Aside from medical conditions, the primary concern is dictated by the client. The aesthetician can provide an overall map of conditions, which navigates the client from primary conditions to secondary. Often times the client is unsure of their main concern. For instance, the client's inflammation and sensitivity has led to dehydration and an uneven skin tone. The aesthetician and client should collaborate on a skin care regimen and set realistic goals to treat the skin conditions.

Establish a sense of security – This involves reassuring clients that what they confide in you is confidential; their information will not be shared. In the same manner their health care information is handled, as HIPPA demands.

Open communication – As stated before, the client comes to you for your knowledge about skin care. Their concerns should be heard and their realistic expectations should be met.

Assess skin condition – Observe skin conditions with use of a magnifying lamp, woods lamp, dermascope, et cetera. At this point, you can determine the client's goals and objectives and provide feedback. If the client's goals are realistic, let them know they can be achieved within the desired timeline.

Effective Communication
Effective communication is a skill learned and is beneficial in the client/aesthetician relationship. As indicated by Keith Davis, in his book Human Behavior at Work, a majority of people only listen with 25 percent efficiency; therefore "hearing is with our ears, but listening is with the mind." In order to fine tune listening skills it is recommended that professionals gain the education needed to utilize active and reflective listening. As an aesthetician it is crucial to use both active and reflective listening skills for optimal understanding of client needs. Active listening is where the listener responds to the speaker based on understanding the communicated message. Regardless, if the speaker is the aesthetician or client there should be questions asked concerning the stated message. If it is the aesthetician addressing a certain skin care protocol for the client to follow, they should make sure to speak with them after – making sure they completely understand the protocol. Reflective listening is when the listener (aesthetician) simply listens and does not offer advice. This form of listening can prove beneficial to ascertaining the client's primary skin concern and narrowing down the secondary concern(s). In order to achieve optimal communication, the listening involves concentration, interpretation and comprehension. Since the only way to know if the client understands what advice has been given to them, the aesthetician should ask questions and summarize what has been stated. By following these techniques when communicating with clients, there is a far greater chance they will openly communicate and feel comfortable confiding in the aesthetician about their skin care condition(s).

The Consultation
Ideally the consultation should be 15 to 20 minutes, and the aesthetician should keep accurate records on the client's skin care needs. It is also advisable to consult with the client regarding any new skin care concern(s) and/or changes in the treatment plan. Anytime a new treatment is required to treat a condition the aesthetician should consult with the client. The consultation should consist of questions concerning both the client's skin and overall health. Regardless of whether the client is new or returning, specific questions regarding their health and skin care should be addressed. For instance, the following elements should be covered during the consultation:

Establish what the client's chief complaint is – their primary skin concern(s).

Conduct a health questionnaire – provides a thorough look at their skin and overall health.

Perform a skin analysis – observations should be noted in detail, providing a map to use when implementing a course of action.

Client compliance – communicate with repeat clients to see if they follow their home care recommendations. Check with new clients to assess their current home regimen and make recommendations. Make sure to provide all clients with specific instructions pertinent to their individualized skin care regimen.

Commitment – acquire a commitment from client(s) involving a summary of what their treatment plan is and what it entails. This plan should include: the duration of the treatment(s), contraindications, product usage, efficacy and cost.

During the consultation, the aesthetician will be able to learn more details about the client's preferences and personality characteristics. This is an important step in establishing a long-term client relationship.

Specific Skin Care Needs
Paramedical aestheticians and aestheticians trained in advanced skin care techniques are skilled to treat specific conditions utilizing noninvasive treatments. If a client's primary concern is to combat signs of aging and often receives facial fillers, a complementary treatment to that would be a mild chemical peel. Some ingredients that decrease aging and assist with sun damage include: alpha hydroxy acids, glycolic acid, beta hydroxy acids, et cetera.
Once a thorough assessment of the client's skin and specific needs are completed their treatment choices can be charted and confirmed. There are a variety of facials and skin care modalities that an aesthetician can offer to complement that of a dermatologist and/or plastic surgeon. Again, determining the correct treatment for a client is contingent on understanding the primary and secondary skin care concerns. When confidentiality and professionalism are exemplified while addressing a client's individual needs, the aesthetician gains the client's confidence in their ability. In addition, it is through actions (effective communication and practical knowledge) that the client gains a greater understanding on product ingredients and learns how one treatment is more advantageous over another. As a professional aesthetician it is crucial to acknowledge, that each client has individual needs and these needs require a specific skin care plan. Moreover, their skin care needs will change over time, so it is vital to update their treatment plan to prevent future skin care conditions.

Ingredient and Resource Specialist
An aesthetician, who advances their training in product knowledge and ingredients, will provide optimal service to their clients by sharing their expertise and education. Similar to apothecaries who educate individuals on knowledge of holistic and natural remedies, an aesthetician can address the active ingredients and assist the client in determining the ideal product to treat their skin conditions. The aesthetician can inform the client on the comedogenicity of a product. In Milady's Advanced Esthetics, comedogenicity is defined as "the tendency of topical agents, primarily emollients to cause the development of comedones." Therefore, it is necessary to warn clients of over the counter products which often have more harmful ingredients than good. It is important to brief clients on the benefits of using a cosmeceutical (professional) product due to the performance and functionality of its ingredients. The active ingredients are what are referred to as performance ingredients such as hydroxy acids or benzoyl peroxide, which bring about visible change in appearance. Functional ingredients are referred to as the vehicle or acts as the spreading agent. Such indicates the concentration and formula of product, whether it is a gel or foam, et cetera.

Visage and Self-Esteem
A client's improved appearance leads to higher self-esteem. As a professional aesthetician, you have the chance every time you touch your client's skin, the opportunity to improve chronic conditions such as acne, rosacea, fine lines, et cetera. Furthermore, as a professional it is recommended to consistently communicate with your client regarding their evolving skin care needs. It is important to emphasize with the client that topical agents, used for facials or in home care regimen, are the skin's first line of defense against environmental and free-radical damage. Though it may be impossible in the treatment room to turn back the hands of time and make a 45 year-old woman's skin appear as that of a 25 year-old – with specialized and advanced skin care treatments the skin will achieve a healthier glow with less fine lines, dehydration and breakouts.
Understand that the client's self-esteem can be easily harmed by your choice of words – though it is common when working as a paramedical aesthetician to use objective and subjective observation along with medical terminology, the demeanor should never be harsh, condescending, insulting or in any form deprecatory. The ultimate objective is to treat your clients with the utmost respect. The ethical principles that an aesthetician should abide to are similar to that which health care practitioners practice and this is the principle of beneficence or benevolence, which is to do good and no harm. A client may come to you unhappy with their appearance and complaints of failed skin care protocols in the past. As their aesthetician, you have the opportunity to turn things around for this client/patient. Your attitude and expertise should reassure the client/patient that their skin care problems will be resolved over a specific period of time. The outcome is to provide the client/patient with a radiant and rejuvenated visage, which inspires them to continue future skin care treatments – entrusting in them that you are the expert they can turn to for their skin care needs.

Sheilah Danielle Fulton is a licensed aesthetician who has worked in the industry over six years in both medical and day spas. She also has experience as an aesthetician instructor and writer for an academic publisher. Her passion for knowledge and education is one which she enjoys sharing with others. Fulton holds a BS and an MBA in Healthcare Management. Her freelance writing has included articles on product ingredients, mineral cosmetics, holistic sunscreens, fitness, anti-aging creams and more.