In the beauty industry, company representatives are always looking to display their latest device, being sure to tell professionals that it is the best and most necessary product to have in the treatment room. When working in a medical spa, it gets even harder to distinguish necessary products due to the variety and amount of lasers, light therapy, skin tightening devices, and fat reduction equipment available.

SAFETY AND SANITATION
Safety must come first in any working environment. The Environmental Protection Agency (EPA) was put in place to protect human health and the environment. According to the EPA, all tools and implements that come in contact with blood or bodily fluids need to be disinfected with an approved sterilizing solution. The Occupational Safety and Health Administration (OSHA) also sets and enforces protective workplace safety and health standards. The regulations set forth must be taken seriously, as well as individual state licensing regulations that oversee salons and spas.

Fire Extinguishers – According to OSHA, fire extinguishers are necessary in any environment that could pose a fire risk, including electrical equipment. Employees should be properly trained on how to use a fire extinguisher in case of emergency.

Stainless Steel-Covered Containers – These containers must be properly labeled with the type of disinfectant used, according to OSHA standards. Commonly used implements include fan brushes, small dishes to hold product, tweezers, comedone extractors, small scissors for hair removal, rotary brushes, and microdermabrasion tips.

Ultraviolet Sterile Light – Ultraviolet light is known for its germicidal action, destroying bacteria, viruses, and other harmful pathogens. This light is necessary for all treatment rooms to properly disinfect tools, including brushes, implements, and devices, after they have been completely cleansed with warm soap and water. This device alone, however, cannot be relied upon to kill all microorganisms.

Sharps Container – A sharps container is used to prevent contamination through accidental needle sticks by safely storing and disposing of used medical needles and other sharp instruments. States vary on regulations for skin care professionals, but, for those that can legally perform extractions with lancets or perform dermaplaning, this container is a strictly enforced OSHA regulation.

Closed Wastebasket with Lining – When treating the client's skin, there is always the possibility of cross-contamination. Anything disposable that is used during a treatment should immediately be thrown into the wastebasket and the lid should be closed. The most efficient and safest type of wastebasket to use is the stainless steel can with a foot pedal. This waste receptacle prevents the technician from accidentally opening the contaminated lid and then touching the client.

Linen Basket with a Cover – This basket is one item that may be forgotten, but, similar to the wastebasket, its use will prevent clients and providers from accidentally touching any contaminated linen.

COMFORT AND SETUP
The proper setup of a treatment room is essential for safety, as well as setting the stage for a positive experience. With all of the new, advanced treatments available, focusing on relaxation can sometimes get lost. With any treatment, the most important goal for the professional is to make the client feel better about themselves when they leave; part of that process is making the client feel better in general.

Facial Bed – A comfortable, sturdy bed is needed for the client's support. A bed is not something that should be taken lightly as an investment. Although adjustable massage tables can do the job, be sure they are high-quality tables that will not fall apart easily. The facial bed should be versatile, since there are several services that may require the client to change positions. Services such as back treatments, body wraps, and waxing all need adaptability when it comes to comfort and safety. Hydraulic or electric beds seem to have the most versatility, with some being able to adjust to almost any part of the body with a simple foot pedal or remote.

Stool – Comfort is not only about the client; the professional's comfort needs to be taken into consideration as well. The right stool should be chosen carefully and should not add extra strain that could eventually cause muscle aches or sores. Ergonomically correct, adjustable stools are best if they are being used by multiple providers.

Hot Towel Cabinet – Warm towel cabinets are one of the no-question staples for any spa. This device can be especially useful in a startup setting, where money for a steamer may not be in the budget quite yet. The towels are simply dampened and placed in the cabinet, being used most commonly as a way to soften the follicles in preparation for extractions. The warm towels also have other uses, including removal of products or relaxation. Some professionals can use the cabinet to warm up products, sponges, and cotton squares during application.

Music Player – The use of soft, tranquil music is essential for relaxation. It is part of the whole experience and helps to drown out distracting noise that may occur while the professional is preparing product or setting
up equipment.

EXTRA COMFORT
Warm Mitts – Mitts can be a nice add-on during facial treatments. They are simply plugged in and placed over a plastic bag, covering the client's skin.

Warm Blanket – An electric blanket is a nice touch, especially when the weather is cold or if the treatment room tends to get cold. The heat also helps with relaxation and the soothing of the back. The blanket should be placed between the layers of linens and the facial bed.

Bolsters – Bolsters are cushions that provide additional support in certain areas for extra comfort. These cushions can be added to any facial bed and are a necessity for treatments on a flat massage table.

Paraffin Wax Heater – Paraffin wax treatments are a great add-on to facials or for use on the hands and feet. Paraffin is a soft, warm wax that has softening properties and promotes increased circulation.

SKIN ANALYSIS
Analyzing the skin pre-treatment is not only going to help the professional choose the best treatment and products for the client, but is also another means of safety. There are several skin lesions that may not be seen thoroughly with the naked eye, which is why specialized equipment is necessary. Some of these lesions can be contagious, as well as potentially harmful to the client, if they are worked on. Using the right analyzing equipment can help the skin care professional to recognize any unusual conditions that may affect treatment or call for a physician referral.

Magnifying Lamp – A magnifying lamp is a magnified lens with lighting around it. A 3x diopter with 75 percent magnification to a 5x diopter with 125 percent magnification are the lamps that are most commonly used in a spa setting. This magnification allows for a closer look at the skin, leading to a better skin analysis. It is also used by professionals to perform detail work, such as extractions and hair removal.

Wood's Lamp – The Wood's lamp is a filtered black light that is used to identify skin conditions by revealing a variation of colors. Normal or healthy skin shows as light blue, while dead skin patches show up white; purple indicates signs of dehydration and yellow represents areas of excess sebum. One of the most useful aspects of the Wood's lamp is to show varying levels of pigmentation. If pigment shows up darker under the Wood's lamp, it is most likely epidermal. If it shows up lighter, it is typically dermal pigment, which is extremely difficult to treat. In dermatology, it can be used to identify more-advanced skin conditions, including varying fungal infections.

Skin Scope – The skin scope is an analyzing device that uses a filtered black light – the same technology as the Wood's lamp – but has an area where the client can view their skin at the same time as the professional. This scope is a great tool to have in a treatment room to show clients what is happening beneath the surface of the skin, allowing the professional to point out the importance of protecting the skin.

TREATMENT ESSENTIALS
The essentials are the pieces of equipment that are most commonly used by skin care professionals and are taught in undergraduate aesthetics programs. These devices may be available individually or can come on a multifunctional device with a magnifying lamp attached. These are all great devices and, as technology evolves, the industry is seeing more options than ever before.

Steamer – A steamer is most often used to prepare the face for deep cleansing and extractions by using heat and moisture to soften the skin that surrounds congested follicles. It also promotes increased circulation and can be used to activate certain substances, including enzymes. Some steamers can produce ozone, which is helpful for acneic clients as it has a germicidal effect.

Galvanic – A galvanic machine uses low-level electrical current on a positive or negative polarity to produce beneficial effects on the skin. Using the positive polarity, known as cataphoresis, the machine enhances product penetration and is commonly used with active serums, hydrating masks, and moisturizers. Anaphoresis is the negative polarity and is used for disincrustation, which softens and loosens congestion in the pores, allowing for easier cleansing and extractions.

High Frequency – High frequency involves the use of a handheld device that ends in a glass probe that is filled with gas, either argon-emitting violet light or neon-emitting orange light. High frequency with argon provides a germicidal and healing effect on the skin. The neon light can stimulate circulation and increase cell metabolism. This machine is a great add-on to any facial, especially for clients with acneic or dull, lackluster skin.

Rotary Brush – A rotary brush is used during a facial for deep cleansing and light exfoliation. The brush head itself is detachable and is available in different sizes for the face and body. Other attachments, such as a sponge, may be available for more sensitized skin.

Vacuum Suction – This extremely small device uses suction to loosen congested pores, allowing for a thorough cleansing. Although the suction is very light, clients love the vacuum feel, especially if their skin is oily.

Wax Heater – The wax heater is an electric warming device used for soft or hard wax applications. Waxing is an essential part of a professional's practice, especially when starting out and trying to build a clientele. The heater keeps the wax warm for continued use throughout the day. The wax heater and other implements must remain sanitary. Never double-dip while using a wax heater, as this practice increases the risk of spreading bacteria.

ADVANCED TREATMENT MODALITIES
The following equipment, although used by many skin care professionals, are seen as advanced modalities. These devices require specialized knowledge and tend to differ per modality. Manufacturers should provide specific training to perform procedures with their equipment.

Microdermabrasion – The term microdermabrasion refers to a technology that uses suction and a rough surface to exfoliate the superficial keratinized layers of the skin. Microdermabrasion involves a well-trained professional to mechanically exfoliate the skin with a handpiece. These devices may be used with abrasive particles such as aluminum oxide crystals, sodium bicarbonate salts, or those that are silicone-derived.

LED – LED is widely used in skin care by professionals and physicians because it demonstrates effective results, is easy to use, and has no downtime. LED uses specific wavelengths of the light spectrum to target areas within the skin to stimulate various responses. LED can stimulate adenosine triphosphate, which helps fuel the cells with energy, resulting in healthier-functioning skin. The most common uses for LED include acne reduction with blue light, inflammation control with red light, skin circulation increase with infrared light, and collagen production stimulation with amber light. LED units can be handheld or in the form of free-standing panels.

Microcurrent – Microcurrent is used to treat loss of muscle tone in the face due to the effects of aging. Microcurrent devices operate on a very low level of electric current. Microcurrent units commonly come with two handpieces or probes that have electrodes on the ends and may either be a single- or double-pronged unit. There are also microcurrent gloves, which have sensors in the fingertips. Clients may feel more sensation with the gloves, so it is best to also have handpieces available for sensitive clients. Handheld devices for homecare use are also available and are great for keeping up the effects of professional treatments.

Ultrasound Technology – There are several devices that utilize ultrasound energy, or sound waves, to induce cavitation, improving the appearance of the skin. The ultrasonic spatula uses low levels of ultrasound to penetrate products or for disincrustation, depending on the polarity used. These devices are handheld and contain an ultrasonic blade or a circular, flat handpiece. There are also more-advanced devices with higher levels of energy that are used to stimulate circulation, enhance product penetration, and assist with lymphatic drainage. These ultrasound devices are most often used in medical settings to stimulate collagen production and induce healing after procedures.

Oxygen Devices – Oxygen skin care is based on the premise that stable, natural oxygen increases skin cell metabolism and destroys bacteria. Some oxygen-based devices use a handpiece that is similar to a makeup airbrush gun. The handpiece uses oxygen as a means to deliver products into the skin. Hyperbaric-pressured, well-functioning machines produce 95 percent pure oxygen. It is a great treatment for clients with dehydrated, sensitized skin.

Microneedling – Collagen induction therapy (CIT), also called percutaneous collagen induction (PCI), is a minimally invasive skin-rejuvenation procedure that involves the use of a device that contains fine needles. These needles are used to puncture the skin to either make way for products to penetrate more effectively or, in medical settings, to create a controlled skin injury that will stimulate collagen production. There are varying devices for skin needling available, including individual needles, stamps, rollers, and automated devices. Professionals and consumers can only use cosmetic devices with needles up to 0.3 millimeters in length, which is, essentially, only for cell turnover and product penetration. Medical professionals may needle up to 3milimeters to reduce fine lines, wrinkles, scarring, and stretch marks.

Cryotherapy Pens – Cryotherapy, the use of freezing temperatures to destroy a target, is widely used in the medical community for several conditions. Cryogenic pens are new to the market and are making their way into aesthetics. These pens do not go past the epidermis and are considered safe to be used by licensed aestheticians in certain states (always check individual state regulations). The extremely cold temperature helps to reduce pigmented lesions, remove skin tags, and rid the skin of actinic keratosis or other sun spots.

The aesthetics industry is continually expanding and the equipment that is available is changing constantly. Skin care professionals are typically educated on the basic devices, which are user-friendly and have unchanging protocols, in undergraduate programs. The more-advanced equipment, including LED and microcurrent, are becoming increasingly popular. Education for advanced devices, however, are typically device-specific since they tend to vary. Regardless of the equipment used, professionals must first ensure safety and always continue their education.

Terri A. Wojak, education director at True U Esthetics and True U Laser, is a highly sought-after professional with 20 years of experience in the aesthetic industry. She is a respected authority on skin care in a medical setting, education, and business development on multiple levels. Wojak has built 30 individual courses based on skin care in a medical setting. Wojak has published two books, "Aesthetics Exposed: Mastering Skin Care in a Medical Setting & Beyond," and "Mastering Medical Esthetics" She has trained over 3,000 aestheticians and medical professionals on the importance of incorporating skin care into cosmetic medicine.