5, anchoring keratinocytes at the interface of the extracellular matrix (ECM) and basal layer cells.

FIBRONECTIN is a glycoprotein involved in many processes, including tissue repair and cell migration, differentiation and adhesion. Also found in the ECM, fibronectin acts as an anchor, adhering cells to collagen and binding various components within the ECM.

When the dermal layers are

thickened through the synthesis of

collagen production, youthfulness is

restored and results are seen immediately.

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93% found that their skin 93% found that their skin was smoother*(*Clinical Study France, Lyon 2012)

REDEFINES YOUR CURVES



HYALURONIC ACID is a key component of the ECM and is necessary for proper dermal function, such as water retention in the tissues. Hyaluronic acid also regulates cell proliferation and migration, as well as wound healing in the dermis and the basal layer, often called the dermal-epidermal junction.

LAMININ-5, an adhesive glycoprotein, is also a key com-ponent of the ECM and assists in the healing of injured epi-dermal cells. It too plays a role in cell migration and the an-choring of keratinocytes by its deposition on dermal collagen.

HEAT SHOCK PROTEIN 47 (HSP47), a “chaperone pro-tein,” functions as a support for maturing collagen and other

matrix components, ensuring they reach maturation success-fully. HSP47 acts somewhat as a project manager, making sure the synthesis of these six major components of the ECM work at their fullest potential and in an organized fashion.

When these components work together, there is typi-cally a visible reduction in wrinkle volume, a decrease in the surface area occupied by deep wrinkling and an overall im-provement in the texture of the skin. Palmitoyl tripeptide-38 is also the most effective peptide available today for thick-ening the dermis and strengthening the ECM, giving way to healthier skin.

PALMITOYL TRIPEPTIDE-5 is also a next generation anti-aging peptide employed for its ability to increase col-lagen deposition, thus minimizing fine lines and wrinkles. What makes this peptide so ingenious is its ability to actively compensate for a collagen deficit in the skin by replacing the missing collagen, further supporting the density of the dermis.

The primary mechanism of action of palmitoyl tripep-tide-5 is the synthesis of collagen by activation of Tissue Growth Factor (TGF). This particular growth factor remains biologically inactive until it is stimulated by thrombospondin I (TSP), a multifunctional protein found in the ECM. Palmitoyl tripeptide-5 mimics the action of TSP, thus activating TGF. TGF is known as the key element in the synthesis of collagen deposition, and therefore plays an important role in revers-ing the breakdown of the ECM. In vitro testing has shown an increase in collagen synthesis by 119 percent, making palmitoyl tripeptide-5 an excellent addition to corrective anti-aging product formulations.

As science evolves and advances, so does the efficacy potential of many corrective products. Treatment products containing next generation peptides, such as palmitoyl tri-peptide-38 and palmitoyl tripeptide-5, stimulate matrix proteins and deliver visible results. When the dermal layers are thickened through the synthesis of collagen production, youthfulness is restored and results are seen immediately. n

Ivana Veljkovic, Ph.D. serves as re-search and development manager for PCA SKIN®. Before joining the skin care industry, she did pharmaceutical re-search on unique bioactive molecules. Dr. Veljkovic is a highly regarded chem-ist, advancing skin care with her techni-cal background and knowledge in the field. Her product testing standards are unrivaled.

skin|the next generation of peptides


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THE CHANGING FACE OF

access to science

BY DUBI LUXMAN, M.D.

2014 IS GOING TO PROVIDE GREAT DISRUPTION TO conventional beliefs, as new technologies and other break-throughs make their way into contemporary esthetics. This especially holds true as the science becomes ever more ac-cessible to those outside the operating room and/or doc-tor’s office.

If I had been told 30 years ago that I could purchase a retail skin care product from a spa or salon with a high-power combination of multiple peptides that were originally designed for better surgical wound care, I would have quickly dismissed the idea. Well, here we are, a fraction of time later, witness-ing an amazing leap in modern skin care—a group of natural, biotechnological active ingredients that have dramatically changed the face of the beauty industry. These achievements are exciting, as they come with the potential for dramatic, vis-ibly effective results with little to no invasive surgery, and less irritation and downtime. At the same time, in the modern skin care industry today, fantastic claims promising the “fountain of youth” appear in the form of new brands and products.

With this in mind, I am reminded of the phrase “to be fore-warned is to be forearmed.” This is important for the end-user (our patient/client/guest) to have as much information about these new cosmetic “wonder ingredients” as possible. When

they understand the value of the science behind the topical products, they value the provider even more, thus creating loyalty and truly obtainable results!

The science behind itThese new peptides and other active ingredients are char-acterized by a highly specific function, thanks to binding to cellular targets on the cell’s membrane or within the cells, and exerting a specific reaction that ultimately improves the skin’s function and structure.

BiopeptidesBiopeptides consist of chains of amino acids that are formu-lated to be stable, increase skin penetration and receptor binding and decrease toxicity. Biopeptides penetrate deep into the skin and stimulate the cells to function in a more nor-mal manner, correcting imbalances that are often responsible for skin problems and aging. Each biopeptide demonstrates a specific bioactivity leading to a visible effect. There are currently four biopeptide families that are incorporated into marketed cosmeceutical formulations:

1. Carrier peptides2. Signal peptides3. Neurotransmitter-inhibiting peptides4. Enzyme-inhibiting peptides

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Carrier peptidesThese are short peptides that facilitate and accelerate trans-portation of important bioactive substances into the skin. One of the founding principles of controlled trauma, and the way a carrier peptide works is a perfect example of why controlled trauma is so important in effective skin care. While there has been decades of study showing the ability of carrier peptides such as GHK-Cu (a tripeptide composed of three amino ac-ids) to help improve wound healing in a cosmetic application, one must ask: “Where is the wound that must be healed? Is a wrinkle considered a wound?” Therefore, we can conclude that as part of any effective cosmetic application one must first cause some kind of controlled trauma to the area to be treated (the face, the neck, hands, etc.) by means of an acid or enzyme peel, a physical exfoliation such as dermabrasion, laser or some other method. When this is done, it allows a carrier peptide like GHK-Cu to attract (carry if you will) important trace elements like copper and manganese, necessary for cell repair, and de-liver them to various cellular receptors in order to initiate and increase effective wound healing.

Studies have shown that in human plasma, the level of GHK-Cu is about 200 µg/ml at age 20. By the age of 60, the level drops to 80 µg/ml. In humans, tripeptide GHK-Cu can promote activation of wound healing and the attraction of im-mune cells and epidermal stem cells. It can also promote tissue repair, antioxidant and anti-inflammatory effects, collagen and glycosaminoglycan synthesis in skin fibroblasts and blood ves-sel growth. Recent studies revealed the ability of GHK-Cu to modulate the expression of a large number of human genes, generally reversing gene expression to a healthier state.

Dermatological studies demonstrated significant improve-ment of photoaged skin in all parameters, including fine lines, wrinkles, skin density and thickness. When GHK-Cu was add-ed to healing wounds, it produced the same effect as when a boss shows up at the office. All the cells who were previously slacking off suddenly burst into enthusiastic activity. In the skin, more collagen was produced. Elastin and glycosaminoglycan production intensified. Inflammation was reduced and healing was greatly accelerated. GHK-Mn is a tripeptide with an affin-ity to manganese that significantly stimulates matrix protein synthesis (collagen and elastin) and improves skin’s antioxidant response to oxidative stress. The most recent study of wound healing activity of GHK evaluated the effect of GHK alone or in combination with LED (light emitting diode, 625 - 635 nm) on human fibroblasts. LED alone did increase cell viability and collagen production. However, a combined GHK and LED treatment resulted in 12.5-fold increase in cell viability, a 230 percent increase in basic fibroblast growth factor (bFGF) produc-tion and a 70 percent increase in collagen I mRNA production compared with the LED alone. These percentages are very ap-pealing, and they are cause to be excited as new formulations and technologies become more readily available.

Signal peptidesSignal peptides are short chain proteins that bind to specific receptors on the outer surface of the cell membrane or in-side the cell, starting a sequence of reactions that eventually results in the production and secretion of proteins.

The most popular signal peptide is palmitoyl pentapep-tide-3, abbreviated Pal-KTTKS (K for lysine, T for threonine, S for serine). It is better known by its brand name Matrixyl®, and has been used in cosmetic formulations for a very long time. The key to the widespread use of Matrixyl is its ability to stimulate fibroblasts to produce the important constituents of the skin matrix: collagen, elastin and glycosaminoglycans.

Another member of this family of signal peptides is Palmitoyl tripeptide-5—a highly bioactive, deeply skin penetrat-ing peptide. Known by its trade name Syn-Coll® (Pentapharm - Swizterland), this short-chain peptide has been shown to promote collagen synthesis in the skin by means of activation of tissue growth factor TGF-beta. In vitro testing in human fibroblasts (using Primos® technique), Palmitoyl Tripeptide-5 increases the collagen synthesis by 119 percent. In vivo studies performed on 60 volunteers with twice a day application of Palmitoyl Tripeptide-5 for 84 days showed a significant visible reduction in the appearance of wrinkles (up to a 350 percent improvement compared to a placebo), and significantly bet-ter results than Pentapeptide-3 alone.

Neurotransmitter inhibiting peptidesFrequent contractile activity of the muscles around the eyes, mouth and forehead results in wrinkle formation in these ar-eas. Neurotransmitter inhibiting peptides act at the neuro-muscular junction to block acetylcholine release and exert a muscle relaxing effect. The overall effect is that skin becomes smoother and wrinkles disappear.

Their mode of action resembles that of botulinum tox-in. Acetyl hexapeptide-3, commercially named Argireline® (Lipotec, Barcelona, Spain), is a small neurotransmitter pep-tide composed of six amino acids. Dermatological studies demonstrated a reduction in wrinkles’ depth by up to 30 per-cent after 30 days of use. Acetyl hexapeptide-3 exhibits the great advantage of its significantly lower toxicity occurrence, as compared with botulinum toxin. It also has the benefit of not having to be injected to produce results. A great variety

continues

Many physicians recommend the topical formulation of Argireline saying

that it “works just like Botox.” Physicians suggest a recommended concentration

of five to 10 percent in a serum.


skin|the changing face of beauty

of cosmetic products are now on the shelves that contain the topical formulation of Argireline, and the results are very positive. Many physicians recommend the topical for-mulation of Argireline, saying that it “works just like Botox.” Physicians suggest a recommended concentration of five to 10 percent in a serum.

Pentapeptide-3, marketed as Vialox®, is a synthetic neu-rotransmitter inhibiting peptide said to block the Acetylcholine receptors on muscle nerves, thereby reducing the frequency of muscle contraction. The effect, therefore, is said to be a reduction in wrinkle formation. Less frequent muscle contrac-tions result in shallower lines. Dermatological studies showed a 49 percent reduction in wrinkle depth after 28 days of twice-daily use. One problem that has arisen is that formulations that only contain Vialox and no other ingredients tend to not restore suppleness or tone to complexions. This is distinct from other peptides such as Matrixyl 3000, which also con-tains micro-collagen and other ingredients that help boost the potency of collagen products, in addition to reducing fine lines and wrinkle depth.

Tripeptide-3, commercially known as Syn®-ake (Pentapharm), is a synthetic, three amino acid neurotransmitter-inhibiting pep-tide that mimics the muscle paralysis activity of the venom of the Temple Viper snake. Tripeptide-3 binds to and blocks the muscular nicotinic acetylcholine receptor, thus inhibiting muscle contractions. Clinical studies have demonstrated a reduction of up to 52 percent in forehead wrinkles’ depth after 28 days of use. Although neurotransmitter inhibiting peptides are clearly less potent than botulinum toxin, der-

matological studies showed remarkable anti-wrinkle activ-ity when applied topically, and a significantly lower risk of toxicity and adverse effects than an injectable.

Enzyme-inhibiting peptidesCertain skin aging conditions are associated with the ac-celerated breakdown of essential constituents like collagen and elastin. This occurs in the skin matrix, and is mediated by degrading enzymes named matrix metalloproteinases (MMP). Dermatological studies have shown that MMP levels rise excessively with age. Maintaining skin’s normal struc-ture and function can be thus accomplished by inhibition of these enzymes. Acetyl Hexapeptide-20 is a selective in-hibitor of MMP that has been shown able to help slow skin aging induced by photoaging. Ergothioneine was shown to reduce the skin aging effects of UV irradiation by reduc-ing MMP activity.

In the skin, glycation (non-enzymatic binding of sugar molecules to proteins like collagen and elastin) accounts for accelerated aging, loss of elasticity and decreased blood cir-culation. Glycation directly increases the release of MMP-1, which preferentially breaks down collagen. Damaged collagen increases skin stiffness and loses its ability to respond to physi-cal stress by stretching—the result is commonly referred to as “lifeless skin.” Glycation preventing amino-acid peptides like carnosine and aminoguanidine are capable of removing the sugar molecules from the collagen and elastin fibers as they help prevent or slow down the skin aging process.

Growth factorsGrowth factors, also termed “cytokines,” are naturally occur-ring proteins in our body that bind to receptors on the cell surface, and are responsible for a variety of cellular activities such as cell division and renewal, blood vessel growth, and collagen and elastin production. Growth factor levels tend to fall with age, which has a major role in the aging process. Growth factors are emerging as the latest anti-aging treat-ments to reverse skin aging.

Recent biotechnological advances improved the abilities to either isolate plant-derived growth factors or synthetically create individual growth factors. Multiple clinical studies have confirmed the ability of these growth factors to reverse or slow down the skin aging process. Among growth factors used to accelerate the repair and renewal of the skin, the most important are:

1. Epidermal Growth Factor (EGF). A powerful peptide that accelerates healing and increases the rate of skin re-newal of aging skin when applied topically. EGF stimulates proliferation of keratinocytes, fibroblasts and blood vessels.

2. Fibroblast Growth Factor (FGF). A large family of pro-teins involved in many aspects of cell proliferation, growth and differentiation. It improves skin elasticity by inducing the production of collagen and elastin by fibroblasts.

continues

Stem cells are the hottest topic in medicine these days. In recent years, the scientific

community has researched and recognized the incredible healing potential of these

cells for various diseases and aging.

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Edwelweiss, a popular source of botanical stem cell extracts



Stem cell extractsStem cells are the hottest topic in medicine these days. In recent years, the scientific community has researched and recognized the incredible healing potential of these cells for various diseases and aging.

Stem cells are unprogrammed, immature cells that ex-ist in almost every tissue in the body. These cells have re-tained the ability to divide and regenerate to replace old dying cells for new ones, and they can replicate any type of cell necessary. The role of stem cells is thus to maintain and repair tissues.

Unfortunately, as humans age, the sheer number of avail-able stem cells is reduced, as is the ability of those stem cells left to replicate tissue. The recent introduction of stem cells in cosmetic applications is an effort to energize and reacti-vate the body’s remaining natural stem cells, not to replace them. The key is to find stem cells that are able to unlock the receptors within human cells and stimulate their rejuve-nation and normal function.

Selling scienceNow skin care professionals have the tools available to deliver great treatments. But there is another important aspect to being a great skin care professional—the ability to sell retail products. So how does one go about selling retail skin care products that have a number of words that are hard to pronounce and/or spell that the common customer might never have heard of?

I asked Eva Kerschbaumer, Hungarian master esthetician and owner of day spa operator ESSpa.com how she success-fully gets her large customer base to buy cutting-edge retail skin care products. “In order for me to really deliver excep-tional results that my clients can see in the mirror, I have to find some way to “continue their treatment” between appoint-ments,” she explains. “The only way to do this is to get them to use specific products on their own. They expect me, as a licensed professional, to know the details of what I am putting on their skin, as well as what it is that I am asking them to use at home. As their esthetician, it is a major part of my job to educate myself about all of the new research and ingredients that are available in the current cosmetic marketplace. It then becomes my responsibility to educate my clients about them and explain why I want them to use these products, and also how they are supposed to properly use them.”

I asked Kerschbaumer how someone with such an organic, green philosophy is able to incorporate such technologies into her offerings. “Again, it all comes down to research, education

and training,” she says. “I rely mainly on traditional holistic therapies, but then at the end of the day, my business is about giving my client what she/he wants. In America, that usually means visible results, and fast. My clients know that I spend a tremendous amount of time and resources on making sure that every ingredient that I use and recommend to them is effective and safe. It is that trust that allows me to sell retail products. Trust and the simple fact that I tell my clients that they need to take this product home with them and use it consistently in order to get the results they want.”

The current landscape of the cosmetic skin care indus-try is something that could have only been dreamed about in decades past. The cosmetic skin care industry in 2014 reminds me somewhat of the American Old West, when hucksters peddled their latest “miracle cure” or “snake oil.” We have come full circle indeed, as synthetic snake venom is actually one of the new ingredients appearing in modern formulations. It is up to the patient and professional to de-termine the comfort level and aggressiveness of the trauma inflicted. This can range from a very invasive trauma that might last a week or more (i.e. Blue Peel, TCA or Jessners Peel), a Fraxel or other laser initiated trauma to something mildly aggressive that can be implemented and controlled in a typical spa treatment such as microdermabrasion. There are a wide variety of products and treatments available. It is an exciting time to be in the esthetic field, as even the newly licensed therapist now has powerful tools available to use in their treatment rooms. As always, it is imperative that both the practitioner and the patient do their home-work and learn about these new ingredients, how they work and what effects they can achieve. Even with all of the new developments, one thing of primary importance has never changed in our industry. If patients ask us the right ques-tions and find the right professional, they will be absolutely amazed at the positive results that are now possible in the cosmetic marketplace. n

Dubi Luxman, M.D. is a retired army surgeon, and has been a practicing physician and ob/gyn for more than 30 years. He believes in treating patients according to the principle of evidence-based medicine, and feels that this same principle should apply to cosmetics as well. He is the founder and chief medical officer of the Biopeptix® product line. For more information about Dr. Luxman, please call 800.908.9659 or email him at [email protected].

skin|the changing face of beauty

The cosmetic skin care industry in 2014 reminds me somewhat of the American Old West, when hucksters peddled their latest “miracle cure” or “snake oil.” We have come full circle indeed, as synthetic snake venom is actually one of the new ingredients appearing in modern formulations.



COMPLETE TECHNOLOGYLumenis Ltd. has received clearance from the U.S. FDA for ResurFXTM, a new fractional non-ablative laser module. ResurFX is the latest application module for Lumenis’ M22TM platform, expanding its capabilities to perform true fractional non-ablative skin resurfacing, says the company. Lumenis’ M22 combines the following three technologies, covering over 30 indications in one system: Intense Pulsed Light with Optimal Pulse Technology™, Multi-spot Nd:YAG and now the ResurFX for a complete esthetic workstation. lumenis.com

SOOTHING RESTORATION The Lipid Recovery Serum from Skin Recovery Science is a breakthrough product for use after dermatological procedures. It enhances the effectiveness of resurfacing treatments and soothes skin irritation from microdermabrasion, chemical peels, laser resurfacing, facial abrasives and hair removers, says the company. srsunlimited.com 888.385.9058

POST-OP TREATMENTThe ReGenica™ Facial Rejuvenation Post Procedure Complex is designed to help restore moisture and promote the healing of damaged skin following procedures such as phototherapeutic laser, dermabrasion and chemical peels. In clinical studies, patients

utilizing ReGenica had improved moisture and healing and a more rapid recovery, following ablative and non-ablative laser treatment, says the company. regenica.com

POWERFUL PEELThe revolutionary Youth Firm® Age Defying Peel fromGlyMed Plus® contains a 30% protease enzyme to mimic the skin’s own biological process, producing AHA results without irritation, says the company. This peel works well any time of the year, as it has been clicially proven to produce less than 5% photosensitivity. glymedplus.com 800.676.9667

SKIN

NEW

S

SKIN CARE PRODUCTS AND

TREATMENTS


marks formed during pregnancy usu-ally occur during the last trimester and appear mainly on the belly. However, they also commonly develop on the breasts, thighs, hips, lower back and but-tocks. These particular stretch marks are known in the medical community as striae gravidarum.

“We have been retailing stretch mark prevention and treatment cream in my practice for over six months and our pa-tients love it,” said Peter Rullan, M.D., a board certified dermatologist in San Diego, CA. “Within the first months of use, the skin surrounding the stretch mark and the stretch mark itself is firmer, smoother and more healthy looking.”

Liposomed plant stem cells of cen-tella asiatica are one of the key ingre-dients to look for. In studies, centella asiatica improves the overall appearance of stretch marks, reduces color intensity and roughness of the skin surface.

In 1991, a double-blind test per-formed on 100 volunteers published by the International Journal of Cosmetic Science stated that centella asiatica ex-tract could prevent the development of stretch marks. In 2008, the Cochrane Collaboration did a review of such tests, and came to the conclusion that it was the only valid study about stretch mark prevention, and that centella asiatica was the main active in a cream.

Stem cells are non-programmed and undifferentiated cells found in multi-cellu-lar organisms that have a large capacity for self-renewal. They are able to replenish themselves through mitotic division into two identical daughter cells, and also have the unique ability to differentiate and be-come specialized cells with specific func-tions. The behavior and characteristics of

MANY PEOPLE HAVE STRETCH marks, which they do their best to keep covered up and hidden. Our mothers would tell us they were caused because we “grew too fast,” while ob/gyns tell us they are caused due to skin being stretched while pregnant. But those are not the only causes of stretch marks. Hormonal changes and genetics influence the skin’s capacity to withstand stretch-ing forces, as do diet and exercise. The glucocorticoid hormones responsible for the development of stretch marks affect the dermis by preventing fibroblasts from forming collagen and elastin fibers, which are necessary to keep rapidly growing skin taut. The change in hormone levels can create a lack of supportive material as the skin is stretched, which leads to dermal and epidermal tearing.

While nothing will ever completely rid the body of stretch marks, there are a variety of options available to reduce their appearance and to help the skin tissue regain lost collagen and elastic-ity. Now, an exciting new result of plant based stem cell research introduced from Europe (naturally) could be the best method to date to reduce stretch marks for retail and home use.

Stretch marks, or striae, as they are called, are a form of scarring on the skin. They are generally red in color, and turn silvery as they age. They are caused by tearing of the dermis. Although they may diminish over time, they will never com-pletely disappear. Stretch marks are often the result of the rapid stretching of the skin associated with changes in weight or growth. They may also be influenced by hormonal changes associated with puberty, pregnancy, bodybuilding and hormone replacement therapy. Stretch

stem cells depends on the signals from the neighboring environment and epi-genetic factors, which induce changes in gene expression. Their special properties provide stem cells with a great potential for regenerative medicine and cosmetic applications. Such is the case with stretch marks. Simply put, natural plant stem cells can duplicate healthy cells in the human tissue and regenerate the skin.

Prescription retinoids, fractional laser treatment, radiofrequency combined with the 585 nm pulsed dye laser, chemical peels and surgical removal via a tummy tuck are other options available that attempt to treat stretch marks. However these options offer limited improvement, especially in regard to the quality of skin tissue.

“We have found that our patients are able to reduce the appearance of stretch marks with an at-home regimen of topical products, as well as using it in combination with our in house treatments,” said Lisa Schiller, esthetician at Dr. Daniel McKenzie of Saddleback Medical Group in Laguna Hills, CA. “We have patients coming to our practice for a variety of health reasons and many of them suffer with stretch marks. Retailing is easy, and patients are seeing exceptional results.” n

Angela O’Mara is a freelance writer and the author of several books. She is also the president of The Professional Image, Inc., a public relations agency. O’Mara is founder of BIG Medicine Magazine—The Magazine for BIG Thinkers, which is distributed in doctor’s offices nationwide. O’Mara can be reached at [email protected] or 949.768.1522.

by Angela O’Mara

spa it’s not a stretch—beautiful skin can be yours!

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February 2014 • Les Nouvelles Esthétiques & Spa LNEONLINE.com • Page 53Page 52 • LNEONLINE.com Les Nouvelles Esthétiques & Spa • February 2014 February 2014 • Les Nouvelles Esthétiques & Spa LNEONLINE.com • Page 53

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AromatherapyMore than just a pleasant scent

AROMATHERAPY AND ESSENTIAL OIL TREATMENTS ARE nothing new for spas. Massage therapists and estheticians have long understood the mind soothing and skin healing benefits of essential oils. Lately, we are seeing more essential oil remedies being offered as supportive therapies in hos-pitals and clinics across the U.S. As interest in the healing benefits of essential oils increases, so too does the scientific exploration into their legitimacy.

We know that in order for essential oils to have thera-peutic effects, they must be pure plant extracts. In the late 1990s, gas chromatography-mass spectroscopy (GC-MS), the choice instrument for analyzing volatile organics like es-

sential oils, revolutionized our understanding of the potential therapeutic application of essential oils by providing us with a chemical component breakdown. GC-MS does not give us the entire picture, but it can confirm purity and quality, and provide us with some of the science that helps us pinpoint the essential oil chemical components that are known to reduce pain, assist with respiratory issues, calm the nervous system and manage stress, just to name a few.

As an example, lavender has been used for centuries as a painkiller and sleep aid. It is composed of hundreds of chemical components, and through GC-MS analysis, we know that it is high in monoterpenols and esters, chemical

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BY TERI PEARMAN

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families that have analgesic and sedative qualities. This, along with ongoing clinical trials, helps confirm what nurses, mas-sage therapists, estheticians and aromatherapy practitioners already know: lavender is calming to the nervous system, provides a local anesthetic effect and is safe and healing to the skin and mucous membranes.

Advances in technology, along with clinical trials proving the therapeutic benefits of essential oil remedies, continues to add credibility to an expanding area of complementary and alternative natural treatments for a host of ailments. The years 2012 and 2013 provided several studies that put some essential oils to the test with exciting results.

Stop nicotine cravingsIt does not take long for an esthetician to figure out if the cli-ent on her treatment table is a smoker. It is all very apparent in the skin. The nicotine in cigarettes narrows the blood ves-sels in the outermost layers of skin, impairing blood flow. Less blood flow means less oxygen. It deters important nutrients, like vitamin A, from reaching the skin and nourishing it to stay healthy and moist. Research has also shown that women who smoke have lower levels of vitamin E secretion in their skin. Chemicals in tobacco smoke damage collagen and elastin, the fibers that give skin its underlying structure, strength and elasticity. As a result, the skin of smokers begins to sag and wrinkle prematurely. The same chemicals damage the blood vessels around the eyes, resulting in dark circles and eye bags. The repetitive muscular action of smoking, such as pursing the lips and sucking in the cheeks, also causes wrinkles. That is why smokers tend to have all those wrinkles in the upper lip and around the mouth. The good news is that there are some natural ingredients that can support a motivated client who is trying to kick the habit.

Black pepper (Piper nigrum) essential oil steam distilled from the peppercorn produces a pleasantly spicy, warm and radiant aroma. Not only is it great for providing relief to sore muscles when added to a massage oil, a recent comparison study confirmed the finding of a study done over a decade ago that inhaling black pepper essential oil (just one drop on a tissue for two minutes) helps to curb the desire to smoke (1).

Phyliss Travis, an esthetician, aromatherapist and reiki prac-titioner at Alive & Well Massage Therapy in Springfield, MO

offers her clients support with smoking cessation. Her menu includes a detox package, starting with a body scrub using sea salts and grapefruit (Citrus pardisi) essential oil, followed by a detox massage to help flush the nicotine from the body. This package ends with a reiki session to help calm the anxiety that comes from trying to quit any addictive behavior. She then of-fers her clients a couple of take home options. These include a Greenland Moss (Ledum groenlandicum) hydrosol spray, which has powerful detoxification properties for people with addictions. Or she will formulate a personalized, half ounce bottle of essential oil blends that include black pepper for her client. They can apply this to the wrist when the urge to smoke hits. Clients can purchase the entire treatment plan for $195.

Addressing the premature aging of the skin caused by smoking can require several follow-up visits, but it is sur-prising how quickly the skin responds once nicotine is no longer in the system.

Manage post-operative nauseaIn a recent study, patients who reported a history of post-operative nausea (PON) were broken up into four groups (2). After their scheduled surgery, they were asked to smell a substance on a gauze pad, and then report if the substance helped reduce their nausea. Two of the groups were asked to smell placebos: isopropyl alcohol or saline solution. The other two groups were asked to smell ginger essential oil by itself, or a combination of ginger, peppermint, spearmint and cardamom. The combination of ginger, peppermint, spear-mint and cardamom hit a home run, with 83 percent of the subjects reporting improvement in nausea after surgery. The conclusion? Aromatherapy is promising as an inexpensive, noninvasive treatment for post-operative nausea, and can be administered and controlled by patients as needed.

Pain reliefSeveral studies explored the anti-spasmodic and painkilling qualities of essential oils for women who suffer from primary dysmenorrhea, or menstrual cramps. Menstrual cramps are a widespread problem that affect many women, and can even cause missed days at work and school. Menstrual cramps negatively impact a woman’s quality of life.

The study concluded that the women who received the essential oil treatment reduced the days they struggled with pain by about half. This essential oil formulation is effective on any pain where muscle spasms are the source .


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Researchers have examined the painkilling benefits of lavender, clary sage and marjoram. In one study, women who suffer from cramps were instructed to massage essential oils (mixed in an unscented cream at three percent concentra-tions) on their stomach daily, starting on the day their cycle ended until the beginning of their next cycle (see insert for the recipe from this study). The study concluded that the women who received the essential oil treatment reduced the days they struggled with pain by about half. This es-sential oil formulation is effective on any pain where muscle spasms are the source.

Another study determined that 10 minutes of inhaling lavender essential oil could alleviate premenstrual emotional issues. Lavender’s success, at least in part, is attributable to its ability to calm the sympathetic nervous system, which is responsible for activities associated with the fight-or-flight response. This is explored further in studies addressing es-sential oils’ effect on reducing high blood pressure.

Control blood pressureOne component of managing high blood pressure is man-aging stress. This is where essential oils appear to have a significant impact. In one study, test subjects with pre-hy-pertension and hypertension were asked to inhale a com-bination of lavender, ylang ylang, bergamot and neroli. The placebo group was asked to inhale a synthetic fragrance, and the control group did nothing. Over a 24-hour period, blood

pressure readings and salivary cortisol levels significantly de-creased in the essential oil group, leading the researchers to conclude that essential oils may assist in controlling blood pressure by helping the participants relax. This essential oil combination, when diffused in a treatment room, helps relax even the most anxious client.

Even though the chemical makeup of essential oils is no longer a mystery, and science can synthesize certain compo-nents, it’s impossible for current technology to completely rep-licate or even understand all the synergistic elements at play in a single drop of essential oil. Plants synthesize molecules in ways that cannot be reproduced in the lab, at least not yet. For now, the deeper questions have yet to be answered. These include questions of exactly why black pepper essential oil helps reduce the desire for nicotine, or what mechanisms are at work that cause lavender to reduce salivary cortisol levels.

Those of us who work closely with high quality essential oils are not overly concerned with not having all the answers as to why they work. The proof for us is seeing with our own eyes how aromatherapy and essential oil remedies positively impact the lives of our clients.

Incorporating quality essential oils into your practice isn’t difficult or expensive. The only way to know for sure that you are buying pure essential oils is if you purchase your oils from a company that provides the GC/MS test that corre-lates with the essential oil you purchased. Unfortunately it’s an expensive process, so currently there are only a handful of companies that offer this service. However, you may be surprised to know that the cost of their essential oils is very competitive with those companies that don’t provide test-ing. Consider the following when purchasing essential oils:

• IstheLatinnameoftheplantprovidedsoyoucanbesureyou are getting the right essential oil? For example, there are several species of eucalyptus. Eucalyptus citrodora is high in the chemical citronella, so it is calming with anti-septic qualities. Eucalyptus globulus is high in the chemical 1,8-cineole, which makes it a good ingredient in muscle pain formulations. They are both helpful with chest congestion.

• Isthecountryoforiginlistedonthebottle?Essentialoilscan vary significantly based on where they are grown. Helichrysum italicum from Corsica, with high levels of the chemical neryl acetate, has strong anti-spasmodic qualities, while Helichrysum italicum from Croatia is high inαpinene, giving it anti-inflammatory qualities.

• Readthelabelverycarefully.Itshouldindicatethatitis100percent pure essential oil. The fine print might tell you that it is diluted with a carrier oil or other essential oils. If you are formulating your own therapeutic blends, you want 100 percent essential oil.

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Lavender’s success, at least in part, is attributable to its ability to calm the

sympathetic nervous system, which is responsible for activities associated

with the fight-or-flight response.



• Essentialoilsshouldbepackagedinadarkglasscontainerto protect it from sun exposure and air. Skin friendly es-sential oils, which have gotten old or oxidized, are actu-ally harmful to the skin and can cause contact dermatitis or mild burns.

• Istheoilcomparablypricedwithotherbrandsofthesame essential oil? If it is too cheap, then it may be old or not even the real thing. On the other extreme, it may be highly overinflated in price, as part of a company’s direct marketing distributor’s payment schedule.

• Don’trelyonyournose.Unlessyouhavebeenworkingwith essential oils for years, you won’t be able to deter-mine the quality by the scent alone. And certainly do not rely on the sample testers at the health food store as your gauge for what quality oil should smell like. Most of them have been repeatedly exposed to the air, and may have oxidized. n

Reference: “Aromatherapy as Treatment for Postoperative Nausea: A Randomized Trial” Anesth Analg September 2013 117:597-604; published ahead of print March 5, 2012, doi:10.1213/ANE.0b013e31824a0b1c

Teri Pearman is the founder and CEO of Infusion Breast Care Botanicals, LLC, a company specializing in plant based, vegan products formulated specifically for breast skin challenged by cancer treatments and breast surgery. Contact Pearman at [email protected].


spa|aromatherapy

Anti-spasmodic massage cream1 oz unscented lotion or cream*10 drops lavender (lavendula agustifollia)4 drops clary sage (salvia sclarea)4 drops marjoram (origanum majorana)

Mix essential oils thoroughly into the cream. Massage cream into the area that is experiencing pain.

* You can substitute the lotion or cream for a carrier oil such as sunflower or sweet almond.

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spa

BY RUTH WERNER

MANY MASSAGE THERAPISTS WHO WORK IN HIGH-volume settings with a fast turnover rate feel that they don’t have the time to gather more than the most basic

information, or document their sessions, or fully discuss what they in-tend to do with their clients. In the interest of delivering the maximum hands-on service to customers, employers sometimes specifically dis-courage massage therapists from record keeping.

Frankly, this is a serious problem, because it deprives clients of re-ceiving the safest, most effective service. To deliver the highest stan-dard of care, it is necessary to take three things into consideration: the therapist’s expertise and judgment, current research findings, and the client’s desires and values. It is impossible to discern those priorities without the right information, and sometimes that information can only be gathered through paperwork.

There is not enough space in this column to provide examples of all the forms discussed here, but a list containing a few sources is pro-vided at the end.

Taking a historyWhile taking a client history can be time consuming, much of it can be accomplished before the appointment begins. In settings where a cli-ent may be a repeat customer, it can be done once (often electronically before the appointment), and then regularly updated as needed. Be aware that clients must give permission for their health information to be shared in a multi-therapist setting.

Without a high-quality client history, critically important pieces of information can be lost—like whether Mrs. Smith’s high blood pressure medication makes it dangerous for her to use the hot tub. Or whether Ms. Lee has an allergy to seaweed that could put her into anaphylactic shock if she gets the wrap she signed up for.

Of course, there is the other critically important question: “What do you want to accomplish today?” This information is best gathered face to face, with full focus and attention.

SOAP chartingThis is a method of record keeping shared by most health care provid-ers. It can track the progression of treatment, and it can be used (with the client’s permission) to share with other providers so they can add their input where appropriate. SOAP charts are also often used for billing purposes, especially in the context of insurance claims related to injuries from on-the-job or motor vehicle accidents.• SUBJECTIVE: The “S” stands for subjective (client-reported) find-

ings. This is where pain is described. The quality of pain (burning, sharp, electrical, dull, aching, etc.), along with location, frequency, severity and duration are important descriptors. A figure of a body that the client can mark at every appointment is a common way to gather this information.

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LNEONLINE.com • Page 67

SOAP CHARTINGTHE IMPORTANCE OF CLIENT INTAKE AND INFORMED CONSENT

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• OBJECTIVE: “O” stands for objective find-ings. For other health care providers, this is where blood pressure, respiratory rate, heart rate and other findings are documented. We can document whatever we see (rash, limping, swelling), feel (fibrosis, coolness or heat), hear (crackling, popping) or smell (bad breath, pungent sweat). Essentially, anything we judge to be a pertinent observation.

• ASSESSMENT: “A” stands for assessment, which is as close as massage therapists come to making a diagnosis. This is where we can note which muscles or facial lines of tension might need attention.

• PLAN: “P” stands for plan. What are we go-ing to do next? Session strategies, exercises, stretches and recommendations for further care appear in this part of the chart.

Informed consent Informed consent is an under-addressed part of massage documentation, but in an age of hair-trigger litigation it is something we all need to consider. Informed consent means that the client understands what the intervention involves, that you have explained the possible risks and benefits, and that he or she agrees to the treatment that you have outlined. It is important that this happens in a way that is not coerced, and that the client is engaged in making decisions.

Each state has different boundaries in their massage regulations. In some states it is legal to work on breast tissue, but only if the client signs a specific informed consent form. Likewise, intra-oral work may require a special consent form. It would be wise to refer to your state laws to see if any aspects of the massage you do requires separate consent documentation.

For most massage therapies, a more general consent is usually adequate, and it is often incor-porated into a health history form.

Where to find examples The Internet has hundreds of templates and sam-ples of any type of form a massage therapist could want. I have included a few suggestions, but there is no shortage of available options.

SOAP CHARTING• AgreatresourceforallthingsaboutSOAP

charting is the book Hands Heal: Communication, Documentation and Insurance Billing for Manual Therapists, 4th ed., by Diana Thompson. Most online samples are based on the material in this groundbreaking book.

CLIENT HISTORY FORMS• Hands Heal also has excellent information

about client history forms. • FromAssociatedBodyworkandMassage

Professionals (ABMP): abmp.com/members/pdfs/client_information.pdf

INFORMED CONSENT • FromtheAmericanMassageTherapy

Association (AMTA): amtamassage.org/career_guidance/detail/102

• Anotherformthatincludesgeneralofficepoli-cies along with consent: wellbalanced.webs.com/Massage%20Consent%20Form.pdf

Why bother? For a massage therapist working in a spa or re-sort where they are likely to see many clients just one time, careful documentation may not seem important. But good record keeping is not only the mark of a high professional standard, it can also subvert trouble if any negative effects oc-cur. For therapists with repeat clients, charting can be a concrete way to demonstrate progress (i.e., comparing the areas marked with pain that decrease over time), or to realize that a strategy isn’t working, and that it’s time to try something new. In short, good record keeping allows us to deliver the very best standard of care, and that should be a priority for every massage therapist. n

Ruth Werner is a writer and National Certification Board for Therapeutic Massage and Bodywork approved provider of continuing education for massage therapists. She wrote A Massage Therapist’s Guide to Pathology, now in its fifth edition. Werner currently serves as president of the Massage Therapy Foundation, a philanthropic organization dedicated to advancing the knowledge and practice of massage therapy by supporting scientific research, education and community service. Contact her at [email protected].

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GOOD RECORD KEEPING IS

NOT ONLY THE MARK OF A HIGH

PROFESSIONAL STANDARD, IT CAN

ALSO SUBVERT TROUBLE IF

ANY NEGATIVE EFFECTS OCCUR.

Lucrece Physicians’ Aesthetic Research, Inc.www.lucrece.com

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STRESSVisual


BY BARRY M. KAY, O.D.

OPTIMAL EYE HEALTH

DO YOUR CLIENTS SUFFER FROM PAIN and stress? Many things in our everyday lives can come together to make us “stressed out,” but most people don’t consider how this factors into ocular or visual stress. Spa therapists have a unique opportunity to offer treatments for fatigued eyes and weary guests who suffer from chronic tension in the face, neck, shoulders and back.

The vast majority of us do not have perfect 20/20 vision, which makes our eyes work signifi-cantly harder than they do for those lucky few.

The most common conditions that contribute to visual stress are hyperopia (farsightedness), astigmatism and presbyopia (age-related sight loss). Hyperopia forces the eyes to focus even harder than normal to see clearly. This causes the need for typical reading prescriptions to even see far away. Astigmatism creates different pre-scriptions within the same eye, so that parts of every letter we see are in and out of focus. Last but not least is presbyopia, which is due to ag-ing of the eyes, and affects every human on the planet. This natural process reduces our ability to focus on items up close, and gets significantly worse between the ages of 40 and 50.

Vision dysfunctions can lead to lifestyle injuries and chronic pain. Many clients don’t even realize that their eyes may be the source of the discomfort.

On the topic of direct eye discomfort is the issue of dry eyes. Particularly when we stare at our computer screens, our blink rate absolutely decreases. Blinking distributes necessary moisture to the surface of our eyes, which keeps our eyes lubricated between blinks. Those who have dry eyes may also often slouch, and this head-forward posture leads to tightness in the pectorals, upper trapezius and sternocleidomastoid muscles. Many people do not realize that dry or irritated eyes can affect other areas of the body, but they do!

How can the spa therapist help?Advise clients to de-stress their eyes during the workday, and suggest that they not work under paddle fans or A/C vents. Offer helpful tips that they might not have thought about, such as re-ducing caffeine intake. Avoid natural diuretics,

which dry out the eyes (as well as the rest of the body). One benefit of reducing or eliminating the intake of coffee, tea, cola, alcohol and chocolate is a healthy and well-balanced guest. Increasing fluid intake to at least eight glasses of water each day will ensure proper hydration. Often, when a client has dry or itchy eyes, their skin and hair may also be suffering from lack of hydration. This keen observation enables the therapist to offer valuable tips and retail suggestions for optimal health and wellness.

Particularly for those clients that complain about dry and burning eyes, incorporate a warm,

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INCLUDE THE FOLLOWING KEY QUESTIONS IN YOUR CLIENT HISTORY INTAKE:• Doyousufferfromregularheadaches?• Doyoureyesburnorfeelsoreor

irritated later in the work day?• Doyouwearglasses?• Doyoureyesquicklytire

from computer work?• Doyougetsuddensharppainsin

your eyes from your daily work routines?• Whenwasthelasttimeyouhada

comprehensive eye evaluation (not just a vision screening)?

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spa|visual stress

moist compress over both closed eyes for approximately five minutes during your sessions. After removing the compresses, you can add a digital massage with moderate pressure from the base of the lids toward the lashes/lid margins. Hold each pressure point for at least six seconds to release tension. This helps open the glands in all four lids, which works to make high quality tears. For puffy and irritated eyes, follow up with a cool stone massage, focusing on and around the eye area. The hot and cold contrast of the treatment is very soothing.

Having an awareness of how stress influences eyesight can help you offer a deeper, more comprehenisve approach to relaxation. n

Barry M. Kay, O.D. has more than 32 years of experience as an optometric physician in South Florida. He served as chief of optometry in a busy surgical practice, where he specialized in advanced vision and medical eye care before starting his own practice, Hollywood Eyes. For more information, call 954.923.5367 or visit hollywoodeyesflorida.com.


acupressure points on the face

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BACNE CONTROLFace Reality Acne Clinic’s 15% Mandelic Serum, made with the efficacious L-mandelic molecule, is a powerful yet gentle exoliant, anti-inflammatory and anti-fungal serum. Strong enough to penetrate the thicker layers of skin

on the back, it controls both inflamed and noninflamed acne, as well as fungal folliculitis, says the company. Combined with lactic acid, it also helps to lift post-inflammatory hyperpigmentation left behind by acne. facerealityacneclinic.com 866.477.3077

RESTORATIVE LIGHTThe deep penetrating light system from the LED Light Wave Umbrella by The Healing Group uses a combination of red, blue, green and yellow lights to penetrate and permeate deep into skin, tissue, muscle, joints and even bones, where the wavelengths stimulate reparative processes. The combination of lights has been shown to ease pain and accelerate the healing process, says the company. thehealinggroup.net 570.296.5613

HEATED SOLUTIONThermiAesthetics has received FDA clearance for ThermiRF temperature controlled radiofrequency. ThermiRF is an esthetic technology that applies the “science of heat” to precisely heat soft tissue and nerves to achieve desired esthetic outcomes, says the company. ThermiRF applications are targeted to patients seeking an “in-between” solution for various esthetic complaints. It is ideal for patients who are asking for longer lasting treatments for frown lines, wrinkles of the face or neck, or those who want to avoid or delay getting a facelift.thermi.com

BODY,EQUIPMENTAND SUPPLYPRODUCTS

MORE NEWS

THERAPEUTIC BEAUTYMicroSilk®, a revolutionary new hydrotherapy from Jason International, Inc., incorporates a unique technology that cleanses, exfoliates and moisturizes the skin with an oxygen-rich blanket of microbubbles. In addition to rejuvenating skin metabolism, the presence of therapeutic levels of anions, known to improve serotonin levels in the brain, delivers deeper relaxation for a holistic hydrotherapy that soothes the mind, muscles and skin, says the company. jasoninternational.com800.255.5766


SPA

NEW

STRIM AND SHAPEChromogenex Technologies Ltd recently launched the i-Lipoxcell, an advanced noninvasive fat reduction and body shaping system. It uses four technologies in one system for intelligent body fat analysis and measurement, laser diode fat reduction, IR vacuum massage and radiofrequency skin tightening.The FDA-cleared i-Lipoxcell system also records the reduction in body fat and overall improvement in patient health, and requires no anesthesia, needles or downtime, says the company. chromogenex.com 855.438.4547

PREMIUM MICRODERMABRASIONThe Vortex-Peel from Silhouet-Tone® delivers unparelleled results in microdermabrasion due to a patented rotating jet. The safe, innovative device combines vacuum and turbo flow technology to provide treatments that are suitable for even the most sensitive areas. The Vortex-Peel works to reduce the appearance of wrinkles, pigmentation spots, a dull complexion and other imperfections, says the company. silhouettone.com800.552.0418

SHAPELY SILHOUETTEBody FX by InMode Aesthetic Solutions has just received FDA clearance in the U.S. Using a three-part mechanism and InMode’s novel A.C.E. technology (Acquire, Control, Extend), Body FX has been proven effective for smoothing and contouring the body for temporary cellulite reduction, says the company. Using vacuum suction, radiofrequency, energy and high efficiency pulses, it is designed to achieve a noticeable difference in appearance.inmodemd.com 855.411.2639

SLIMDOWN SUPPORTOffer slimming shapewear to your clients who have undergone surgical procedures to help them get back into shape post-operation. The Slimming Full Body Shaper by Leonisa comfortably adjusts to one’s body to help them recover their figure after surgery, says the company. leonisa.com 800.657.9107

BODY,EQUIPMENTAND SUPPLY

PRODUCTS


by Susanne Schmaling

business medical spa service

IN THE EVER-CHANGING WORLD of esthetics, the medical spa has be-come increasingly prominent. Medical spa owners usually give a lot of thought to treatment results and client safety, but running alongside these priorities is customer service. As soon as you add the word “spa” to your business name, clients will have certain expectations. Relaxation, beauty and wellness services will be foremost in their minds. In order to grow the medical spa business, those expectations need to be met.

Building a service culture and increas-ing sales while respecting the unique boundaries of a medical setting can be a challenge. In a non-medical spa, a cli-ent’s request is rarely denied. If she is contraindicated for her requested ser-vice, another option will be presented to continue the relaxation experience that a spa offers. But in a medical spa, saying “no” to a client may be more fre-quent and come with fewer alternatives.

Another challenge in the area of cus-tomer service is the fact that where medi-cal services are provided and there is a health care provider involved, HIPAA rules must be followed. This limits the amount of direct marketing and sales follow-up that the business is legally al-lowed to do.

Despite these challenges, it is pos-sible to offer stellar customer service at your medical spa that will improve every client’s experience. Achieving this is essential to any successful business.

To understand how to create good customer service, it is helpful to first de-fine that concept. Good customer ser-vice has been provided when your ac-tions create a feeling of gratification by exceeding your guest’s expectations.

1. Be responsive to client needsQuestions to ask:• Aremyhoursappropriate

for my demographic?• Canclientsmakeappointments

easily, in any way they prefer (via phone, email or online scheduling)?

• Arequestionsansweredaccuratelyand in a timely manner?

• AreHIPAAlawsfollowedbyeveryone on staff?

• Areallclientswelcomedandtreated with respect?

• Areallclientseducatedaboutthe benefits and risks of every treatment (informed consent)?

2. Create an exceptional client experienceThis relates to spa design, effective and safe esthetic medical treatments, and ease of use. Questions to ask:• Ismymedicalspaeasytoaccess

(location, website, printed material)?

• Doesmydécorinspirerelaxation?• Aremytreatmentsbasedonsound

science with no hyped-up claims?• Ismyservicemenuclear?Doesit

state the benefits of treatments?• Aretheretailproductsprofessional

and priced appropriately for my client demographic?

• Areallserviceproviders,includingM.D.s and R.N.s, fully trained on the machines and procedures offered?

3. Create effective standards of serviceQuestions to ask:• Arethemedicalspa’s

goals and vision expressed to every employee?

• Arehiringstandardsandcompensation clearly defined?

• Areprotocolsforevery treatment standardized?

• Doesthestaffpresentaprofessional and competent image?

• Isthereaclearlyoutlinedcodeof conduct within the employee handbook?

• Areallstateandnationalscopeofpractice laws followed?

• Isthereaneffectivetrainingprogram in place for all employees?These points are just a start; the whole

process of improving the client/patient experience can take some time. A com-plete business culture shift may be in or-der, but it is possible to succeed. In some cases, the help of a spa expert can really lead to a positive outcome. n

Susanne Schmaling is the director of education for Associated Skin Care Professionals. The licensed esthetician, makeup artist, nail technician and in-structor authored the critically ac-claimed Milady’s Aesthetician Series: TheComprehensiveGuidetoEstheticEquipmentandMilady’sAestheticianSeries: Aging Skin. Schmaling is the founder and former director for the Pacific Institute of Esthetics, and has previously owned an award winning day spa.

HIPAA Survival Guide notehipaasurvivalguide.com/ hipaa-privacy-rule.phpThe HIPAA Privacy Rule prohib-its certain forms of marketing without authorization. If you are receiving remuneration from a third party to disclose private health Information, then you are almost certain to be engaged in marketing. Any such remunera-tion must be explicitly captured in the required authorization.


MED SPA OWNERCONCERNStop five considerations

BY RENEE ELISE COOVER

MED SPAS CONTINUE TO INCREASE IN popularity, and the growth in this industry is staggering. Last year, 6.1 million Botox proce-dures were performed, mostly in med spas. But the lack of regulations and oversight is threat-ening this growing industry. In several states, regulatory agencies are taking a hard line against med spas—suspending and revoking physician licenses, invoking fines and penalties, and even going so far as to shut down spas that are op-erating illegally.

Many physicians open med spas with little awareness of the potential legal pitfalls that can quickly threaten an unprepared med spa business. Spa owners commonly face the fol-lowing five issues:

• Operatingamedicalspawithoutproperphysiciansupervisionandoversight

• Payingmedspaemployeescommissionsformedicalservicesandtreatmentsper-formedonpatients

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• Dealingwithemployeeswhotrytotakepatients with them when they leave

• Usingsocialmediaandmarketingwiselytoadvertisemedspaservices

• Handlingpatientcomplaints

1 First and foremost, it is crucial to know what your state requires in terms of medi-cal supervision for med spa services, and

what constitutes an adequate amount of su-pervision. In Illinois, for example, all medical treatments—including Botox and laser hair re-moval—require physician supervision. Although a physician may delegate initial patient consults and medical treatments to nurse practitioners (NPs) and physician assistants (PAs), the physi-cian must be involved and available to patients should an emergency occur.

Remember that ultimately, physicians are responsible for each patient that walks through the door of a med spa; their license is on the line. Some states have additional oversight re-quirements as well. In Illinois, a medical profes-sional must be onsite at the med spa at all times when medical procedures and treatments are performed. This means that if a physician owner only has one other employee and that individual is a non-medical professional, the physician must be onsite at all times to supervise.

2 Second, almost all states prohibit “fee-splitting” between physicians and non-physicians. This means that in a med

spa, a physician may not share or divide fees from medical services with a non-physician em-ployee (i.e., a nurse, PA or esthetician). In the med spa industry, many non-physician practitio-ners are accustomed to receiving commissions for Botox and laser treatments performed on clients. However, in the majority of states, in-jectables and laser procedures are considered the practice of medicine.

If the non-physician receives a commission or bonus from the med spa for performing these medical treatments, it is fee-splitting—and it is illegal. To play the game safely while also ap-peasing your med spa employees, it is best to use a pre-set bonus structure based on employ-ee performance to avoid fee-splitting concerns.

3 Another issue facing med spa owners is dealing with employees that threaten to steal patients or patient lists when they

accept a new job at another med spa. In many cases, nurses and estheticians build relationships with patients of the med spa, and the patient prefers to see them instead of the physician for treatments. But what happens when the nurse or esthetician leaves a med spa for a competitor and tries to take those patients with them? This has become a real issue in the med spa indus-try as owners struggle to maintain a loyal client base and employees threaten to take it away. Onesolutionistohaveemployeessignconfi-dentiality, non-solicitation and non-competition agreements to protect patient lists. By signing this kind of agreement, the employee agrees that they are prohibited from soliciting patients and other employees away from the med spa. But before you hand a non-competition or non-

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BEFORE YOU HAND A NON-COMPETITION OR NON-SOLICITATION AGREEMENT TO YOUR EMPLOYEES, IT IS IMPORTANT TO RETAIN AN EXPERIENCED ATTORNEY TO DRAFT OR REVIEW THE AGREEMENT YOU PLAN TO USE.


solicitation agreement to your employees, it is important to retain an experienced attorney to draft or review the agree-ment you plan to use. In some states, courts critically review restrictive employee agreements to ensure that the limita-tions and scope of the agreement are fair and enforceable.

4 With the advent of social media, med spa owners have encountered a whole new set of issues—the primary one being how to use social media wisely to adver-

tise their med spa without divulging patient information or making deceptive or false representations. A very common mistake being made by med spas is the failure to create and maintain a website, Facebook page or LinkedIn account that

accurately reflects and realistically represents the business structure and ownership of the med spa.

For instance, in Illinois, the Department of Financial and Professional Regulation (IDFPR) has begun launching investiga-tions against med spas based solely on their website content. Investigators are tasked with reviewing the websites and social media pages of med spas to obtain information on ownership, business structure, fee structure, staff qualifications and services. If the med spa website does not realistically reflect its business practices, divulges patient information or falsely depicts a non-physician ownership, it will quickly be on the IDFPR’S “radar,” and the owners and employees associated with the med spa can face suspension of licenses, fines and penalties.

But as technology advances, websites and other forms of so-cial media become increasingly important for med spas looking to grow their business and compete in the marketplace. Thus, the time is now for med spa owners to reevaluate their online presence and ensure compliance with the law.

5 Patient complaints probably plague every med spa busi-ness at one time or another. In an industry where patients are looking to enhance and rejuvenate their youth and

beauty, patients may complain about a treatment’s level of ef-fectiveness or the results of a procedure. Although complaints may be inevitable, knowing how to respond to them may save a client—and your business. Before automatically giving the patient a refund, it is important to sit down with them and lis-ten to their complaint to better understand the right response. Sometimes, just by listening, you can ease the patient’s con-cerns and resolve the complaint without losing their business.

There are several legal pitfalls a med spa owner may face, but by being a well-informed and well-prepared business owner, you can avoid costly legal battles. n

*Please note that none of the information in this article should be considered legal advice. Each situation is unique, and the laws of every state are different. Only a qualified local health attorney can advise you after hearing all the facts of your specific case.

Renee Elise Coover practices law for Thiersch & Associates in Chicago, IL. Thiersch & Associates specializes in med spa law and serves as special counsel for the American Med Spa Association. For more information, contact Thiersch & Associates at 312.981.0990, or email [email protected].

business|med spa owners concerns

SOMETIMES, JUST BY LISTENING, YOU CAN EASE THE PATIENT’S CONCERNS

AND RESOLVE THE COMPLAINT WITHOUT LOSING THEIR BUSINESS.

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Say you saw it in LNE & Spaandcircle#177onreaderservicecard

Spice up your fall with a range of refreshing HydroPeptide® peels and masks to leave skin bright, nourished, smooth, and looking years younger. Blueberries, apples, citrus fruits, and pumpkin create a range of exfoliating intensities to customize the perfect peel experience with no “downtime.” Skin will be left glowing and more even. HydroPeptide also offers a series of masks to clarify, rejuvenate, and balance skin, each delivering refreshing, rejuvenating peptides and vitamins to minimize fine lines and wrinkles.

With combinations to nourish, hydrate, and brighten, HydroPeptide’s award-winning and scientifically advanced skin care elements can address a wide range of complexion concerns in just a few steps. Give your clients visible results while increasing your bottom line with HydroPeptide.

Call to discuss the perfect seasonal facial. 800.932.9873 www.hydropeptide.com

the perfectFACIAL

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EXPANDING services, business and revenue

BY LOUIS SILBERMAN

HAVE YOU EVER WANTED TO EXPAND your services by taking them from the salon or spa and into a medical setting? Advances in non-surgical cosmetic procedures continue to offer amazing results with little to no downtime at a fraction of the cost of surgery, and many esthe-ticians have found success by partnering with a doctor, nurse or other medical professional. In this environment, estheticians with proper train-ing are able to offer procedures such as laser hair removal, photofacial skin rejuvenation, nonsurgi-cal body contouring and other services that fall under the umbrella of medical aesthetics.

If you have ever thought about branching out into a doctor’s office, clinic or other med-

ical facility, it may be easier to do than you think. Many medical professionals are looking for resourceful ways to add additional revenue streams.Overthepastseveralyears,theyhavebeen met with higher operating costs and lower health insurance reimbursement rates—making it hard to keep their practices afloat.

Adding medical aesthetic treatments is a synergistic way to add another source of profits while providing services that are in demand. And unlike opening a medical spa from scratch, if a medical professional has an established prac-tice, he or she already has a facility; all that is needed is a medical aesthetic device and the right provider. 4

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While some doctors and nurses are actively seeking out estheticians and laser technicians to provide medical aesthetic treatments, oth-ers may not know that they are in a good posi-tion to add these services. This is where you can educate them on this opportunity.

Why partner with a doctor or nurse?You may wonder how partnering with a medi-cal professional can benefit you. The primary benefit is exposure to a diverse pool of patients who may be interested in your services. I know doctors who see more than 30 patients each day, and some of those doctors have multiple medical professionals in their practice. This can add up to hundreds of patients coming to the office each week.

There are medical professionals in all sorts of specialties that would make good partners. For example, by partnering with an ob/gyn, you will likely gain access to female patients of all ages. If you partner with a dermatologist, your services may complement the treatment that a patient is receiving from his or her doctor. A general prac-titioner has patients from all walks of life—men, women and teens—who may be seeking solu-tions for their skin care troubles.

This constant stream of traffic will enable you to expose your services to people who may never have otherwise considered a procedure or even known that such procedures existed! For example, how many people know that radiofre-quency waves can be used to tighten skin? At my medical spas, we have introduced countless people to various medical aesthetic treatments who have become devotees of this technology!

Another good reason to set up shop in a medi-cal office is that the patients are already familiar and comfortable with the setting. They know that if their doctor has chosen you to perform these services, they can feel a sense of trust along with a high level of confidence in your abilities.

How to partner with a medical professionalFinding a medical professional to partner with will take some research and possibly a little bit of salesmanship on your part. You will need to find a doctor or nurse who does not currently offer these services and explain how this rela-tionship will benefit him/her and their medical

practice. This is best achieved by presenting facts and statistics that show the popularity of these procedures.

Begin your pursuit of medical professionals by conducting a web search of medical provid-ers in your area (and possibly surrounding areas nearby).Checkoutthewebsitesthatturnup,and look at the social media profiles for the medical professional or office. Next, call the of-fice to confirm that medical aesthetic services are not currently offered at that location.

The next step is to set up an appointment withthedoctor,nurseorofficemanager.Explainthat you are a skin care professional who may be able to help generate new revenue and business for the office.

You can choose to buy or lease your own medical aesthetic machine and pay a monthly fee to rent space in the medical office.

Greetings (Dr./Mr./Ms. Insert name here),

Are you interested in expanding your practice by offering medi-

cal aesthetic services? I am a licensed/certified (insert title here) who is

skilled in performing many of the industry’s newest and most innova-

tive skin care and anti-aging techniques. Some of the services I offer are

laser hair removal, laser wrinkle reduction, nonsurgical skin tightening

and chemical peels to treat a variety of skin conditions.

As a physician/medical professional, you may be looking for a way to

grow your business that will offer your patients a valuable amenity while

increasing revenue. Adding medical aesthetics is a great option because

it is a cash business, and you already have the infrastructure in place.

These services are in demand. The 2012 statistics from the American

Society of Plastic Surgeons show that, in that year alone, more than 13 mil-

lion minimally invasive cosmetic procedures were performed.

Together, we can develop a partnership to cross-promote my ser-

vices to your patients. Additionally, I will take care of all marketing

efforts to bring in new clients; these clients will also be introduced to

your office and have the potential to become new patients.

Adding an esthetician/cosmetic laser technician would benefit your

office from both a financial and marketing standpoint. I would love to

schedule a meeting with you to discuss this further.

Best regards,

(name, title, phone number, email address)

above: Example letter to introduce yourself to a physician or other medical practice

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Onceyouareinfrontofthedecisionmaker,explain that medical aesthetics is a multi-billion dollar business that has seen growth year after year. Be prepared to present facts and figures that show why this is a great opportunity for a medical office. For example, more than 13 mil-lion minimally invasive cosmetic procedures were performed in 2012. While a large number of these procedures are cosmetic injectables like botuli-num toxin type A and dermal fillers, you can also show that there is a great demand for services that estheticians can perform in most states, such as laser hair removal and chemical peels.

To further sweeten the deal, offer to do all the marketing and promotion for your services! This can include marketing to the office’s cur-rent patients as well as new clients to generate even more business.

Let’s make a dealIf the medical professional and/or office manager is intrigued by your offer, it is time to talk modali-ties, machines and money. You will need to work out an agreement that outlines the medical aes-thetic services you will perform, the machine(s) you will be using (whether it is a laser, IPL, radio-frequency or other device) and the structure of the financial deal for yourself and your medical professional partner.

There are several options for striking a deal. These are some guidelines based on informa-tion I have gathered from more than 10 years in this business. However, rates and fees may also depend on other factors, like experience, geographic location and esthetic specialty.

Oneoptionforanagreementissimilartopay-ing “booth rent” at a salon or spa. You can choose to buy or lease your own medical aesthetic ma-chine and pay a monthly fee to rent space in the medical office. You can also do this by agreeing to give the medical office a certain percentage of your monthly revenue (most often this figure is around 15 to 20 percent) in exchange for using the space.

If the medical professional is the one who will take on the responsibility of owning or leasing the laser in addition to providing the space, you can arrange a different payment plan. Typically, estheti-cians in this situation will either earn a straight com-mission on services or receive an hourly rate plus commission. For the straight commission agree-ment, the esthetician will typically receive 30 percent of the fee for each service performed. If the doctor or nurse offers you an hourly rate, the commission would likely go down to five to 15 percent.

Dual residencyOneofthequestionsIoftenhearfromestheticianswho are interested in getting into medical aes-thetics is, “Do I have to leave my current salon or spa?” The answer is usually no. Partnering with a medical office does not mean that you have to leaveyoursalonorspabehind.Onthecontrary,it offers you a great chance to cross-promote your services at two diverse locations.

You may want to start off by working at the medical office one or two days a week and sched-uling your appointments accordingly, dividing your time between your traditional skin care clients and your medical aesthetic clients. Not only will this help you expand your offerings, it also helps you “spice up” your week, by allow-ing you to work in different environments and utilize a variety of skill sets.

As I mentioned, when you have two loca-tions that offer different services, you also have an amazing opportunity for cross-promotion. For ex-ample, one of the patients who was introduced to laser skin rejuvenation at the doctor’s office may want to complement her treatments with a hydrating facial at your spa!

In addition to the tips listed here, proper train-ing is also critical in displaying your competence to a medical professional and entering the won-derful world of medical aesthetics. If you have not received training to perform procedures like laser hair removal, laser skin rejuvenation, intense pulsed light photofacial, radiofrequency skin re-juvenation, nonsurgical body contouring, laser tattoo removal, microneedling, spider vein reduc-tion and other nonsurgical cosmetic procedures, be sure to contact a reputable training institute that offers a wide range of laser and medical aesthetic courses. If you are unsure whether or not you are able to offer these services, contact the licensing board in your state to confirm that you are within your scope of practice. n

Louis Silberman is pres-ident and founder of National Laser Institute, the largest cosmetic la-ser and medical aes-thetic training center in North America. An ex-pert in medical aesthet-ics, Silberman is a medical

spa owner and nationally recognized author, mar-keting speaker and business consultant. Contact Silberman at 800.982.6817 or [email protected].

business|expanding services, business and revenue

When you have two locations that offer

different services, you also have an

amazing opportunity for cross-promotion.



DEVICE RULESANDREGULATIONSBY DAVID SUZUKI

STATE AND FEDERAL RULES AND REGULATIONS regarding device usage and manufacturing have always been very ambiguous, to say the least. Because of this lack of clar-ity, it remains challenging for the skin care professional, dis-tributors and manufacturers to clearly understand what they can or cannot use, sell and manufacture. To make matters even more challenging, the very organizations that inspect and regulate our industry and device manufacturing are of-ten equally as confused by outdated regulations. The end result is complete chaos, which can lead to the disruption of our businesses, industry and the economy.

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classes, based on the level of control necessary to ensure its safety and effectiveness.

The class to which your device is assigned determines, among other things, the type of premarketing submission/application required to obtain FDA clearance to market it. If yourdeviceisclassifiedasClassIorII,andifitisnotexempt,a 510(k) will be required for marketing. All devices classified

as exempt are subject to the limitations on exemptions. For ClassIIIdevices,apremarketapprovalapplication(PMA)willbe required unless the device is a pre-amendments device (on the market prior to the passage of the medical device amend-ments in 1976, or substantially equivalent to such a device), and PMAs have not been called for. In that case, a 510(k) will be the route to market.

Device classification depends on the intended use of the device and also upon indications for use. In addition, classification is risk based. That is, the risk the device poses to the patient and/or user is a major factor in the class to which itisassigned.ClassIincludesdeviceswiththelowestriskandClassIIIincludesthosewiththegreatestrisk.

As indicated above, all classes of devices are subject to GeneralControls.GeneralControlsarethebaselinerequire-mentsoftheFood,DrugandCosmetic(FD&C)Actthatap-plytoallmedicaldevicesinClassI,IIandIII.

To summarize, the FDA has three primary categories for devicesinClassI,ClassIIandClassIII.Theconceptoftheclas-sification scale is logical, in that it was developed based on the possible risk and invasiveness of the device or use of the device tothefinalconsumeroruser.ClassIisprimarilyoverthecoun-ter (non-medical) consumer targeted devices, such as a back massager that you may find in a department store. However somedevicesinClassIarenotexclusivelyoverthecounter.

ItemsinClassIIcanbeoverthecounterinsomecasesaswell. However, use of these items is predominantly restricted to an applicably licensed practitioner, and they are considered medical devices. The scope of practice for licensed practi-tioners is determined state by state and defined within the parameters of state licensures. A radiofrequency device, for example,isconsideredClassII,asisacatheter.ClassIIIde-vices are predominantly those that are life sustaining and/or used on the inside of the human body. A breast implant and pacemakerarebothexamplesofClassIIIdevices.

Federal regulationsAll devices that the Food and Drug Administration (FDA) regulates are considered medical. Manufacturers and im-porters of medical devices are required to register with the FDA to declare what they are manufacturing, importing and distributing. The caveat is defining what is (and what is not) considered medical. This is where the confusion begins.

The FDA has established classifications for approximately 1,700 different generic types of devices, and grouped them into16medicalspecialtiesreferredtoaspanels.Eachge-neric type of device is assigned to one of three regulatory continues

business

ItemsinClassIIcanbeoverthecounterinsomecasesaswell.However,useoftheseitemsispredominantlyrestrictedtoanapplicablylicensedpractitioner, andtheyareconsideredmedicaldevices.

AVOIDTHECONFUSION


Device usage in skin careAs estheticians, we do not make medical claims, nor do we perform medical services or applications. The products and technology that we work with are used in accordance with our state, and also federal guidelines set forth in our licensure, which is to beautify the skin. Historically, most devices for our industrywereClassI,orsimplynotclassifiedatallduetothenature of the device and/or the amount of time the device had been in use. In many cases, device usage pre-dates esthetic licensures altogether. Because of this, many states adopted the stancethatestheticiansareonlyallowedtouseClassIdevices.

MUCH OF THE CHANGE HAS COME FROM LEGISLATION, SUCH AS THE FDA SAFETY AND INNOVATION ACT: fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/SignificantAmendmentstotheFDCAct/FDASIA/ucm20027187.htm

Rapid, assertive changes are currently being implemented in device categories. This is coupled with aggressive enforce-ment to ensure that the changes are realized immediately, regardless of how things may have been done historically, and what such change may do to our personal businesses, industry or the economy.

What questions should you ask your manufacturer or equipment supplier?As the process of changes and modifications to regulations, product codes and “intended use statements” change rapidly, most of the new pathways are not clearly defined as of yet, and will likely take years to completely filter out on a federal level. Then they will be interpreted and adapted on a state level. This makes it even more challenging than before for the skin care professional to understand what they should be considering for their business. Nonetheless, there are some basic rudimentary keystones that you should be asking any manufacturer or sup-plier you are considering doing business with: • IsthemanufactureranFDAregisteredmedicaldevice

manufacturer? The manufacturer of the device should be abletosupplyyouwiththeirFDAEstablishmentNumber.

This registration can be verified at accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/rl.cfm. Remember, if the supply-ing company is not the manufacturer, they should still be able to supply you with the original manufacturer’s FDA EstablishmentNumber.

• IsthemanufacturerISO9001andISO13485listed?Thisisessentialtoverify.EachmanufacturershouldhavebothISOcertificates available, and they should be willing to email these to you upon request. Verifying this information ensures that the manufacturer or

supplier is compliant and adheres to the required safety and quality systems set forth by the government’s good manu-facturingqualitystandards.ISO13485iscrucialtoverify,asitrepresents the highest accepted device-manufacturing stan-dards recognized worldwide. If a company maintains these registrations, you can rest assured that they are audited an-nually. This means that they are likely a compliant manufac-turer or supplier who adheres to the highest quality and safety practices recognized worldwide, regardless of where they are located. If the manufacturer cannot verify this information, look for a manufacturer or supplier who does.

Don’t be afraid to ask questions! This protects you and your business. In the unfortunate situation of being sued, the insur-ance company will ask you what equipment you were working with, and whether it is compliant with federal and state guide-lines. Not knowing is not an excuse, and it can leave you liable.

For many skin therapists who operated esthetic technol-ogy before most states had licensures, equipment restriction is hard to swallow. We all value our professional collaboration and referral networks with physicians, and want to work within the FDA’s guidelines. By keeping abreast of state and national laws and guidelines, we can protect ourselves, be active and stay within our scope of practice, all while giving our clients the very best services and treatments. n

David Suzuki, president of Bio-Therapeutic, Inc., has been an active licensed member of the esthetics in-dustry for more than 18 years. He is an authority on technology and regulatory issues, including FDA submission and acquisition. Suzuki serves as an advisor to institutions and state boards, writes for numerous industry publications and jour-nals and conducts educational seminars and classes. E-mail him at [email protected] or visit www.bio-therapeutic.com.

Formanyskintherapistswho operatedesthetictechnologybeforemoststateshadlicensures,equipmentrestrictionishardtoswallow.

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MED SPA MARKETING AND PR STRATEGIESMARKETING, BRANDING, PROMOTIONS AND MEDIA relations are extremely important for medical spas. Today, most people in your community probably do not know what special medical or spa services you offer, or how beneficial each of your specialties may be for meeting their needs. Nor do they truly understand the differences between a medi-cal office, day spa, resort spa and medical spa. Sure, many people have heard of massage, Botox, fillers, cellulite treat-ments and microcurrent, yet the vast majority of your local community may not really know the true benefits of each

of your services and products. Thus, your annual marketing strategy must involve a comprehensive plan to educate the local community.

Annual medical spa marketing calendarsLike any spa, you must be prepared to successfully market each of your laser, esthetic, massage, skin rejuvenation and anti-aging services along with medical treatments throughout the calendar year by paying attention to seasons and the holidays. Be ready to create a strategic calendar plan to help your business grow

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into advertising, promotions and PR programs through invest-ing. Sit down with your staff and vendors, as well as with your professional medical and beauty supply distributors so you can effectively map out your marketing plans for the next year.

Seasonal med spa marketing campaigns Whether you are a pure medical spa, an essential part of a cos-metic surgery practice, or a day spa with an affiliated medical team, you must take advantage of each season. While most esthetic, massage, hair replacement, medical and spa treat-ments are valuable all year long, there are preferred “seasons” for marketing some specialty services like hair removal, cellulite treatments, breast augmentation and spray tanning.

Createanannualmarketingcalendar.Youmaywantto have new promotions every month, every two months, quarterlyorseasonally.Everyserviceandproductshouldbe promoted at least twice per year. The calendar needs to become a way for you to create at least one to two promo-tions for each of your strongest and weakest medical spa service categories per year. If you have any signature facial treatments, fillers, microcurrent, microdermabrasion, mas-sage therapies or other special services that are critically important to your business, then plan to promote it at least three times per year. Your annual marketing calendar re-quires you to include your assigned marketing budgets for each promotion, as well as note whether you will be doing any special advertisements, events, printed materials and point-of-purchase merchandising.

Promotional strategies Remember that having a special promotion does not mean that you need to offer a discount. You can always promote your medical spa services, professional products and spe-cial beauty care therapies at full price. You can certainly offer special incentives, membership programs, discounts and treatment series packages to your clients and patients.

Gift certificate marketing Medical spas can promote gift cards just like any regular salon, spa or day spa! Promotions should be creative, with an exciting new twist every season. Medical spa gift card sales should become one of your most important marketing calendar strategies, since a strong percentage of recipients will be first-time clients referred by your loyal regulars. Use holidays like Valentine’s Day, Mother’s Day, Father’s Day and the year-end holidays to promote your medical spa gift cards.

Seasonal advertising and media marketingSet aside a projected advertising budget so you can cre-atively “invest” in building your brand while promoting each targeted service category through regional magazines, direct mail, email blasts, Internet/social media and TV advertising.

Some of your seasonal spa offerings can be promoted with direct mail postcards, mail services, regional magazines, telephone calls, email blasts, social media, media relations campaigns or special event marketing.

Contacteachofyourtargetedlocalmediaresources.Askthem for their annual editorial and promotional calendars to see how you can integrate your marketing plan with theirs. Createaspecialbudgetforeachseasonalmarketingandpromotions period. While monthly email blasts do not really cost much, you may want to purchase a few full-color regional magazine advertisements with at least four direct mail maga-zine campaigns per year. If your local and regional magazines havea“BestOf”featuresectionfordoctors,spasandmedi-cal spas, consider advertising in these issues! Whether or not your medical spa is honored in the editorial, it will be great to later create advertising reprints to share that your medical spawasfeaturedinthat“BestOf”issue.

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Open house events are great for medical spas.Make each event fun and educational, and include PowerPoint presentations, hands-on demonstrations, guest speakers, door prizes and refreshments.

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Email and direct mail Createpromotionalopportunitiestocollectemail addresses from each new client right away from their first visit to your med spa. Plan to create a series of medical spa newsletters and promotional email blasts to promote every-thing on your annual marketing calendar. Just try not to overdo it. We suggest no more than two email blasts per month. Today, it is impor-tant to consider going back to colorful snail mail with visually exciting presentations once in awhile. You should plan to share makeovers, special events and seasonal promotions with soloandcooperativedirectmail.Keepyourwebsite updates with each of your special ser-vices and promotions.

Med spa events:Openhouseeventsaregreatfor medical spas. Make each event fun and edu-cational, and include PowerPoint presentations, hands-on demonstrations, guest speakers, door prizes and refreshments. Focus on specific treat-ment therapy themes for each event. They can havenameslike“Anti-Aging&SkinRejuvenation,”“Microcurrent&Microdermabrasion”or“Botox&Fillers.”Createaseriesofaboutfouropenhousesessions per year.

Community and charity involvementIt is a great idea to get out of your med spa into the community to network with women’s groups, theChamberofCommerce,businessgroupsandhealth and wellness fairs. Plan at least one charity event per year to help support a special cause like Parkinson’s disease, breast cancer, leukemia or something more localized.

Seasonal media and PR campaignsMake sure that you carefully review your local media’s annual editorial calendars. Plan your sea-sonal medical spa service treatment promotions to match the features in local newspapers and regionalmagazines.Createpressreleaseswithprofessional high resolution service and make-over photographs as well as cover pitch letters. Work to professionally inspire the local media to work with you each season as you promote your newest med spa services, therapies, skin care trends, gifts of beauty, new laser hair removal alternatives, cosmetic fillers or anything else

that you want to promote. Just remember that you must present your seasonal PR campaigns in a non-commercial manner while attempting to educate the local community on medical spa services and products. Also, present your campaigns at least three months in advance, as most major media works on that deadline.

Med spa marketing budgetsSet up an annual marketing, advertising and PR “budget.” This should be at least five to eight percent of your projected total annual sales vol-ume for an average marketing program. If you are a new medical spa or plan to take an aggressive strategy, set aside about eight to 10 percent. In other words, set aside at least $5,000 to $8,000 in your advertising, marketing and PR fund for every $100,000 you plan to achieve in total sales. If you are able to be more aggressive, set aside at least $8,000 to $10,000 for every $100,000 you plan to earn. Set goals that are challenging, yet realistic.

Use external marketing and PR resources. Hire local graphic designers, publicists and so-cial media gurus and/or hire nationally respected resources that understand the various medical spa service therapies and protocols. With com-petitive full-service salons and day spas in almost every nearby shopping center today, you must aggressively team up with the best to develop a comprehensive marketing strategy to set your med spa ahead of the local competition. n

Larry Oskin is president of Marketing Solutions, Inc., a full-service market-ing, advertising and PR agency specializing in the professional beauty business. Clients include salons, day spas, medi-cal clinics, manufactur-ers, associations and beauty care entrepreneurs from across North America. For more information contact Marketing Solutions in Fairfax, VA at 703.359.6000, email [email protected] or visit MktgSols.com and ArtBeautique.com.

business|med spa marketing and pr strategies

Plan at least one charity event per

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MOBILE BOUTIQUESkin care therapist and board certified esthetician Beth Ross has blazed new trails with her mobile retail cosmetics and skin care boutique, founded this past fall. Beth’s Beauty Bus stops at commercial locations across Los Angeles. “Along with convenience, I offer high quality, locally sourced natural and organic products which are difficult to find in brick and mortar stores, in addition to a personal consultation for each client,” says Ross, who is also a former television producer and marketing professional. Le Mieux’s serums, moisturizers and masks are among the cosmetics available through the first ever mobile retail bus.bethsbeautybus.com 888.327.8188

SPA COACHING FOR SMALL BUSINESSESInSPAration Management introduces the Solo-Preneur & Beyond series.ThisCoachMe!Silver educational series is ideal specifically for solo-preneurs or small spa or salon businesses. “TheSolo-Preneur&Beyondseries will focus on strategies to help small business owners chart a successful path and plan for growth,” says Dori Soukup, founderandCEOofInSPArationManagement. “This is a monthly tele-seminar where we provide easy-to-implement strategies to ensure success. Members have access to a private page to download content, MP3 files and business tools. It’s the ideal program for a small business to stay focused, motivated and gain effective strategies.” InSPAration Management is a leader in providing spa business education, but in most cases, programs are geared toward bigger spa and salon businesses. insparationmanagement.com386.226.2550

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SONCOLOGY COSMETICSCARA Cosmetics proudly presents their latest DVD release, Beauty in the Face of Cancer. This story of a woman’s journey with cancer includes a step-by-step makeup tutorial, demonstrating techniques on recreating

brows and lashes, a common loss for many who suffer form cancer.CARAiscommittedtodonating10percentofthenetproceeds from the sale of the DVD to several cancer associations, says the company. caracosmetics.com 407.622.1997


by Kris Campbell

organic & wellness avoiding irritation in the nasolabial folds

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CLIENTS WITH SENSITIVE OR health challenged skin are on the rise. One area of concern in everyday anti-aging is the nasolabial folds. These are the two skin folds on each side of the face that run from the side of the nose to the cor-ners of the mouth. Commonly referred to as “laugh lines,” these folds become more noticeable as we age. This change

usually begins in our 30s. Sensitive skin reactions in this area are something we need to keep in mind as providers.

The first thing to determine when a client has some form of breakout, rash or scaling in this area is the cause, so as not to do more harm to the already irritated skin. Ask your client the following ques-tions: How long has the irritation been there? Have you made any recent dietary changes? Have you changed your skin care routine? Have you developed any new health conditions? Are you taking any new medications? The answers to these questions will help you determine a course of action. If the irritation is not due to an obvious cause such as skin care product issues, temporary cold/flu symptoms or menstrual cycle phase, the client should be advised to also see a physician to look at deeper causes and possible medical solutions. Seborrheic dermatitis, perioral dermatitis, rosacea and even psoriasis are common issues that cause nasolabial irritation, but skin

care specialists should be aware that it is best for a dermatologist to actually diagnose these conditions. Many clients “live” with irritation in the area of the na-solabial folds, not realizing that a simple course of action is needed. After they see a provider, they are very pleased with their new knowledge and not having to live with this constant irritation.

Skin reactions in the nasolabial folds are very common when people are going through hormonal issues. A client’s skin can react much more to peels, enzymes, microdermabrasion and various ingredi-ents during certain stages of their men-strual cycle. During menopause the skin can become dry and irritated. Hormonal acne is also an issue, and breakouts can occur in the nasolabial folds. That area of the skin is very sensitive, as the folds are in motion when we talk and smile.

It is also common for irritation to de-velop as a reaction to products that are too strong. The nasolabial folds become more prominent as we age due to elas-ticity loss. Common fillers can even do more harm than good at times. A vari-ety of negative reactions may occur for someone with sensitive skin. A client that experiences these reactions should be given gentler, less aggressive solutions. For example, retinaldehyde is a better choice than retinol, as it provides anti-aging benefits to the nasolabial area, yet

it does not cause the redness/peeling/sensitivity issues that most retinols cause.

No matter what the cause of the irrita-tion is, the key is to keep the area clean, because the folds will be more prone to infection if picked at or scratched due to bacteria. The area also needs to stay hy-drated. Use calming, gentle products—no peels, acids or invasive skin treatments. Always recommend sun protection, and include it in your treatments. Calming ingredients, a healing touch and gentle linens such as microfiber will lessen the ir-ritation factor in the nasolabial folds area and make your client less irritated! n

Kris Campbell is CEO and a formula-tor for Tecniche, a skin care line dedi-cated to sensitive skin. She is a certi-fied oncology esthetician, and works to address the skin concerns of clients who are undergoing cancer treatments. Campbell trains professionals, writes for trade publications and speaks at industry events about conditions faced by people with health challenged skin.

If the irritation is not due to an obvious cause such as skin care product issues, temporary cold/flu symptoms or menstrual cycle phase, the client

should be advised to also see a physician to look at deeper causes and possible medical solutions.


marma pointsfor healing, reducing bruising and swelling

BY ROBERT AND MELANIE SACHS

JAPANESE SCIENTIST MASARU EMOTO IS BEST KNOWN for his claims that human consciousness has an effect on the molecular structure of water. Similarly, one of America’s great research scientists, Patrick Flanagan, has used a tensiometer, an instrument that measures the surface tension of liquids, to demonstrate that the surface of water changes when a person walks into a lab.

Moods, emotions and words all hold energy. In the East, it is said that mind precedes body; that all imbalance and illness arises first in the thoughts and words we use, which then are physicalized and reinforced by our lifestyle.

These points are made to illustrate an important factor in the preparation for and recovery from surgical procedures. Activity, foods and moods can make the journey smoother or more difficult.

Ayurveda clearly states that the condition of our skin is dependent on the quality of our blood via the food we eat. Diet is an important part of our daily lifestyle. A nutritious diet can help reduce pain and promote rapid healing in the short-term time frame, building up to surgical intervention and what would be considered the critical time of post-op recovery. The Ayurvedic therapy known as marma chikitsa can play a powerful and significant role to affect the same.

For people who study yoga and Eastern medicine and philosophy, marma points are to the subtle chakra grid what acupuncture points are to the meridians of Chinese medi-cine. At the same time, sometimes marma and acupuncture points intersect and are the same thing. As the transmission of nervous impulses via our nervous systems were once un-able to be identified due to a lack of technological exper-tise, marma and acupuncture points were similarly elusive in being identified. But today, through new forms of scien-tific instrumentation, these points are identified, and in the case of pain management or anesthesia, even employed in Western medical clinical practice.

Acknowledged as neuro-lymphatic points, author Deepak Chopra says that marmas are the points through which the conscious and unconscious mind communicate with each other. Although there are thousands of these marma points on the surface of our skin, clinical Ayurveda identifies 107 points as essential for treating virtually any conditions of stress and imbalance we experience. However there is one marma worth noting—the 108th. This marma is the entire surface of the skin, which is why massage and skin care in Ayurveda is so important to the process of maintaining balance, health, recovery, rehabilitation and rejuvenation. Putting all of this

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together, as marmas are points by which the unconscious and conscious mind communicate and the largest marma in the body is the skin, it makes sense that when we are worried, under stress and feeling out of sorts, our skin would show eruptions, excessive dryness, oiliness, tightness and all the manifestations that come as a result—wrinkles, liver spots, rosacea and so on.

Marmas can be described as little eyes looking out on the world. When these little eyes are open and the energy is moving through them freely, we are healthy. If these little eyes shut down, our marmas show the strain through feel-ings of pain, as well as disturbances in energy due to shock or trauma from injury or poor lifestyle choices.

When marmas are therapeutically and/or lovingly touched, they open up, and the communication between the conscious

and unconscious mind and body begins to flow more freely again. This is seen in positive changes in complexion due to increased circulation that is better distributed to ensure greater nourishment, hydration and effective cleansing of tissues. Such changes come about initially for more mental and emotional reasons. No one goes into surgery without some heightened level of stress and apprehension, regardless of whether it is an elective or necessary procedure. Knowing which marmas to touch tells the body and mind, “Don’t worry. Everything is going to be fine. Relax.”

Then, like water being spoken to lovingly, our skin re-sponds. Being more receptive, the procedure goes more smoothly. Afterward, when all the cutting, tucking, stretching and stitching is over, and the marmas are once again touched skillfully, the message the mind and body receive is, “That was a challenge. You have gone through so much change. Now it is time to rest. Let go of the pain and stress. Feel your breath relax. Feel the gifts of better circulation and hydration.”

The Ayurvedic Face Rejuvenation technique creates a spa treatment that is both healing and extremely pleasurable. One of the most important factors in making this technique healing is the marma sequence that is included. Ayurvedic Face Rejuvenation can be used for both pre- and post-surgi-cal treatment. What follows is an abridged version that any esthetician can easily learn to bring greater peace, ease and healing to clients preparing for and recovering from surgical procedures. Bear in mind that this technique is intended for those receiving facial surgery.

The smooth strokes release subtle tensions underneath the skin. The marma points work on the deeper tissues of the

face and corresponding organs of the body. They awaken the processes that heal and renew tissues, and restore the flow of subtle energy that brings a healthy glow to the complexion.

Marma face massage This treatment can be offered as a 15-minute à la carte ser-vice or included in a basic 30-minute facial with a cleanse, massage and sun protection. Depending on the location of your spa, the price point for the à la carte menu may vary for this added service, ranging from $15 to $30. Always follow a physician’s post-op recommendations to determine if this service can be administered immediately following sur-gery. There may be a wait time for bandages to be removed or swelling to diminish. Maintain a light touch, as it is very effective and works well to reduce bruising and swelling.

You will be working with a jojoba based oil with an empha-sis on Vata pacification, meaning nourishing, hydrating and rejuvenating. Since surgery is very traumatic and skin becomes more dehydrated, adding a rich oil is important. Other heal-ing oils are rosehip seed, avocado and argan.

1. Apply 5 to10 drops of the oil to the face. The amount should be sufficient to allow the fingertips to move freely over the skin’s surface.

2. Use your fingertips to massage underneath the chin, alternating between the right and left sides.

3. Stroke from the tip of the chin following the jaw line toward the hollow of the temple. Pause at SHANKAR marma and instruct your client to take a breath or two. Use your fin-gertips to make five gentle circles, about the size of a quarter.

4. Let your fingers slide down over the cheeks and allow one fingertip from each hand to rest in the middle of the chin. Press and release three times at this mid-chin point, HANU marma, keeping your fingers on the surface of the skin. Stroke out to just below the corners of the mouth and make five clockwise circles. Stroke up and out into the middle of the cheeks and feel for the front surface of the muscle that opens and closes the mouth. Press and release three times on the front surface of this muscle, pressing toward the back of the teeth. Stroke up to the temples and repeat the five circles there, as in Step 3. Repeat twice more.

5. Place the index fingers one on top of the other at the point in the middle of the upper lip, the USTA marma. Press and release three times. Stroke out to just above the corners of the mouth and make five gentle circles in the area where fine lines form. Continue by stroking outward to the points

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Ayurvedic Face Rejuvenation can be used for both pre- and post-surgical treatment. What follows is an abridged version that any

esthetician can easily learn to bring greater peace, ease and healing to clients preparing for and recovering from surgical procedures.


organic & wellness

TOUCH THE FIRST FIVE POINTS IN 15 TO 30 GENTLE CLOCKWISE CIRCLES FOR THERAPEUTIC EFFECTS.

1. ADHIPATI. On the midline of the head, 11 finger widths above the eyebrows. Calms the mind, kindles deeper understanding, fosters contentment, heightens perception and assists with spinal alignment.

2. BRAHMA RANDRA. On the midline, eight finger widths above the eyebrows. Helps insomnia, elevates mood, eases headache and balances body weight.

3. SHIVA RANDRA. On the midline, 15 finger widths above the eyebrows. Helps lower blood pressure, re-lieves dizziness, improves memory and boosts alertness.

4. VDHURA. Over the jaw. Addresses ear conges-tion and anxiety or mental tension.

5. KRIKATIKA. Both sides at the top of the spine. Helps relieve tension in the neck and back and im-proves posture.

6. SIMANTA (movement). Work with all your fingertips to move the joints in the skull. This encourages rest and re-laxation in the scalp, along with a deep sense of well-being.

7. ARSHAK. On the top of the collarbone, where it joins the breast bone. Press and release down toward the waist. Helps to balance liver (right) and spleen (left), which helps dispel anger and boosts energy.

8. MANYA. Side of the neck, four finger widths be-low the earlobe. Improves circulation to face and stimu-lates lymph.

9. SIRA MATRIKA. On either side of the upper wind-pipe. Helps to improve the voice and circulation in the facial area.

10. NILA. On either side of lower windpipe. Helps to improve the voice and ease throat pain.

11. KANTHA. Mid-neck or around the Adam’s apple. Gentle circles help to improve thyroid function, as well as one’s ability to express feelings and regulate mood.

12. KATHANADI. Slightly behind the top of the breastbone. Press and release gently toward the waist. Helps to clear the voice and upper respiratory congestion.

TOUCH THE NEXT FOUR POINTS BY GENTLY PRESSING AND RELEASING 10 TIMES.

13. HANU. In the middle of the chin. Helps one connect with their inner feelings and improves circula-tion to the face.

14. OSHTA. In the middle of the upper lip. Helps to ease dizziness and fainting, and improves mental clarity and sexual desire.

15. PHANA. The point at which each nostril joins the face. Helps to clear sinuses, strengthen lungs and manage stress.

16. GANDU. Halfway up the nose on either side. Helps to clear sinuses and brighten eyes.

17. APANGA. In the outer corner of each eye. Press away from the eye toward the bony orbit to help relieve eyestrain and puffiness or inflammation.

18. BHRUH. Below the inner corners of the eyebrows on the upper bony orbit. Gently press away from the eye toward the top of the head to help ease eyestrain and headaches.

19. AVARTA. In the middle of the eyebrows. Helps bring energy to the head and promotes a centered feeling.

20. SHANKHA. In the hollows of both temples. Gently rub with small circles to improve memory and one’s feelings of connection.

21. STHAPANI in the middle of the forehead. Gently rub in clockwise spiral to help relieve tension and bring peace and harmony to the mind.

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in the middle of the cheeks; press and release three times as before. This time the stroke goes up, over and behind the ears. Rub thoroughly behind the ears where they join the head. Find KARNA marma behind the earlobe and make five gentle clockwise circles. Repeat twice more.

6. Cover the left side of the head with your left hand. Place your right index finger in the hollow where the flare of the right nostril joins the face, the NASA marma. Press and release three times, then stroke under the cheekbone, up and over the ear as in Step 5. Repeat twice more on the right side, then switch hands and do three strokes on the left side.

7. Working with both hands together, touch the tips of index fingers to the points on either side of the nose and halfway up, on the GANDU marma. Gently massage in five clockwise circles. Expand the stroke out over the cheekbones and again over the ears, ending at the KARNA marma, and do five clockwise circles. Repeat twice more.

8. Now quietly tell your client that you are going to be touch-ing them gently underneath their right eye. Use the tip of your thumb to gently press on the top edge of the bones that you find under the eye. Lift your thumb completely and move a fraction to the right, away from the inner corner of the eye, and gently press again. Press and release in this manner, working from the inner corner to the outer corner of the eye three times. After the third time, use your index finger to find the APANGA marma, the point in the outer corner of the eye just on the inner surface of the bony eye socket. Point in toward the middle of the head, then gently press away from the eye and jiggle your finger up and down. Jiggle for a slow count to 10. Repeat on the left eye.

9. Using two fingers on each hand, stroke from the tip of the nose up along the sides of the nose to either side of the bridge. Let the tips of your right index and middle fingers rest just below the inner end of the eyebrow. Rest your left hand over the left side of the head. With your right hand, find the little bumps on the upper bony orbit of the eye that are closer to the bridge of the nose. Gently rub here, then press and release in tiny steps along the upper bony orbit of the eye to the outer corner. Press toward the top of the head, releasing completely in between steps so as not to pull on the skin. Repeat for the left eye, starting at the tip of the nose again.

10. Firmly pinch both eyebrows from the inner to outer ends three times.

11. Stroke from the tip of the nose as in Step 9. This time, the left hand moves to the top of the head and rests over the crown, and the middle finger of the right hand moves to the center of the forehead, AJNA marma. Draw a clockwise spiral that starts small and gradually moves out to fill the forehead. Return to the middle of the forehead and make two more spi-rals. Take your time, as this is the last move of the sequence. n

Robert Sachs is a counselor, licensed massage therapist and educator. He is the author of Health Secrets From the Roof of the World. Melanie Sachs, a certified Ayurvedic life counselor, healer and teacher, is sought after by some of the world’s leading spas and beauty schools. She has pub-lished Ayurvedic Beauty Care, and is

recognized internationally for the application of Ayurveda to the beauty world.

organic & wellness

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Working with both hands together, touch the tips of index fingers to the points on either side of the nose and halfway up, on the GANDU marma. Gently massage in five clockwise circles.


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touchpoints to support a dynamic system

BY ANNE C. WILLIS

A DOMINEERING NERVOUS SYSTEM, DEMONSTRATING reckless behavior, can hijack the health of the entire body. We live in a culture that prizes the excitement, aggressiveness, high-stress

work life, pace and general intensity that is fueled by this domineering system. It is a simple fact that our society struggles to take the necessary steps to lower much of the nervous system, activating the anxiety that affects most people.

The nervous system that deals with immediate, rapid responses to chang-ing environmental conditions is called the sympathetic nervous system. It becomes engaged when an organism is feeling threatened, such as when it receives challenging news or is faced with a stressful decision. You have to strive to do something actively to preserve its equilibrium, or it can impair your physical and mental health.

Much of the sympathetic nervous system’s activity is not a dramatic threat. For example, standing up would cause a big drop in your blood pressure if the sympathetic nervous system did not compensate by momentarily in-creasing it. Similarly, sympathetic activity increases just before you wake up, getting your body ready to be active. The sympathetic system deals with “fight or flight” reactions, but it’s more versatile than that. Even in high drama survival situations, the SNS may trigger not fighting nor fleeing, but freezing. This response can become increasingly habitual in victims of ines-capable trauma, such as rape or spousal abuse.

When individuals experience excessive sympathetic nerve stimulation, the adrenal medulla causes the release of dopamine into the blood. This hormone is referred to as “sympathomimetic,” meaning that they mimic the effects of the sympathetic nervous system (i.e., increased heart rate, constriction of blood vessels in the skin and the gut, dilation of bronchia, increased respiratory rate and hypergly-cemia). This excess activity can wreak havoc on skin function by extreme fluctuations in skin temperature, glandular secretions and immune responses. An overactive sympathetic nervous system can cause the skin to become thin, dry and even

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of all the nerve!


organic & wellness|of all the nerve!

crepe-paper-like. Many skin conditions that we are currently seeing, such as rosacea, inflamed acne and hyperpigmentation may be traced to an overactive sympathetic nervous system, and excessive secretion of dopamine and other ad-renal discharges.

Sympathy for the nervous systemIt is remarkable but true; part of your nervous system exists to make you feel peaceful. The parasympathetic nervous system gives you more control over your inner landscape, a nice thing at times when the outer world seems driven by forces that are beyond your influence.

The regenerative effects of the parasympathet-ic nervous system are designed to give sympathy to your body, allowing it to recover, regenerate and repair. You can trigger the parasympathetic nervous system at will through slow breathing, which immediately lowers your sense of stress, lifts your mood and brings health benefits, such as reducing blood pressure and strengthening the immune system.

The parasympathetic nervous system conserves energy in your body and is responsible for an on-going, balanced state of activity. The feeling of it is relaxation, often with a sense of contentment.

The parasympathetic nervous system dilates blood vessels leading to the GI tract, aids diges-tion, stimulates salivary gland secretion and ac-celerates peristalsis, helping with the absorption of nutrients. In addition, it promotes healing and cell regenerating, and increases the oxygen car-rying capacity to cells. Human skin regenerates mostly during the night while we are asleep and the parasympathetic system is activated. Moist, resilient skin is a sign of a healthy parasympa-thetic rhythm.

All of these physical effects are possible be-cause the parasympathetic nervous system en-ables the body to disengage from the external environment. It lowers levels of energy, allows the body to recover from stressful experiences and returns it to homeostasis.

Balancing your sympathetic-parasympathetic responsesIn short, the sympathetic nervous system pre-pares the organism to act upon its environment, while the parasympathetic nervous system pre-pares the organism to act upon itself. Put more dramatically, if the sympathetic nervous system is for “fight and flight,” the parasympathetic nervous system helps you “rest and digest.”

To deactivate the nervous system,

practitioners should utilize techniques

such as topical hydrotherapy and

pressure point.

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organic & wellness

Both systems evolved to help us survive in very harsh and potentially lethal environments, and we need them both.

Nerves and skin therapies The nervous system regulates all skin functions. Therefore, one of the goals of any skin therapy treatment should be to either activate or deac-tivate nerve response. In holistic therapies, we look beyond the surface of the skin and move through the layers to its internal environment. Estheticians should begin by assessing der-mal activity. This is accomplished by evaluating blood vessel dilation, levels of fluid secretions, circulation of lymph and the integrity of the fol-licle. If any of these functions or structures dem-onstrates excessive activity, then the sympathetic nervous system is probably stuck in high gear.

Once you have assessed the skin’s level of functioning, determine what type of products and manipulations would assist in self-regulation. Skin that is highly active requires products and manipu-lations that will down regulate nerve response. On the other hand, skin that is passive requires treat-ments that have the reverse effect.

Skin peels, effleurage, stimulating exfoli-ants and steam are examples of techniques and products that have an activating effect. To deac-tivate the nervous system, practitioners should utilize techniques such as topical hydrotherapy and pressure point.

All facial treatments should focus on breath. A client can control certain nerve functions by taking in aromas through breath. So starting your facials with an inhalation therapy has a profound effect on the nervous system. Long inhalations expand the bronchioles. The parasympathetic nervous system is in charge of constricting the bronchioles, so by

making them swell up with a big breath, you trig-ger the parasympathetic nervous system to bring them back to their “resting” size.

Concluding perspectivesIn a day and age where everything is intense and rapid, introducing therapies that reduce the domination of the sympathetic system can provide profound results that are long lasting. The skin truly longs for slow movements, which can help it return to self-regulation and begin to repair. The influence of human touch, herbs and gemstones can also have a sedative effect, providing profound results for the mind, body and spirit. With 32 inches of nerves winding their way through only one square inch of skin, this dynamic system is the hub of successful profes-sional treatments. n

Anne C. Willis, a licensed esthetician and world-wide leader in holistic and medical skin thera-pies, is the founder of De la Terre Skincare.

She is an accredited skin care instructor and the director of Oncology Skin Therapeutics™, bringing more than 30 years of experience and knowledge to the new generation of skin thera-pists. Willis is a contribu-

tor to The Esthetician’s Guide to Working With Physicians, and has been featured in numer-ous publications. For more information, con-tact her at [email protected] or visit delaterreskincare.com.

The influence of human touch, herbs and gemstones can also have a sedative effect, providing profound results for the mind, body and spirit.

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Ah-Choo! Can Spa Services Help Allergies?

LUCY WAS A FIRST-TIME SPA-GOER. SHE WAS excited after receiving a gift card to a local day spa for her birthday. When she booked a massage, she was expect-ing a stress relieving hour of enjoyment. Unfortunately, the

massage oil used by the therapist included nut oils, and she left the spa with a red, itchy rash—and vowed to never return again. Lucy’s nut sensitivity was not noted on her intake form, and the therapist simply used the lotion she generally uses, without asking Lucy about allergies or sensitivities.

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There is undoubtedly a large number of guests

at your salon or spa who test positive to one

or more allergens.


organic & wellness

BY PATTI BIRO

Allergies, and who has themOne in five Americans has allergies. Given this large percentage, there is undoubtedly a large number of guests at your salon or spa who test positive to one or more allergens. While simply a seasonal nuisance for some, allergies can also wreak havoc on a person’s quality of life and wellness. It is estimated that the cost of work days lost to hay fever alone is over four million a year! Allergies currently rank fifth among chronic diseases in the U.S.

The basics An allergy is simply your immune system react-ing to a food, plant or other substance that most people do not react to. Under normal circum-stances, your immune system’s job is to fight off germs and other threats. With allergies, the im-mune system is experiencing a “false reaction” to the exposure to an allergen. There are contact allergies, airborne allergies like dust and pollen as well as food allergies. Regardless of the type of allergen, they can and do cause a reaction in some individuals. This reaction can be mild or severe, ranging from sneezing, runny eyes and nose—or a more severe reaction that can be life threatening. The allergen is an irritant to the im-mune system, and should not be taken lightly.

Harry Fallick, D.O., a board certified plastic surgeon and dermatological chemist, feels that the most important fact for beauty and wellness professionals to understand is that irritation is not a normal healthy state. Irritation can lead to inflammation—which is the body’s attempt to rid itself of foreign threats such as viruses, bacteria, toxins and trauma. The link between inflammation and more serious health problems ranging from periodontal disease, heart disease, gastrointestinal problems, arthritis and other diseases is an active area of research. As the skin is the body’s largest organ, it makes sense that skin health and wellness is a key compo-nent of a wellness lifestyle.

Allergies are also thought to play a role in obesity and weight loss. Some nutritionists and physicians believe that cravings and overeating of certain foods may be symptoms of a specific type of food allergy. Even though the actual num-ber of individuals who have true food allergies is estimated to be only three to four percent, the number of people who believe that they have food allergies is as high as 15 percent.

An additional factor is bloating, water re-tention and gastrointestinal problems, which may be an unwanted side effect of some aller-gy medications. These side effects may make people who are not at all overweight look fat.

Intake protocols for guests with allergiesAs demonstrated by Lucy’s experience, it is impor-tant to know if your guest has allergies. In Lucy’s case, her reaction subsided after a few days, but it could have been more serious. Your intake and guest information forms should ask questions re-garding allergies and symptoms. The spa or salon environment is one that can easily trigger reactions to products and services. Some guests may not be aware that they have sensitivities or actual al-lergies. You may have to do some detective work.

A good question to include on your guest intake form is, “Have you ever developed a skin rash, swelling or redness after using a skin lotion, bath gel or soap?” Also ask, “Do any fragrances or smells make you sneeze, cough or have runny eyes or nose?”

People who have a history of hay fever, asth-ma or food allergies may develop skin irrita-tions (contact dermatitis) from the use of plant essential oils. Nut allergies are quite common, and a question regarding allergies or reactions to eating nuts should always be asked. Review your current intake forms and update if needed. Plan a staff training on the issues, protocols and safety measures for guests with allergy issues.

continues

Use anti-inflammatory oils such as blue tansy, lavender, niaouli and blue chamomile.

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focusing on wellness

Skin health and wellness As the largest organ of the body, our skin is our first line defense against environmental threats. As day spas, medical spas, skin care studios and spas/salons begin to shift their focus to a more wellness driven mission, skin health makes sense. It could be said that any and all treatments that promote skin wellness and support the immune system can help the guest with allergy concerns. Some spa treatments may also help to alleviate specific symptoms for those guests. As certified aromatherapist Cristina Proaño-Carrion shares, any

guest with allergy issues probably will not enjoy or truly benefit from a spa visit if they are experi-encing symptoms. Why not include allergy relief aromatherapy as a service add on? (See sidebar)

Spa treatments for allergy reliefThe following treatments and therapies have been shown to potentially offer relief to guests who experience allergy symptoms.

• Headandsinusreliefmassage• Aromatherapy• Ayurvedictreatments• Steam,saunaorhydrotherapy

Allergy testing at the med spaGood news! Needle free testing is now avail-able at med spas. An innovative method takes only 20 minutes and can be offered to patients. A test pad is placed on the back, specific reac-tions are noted and a prescription is written by the physician for allergy treatment. More than 80 percent of patients notice a significant reduction in their allergy symptoms by the end of the first month of treatment.

An important concept to remember is that most allergy treatments involve a microdose of the very allergen that causes irritation, with the hope of boosting the immune system’s ability to respond without symptoms. That sounds a lot like a homeopathic treatment to me!

Promoting wellness and optimal health in the spa and salon environment is enhanced when you stay mindful of the common issues of aller-gies and sensitivities. n

Patti Biro is the found-er and principal of Patti Biro and Associates, a consulting firm specializ-ing in brand enrichment through creative special events, retail consulting and education in the spa and wellness industry. She is a frequent presenter on the national and international trade show circuit. Biro recently completed a Spa-fari in Africa and Dubai, where she visited unique spa venues.

CRISTINA PROAÑO-CARRION, aromathera-pist and founder of Aromandina, shares her idea for offering a symptom busting treatment for allergy-suffering guests.

Aromatherapy for allergy symptomsAn aromatherapy treatment for allergies can be integrated into any spa treatment as an add-on. If your allergy-suffering guests are stuffy and congested, they won’t be able to enjoy a spa treatment.• Useanti-inflammatoryoilssuchasbluetansy,

lavender, niaouli and blue chamomile.• Combineonedropofeachwithateaspoonofjojobaoil,

and massage a small amount onto the sinus areas on the sides of the nose.

• Withapressandreleasemotion,startfromthecenteroftheforehead and move outward to the temples. Then start again at the center of the forehead. Massage toward the temples with a swiping motion. Do the same starting on both sides of the nose, moving toward the ears.

• Repeatfourtimes.• Finishthetreatment

by putting one drop of eucalyptus radiata on your fingertips, placing them next to the guest’s nose and asking them to breathe deeply.

When you relieve these allergy symptoms, your guest will be forever grateful!

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organic & wellness


STRONG AND HEALTHYThe FORTIFY supplements from Gloss & Toss® provide the benefits of strong nails and healthy, shiny and beautiful hair from the inside out, says the company. FORTIFY contains biotin, folic acid, grape seed and ginkgo biloba. glossandtoss.net 310.430.4045

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ECOFRIENDLY SKIN AND SPA PRODUCTS AND THERAPIES

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SPICE THINGS UP!The Paprika Stimulating Massage Cream from ilike organic skin care is a great product to use during regenerating treatments. The formula of carotene-packed paprika, bioflavonoids, capsaicin, tocopherol and selenium has a high phytoestrogen content, which increases elasticity, firms and vitalizes the skin. Due to its stimulating effect, it cleans the accumulated deposits and sclerosis from the deeper tissues, says the company. szepelet.com 888.290.6238

BANISH BLOATGliSODin Skin Nutrients introduces Advanced Lymphatic Formula, ideal for pre and post esthetic treatments. Proven to reduce swelling and water retention, the formula is developed to enhance the results of treatments such as body contouring, lasers, injectables, fillers and spa treatments. GliSODin products complement surgical procedures, reducing pain and discomfort as well as decreasing bruising, says the company. glisodinskin.com 866.534.5868

MORE NEWS


BRIGHT-EYED BEAUTYThe Eye Rescue Pads from Repêchage® tackle dark circles with the ultimate “10 minute vacation” for eyes. Green and black teas, rich in antioxidant polyphenols, act as powerful free radical scavengers for anti-aging benefits, while natural seaweed infusions replenish moisture and enhance the appearance of skin around the eyes. repechage.com 800.248.7546

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SPREADABLE SENSATIONThe Whipped Healing Butter from Sans Skin Care is formulated to promote healing post-surgery. The 100 percent natural product is packed with antibacterial, anti-inflammatory, tissue regenerating plant based ingredients that can be applied to patients’ incisions, so they will never be tempted to use Vaseline again!sansskincare.com

BOTANICAL ENHANCEMENTThe Bedside Manner Anti-Aging Lip+Hand Treatment from BijaBody enhances skin’s lusciousness! It contains a base of organic honey, rice bran oil, rosehip seed oil, carrot extract and a series of complementary, highly active, naturally derived ingredients that have been shown to significantly enhance the health of skin, improve collagen synthesis and prevent/reduce hyper-pigmentation, says the company.bijabody.com 406.209.8460

BERRY REPLENISHMENT The ultra-hydrating Blueberry Firming Facial Masque from Ossetra tones down redness in the face, says the company. Fine oils, mango/shea butter, botanicals and extracts replenish the skin, and hyaluronic acid gives the face fullness, easing wrinkles, fine lines and smoothing the surface with a slight plumping action. ossetra-global.com 866.443.7SPA

ECOFRIENDLY SKIN AND SPA

PRODUCTS AND THERAPIES


lighter for hollowness will highlight the skin and bring it forward or give the il-lusion of fullness. Apply the concealer first, then add your lighter undertones over it. Be careful with undertones to the concealer; go two shades lighter but make sure to maintain a warmer color.

Extra skin/bags: This issue is the most challenging of all, as it involves working with extra skin rather than levels of color. Many women think that makeup artists can do magic on these types of under eye problems, which generally are more obvi-ous on mature skin. Communicate with your clients about what you can realisti-cally accomplish with their “bags.” We cannot make them vanish completely, but we can help our clients look more awake by applying a concealer one shade lighter just above and just below the darkest part of the bag. I love to use a concealer pen-cil for this, so I can draw precisely where the color is needed.

For highlighting and contouring, the key points to remember are that lighter shades bring out features and contouring diminishes them.

Step 1: Place the lighter color just on top and just underneath the darkest part of the bag, and the slightly deeper color in between the two. The play on lighter and darker will cause a smooth-ing effect so the skin looks flatter. Use one uniform layer of finishing concealer for all three types of dark circles.

Step 2: This is the second of three steps, each of which are equally important. Find a concealer that matches your client’s skin tone, and gently pat under the entire eye with your ring finger. You are about to layer, so press gently to avoid moving the first layer. The heat from your finger helps blend the concealer nicely, while warming it up at the same time.

WITHOUT A DOUBT, THE NUMBER one question beauty experts and make-up artists receive from women is: “How do I cover the dark circles under my eyes?” Not only is this the most fre-quently asked question, it is also the most difficult to answer.

It is important for you to first recog-nize what is going on under your clients’ eyes. Is the skin dark, sallow or hollow? Is there extra skin causing bags and mak-ing your client look older? Answering these questions will help you determine what will work best for them.

Darkness: Darkness can take on many forms, from a hereditary/cultural shadow appearing under the eye to thinner skin showing tints of blue and purple. Hereditary darkness must be ap-proached with some serious ammuni-tion! Layering different products is the key to banishing darkness. I suggest always prepping the under eye with an eye cream, which will brighten first and create a moisturized canvas for the next two products to glide onto.

Peach color correctors are applied first. Since orange is the opposite of blue on the color wheel, a slightly orange color corrector is needed to neutralize as much of the darkness (blue/gray) as possible. Then apply a color correcting concealer.

Sallowness/hollowness: The goal here is to create the illusion of fullness under the eye. Many times, darkness is caused by a recess in the skin and not actual skin color. Work with light to pop out the hollow part of the under eye. This can be done with a concealer that is two shades lighter than the skin. Place it only in the hollow of the eye and blend up to the lash line. Generally, the color used for concealing is only one shade light-er than the skin. But going two shades

Look for a concealer with a silicone base, so it resembles the natural skin and is light reflective in a way that water based concealers are not.

Step 3: Powder! This step is missed by many women, but it is crucial to finish-ing off the look. Powder the under eye lightly with a fluff brush, making sure to smooth it into all the tiny crevices in and around the eye. Never use just an HD powder under the eye. It will pick up too much light and look patchy and chalky, which cannot be seen by the naked eye. I prefer mixing 30 percent HD with 70 percent regular translucent powder. This maintains the silkiness of the HD, so it does not settle in facial lines to create a cakey, dry appearance. n

Amanda Shackleton is a hairstylist and makeup artist who has worked exten-sively over the past 26 years. She is owner of the Media Makeup Academy, which has three branches located in Chicago, New York City and Miami. Shackleton has contributed to major advertising campaigns, and her celeb-rity clientele has included big names such as Martha Stewart, Javier Bardem, Harrison Ford, Sarah Michelle Gellar and Rosario Dawson.

by Amanda Shackleton

image dark circle coverage

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MedicalBY KAREN HODGES

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PEDICURES


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providing quality care for clients

BY KAREN HODGES

THE WORD “PEDICURE” IS DERIVED FROM the Latin term “pedis cura” or “care of the foot.” There is more to a nail technician’s repertoire of services than just decorating toes. Medi-pedis are an opportunity to enhance the menu and offer excellent care for clients.

Scope of licensureMost states regulate the level of care a salon work-er can provide for their clients, limiting the work to “beautifying” or cosmetic treatments only. This means that under the scope of a nail tech’s licen-sure, you are not allowed to look at a client’s toes and announce, “It looks like you’ve got fungus un-der your nails!” Diagnosis of a disease or disorder falls under the scope of a medical professional. Further, even trimming nails that are potentially infected would be prohibited. As a rule of thumb, nail techs are prohibited from working on cli-ents that have an “I” in the picture:• Noinfections• Noinjuries• Noinflammation

So what should happen in cases where a client does have any of the above? The nail tech should respectfully decline to perform the ser-vice and refer the client to a medical practitioner.

Practical applicationBeyond the esthetics of a pedicure, taking care of the health of the foot is important as well. Some cli-ents absolutely require a level of foot care beyond the usual “buff and fluff” pedicure. Chronic health conditions such as diabetes, neuropathy and on-going chemo treatments can impact the level of service needed in a foot care service. Sensitivity to temperature, fragile skin and broken capillaries all require an awareness and paying strict attention to every step in the service, soliciting feedback from the client and observing the reaction of their skin and nails while you are working. Ingrown toenails require skill in trimming. Bunions, hammer toes and plantar fasciitis all require care in handling

the feet. This level of skill and training can be acquired with the advanced certifications that are available in the industry for nail technicians who are interested in this unique clientele.

Nail technician and industry blogger Tina Alberino, a veteran of 13 years, has her own nail salon located inside a podiatrist’s office in Wesley Chapel, FL. She and a medical esthetician/mas-sage therapist each rent their own separate rooms and provide ancillary services to the doctor’s pa-tients. Alberino, a former paramedic and medical assistant who holds the Medical Nail Tech (MNT) and Certified Clinical Podiatric Medical Assistant (CCPMA) designations, provides pedicures that are more medically focused.

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Medical pedicure protocolIntake and assessment: Gather health information such as allergies, medi-cines and issues with the feet and legs. Observe gait, provide blanch test-ing, and assess sensitivity to touch and health of the skin and nails. The nail blanch test, also called the capillary nail refill test, is performed on the nail beds as an indicator of tissue perfusion (the amount of blood flow to tis-sue) and dehydration.

Nail work: Curettage to determine nail margins is a necessary step to allow safe trimming. Debride thickened nails if necessary. Trim nails, paying special attention if a client has nails that tend to ingrow.

Cuticle treatment: Exfoliate with a cuticle sloughing agent, pushing back and trimming only excess, non-living tissue.

Callus reduction: This is accomplished with the appropriate implements and tools. The grit on any abrasives is graded coarse-to-fine to refine the skin. Only excess “horny layer” skin is to be exfoliated. Removing the callus com-pletely is never appropriate.

Scrub (exfoliation): The lower leg and foot are exfoliated with an appro-priate product—any number of ingredients may be made into a sloughing lotion rather than a scrub.

Rehydration: A water-based, hydrating foot cream is applied to promote hydration of the skin. Apply a form of heat, hot towels, paraffin or heated booties to aid in the hydration process.

Nail finish: The chosen nail finish can now be added. Rather than an oc-clusive polish, the technician may recommend a medicated nail treatment or a simple buffed shine for a client undergoing treatments for a foot condition.

“We begin with a consultation appointment and a medical intake form, giving me their medical background, medications, health concerns and goals for their foot care treatments.”


“We begin with a consultation appointment and a medical intake form, giving me their medical background, medications, health concerns and goals for their foot care treatments,” she explains. “I perform a brief examination, during which I evalu-ate sensation, capillary refill, broken or ulcerated skin, ingrown toenails, skin irritation or discoloration, bone deformities and swelling. I also have them stand so I can evaluate their stance and gait. All of this helps me determine whether they need to visit the podiatrist prior to receiving a service and obtaining physician clearance. If all seems well, I book a pedicure appointment.”

A typical one-hour “Signature Pedicure” includes curet-tage, debridement, complete heel and cuticle treatment, an exfoliating scrub from the knees down, a foot massage, hot towels and a nail finish. Curettage is the removal of excess subungual tissue from under the free edge of the nails to determine the nail margins prior to trimming. Debridement is

accomplished with a medical drill and burrs (bits) to remove excess nail plate overgrowth so shoes are more comfortable.

With a clientele made up predominantly of people on fixed incomes and the elderly, Alberino offers affordable quality ser-vices with her Signature Pedicure at a price point of $35. She says that the joy on their faces warms her heart, and her ap-pointment book is always filled.

Alberino also offers a “Medical Pedicure,” which includes an additional half hour to use as needed for her clients’ spe-cific challenges, such as additional debridement, heavy cal-lus reduction and ingrown toenails that require meticulous filing. The medical pedicure is again set at a very affordable price point of $50. Some of her clients alternate between the signature pedi and the medical pedicure. Fully booked with a waiting list, Alberino’s clientele consists mostly of standing appointments. She has recently taken on a business partner, who is working with the podiatrist and will obtain her CCPMA accreditation in one year.

Providing clients with a higher level of care is an excel-lent career booster for nail techs looking for their next chal-lenge. Developing a relationship with foot specialists in the medical sector leads to referrals that can fill your book with loyal, appreciative clients. n

Karen Hodges is a licensed estheti-cian and manicurist with more than 15 years of experience. She is a freelance writer, as well as an industry educator and public speaker around the globe. Hodges does consulting and training in salons, as well as on a one-on-one basis with individuals. Arrangements for classes, speaking engagements, web-based or personal training can be made by contacting her at [email protected].

image|medical pedicures


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permanent makeup professionalat our world renowned permanent makeuptraining center. Our graduates may choose to work in a medical practice, medi spa, salon, or as a solo practitioner... there are boundless opportunities. Whether it’s restoring the natural beauty to women’s face with permanent makeup and giving her a renewed sense of beauty, or tattooing a women’s areola following a mastectomy, you will change her life!

Alberino also offers a “Medical Pedicure,” which includes an additional half hour

to use as needed for her clients’ specific challenges, such as additional debridement,

heavy callus reduction and ingrown toenails that require meticulous filing.

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PROBLEMSCALLUSES, WARTS AND THICKENED INGROWN NAILS

HAVE YOU EVER WONDERED WHY SOME CALLUSES remain painful even after you file them down? All calluses are not created equally. The typical callus is a broad, smooth, thickened skin lesion, caused by excessive pressure to the bot-tom of the foot or toe. There are many underlying causes for calluses, but ultimately, most of them are the garden variety that respond well when they are filed or buffed down. The ex-cess skin with normal calluses, once removed, results in pain reduction and relief.

The purpose of this article is to educate the pedicurist about those calluses that just seem to remain painful no mat-ter what is done. I highly recommend that every nail tech wear gloves—both for your clients’ protection and your own. If you do not wear gloves, make sure you wash your hands both before and after you perform services on your client.

Once you encounter a callus or corn on your client that looks abnormal or remains painful after treatment, more evaluation may be needed—with an eventual referral to a podiatrist. Some helpful hints to consider when looking at resistant painful calluses are as follows:

1. Use a magnifying lens. Does the callus have a rough surface or cauliflower appearance?

2. When you file the callus down, does it tend to bleed? If you notice black dots or abnormal looking small white circles that do not follow the skin lines, consider the pos-sibility that it may be a wart.

3. You can also wipe alcohol over the lesion, which helps magnify the tissue for easier identification.

4. Pinch the callus. If that is painful for your client, it is an-other indication of a wart. Normal calluses do not hurt when pinched.

5. If you observe closely and notice a heartbeat in the callus, this again indicates that it could be a wart. The heartbeat is the wart’s independent blood supply, and it is the reason why they bleed so easily. Remember, a wart is caused by a virus, and it is contagious. It may spread if not treated.

In all of these circumstances, a referral to a podiatrist is necessary for examination and treatment, as it is not legal to work on an infected area. See photo below.

The last common type of problem callus is one that has a center core or corn within it. These calluses are often small and round in shape, and have a very dense center or core. This type of lesion is called an intractable plantar keratosis, or IPK. These lesions are usu-

ally caused by a plugged sweat gland from frictional forces, and are most commonly seen in tennis players. IPKs are tender to direct pressure—unlike warts, which hurt more with pinching. While IPKs are not caused by a virus and are not contagious, they can require more care than a nail tech can provide for relief, and should also be referred out to a podiatrist.

Thickened toenailsToenails, like fingernails, should be thin. If the nail is thicker and/or discolored in any way, start thinking “fungus.” While there are other reasons for thickened and discolored nails, the vast majority of these cases are due to a fungal infection. Another tip-off to a fungal infection is if your client has dry, scaly skin on their feet or between the toes. This is a sure sign that an athlete’s foot infection has invaded the nail. Thickened nails must be considered as fungal infected nails, and thus this client should be referred out for diagnosis and treatment.

In regards to thickened nails, it is important to remember to use sterilized instruments for each and every client. This fungus is contagious and very common. The chance of spreading this to other clients is very likely if the instruments you are using are contaminated. There are many treatments for fungus nail, but catching the fungus early and preventing it from worsen-ing is a key factor to consider. Thus, referral is important with any thickening/discoloration of toenails.

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wart on the sole of the foot


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Ingrown toenailsWith ingrown toenails, the great toenail is often involved. The nails generally become deformed and grow in a semi-circle fashion, making the borders dig into the flesh. Another cause of ingrown nails I have seen frequently is when the nail tech tries to cut the corners out and leaves a small spicule of nail. This leftover protruding rough edge of the nail pierces the skin, and a painful ingrown or infected toe follows. Any

time the nail tech sees a toe that is red, throbbing or pain-ful, the client should be referred to a podiatrist.

One helpful suggestion you can make before offering your client a referral is to try warm Epsom salt foot soaks. The main cause of ingrown toenails is a nail physically growing into the skin that needs to be removed. Therefore, making the correct referral is key, as a podiatrist will know exactly

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BY IVAR E. ROTH, D.P.M., M.P.H.

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what to do. Unfortunately, I have seen patients referred to non-podiatrists who are ill-equipped to handle this problem. In these situations, all the patient gets is an antibiotic. This rarely solves the problem, and just delays treatment—result-ing in continued pain and infection.

The best way to avoid a potential ingrown nail is to make sure to completely remove the entire side of the nail so that no edge is left behind when you cut down the side of the nail. Use a magnifying glass to inspect your work—and use a curette on the edge of the nail to smooth off any rough edges or residual nail spicule.

Have a specific podiatrist as a referral source, as they are uniquely trained to handle these nail and callus problems. Visit three podiatrists in your community that are within close proximity to you, and select the one that you feel would best cater to your clients. While we know that nail technicians are the first line of professionals to notice many plantar problems and nail fungus issues, addressing the concerns of your cli-ents, staying within your scope of practice and being able to refer them out makes for a truly professional technician! Let

your clients know that you have personally selected a podia-trist to work with them. Also instruct them to report back to you about their experience, as you want to confirm that they were well taken care of. Follow through on your client’s ap-pointment to see what procedures were done or any medica-tions that were prescribed. This thoughtful customer service on your part will add to your value and gain client loyalty. n

Ivar E. Roth, D.P.M., M.P.H. devel-oped the concept of concierge podia-try so that his patients could benefit from better care for their foot and ankle problems. Dr. Roth is the sole active staff podiatrist with full surgi-cal privileges for the foot and ankle at Hoag Hospital in Newport Beach, CA. He has now expanded his prac-tice and is the owner of Concierge Podiatry Spa. Dr. Roth can be reached at [email protected].

image|pedicure problems

The Environmental Protection Agency’s step by step instructions for disinfecting pedicure foot spa equipment:epa.gov/pesticides/factsheets/footspa_disinfection.htm

Follow this procedure for each client. It can take place any time after the client’s feet are out of the footbath, while feet are massaged, toes are painted or other opportunities.

1. Drain the water from the foot spa basin or bowl and remove any visible debris.

2. Clean the surfaces of the foot spa with soap or deter-gent, rinse with clean water and drain.

3. After cleaning, disinfect* the surfaces with an EPA-registered hospital disinfectant according to the manufac-turer’s directions on the label. Surfaces must remain wet with the disinfectant for 10 minutes or the time stated on the label, which may be shorter.

* For whirlpool foot spas, air-jet basins, “pipe-less” foot spas and other circulating spas, it is best to disinfect by filling the basin with clean water, adding the appropriate amount of liquid disinfectant, and turning the unit on to circulate the disinfectant for the entire contact time.

4. After disinfection, drain and rinse with clean water.

Forwhirlpoolfootspas,air-jetbasins, “pipe-less” foot spas and other circulating spas:

1. Remove the filter screen, inlet jets and all other remov-able parts from the basin, and clean out any debris trapped behind or in them.

2. Using a brush, scrub these parts with soap or disin-fectant (following cleaning directions).

3. Rinse the removed parts with clean water and place them back into the basin apparatus.

4. Fill the basin with clean water and add an EPA-registered hospital disinfectant, following directions on the label. Turn the unit on and circulate the system with the liquid for 10 minutes, or the time indicated on the label if different.

*The whirlpool mechanism of the tub must be operating for the entire disinfection period, so the piping and internal components that contain hidden bacteria are disinfected.

5. After disinfection, drain, rinse and air dry.

For simple basins (no circulation): 1. Drain the basin and remove any visible debris.2. Scrub the bowl with a clean brush and soap or disinfec-

tant (following cleaning directions). Rinse and drain.3. Disinfect basin surfaces with an EPA-registered hospital

disinfectant, following manufacturer’s instructions. Surfaces must remain wet with the disinfectant for 10 minutes or the contact time stated on the label.

Drain the basin, rinse with clean water and let it air-dry.

guide to disinfecting


Safety SellsGet Clients Who Will Never Leave You

by Janet McCormick

THE “THREE QUARTERS RULE” IS A FACT THAT CAN put a salon underwater or drive an individual nail technician out of business if they are not aware of it. This rule states that a salon or technician can have a stable core clientele, comprised of about 25 percent. But over three quarters of the rest of their clientele will still turn over every three to four years. If these figures are true, salons must continually attract replacement clients, preferably those who will become part of the core clientele—the ones who will never leave the salon.

There is one type of client that almost all nail salons com-pete for. This sought after individual has discretionary income, and must have perfectly beautiful, well maintained nails all the time. When she comes in, the spa or salon crosses their fingers that she will love the facility and technicians, so she will quickly settle into their core clientele.

But there are numerous other target marketing groups with special needs that almost always settle in, and never leave their salon of choice for another one down the street. There are

four client groups in particular that have one specific reason for staying forever in a particular salon—safety from infection. Fulfilling this requirement is the singular reason that some salons and technicians are booked solid with a waiting list.

Fearful clientsThese clients are afraid to go into nail salons because of me-dia coverage they have been exposed to about deaths and injuries that have resulted from visits to a nail salon. Mention a salon pedicure to them, and they will recoil in fear. It is not that they do not want the services; they are just not confident that the services are safe. You must market safe services in your nail salon if you want them to come. “Many of my clients are people who were afraid to go into a nail salon until they heard of mine,” says Athena Elliot, CMNT of SPAthena in Houston, TX, “They feel safe here and they tell me so. I doubt they will leave me unless they move out of town.” Elliot was the first Certified Medical Nail Technician in the United States. 4

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Safety sells• Asafesalonmust have an autoclave for their nail imple-

ments. A salon without an autoclave can be perceived as unsafe. Keep the autoclave out in the open where it can be seen; this is an effective way to market your facility’s safety.

• Thenailsalon/departmentmusthaveanewclientsheetwith health evaluation questions on it.

• Inasafesalon,everynailtechnician wears gloves when working on clients.• Safesalonsneedtoincludeapageontheirwebsitethatpro-

vides a list of the reasons clients should go to their salon. • Provideaseparatebrochureaboutthereasonstocome

to a safe salon, and hand one to every client in the salon when they check out.

• Theownerordepartmentmanagershouldvisiteverypo-diatrist in the area and leave them with the salon safety brochure, along with a business card. At the same time, they should offer the manager a free pedicure, with the offer printed on the back of the card. A stable podiatry

office will often have more than 4,000 patients. Creating a partnership with the podiatrist’s office can often fill all the spaces in a nail salon’s schedule.

• Asafesalonshouldsignupforwesterilize.com.Thisisafree service where consumers can find salons in their area that use autoclaves.

• Apressreleaseshouldbesenttothelocalmediadiscuss-ing the salon’s safety, and an explanation of what clients should look for in a salon when booking an appointment.

• Atechnicianordepartmentmanagershouldcallonthelo-cal independent living locations and discuss safe pedicures with the manager. Leave the safety brochures behind for residents, and put one up on the bulletin board. Residents do read the board. If it is allowed, consider giving residents a brief speech on home care for the feet, and offer discounts.

• Sendclientstosafesalonrating.comtofillouttheinforma-tion about your salon and rate it.

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Elderly clientsThe population in the United States is living longer due to the availability of better medical care for their chronic illnesses, so the elderly population is exploding. In conjunction with this, the number of persons with chronic illnesses is rising. These individuals require special care and precautions during their beauty services. For this reason, many physicians discourage them from getting manicures and pedicures in nail salons.

However, many elderly individuals are unable to perform their own routine foot care. Many cannot reach their feet due to arthritis or weight problems. Some cannot even squeeze nail trimmers because of their arthritis. If they want their toenails to be trimmed, they must go to a podiatrist or find a salon that has exceptional infection control with trained nail technicians. “I live in an area where there are many elderly,” says Claudia Cox, CMNT in Sebring, FL. “I work, work, work and that is not a bad problem to have most of the time! People who do not reappoint have to wait until an opening comes up.” Currently, her only open appointments are eight weeks out.

Chronically ill clientsThe number of chronically ill individuals in the U.S. is growing rapidly. For example, in 2000, diabetics made up 5.8 percent of the American population. By 2010, the number had grown to 11.3 percent, and is estimated by the CDC to go to 20 percent in 2020. These clients are at risk when they go into a nail salon due to inherently slow healing processes. A minor injury or poor infection control during a diabetic’s pedicure can cause severe suffering, even amputation or death.

Safety-trained nail technicians can market their safe salon to these chronically ill clients and expand their clientele dra-matically. “About half of my clients are diabetics,” says Elliot. “Many are referred by physicians, others by their friends, and safe services are what they want.” Eliot also has many clients who have cancer and other conditions. “These special clients require specific precautions for keeping them healthy,” she says.

Patients referred by physicians and podiatristsIf physicians or podiatrists find a salon that meets their cri-terion for the safety of their patients, they will refer them to that salon and tell them why. This includes perfect infection control practices by technicians who are trained in the many precautions needed for working on chronically ill clients. For example, insulin dependent diabetics must not be soaked in a whirlpool because it dries out their skin, which later may crack and allow the entrance of infection. Cancer patients may be intensely bothered by aromatics, so it is important to have some scent-free products. Safety-trained nail technicians can market their services to physicians and podiatrists, and invite them in for a service to see their aseptic techniques in action. Then the referrals begin.

The common denominator for these groups is safety training of the nail technicians. Salons that develop the safe salon concept attract these guests through minimal market-ing. After these clients see the obvious differences, they will not go anywhere else.

“Our clients measure other salons by our safe salon,” says Denise Baich, spa director of CleanSpa in Chesterfield, MO. “They will not go to another salon that does not demonstrate perfect infection control, and that includes using an autoclave. Word has quickly spread throughout the community and also to professional medical practioners on our policy and facility, leading to a growing referral service. Our technicians are spe-cial people. They have high standards of care, and besides wanting their clients to enjoy their services and the relaxation, they are empathetic and committed to helping them be safe. We also remove all soiled towels and linens from the premises and they are washed, steamed and sterilized in a professional laundry facility. At the end of each day, lights are turned off and the facility is scanned with a black light that illuminates fungal spores. We are serious about creating an environment of safety and cleanliness in a relaxing setting.”

“I have a full book and cannot take a new client except when one leaves,” says Brenda Dolin, ANT-C (Certified Advanced Nail Technician) of Tips and Toes Design in Pulaski, PA. This new breed of safe, conscientious clientele respects and trusts their safety-trained nail technician completely, and loyalty is the result. The turnover of the clientele in these salons is minimal, creating a dynamic and successful business. Safety is more than a matter of vital importance—it sells. n

Janet McCormick is an esthetician, nail technician, sought-after trainer and former spa director and salon owner. She has written more than 400 articles for nail and esthetic industry maga-zines, and has contributed to the texts for these specialties. McCormick is the co-owner of Medinail Learning Center, a provider of online and school courses for nail technicians. She is also the co-founder of the National Aesthetic Spa Network. McCormick can be reached at [email protected] or 863.273.9134.

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A safe salon must have an autoclave for their nail implements. A salon without an

autoclave can be perceived as unsafe.

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Page 118 • LNEONLINE.com

LASH & BROW TINTINGEYELASH AND EYEBROW TINTING IS A FAST, easy and lucrative service you can offer to clients with very minimal cost and preparation. You can significantly increase your service tickets while providing added value for clients with these types of add-on treatments.

Training and preparationLash and brow tinting is a very easy service to learn and promote. Jenny Farrand, an esthetician and director of education for Universal Companies, explains that learning this new service should be a team effort. “Before you begin your lash tint-ing services, make sure that your technicians are confident,” she says. “Give your team ample time to practice on each other, which is the best way to learn. Create time in the schedule just for practice, and give them a space to work on each other several times before they see clients. This is especially true if you are promoting lash extensions in conjunction with tinting. It will allow them to build up their confidence and their speed. When you first perform the service you will likely be slow, shaky and a bit nervous working so close to the eye area. But after doing it a few times, you will quickly build up speed and precision!”

Common challengesThe most common mistake new users make is failing to fully read and follow the product direc-tions. While lash and brow tints are safe to use, they still need to be applied correctly. Misuse could injure clients and damage your reputa-

tion! “One of the biggest mistakes I see is that clients are being laid down flat for the tinting application,” Farrand says. “It is very important to incline the client, so that the tint does not get into the eye. They can either be sitting straight up in a salon chair or tilted back, no further than a shampoo bowl would allow.”

The most common lash and brow tinting challenge is simply misjudging the tinting time. “You can always reapply the tint that you’ve al-ready mixed for continued darkening, but you cannot lighten if you allow it to develop for too long,” says Farrand. “Start checking and remov-ing the tint sooner rather than later, especially for your fair skinned clients. If the results are not as dark as desired, simply reapply, checking the color every 60 seconds. To avoid tinting the skin under the brows, which can create a temporary darker color, apply the tint gently to the surface of the hairs. Do this without applying pressure right down to the skin, coating the brows rather than saturating them. If you do end up dying too dark, the skin underneath the brows can be gently exfoliated, which may help correct the ap-pearance of the brows. However, good quality tint never fades. The tint should last about 15 to 30 days as lashes and brows naturally shed and start a new growth cycle.”

Always consult with your client on their de-sired lash and brow color before you begin prepa-ration. Remember that the color of the mixture is not the color that the hair will be once it is tinted.

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BY JENNY HOGAN


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To get an idea of the final color, leave a wooden applicator in the mixture for the desired time. Always do a patch test on cli-ents to determine if there is any sensitivity to the product, as certain individuals may have skin irritations or allergic reactions. Using soap and water, cleanse a small area of the skin behind the ear or on the inner surface of the forearm. Mix the color and developer according to preparation instructions, and ap-ply the tint to the area you have prepared for the patch test. Allow to dry. Advise clients to leave the color on the skin for 24 hours, and then remove with soap and water. If no irrita-tion or inflammation is apparent, it is usually assumed that no hypersensitivity to the dye exists.

“If lash and brow tinting are being included in a facial treatment protocol, they should be done at the beginning of the service,” Farrand explains. “If the tint gets onto skin, it can be easily removed. It will also be more soothing to have the tinting done first, so clients can relax afterward during their facial. For lash extension services, the facial protocol would be performed first with the extensions applied afterward, as they will need time to dry completely.”

Temperature fluctuation may cause the developer solu-tion to settle, yet this does not have a negative effect on the quality of the product. Shake the product well and store in a cool place. Always wear gloves, so you don’t get the tint on your skin and nails. Put them on prior to mixing the tint. Mix ¾ inch of intensive color cream with two to four drops of intensive developer solution. Mix until it has the consistency of a creamy paste, not runny or drippy. Let it set for at least three minutes while you prepare your client.

Tinting procedureThe client should be sitting upright in a chair or on a facial table with their head tilted slightly back. Do not apply with head or body in a fully reclined position. Cleanse eyelashes and eye-

brows thoroughly. Lashes and brows should be free of oil and makeup. Instruct the client to look up; apply petroleum jelly or an eye cream under the lower eyelid. Place protection pad under the lower lid, which will prevent the tint from staining the skin. You may also opt to use self-adhering under eye gel pads, which offer additional anti-aging properties and do not require the use of eye cream or petroleum jelly to hold the eye pads in place. Using a tint brush, apply a non-drip cream tint to lower lashes first on both eyes. Make sure the tint covers lashes from base to tip, as well as in the corner lashes of the eyes. When lower lashes are completed, instruct the client to close their eyes until the applications and removal process is completed. Apply cream tint to upper lashes from base to tip. Again, make sure the corner lashes are covered.

If tint accidently gets into the eyes, take the client to your spa’s eyewash station and flush their eyes with plain water im-mediately. If you do not have an eyewash station available, flush the eye with saline solution or warm water and pat dry. If no irritation occurs, you may reapply the tint immediately. When applying to eyebrows, make sure eyebrow hair is com-pletely covered. If any tint gets on the face, remove it as soon as possible with warm soap and water. Do not use the tint spot cleanser on the face.

Developing timeDeveloping time differs depending on temperature fluctuation, texture and coarseness of the client’s hair and its original color. Although the normal time for developing is 10 minutes for lashes and three minutes for brows, these times may produce darker results than expected. If you are working with middle brown, brown or graphite, it is recommended that you allow eyelashes to develop for three minutes and eyebrows to de-velop for one and a half minutes, then cleanse and check the color. If the eyelashes or eyebrows are not dark enough, reap-

The average treatment time is 15 to 20 minutes. Jenny Ferrand recommends that estheticians charge $35 per treatment.

lash and brow tint step-by-step

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ply and allow them to process again until the desired color is achieved. Check the color frequently. You can always reapply to go darker. However, if they become too dark, you will be un-able to lighten them. The color will have to wear off over time.

Remove the tint from the eyebrows by gently massag-ing a damp cotton ball or cotton round back and forth over the eyebrows until no dye remains. Remove protection pads from under eye area. Use a dampened cotton ball with warm water to remove product from closed eyes until no residue is visible. Hold the tissue near the eye area to capture any excess water. Provide a finishing touch by applying an eye cream around the eyes. If eyebrows have been tinted, apply eyebrow gel to finish them. Give your client a mirror so they can see their fabulous new look! The client can wash their face, apply makeup and resume all activities immediately.

Promote tint servicesThe most commonly missed opportunity for spa professionals is simply failing to effectively promote add-on services. No service sells itself. It is very easy to talk about lash tinting, no matter what other service you are providing. For instance, you could be doing a brow wax and say, “Mrs. Jones … I would like to professionally recommend a great finish for your eyebrows that would really make your eyes pop with a lash tint.” After a makeup application you could say, “This evening look is beautiful! If you also want a great daytime

look, you should consider lash tinting so you can roll out of bed with beautiful lashes every day!” Hairstylists applying hair color can say, “Would you like great dark eyelashes too, and brows to match your hair color?” Emphasize the benefits to your clients, explaining why they should receive a lash tint created just for their eyes. It is not safe to use hair dye on the eye area, yet plenty of hairstylists do this. Clients may also be using at-home hair color to dye their brows themselves.

“Once lash tinting has been successfully introduced to clients, it will usually become a regularly scheduled service,” says Farrand. “When clients know this service is available, lash and brow tinting will become a normal service, just like eyebrow arches or professional hair removal. Clients will add it onto their appointment without even thinking about it, after they experience it for the first time. You should also promote it seasonally. Summertime is a great opportunity to suggest that your clients go without mascara for swimming, as is win-ter, so eyes don’t get watery and red in the cold weather.”

To complement your new lash and brow tinting services, consider offering other services for the eyes, as well as re-tail items. Eyelash extensions, eyebrow shaping, threading, lash serums or enhancers are great services and items to offer. Farrand also recommends lash tinting as a necessary first step to all lash extension services, to create a seamless transition from clients’ light-tipped natural lashes to the dark black extensions. Semi-permanent mascara is another new treatment worth considering. This uses technology originat-ing from lash extensions to thicken, darken and lengthen lashes with a coating that lasts about a month.

“After you perform the lash and brow tint, always retail other lash items so the client will get the ultimate results,” Farrand advises. “If you can create thicker, healthier lashes for clients, they will definitely keep coming back to you!”

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1. Mix until the consistency is a creamy paste, not runny or drippy. 2. Cleanse eyelashes and eyebrows thoroughly. Lashes and brows should be free of oil and makeup. 3. Instruct the client to look up; apply petroleum jelly or an eye cream under the lower eyelid. 4. Place protection pad under the lower lid, which will prevent the tint from staining the skin. 5. Using a tint brush, apply a non-drip cream tint to lower lashes first on both eyes. 6. Apply cream tint to upper lashes from base to tip. 7. When applying to eyebrows, make sure eyebrow hair is completely covered. 8. Remove protection pads from under the eye area. 9. With eyes closed, use a dampened cotton ball with warm water to remove product until no residue is visible. 10. Hand your client a mirror so they can see their fabulous new look!

image|perfect lash & brow tinting

Always wear gloves, so you don’t get the tint on your skin and nails. Put them on prior to mixing the tint. Mix ¾ inch

of intensive color cream with two to four drops of intensive developer solution.

images courtesy of Universal Companies

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Lash and brow bar designBy creating a lash and brow bar in your front reception area or other visible space in your business, you can create a buzz about your new services. Clients will see your new lash and brow ser-vices on their way to and from appointments, enticing them to book a service for next time or just get one on impulse. What you offer in your lash bar will vary based on what other services you have. You can provide your lash and brow services, retail lash products, cosmetics and more. The more you offer, the more clientele you will attract!

Every lash bar design will be as unique as the business it-self, and the layout depends on your available space and staff. “There is no 100 percent formula for creating the perfect lash and brow bar,” Farrand notes. “Don’t feel that if you don’t have a space by the front window, you can’t be successful. If you do have a visible area near the front of your salon or spa that is great, you can consider using a lounge or other area where you won’t disturb your other clients. What you really need is a space for one or more clients, preferably at least two. That way girlfriends or mothers and daughters can get the service together. You’ll need a good chair that is the right height for the practitioner and comfortable for a client of any size to sit in for at least 10 minutes. Our favorite is a high director’s chair commonly used by makeup artists. You need a cart or surface for your supplies and good lighting. Apart from that, you can design it any way you desire!”

Don’t stop at lashesIf you are offering any new add-on treatment, you don’t need to stop with just one! Offer additional treatments while you are doing the lash and brow tinting. The client will be sitting for 10 minutes with their eyes closed. This is the perfect op-portunity to offer additional treatments, such as anti-aging hand services, neck and shoulder massages, aromatherapy, scalp treatments and spot patch treatments for the eyes or lips. If the client is reclined in a lounge chair, you could offer foot treatments, reflexology or energy work. Offering these types of add-ons will dramatically increase your service tick-ets. You should always consider what individual clients will be interested in receiving beforehand, so you can work ahead of time to offer them add-ons!

“Even if you don’t have a lot of initial bookings, this is one of the times you want to encourage your staff to work on each other between clients,” Farrand notes. “Their playfulness will attract others, and once clients see professionals trading ser-vices, they will know the service is worth trying. Your reception staff should also get the lash services. As they’re talking with

clients regularly, they are the first people who can promote your new services and generate excitement about them!”

Di Medlock is an esthetician and the national director of waxing for Exhale Companies. She oversees waxing profession-als at 21 national Exhale Spa locations and sees clients in the Exhale Spa on Madison Avenue. As Exhale is a comprehensive spa and wellness facility, many guests come in for the entire day. Guests may be taking a yoga class, getting a massage, facial or other spa service, and will often receive multiple treatments in one visit. Lash and brow tinting is a very common add-on service that goes hand-in-hand with their many other esthetic and spa services. “Reshaping eyebrows is a very popular ser-vice that we provide,” Medlock notes. “Guests may be in for a facial and brow shaping service, and they often ask for the brow and eyelash tinting as an add-on. It is a really useful tool to help guests enhance the look of the lashes and brows that they have, and helps them get the results they desire.”

Exhale Spas have received “Best Of” reviews in multiple locations for their waxing hair removal services. Medlock re-lays that it is important for the upscale spa to be extremely consistent with their results, for returning guests as well as first time visitors. “A spa guest can come in every three weeks for a re-tint and we know that her brows will always look exactly the same, every single time,” Medlock says.

Medlock shares that the best results will come with cus-tomizing the color for each client. She notes, “We rarely ever use just the color shades straight from the tube. Because it is so versatile and we can mix colors, we formulate as you would with hair color to get the specific shade your client needs. For instance, if a strawberry blonde guest comes in, I can mix a middle brown tint with a little bit of auburn to get the exact color I want.” Start with base notes of brown or middle brown, while adding graphite or auburn for accent points. You will be able to play with the colors and really get versatile for each guest. “For people with blue or green eyes, the blue-black lash and brow tint really brings out their aqua tones,” Medlock adds. “It’s a nice accent for people who have darker lashes and brows to begin with. Mixing the tints makes for more dynamic, multi-dimensional results.”

Grow your business with new add-on lash and brow services. Get started now with this lucrative new service to increase rev-enue, create a buzz, and give clients great lashes and brows! n

Jenny Hogan is the media director at Marketing Solutions, Inc., a full-service marketing, advertising and public relations agency specializing in the professional beauty industry. For more information, call 703.359.6000 or email [email protected]. For additional information on Quantum Health and Wellness, LLC, email info@QuantumHealthandWellness.

image|perfect lash and brow tinting

“Guests may be in for a facial and brow shaping service, and they often ask for the brow and eyelash tinting as an add-on.”


NAILS, MAKEUP, TOOLS AND TRENDS

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NAIL SERVICE SAFETYThe Medinail Learning Center has expanded their Advanced Nail Technician online program to 10 modules and upgraded all the information to enhance the success of salon/spa-based nail technicians through marketing safety. According to the Centers for Disease Control, 11.3 percent of Americans are diabetic, and six percent have other chronic illnesses. Therefore, with a significant percentage of their clients being chronically ill, nail technicians need solid information on how to perform safe services.medinail.com 863.273.9134

ELIMINATE CROSS CONTAMINATIONThe FDA registered Prestige Medical 2100 Autoclave distributed by Universal Companies enables spas to eliminate the risk of cross infection through contaminated instruments, providing a higher level of safety and cleanliness. The automatic device has safety features such as electronic detectors that turn off power if there is insufficient water, as well as a mechanical interlock system to prevent the lid from being removed while pressure remains in the large capacity chamber. Steam sterilization, or autoclaving, is the preferred method for avoiding cross infection through contaminated instruments, says the company.universalcompanies.com 800.558.5571

TARGETED TECHNOLOGYThe NuFACE Trinity ELE (Effective Lip & Eye) Attachment provides a non-invasive solution to address hard to reach areas such as eyebrow furrows, crow’s feet and smile lines, says the company. Innovative treatment wands enable users to effectively treat skin around the eyes and lips. It uses a soft wave microcurrent technology for targeted facial stimulation. myNuFACE.com888.360.9171

COLLAGEN BOOSTERThe Eclipse MicroPen™ from Eclipse Aesthetics is applied to collagen induction therapy (CIT). It is used during CIT treatment to create thousands of micro channels or micro wounds to stimulate collagen and elastin formation within the skin, says the company. The Eclipse MicroPen has been introduced to the U.S. esthetic market and worldwide. eclipseaesthetics.comeclipsemicropen.com 800.759.6876


WestCentralEastInternational

WEST | CENTRAL | EAST REGIONAL EDUCATION & ONLINE CLASSES

CALENDAR OF EVENTS

LEARN ON LOCATION

West

ONGOINGAdvanced Chemical Peels with Skin Assessment

by A Natural Difference.Encinitas, CA. 888.568.3150.

Advanced Chemical Peels with Skin Assessment

by A Natural Difference.Long Beach, CA. 888.568.3150.


by A Natural Difference.Seattle, WA. 888.568.3150.

Full-Spectrum Reiki for Beauty Professionals: Integrated Reiki Spa Treatments

by Linda Bertaut at Bertaut Beauty.Pasadena and San Francisco, CA. 626.405.0424.

Seasonal Peels and Unusual Actives

by A Natural Difference.Encinitas, CA. 888.568.3150.


by A Natural Difference.Long Beach, CA. 888.568.3150.


by A Natural Difference. Seattle, WA. 888.568.3150.

FEBRUARY 9Skin Biology & Chemical Peel Seminar

by PCA Skin. Santa Monica, CA.877.PCA.SKIN.

Skin Biology & Chemical Peel Seminar

by PCA Skin. Seattle, WA.877.PCA.SKIN.

FEBRUARY 10Peel Fundamentals: A Hands-on Course

by PCA Skin. Santa Monica, CA.877.PCA.SKIN.

Peel Fundamentals: A Hands-on Course

by PCA Skin.Seattle, WA.877.PCA.SKIN.


by PCA Skin.Scottsdale, AZ.877.PCA.SKIN.

FEBRUARY 16Advanced Peeling Techniques for Complex Skin Conditions: A Hands-on Course



by PCA Skin.San Diego, CA.877.PCA.SKIN.


by PCA Skin.San Francisco, CA.877.PCA.SKIN.


continues


by PCA Skin.San Diego, CA.877.PCA.SKIN.


by PCA Skin.San Francisco, CA.877.PCA.SKIN.


by PCA Skin. Seattle, WA.877.PCA.SKIN.


by PCA Skin. Scottsdale, AZ.877.PCA.SKIN.



Central


by A Natural Difference.Dallas, TX. 888.568.3150.


by PCA Skin.Chicago, IL.877.PCA.SKIN.


by PCA Skin.Chicago, IL.877.PCA.SKIN.


by PCA Skin. Houston, TX.877.PCA.SKIN.


by PCA Skin. Houston, TX.877.PCA.SKIN.


by PCA Skin.Dallas TX.877.PCA.SKIN.


by PCA Skin. Chicago, IL.877.PCA.SKIN.


by PCA Skin. Chicago, IL.877.PCA.SKIN.

WestCentralEastInternational


Seasonal Peels & Unusual Actives

by A Natural Difference Skincare. Wilmington, DE. 888.568.3150.


by PCA Skin. New York, NY.877.PCA.SKIN.

Advanced Peeling Techniques for Complex Skin Conditions: A Hands-on Course

by PCA Skin. Virginia Beach, VA.877.PCA.SKIN.

Advanced Peeling Techniques for Complex Skin Conditions: A Hands-on Course

by PCA Skin.Washington, DC.877.PCA.SKIN.


by PCA Skin.Atlanta, GA.877.PCA.SKIN.


by PCA Skin.Boston, MA.877.PCA.SKIN.


by A Natural Difference Skincare. Wilmington, DE. 888.568.3150.

Knowledge is Power Series

by A Natural Difference Skincare. Cooper City, FL. 888.568.3150.


by A Natural Difference Skincare. Atlanta, GA. 888.568.3150.


by A Natural Difference Skincare. Columbus, OH. 888.568.3150.


by A Natural Difference Skincare. Fort Lauderdale, FL. 888.568.3150.


by A Natural Difference Skincare. Philadelphia, PA. 888.568.3150.


by PCA Skin. Tulsa, OK.877.PCA.SKIN.


by PCA Skin. Tulsa, OK.877.PCA.SKIN.

East


by A Natural Difference.Atlanta, GA. 888.568.3150.


by A Natural Difference.Columbus, OH. 888.568.3150.


by A Natural Difference.Fort Lauderdale, FL. 888.568.3150.


by A Natural Difference.Philadelphia, PA. 888.568.3150.

calendar|central|east

CALENDAR OF EVENTS



by PCA Skin.Atlanta, GA.877.PCA.SKIN.


by PCA Skin.Boston, MA.877.PCA.SKIN.


by PCA Skin.Richmond, VA.877.PCA.SKIN.


by PCA Skin.Richmond, VA.877.PCA.SKIN.


by PCA Skin. Fort Lauderdale, FL.877.PCA.SKIN.


by PCA Skin.New York, NY.877.PCA.SKIN.

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Exploring Intrinsic & Extrinsic Aging

by PCA Skin. Online Course.pcaskin.com/online-courses

HydroPeptide Product Training Webinar

by HydroPeptide. Webinars held Mondays at 1 p.m. EST., 12 p.m. CST, 10 a.m. PST.hydropeptide.com/webinars

Identifying & Treating Papulopustular Rosacea


Investigating Impaired Barrier Function


Laser and Light Therapyby NCEA Commission on Accreditation. Online Continuing Education. 201.670.4100.nceacertified.tv/online-ce-activities

Medical Estheticsby NCEA Commission on Accreditation. Online Continuing Education. 201.670.4100. nceacertified.tv/online-ce-activities

Product Formulations as a Whole


ONLINEEDUCATION

ONGOINGA Deeper Look at Topical Ingredients


Addressing Adolescent Acneby PCA Skin. Online Course.pcaskin.com/online-courses

Alternate Therapiesby NCEA Commission on Accreditation. Online Continuing Education. 201.670.4100.nceacertified.tv/online-ce-activities

An In-Depth Look at Melasmaby PCA Skin. Online Course.pcaskin.com/online-courses

Customizing Daily Care Regimens


Diminishing Deep Wrinklingby PCA Skin. Online Course.pcaskin.com/online-courses

Evening Post-Inflammatory Hyperpigmentation



by PCA Skin. Orlando, FL.877.PCA.SKIN.


by PCA Skin.Washington, DC.877.PCA.SKIN.

FEBRUARY 24Body Bleaching

by Vivant Skin Care.Miami Lakes, FL.800.984.8268.


by PCA Skin.Fort Lauderdale, FL.877.PCA.SKIN.


by PCA Skin. New York, NY.877.PCA.SKIN.


by PCA Skin.Orlando, FL.877.PCA.SKIN.


by PCA Skin. Washington, DC.877.PCA.SKIN.

calendar|east|online

CALENDAR OF EVENTS


Treating Acne in Skin of Color

by NCEA Commission on Accreditation. Online Continuing Education. 201.670.4100.nceacertified.tv/online-ce-activities

Triggers and Treatment of Atopic Dermatitis


Rosacea: Signs, Symptoms and Subtypes


Sclerodermaby NCEA Commission on Accreditation. Online Continuing Education. 201.670.4100.nceacertified.tv/online-ce-activities

Shedding Light on UV-induced Hyperpigmentation


Simple Steps to a Booming Business


Targeting Adult Acneby PCA Skin. Online Course.pcaskin.com/online-courses

The Daily Care Product Overview


The Professional Product Overview


calendar|online

The International Congress of Esthetics and Spa, Miami Beach 2014April6-7•MiamiBeach,FL1.800.471.0229

The International Congress of Esthetics and Spa, Dallas 2014May4-5•Arlington,TX1.800.471.0229

The International Congress of Esthetics and Spa, Long Beach 2014September7-8•LongBeach,CA1.800.471.0229

The International Congress of Esthetics and Spa, Philadelphia 2014October19-20•Philadelphia,PA1.800.471.0229

TRADE SHOWSSponsored by Les Nouvelles

Esthétiques & Spa and Dermascope

Pre-Congress NCEA Certified Prep ClassSaturday, April 5, 2014 MiamiBeach,FL•1.800.471.0229

Pre-Congress NCEA Certified Prep ClassSaturday, May 3, 2014 Arlington,TX•1.800.471.0229

Pre-Congress NCEA Certified Prep ClassSaturday, September 6, 2014 LongBeach,CA•1.800.471.0229

Pre-Congress NCEA Certified Prep ClassSaturday, October 18, 2014 Philadelphia,PA•1.800.471.0229

Pre-Congress National Esthetic Teacher Training (NETT)Saturday, April 5, 2014 MiamiBeach,FL•1.800.471.0229

Pre-Congress National Esthetic Teacher Training (NETT)Saturday, May 3, 2014 Arlington,TX•1.800.471.0229

Pre-Congress National Esthetic Teacher Training (NETT)Saturday, September 6, 2014 LongBeach,CA•1.800.471.0229

Pre-Congress National Esthetic Teacher Training (NETT)Saturday, October 18, 2014 Philadelphia,PA•1.800.471.0229

National Esthetic Teacher Training Sponsored by NCEA

NCEA Certified Prep Class


111 ............ Athena .................................................................... athenabeauty.com ......................................................... 162

110 ............ Beau Institute .........................................................beauinstitute.com ........................................................... 167

63 .............. Bio Jouvance ..........................................................biojouvance.com ........................................................... 140

8,25 ........... Bio-Therapeutic .....................................................bio-therapeutic.com ...................................................... 139

64 .............. Biomani ..................................................................biomaniskincare.com .................................................... 276

41 .............. Bioslimming ...........................................................bioslimming.com ........................................................... 335

27 .............. Circadia by Dr. Pugliese ......................................... circadia.com .................................................................. 101

132 ............ Darphin ..................................................................darphin.com .................................................................. 159

37 .............. DermAware ............................................................dermaware.com ............................................................ 256

5 ................ Dr. Grandel .............................................................grandel-usa.com ........................................................... 109

116 ............ Dr. Jeff ....................................................................dr-jeff.com ..................................................................... 248

2-3 ..............Éminence Organic Skin Care ................................. eminenceorganics.com ................................................... 157

26 ...............Enspri ..................................................................... enspriskincare.com ......................................................... 318

131 ............ Equipro .................................................................. equipro-bty.com ............................................................. 242

49 .............. GlymedPlus ............................................................glymedplus.com ............................................................. 303

43 .............. GrandeLASH-MD ...................................................grandewholesale.com ..................................................... 286

97 .............. Hale Cosmeceuticals ................................................ halecosmeceuticals.com ............................................... 133

79 .............. Hydropeptide ......................................................... hydropeptide.com .......................................................... 278

11 .............. Image Skincare ....................................................... imageskincare.com ......................................................... 178

32-33 ........ International Congress of Esthetics and Spa .........dallas.skincareshows.com ............................................... ......

20-21 ........ International Congress of Esthetics and Spa .........miami.skincareshows.com ............................................... ......

6 ................ Kat Burki ................................................................. katburki.com .................................................................. 222

13 .............. Lady Burd .....................................................................ladyburd.com ................................................................ 119

14-15 ........ Le Mieux ......................................................................lemieuxcosmetics.com .................................................. 294

69 .............. Lucrèce Physicians’ Aesthetic Research ...................lucrece.com ................................................................... 263

87 .............. Minkys ..........................................................................minkys.com ................................................................... 236

72 .............. Palacia Skin Care .........................................................PalaciaSkincare.com ....................................................... 225

7 ................ PCA Skin ......................................................................pcaskin.com .................................................................. 110

78 .............. PostQuam Professional ..............................................postquamusa.com ......................................................... 177

28-29 ........ Professional Hair Removal Conference ....................phrconline.com ............................................................. ......

18 .............. Professional Program Insurance Brokerage .............medispa-ins.com ........................................................... 208

83 .............. Rejuvi Laboratory ..........................................................rejuvilab.com ................................................................. 149

42 .............. Rena Levi .......................................................................renaleviskincare.com ..................................................... 105

91 .............. Revitalash .....................................................................revitalash.com ............................................................... 346

17 .............. Shira ........................................................................ shiraesthetics.com ......................................................... 249

47 .............. Silhouet-Tone USA ................................................... silhouettone.us .............................................................. 192

65 .............. Vivoderm .......................................................................vivoderm.com ............................................................... 269

*Les Nouvelles Esthétiques & Spa/American Edition has all publishing rights reserved. Reproduction in part or in whole without written permission by the publisher is prohibited. *Les Nouvelles Esthétiques & Spa/American Edition is protected through Trademark registration in the United States and in foreign countries where Les Nouvelles Esthétiques & Spa/American Edition circulates. The publishers cannot accept responsibility for unsolicited manuscripts. Articles appearing in this journal may not previously have been published elsewhere either inside or out-side the United States of America. Exceptions to this rule will be made only by agreement in writing between the author and the editors. The editors reserve the right to edit letters and other submitted materials or omit letters that are considered outside the laws of libel, slander and good taste. Claims and other statements by written and/or advertisement do not neces-sarily reflect the opinions of the Publisher/Editor of Les Nouvelles Esthétiques & Spa. Les Nouvelles Esthétiques & Spa’s Publisher/Editor assume no responsibility for any and all claims. Publisher is not responsible for any mailing delays beyond our control. *Direct all advertising rate inquiries to: Les Nouvelles Esthétiques & Spa/American Edition, Advertising Department, 3929 Ponce De Leon Blvd., Coral Gables, Florida 33134.

advertisers’ indexReader

Service No.PageNumber


PROJECT: Darphin New Beauty Ad DATE: Fall ‘13 TRIM SIZE: 9” (w) x 10.875” (h) BLEED SIZE: 9.5” (w) x 11.375” (h) SAFETY SIZE: 8” (w) x 9.875” (h) PRINTS: 4 Color

A few precious drops will change your skin.

And your mind.Seems everyone who tries Darphin Essential Oil Elixirs calls it her

new miracle skin product – and with good reason. Crafted with essential plant oils, they instantly melt into skin to quickly remedy your most pressing need – without any afterfeel. Choose your best formula to hydrate dry skin, calm sensitive skin, energize tired looking skin, renew aging skin’s youthful

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PURIFYINGNiaouli Elixir for oily skin

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ANTI-AGING8-Flower Elixir for aging skin

HYDRATINGRose Elixir for dry skin

CALMINGChamomile Elixir for sensitive skin

Learn more and shop now on www.darphin.com


Documents

LNE & Spa - February 2014