COMPETING WITH DERMATOLOGISTS
In some ways, many might say medicine has lost its soul. Medical appointments, especially at the dermatology office, are often quick prescription writing sessions that fail to properly consider all aspects of what goes into the skin issues that many people face. In more remote parts of the country there are still a few generalists that maintain the family-friend, 24-hours-a-day, 7-days-a-week mentality with their patients, however, that has been lost in most parts of the country. In some ways, aestheticians provide the bridge between what medicine used to be and what it is today when it comes to treating skin conditions. Diagnosing medical conditions is not always necessary in order to treat them. After all, in the medical setting, often, no matter what label is put on the skin concern, the prescription is frequently steroids or antibiotics with a side of Cetaphil cleanser. On the other hand, aestheticians often take the time to understand emotional and environmental impacts and consider more natural alternatives to pacify inflamed skin. The good news is that even though dermatologists are the authority, the wise, intuitive abilities inherent in aestheticians inspire the majority of Americans to seek out more holistic alternatives first.
One of the most frustrating experiences for an aesthetician is when their expertise is completely dismissed or controverted by a local dermatologist who happens to be seeing one of their clients. The pedestal that physicians are inappropriately put on can often result in their advice swaying a client no matter how much the client loves the spa or professional. For this reason, it is important to identify those dermatologists that are more open-minded to approaches outside of the prescription and refer to them when possible. It is also wise to consider choosing the dermatologists that are more Moh’s focused and less cosmetically inclined – but that is becoming harder to find.
Conflict often comes up between aestheticians and dermatologists as more and more dermatologists are adding aesthetic services to their practices. Without having a relationship with them, professionals will often find them trying to lure their clients into that department or, at the very least, persuading them to scrap skin recommendations for theirs. The best way to prevent clients from turning to dermatologists is to keep them happy. Since over 60 percent of people in the United States prefer more holistic strategies for skin conditions, professionals actually do have a leg up on the competition. They are often the gatekeepers for skin conditions so they should take that role seriously. The key is perfecting skills and expanding knowledge so that expertise cannot be duplicated. Just because dermatologists offer high strength peels and lasers does not mean they offer better solutions. More inflammatory approaches are not better and are, arguably, worse.
Many people believe that the collagen in skin is old and so the destruction and replacement of it has to be a positive and rejuvenating event. What science teaches is that the vast majority of the collagen holding up the fort is in good condition and the only time the skin tears down collagen is after it has become damaged. In other words, the skin is very efficient at tearing down damaged collagen and far too busy with maintenance to be tearing down healthy collagen. The typical response to aggressive procedures is a clear indicator the skin is in emergency repair mode. This is why there are only a few things that dermatologists offer compared to an aesthetician’s services that warrant a visit to them. The rest can be matched or bettered when professionals take their game to the next level.

THE AESTHETICIAN’S SCOPE
Before getting to the details of what should be referred out, it is important to, first, identify what is possible for an aesthetician. The rules vary a little between states, but the general premise is that aestheticians cannot work on more than the top layers of the epidermis. The other rule (that is a bit gray) is that aestheticians cannot diagnose skin disease. As many know, once past the stratum corneum, a professional is also, often, working on the deeper layers of the skin, including the dermis, as ingredients work their way down. As for diagnosing, many aestheticians have seen enough to have a good idea about what their client’s skin condition is and they can act on that information without actually diagnosing it. Obviously, everyone has to know their limits and know when an educated guess is too dangerous, but the goal is for aestheticians to expand their potential to its limits.
For example, eczema is often a skin condition that people think requires medical attention. This may not always be the case. After all, the dermatologist will often prescribe steroids and those are toxic to the skin and body and do not actually treat the problem. Instead, they suppress the repair response underway. A high-level aesthetician who has researched the alternatives may know that stress and a diet heavy in dairy, beer, or sugar is often part of the problem. The reason for this is because eczema is thought to be caused by an overgrowth of candida in the gut, which is often better treated with supplements and dietary changes, rather than medication.
The savvy aesthetician can also explain that steroids severely damage the skin over time, a point rarely made at the dermatologist’s office. Acne is another example of a skin condition that can be treated more completely by someone who understands the source of acne rather than the medical approach of benzoyl peroxide, antibiotics, and so forth. Acne is the result of a detoxification process. When the upper face is involved, the toxins coming out come from a specific strain of candida. When the lower face and body are involved in acne, the culprits are estrogenic toxins like chlorine and pesticides. While this may be new information to some, skin care professionals have been proving this to be true for years through the successful implementation of holistic strategies. Knowing this information allows professionals to be more precise in their protocols and helps clients avoid another round of antibiotics. There are many examples of skin conditions that have internal sources – that would never be considered by a local dermatologist – where a holistic approach not only results in client retention, but also lives changing.

KNOWING LIMITATIONS
Still there are certain conditions that should always be referred to a dermatologist. Here are some of the most important ones.

• Questionable moles – The most important indicators are a change in the size or color of the mole or new moles with irregular borders or pigment.
• Infectious lesions – Look out for anything that looks inflamed or infected that is growing or not healing and is not part of a typical acne pattern.
• Gut instinct – Anything that seems odd or suspect to either the professional or the client, especially when inner guidance is expressing concern, is worth a quick medical checkup.

BRIDGING THE GAP
The truth is that aestheticians can really help bridge the gap for unsuspecting, or unaware, clients who would have not known enough to make an appointment for the above concerns. For everything else, do not be afraid to explore holistic alternatives. That is what will separate a professional from local competition and that is what most clients are looking for ideally. It is not realistic to think that dermatologists are going to embrace aestheticians’ opinions or efforts unless they are directly employed by them. However, the real change in the dynamic between the
client, their aesthetician, and the physician can come from the professional’s ability to be seen as valuable by their clients.
Additionally, learn the most common recommendations given by dermatologists for the skin conditions seen most at the spa. This way, time can be taken to counsel the client about what to expect and, hopefully, provide some guidance. For example, they may be considering Fraxel laser. Have a general idea of how it works and the pros and cons of the procedure. It should not be surprising that a professional’s advice on these subjects may be the most information a client gets on the safety and efficacy of a procedure. Do a little research on the chat rooms and websites where patients share their experiences post-procedure. Get familiar with a few of the most common prescriptions, like antibiotics and steroids, and know the pros and cons of each. While this may sound daunting, it will definitely reinforce trust and make it much more likely a client returns after the appointment. Dermatologists rarely mention how antibiotics damage the gut bacteria with short durations and the severe intestinal lining damage that can result with three or more months of antibiotics. Perhaps the client is considering Accutane and needs some counseling on how toxic it can be. Maybe the client needs to be reminded that diet is a factor and shown the latest on holistic skin mapping to understand the true source of acne.
There are internal sources for just about every skin condition. Aestheticians, in their hour-long, often intimate appointments, have the best opportunity to understand the environmental and emotional factors that may be at play. Holistic modalities, targeted skin care technologies, and wellness supplements can be powerful tools to help raise the bar. Many aestheticians already excel in these areas and take the time, every week, to learn something new. Many others have lost their passion and may find this new perspective to be quite exciting as it results in transforming a business.

It is important to note that the wide variations in skill, experience, and comfort levels between aestheticians are significant and should be considered. What has been said is meant simply to encourage. Dermatologists can provide valuable assistance in the management of certain skin conditions as discussed. There is even more value in an aesthetician knowing and working with someone more intimately because of the information that opportunity provides. Become the empowered aesthetician clients need. Understanding their dermatologic choices from a holistic perspective will considerably diminish the potential for losing clients.

Ben Johnson, M.D. is the founder and formulator of Osmosis Skincare. Dr. Johnson began his career starting one of the first medical spa chains in the country, along with founding and formulating Cosmedix. He is an established speaker, educator, and formulator who is well-known for his unique approach to skin conditions by thinking outside of the box. Dr. Johnson’s passion is creating tremendous change in the skin without constantly exfoliating away the protective benefits of the epidermis.