Aesthetic Department
The “Nuts & Bolts” of Becoming an Aesthetic Provider: Part 3–Maximizing Your Aesthetic Practice and Client Outcomes Connie Brennan, RN, CPSN, CANS, CPC
The final installment of this 3-part series of articles on becoming an aesthetic provider centers on the steps necessary to maximize an aesthetic medical practice and tips for optimal client outcomes. We discuss the importance of education for the aesthetic provider, the staff, and the client, as well as how to create client loyalty. On the basis of years of experience, “pearls and pitfalls” are discussed, so the novice, intermediate, and advanced aesthetic providers can minimize mistakes and maximize their success in this exciting and growing profession.
I
n Part 1 of The “Nuts and Bolts” of Becoming an Aesthetic Provider series: How Do I Get Started? (Brennan, 2013b), we learned about the basic psychological, educational, business, and legal considerations involved with becoming an aesthetic provider. In Part 2 of The “Nuts and Bolts” of Becoming an Aesthetic Provider: Building Your Aesthetic Practice (Brennan, 2014), we discussed detailed legal (e.g., licensure, scope of practice, malpractice, and documentation) and business (e.g., establishing “your brand,” developing staff, networking, marketing, and revenue possibilities) aspects of building an aesthetic medical practice. This final installment of the series addresses a more comprehensive view for the education of the aesthetic provider, the client, and the staff;
Connie Brennan, RN, CPSN, CANS, CPC, is currently the Director of Medical Aesthetic Education at the Center for Advanced Aesthetics at Life Time Fitness and President/Founder of Aesthetic Enhancement Solutions, LLC. Connie is a licensed registered nurse in 10 states and has earned advanced certifications in aesthetic injectables, laser resurfacing, skin care, sclerotherapy, and perioperative nursing over the course of 25 years in aesthetic medicine. Connie has worked as an expert alongside the ASPSN task force in creating the first Certified Aesthetic Nurse Specialist (CANS) examination. The author is a consultant to Allergan, Inc., Medicis Aesthetics/Valeant Pharmaceuticals, and Nordson Micromedics, Inc., but has not received any funding to write or publish this article. Address correspondence to Connie Brennan, RN, CPSN, CANS, CPC, 5905 Troy Lane, N, Plymouth, MN 55446 (e-mail: [email protected]). DOI: 10.1097/PSN.0000000000000042
62
www.psnjournalonline.com
practical client care tips to maximize a practice; how to produce positive clinical outcomes; and steps to create client loyalty.
THE “JUNGLE GYM” OF A SUCCESSFUL AESTHETIC MEDICAL PRACTICE In Part 2, we introduced the “Jungle Gym” of a successful aesthetic medical practice to represent the interconnected aspects and to reinforce the importance of each facet (Figure 1). This complicated network of factors must be implemented in concert to achieve positive outcomes for both the budding aesthetic provider, and ultimately, the clients. More specifically, we explore “pearls and pitfalls” for effectively educating the aesthetic provider, the clients, and the staff. We also address client care, which includes client goals, solutions, and outcomes. Incorporating these important aspects into the aesthetic provider’s routine maximizes the aesthetic medical practice and potentiates client loyalty through the consistent delivery of a superior personalized experience.
Education The saying “an investment in knowledge always pays the best interest” has particular relevance when building a successful aesthetic medical practice. Education is so important for success that it figures prominently into the “Jungle Gym” of a successful aesthetic medical practice (Figure 1). Education is the most powerful weapon, which you can use to change the world. (Mandela, 2003)
The acquisition of knowledge through educational and training venues is a lifelong pursuit for an aesthetic provider. The ability to weave art, science, psychology, and business together during a perpetual educational journey enhances skills and increases the odds of achieving the status of a “top notch” aesthetic provider. We discuss the relevant types of training and rationale for pursuing each one, so the aesthetic provider can optimize lifelong education. Volume 34 Number 2 April–June 2014
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 62
5/17/14 1:41 PM
Aesthetic Department
FIGURE 1. The “Jungle Gym” of a successful aesthetic medical practice. AE, adverse event; HIPPA, Health Insurance Portability and Accountability Act of 1996; MOA, mechanisms of action.
AESTHETIC PROVIDER EDUCATION Anyone can be trained to puncture the skin with needles (e.g., venipuncture, insulin for diabetes management, and in vitro fertilization treatments), but it takes a unique knowledge of art, science, psychology, and countless hours of training to achieve superior aesthetic outcomes. Figure 2 highlights the multifaceted education of the aesthetic provider, the client, and the staff; it calls out the specific educational elements involved to create a successful aesthetic medical practice.
Art To truly be successful in aesthetics, one needs to appreciate and understand beauty. Some important aspects of beauty include the following: its history, culture, mathematics, symmetry, harmony, and divine proportions (Brennan, 2013a). All these aspects need to be considered when analyzing a client’s face during the initial and ongoing assessments. Many aesthetic providers have an artistic background, which can be very helpful. Artistry prominently factors into the aesthetic provider’s ability to help clients achieve their optimal beauty potential. Plastic Surgical Nursing
Science Sound knowledge of facial anatomy and physiology, including bone architecture, muscle strength, fat pad areas, and vessel and nerve locations, is paramount in aesthetic medicine. Knowing where blood vessels and nerves intersect, relative to targeted muscles for injection, helps define those critical “danger zones” to be mindful of before embarking on any rejuvenation strategy. A solid understanding of the consequences of skin aging and how this affects skin integrity increases the odds of success. Similarly, keen knowledge of the pros and cons of product choices-–where and when not to use them, mechanisms of action, rheology, safety profiles, duration, and how to prepare and inject them properly (Brennan, 2013a)-– ensures that the aesthetic provider is well equipped to deliver optimal outcomes.
Psychology Understanding the client’s rejuvenation goal(s) is an important first step when providing education (Brennan, 2012). Vivian Diller, PhD, describes the “beauty paradox” as the predicament created by two incompatible messages that our generation has internalized:
www.psnjournalonline.com
63
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 63
5/17/14 1:41 PM
Aesthetic Department
FIGURE 2. The multifaceted role of education in an aesthetic medical practice. AE, adverse event; MOA, mechanisms of action.
Message 1: Deny. Your looks shouldn’t matter. If they do, don’t let anyone know. Stay true to your real self. Let your looks take their natural course as you age.
and medical ethics, it is critical to manage client expectations and not to create false hope. “Under promise and over deliver” is a good mantra to follow.
Message 2: Defy. Your looks should matter, and don’t you forget that. Buy wrinkle creams, work out at the gym, and defy aging at whatever cost, in any way you can. Oh, and be sure to make it look natural! (Diller, 2010)
Training
The aging process can be a daunting concept to understand, let alone explain to clients when contradictory “beauty paradox” messages like these influence clients’ perceptions of themselves. As clients face the realization of their own aging, especially when they take inventory of their face in the mirror, the harsh reality that often sets in can elicit a profound psychological and emotional response. Be prepared for this potential emotional outpouring and redirect client concerns with education on viable options specific to their needs. This will provide hope while mitigating some of the stress that clients may feel during the initial consultation. Be on the lookout for red flags such as body dysmorphic disorder, depression, and other psychological distress. In the spirit of integrity
64
www.psnjournalonline.com
A successful aesthetic provider never stops learning and makes the most of specialized training. Tell me and I forget. Teach me and I remember. Involve me and I learn. (Franklin, 1706–1790)
There are many opportunities for continuing education in aesthetic medicine. As mentioned in Part 1, hands-on training, preceptorships, and Web-based learning can be very helpful to the aesthetic provider. In addition, some companies offer private one-on-one training options and private consulting sessions for continuing education. There are vendor-driven sessions (provided directly by some companies) and continuing medical education courses available online. Take advantage of any and all educational opportunities and create a network of peers in the profession, so you continually share tips and knowledge. Innovative products, techniques, and tips transform the delivery of superior Volume 34 Number 2 April–June 2014
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 64
5/17/14 1:41 PM
Aesthetic Department aesthetic outcomes, keeping educated injectors on the forefront of the industry as it continues to evolve. The aesthetic provider owes it to their clients to maintain a current knowledge base and razor-sharp skills; do not fall prey to complacency by relying only on initial training. Success dictates that aesthetic providers become habitual learners.
THE “LEARNING RELATIONSHIP” In aesthetic medicine, knowledge of anatomy and physiology is critical, but an equally important part of being good at one’s craft is knowing how to effectively treat clients. The foundation of a successful aesthetic medical practice lies in a concept called the “learning relationship.” It is a mutually beneficial consultation process, where the aesthetic provider learns about the client as he or she converses with them. The aesthetic provider should tailor the product, service, or elements associated with it to the client’s specific needs. In turn, clients invest their time and money to benefit from the aesthetic provider’s expertise and assessment of their aesthetic needs. Clients learn about the products, services, and procedures, whereas the aesthetic provider learns about the client. This partnership can set the stage for helping the client achieve personalized aesthetic goals. The greater the effort (i.e., time and money) the client invests in the aesthetic provider, the greater the stake they have in making this “learning relationship” work. Going to a competitor equates with “reinventing” the relationship-–a frustrating, emotional, time- and moneywasting endeavor. It cost five times more to acquire a new customer than to retain an existing one. (Reichheld, 2001)
Forrester Research defines “experienced-based differentiation” as a systematic approach to interacting with clients that consistently builds loyalty (Tomkin, 2010). The three key principles include the following: • Obsess about clients’ needs, not product features • Reinforce brands with every interaction, not just communications • Treat the client experience as a competence, not as just a function As clients look in the mirror during the aesthetic consultation process, prompt them to disclose what they want to achieve and how they want to look (Brennan, 2012). The aesthetic provider’s job is to select a product or procedure that fits the client’s goal(s) and face; it is also important to present the rationale behind the appropriate product or procedure under consideration and the relevant features and benefits of the product or service. The aesthetic provider should seize Plastic Surgical Nursing
this opportunity to credential themselves. A sincere compliment goes a long way in making the client feel at ease because the aesthetic provider identifies a client’s innate beauty while addressing opportunities to improve or maximize their appearance. Personalize the aesthetic experience by remembering and conversing about the personal things relevant to that client (e.g., what is the latest regarding their family, work, and vacation plans). A client who feels genuinely cared for is less apt to engage in negative legal action if faced with a future adverse event (e.g., necrosis). It takes 12 positive service experiences to make up for one negative experience. (R. Newell-Legner, personal communication, January 8, 2014)
A fundamental philosophy of aesthetic medicine is that client–aesthetic provider interactions are even more important than the actual transactions. In other words, rather than just recognizing the economic value of a client, recognize the value of every interaction with that client-–whether it is over the phone, discussions in the clinic with other staff, enrolling in different loyalty programs, or recommending a friend. The impact of client– aesthetic provider interaction activities translates into the following: • Increased level of involvement with the practice • Deeper client–aesthetic provider relationships • Improved level of client engagement • Enhanced client loyalty Expanding opportunities for client interaction and dialog creates more value for the practice because it allows the aesthetic provider to do more things at a lower cost and effort (i.e., it takes considerably more time and money to acquire a new client than to keep an existing one or to obtain a referral).
STAFF EDUCATION Educating the clinical staff is ultimately the responsibility of the aesthetic provider. As discussed in Part 2, the aesthetic provider’s investment of time, product, education, and training of the clinical staff is an important element of success. The clinical staff is the “voice of the practice” and an extension of the aesthetic provider’s brand (Brennan, 2014). Keep them informed of the team approach, and review product and treatment or procedure information with them routinely. Perform treatments on them, so they understand what services clients are receiving and how important the staff’s role is in the entire client experience. Educate the staff on every aspect of the business and the aesthetic provider’s credentials, so they feel appropriately empowered and informed to answer questions over the phone or in person. When the staff understand the www.psnjournalonline.com
65
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 65
5/17/14 1:41 PM
Aesthetic Department products and procedures and believe in the aesthetic provider, they speak firsthand to the talent and abilities of the aesthetic provider.
CLIENT EDUCATION The aesthetic provider’s job is to educate clients and offer solutions, so clients can ultimately choose whether or not to proceed with the solutions presented to them. Education is not selling the products or services provided, but rather it is simply “education with benefits.” “Education with benefits” means that the aesthetic provider is making an investment in their clients’ facial rejuvenation future by thoroughly presenting all the facts and options associated with the potential solutions. The more clients know, the more informed they will become; the more informed they are, the more confidently they will expand their “learning relationship” with the aesthetic provider. Aesthetic providers thrive and shine during the educational process by arming clients with pertinent information; this empowers clients to determine how to spend their money on the basis of solutions provided. Money is less of an objection when the clients are educated on the options that are specific to their needs and result in superior outcomes. It is important that the aesthetic providers give their clients a “reality check.” Lay it out for them-–plainly and honestly: • Total cost for a treatment • Units and syringes involved • Expectation in terms of bruising and discomfort • Duration of products or procedures • Risks and complications involved (i.e., potential adverse events that can occur pre- and posttreatment) • Recommended strategy for achieving particular aesthetic goals and how long this could take It is not the aesthetic provider’s job to determine whether a client can afford a treatment or not. The client may present to the appointment with a proposed budget, but providing recommendations and treatment options will ultimately lead to a more satisfied client. A mutually agreed-upon timeline of when it makes sense to embark on each step of the customized facial rejuvenation strategy goes a long way in managing a client’s budget and their expectations. Similarly, map out what changes may happen over time following each step in the aesthetic plan. The aesthetic provider should strive to provide additional education at every client visit. There is a direct correlation between the amount of client education and increased revenues per client. 66
www.psnjournalonline.com
For example, a client may initially approach the aesthetic provider to have their glabellar area injected with a neurotoxin. They return for their follow-up evaluation with the goal of further softening the static line in their glabellar region. This is the aesthetic provider’s opportunity to inform them about the value of dermal fillers to help support the deep groove. The aesthetic provider takes the time to inform this client about the safety, mechanisms of action, how long dermal fillers typically last, their safety, and so forth. By the next appointment, 3–4 months later, the client requests the addition of dermal filler to their treatment regimen to potentially address deeper wrinkles or folds. The aesthetic provider’s return on investment of time educating this particular client just quadrupled the revenuegenerating potential for him or her. Education = $ + satisfaction + loyalty
Client Care A critical client care goal should be to ensure realistic expectations. Figure 3 describes the aesthetic provider’s client care considerations. Comprehensive client education during the initial consultation is the first step toward ensuring realistic aesthetic expectations. Practical client education tips to enhance understanding and increase the potential of achieving realistic client expectations include the following: • Inform that undertreatment will likely lead to an unsatisfactory outcome. • Discuss their expectations, anxieties, distress, or possible misinformation that could influence their perceptions (e.g., the fear of looking unnatural and pain associated with the procedure/ treatment). • Review the pros and cons of surgical and nonsurgical options. • Discuss all the product choices relevant to their goal(s). • Differentiate the products on the basis of clinical outcomes (both published and provider clinical experience). Aesthetic providers are professionally obligated to recommend solutions to problems and concerns; this helps clients achieve their best look. It is important to educate clients about the difference between correction and prevention of rhytids and the appropriate treatments/products available. With respect to prevention, the aesthetic provider should exercise “L3 or LLL” during the aesthetic consultation process: • Look: Look at the client for symmetry, volume, hyperfunctional rhytids, and so forth. Volume 34 Number 2 April–June 2014
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 66
5/17/14 1:41 PM
Aesthetic Department
FIGURE 3. Client care considerations for the aesthetic provider.
• Listen: Listen to the client for concerns, complaints, and so forth. • Lay it out: Give solutions to their problems. Examples of prevention/correction points to discuss with clients might include the following: • Neurotoxins can be used to prevent lines in the younger adult population (i.e., dynamic lines that have not become static lines to date). • Neurotoxins can be used to decrease the gingival display commonly associated with “gummy smile.” • Dermal fillers can be used to fill the sagging lobe by restoring earlobe volume. • Neurotoxins are routinely used to treat facial widening because of robust masseter muscles. • Dermal fillers and volume enhancers may stimulate collagen for anti-aging purposes. • Combination therapy (i.e., neurotoxins and dermal fillers) may be needed to achieve desired outcome. It is also incumbent upon the aesthetic provider to be cognizant of their clients’ emotional, economic, and psychological well-being. During the aesthetic consultation process, probe how clients feel about themselves (Brennan, 2012). Similarly, determine whether clients have a budget to abide by, and then discuss full versus partial correction to comply with their financial situation. The aesthetic provider must strive to provide their clients with superior clinical outcomes, exceed their expectations, and give them the “best bang for their buck.” Clients also need to understand the Plastic Surgical Nursing
commitment to long-term maintenance with sufficient product. An exceptional experience during the initial phone conversation, the aesthetic consultation, and the treatment-–providing solution-based options—propel the client to a better understanding of the continuum of care, both surgical and nonsurgical. This ultimately results in client loyalty (see Figure 4).
CLIENT LOYALTY In aesthetic medicine, loyal clients represent the most defensible and enduring competitive asset. In Part 2, we described the merits of client loyalty programs (Brennan, 2014). To reinforce the importance of client loyalty, consider the following traditional sources of “fleeting” competitive advantage: • Product expertise can be duplicated. • Promotions and price specials can be matched or beaten. • Service can be duplicated. • Key knowledge keepers from the practice can be recruited away. Managing clients’ experiences is the best bet to building long-term relationships and ultimately loyalty. There are three key factors in the new era of client loyalty as follows: • Economic: Clients are attuned to calculating the value of price and quickly sizing up alternative selection offers. • Functional: This is the client’s desire for quality service and instant results. www.psnjournalonline.com
67
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 67
5/17/14 1:41 PM
Aesthetic Department
FIGURE 4. Button up the practice! The “Practice Building Continuum” for successful outcomes. FIGURE 5. “Client-centric” view of an aesthetic medical practice.
• Emotional: Clients without loyalty = minimal emotional bond. What are some tangible ways to instill loyalty in clients? Clients are looking for a superior personalized experience. Clients look for an experience that is: • Approachable (i.e., not stuffy or pretentious) • Connected (i.e., clients want to connect with the aesthetic provider, the staff, and be educated) • Customized (i.e., to their unique needs, their issues, and their concerns) • A results-driven investment (i.e., a superior personalized experience is a great value for the superior clinical results obtained) Once positive outcomes are achieved and the client is satisfied with their care, they develop loyalty over time. This eventually translates into the client telling their friends about their great experience, which eventually turns into referrals of new clients to the aesthetic provider’s practice.
PRACTICE BUILDING CONTINUUM The aesthetic provider will maximize their potential for success if they keep in mind how the following key “buttons” of an aesthetic medical practice connect and depend on each other to progress on to the next one (Figure 4). The aesthetic provider cannot just offer solutions; they must precede it by being an excellent educator to their clients. The aesthetic provider cannot achieve client satisfaction without first obtaining positive outcomes. Although Figure 4 may seem self-evident, it is, at times, easy to lose sight of the importance of the following
68
www.psnjournalonline.com
these “buttons” well at the same time to ultimately drive one’s aesthetic medical practice.
THE ABCs OF AESTHETIC MEDICINE • Assessment • Build client loyalty • Consents reviewed and signed by all clients prior to treatment • Discuss options and document • Educate • Facial rejuvenation is the goal • Give solutions • Harmony and balance • Injection technique is crucial • Joint collaborative efforts with continuum of care specialists • Know facial anatomy and physiology • Listen to client’s needs • Malpractice insurance/legal counsel • Natural results • Outcomes need to be excellent • Photographs are the best documentation • Realistic expectations • Symmetry • Training • Under-promise and over-deliver • Volumization is needed in most faces older than 40 years • Write out plan on paper • X-ceptional client experience • You are the reason the clients return to the office • Zero tolerance for error
Volume 34 Number 2 April–June 2014
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 68
5/17/14 1:41 PM
Aesthetic Department
CLIENT-CENTRIC PRACTICE Consistently high client satisfaction is the holy grail of every aesthetic medical practice, and this ultimate goal is easier to attain as long as the aesthetic provider keeps their clients’ goals, best interests, and positive clinical outcomes at the center of everything they do (Figure 5).
CONCLUSION Maximizing an aesthetic medical practice to deliver superior client outcomes involves education of the aesthetic provider, the staff, and the client. The aesthetic provider should take advantage of every educational opportunity, and consistently doing so throughout their career increases the odds of obtaining superior clinical outcomes. Educating the clinical staff—the “voice of the practice”—on the products and procedures and injecting them routinely will ensure that clients receive accurate and timely information about the aesthetic provider’s abilities and the services provided. Consistently investing time in educating clients on their options and what to realistically expect from the products and services is a proven way to manage client expectations. Making client care a core competency ensures delivery of superior outcomes and ultimately increases client loyalty. An aesthetic provider who consistently embraces the “Practice Building Continuum,” has a
Plastic Surgical Nursing
“client-centric” view of their practice and who engages in all the facets of the “Jungle Gym” of a successful aesthetic medical practice has the potential to build a rewarding career.
REFERENCES
Brennan, C. (2012). Art of the aesthetic consultation. Plastic Surgical Nursing, 32(1), 12–16; quiz 17–18. Brennan, C. (2013a). Dermal fillers and volume enhancers for facial rejuvenation. Plastic Surgical Nursing, 33(3), 118–130. Brennan, C. (2013b). The “Nuts & Bolts” of becoming an aesthetic provider: Part 1—how do I get started? Plastic Surgical Nursing, 33(4), 179–184. Brennan, C. (2014). The “Nuts & Bolts” of becoming an aesthetic provider: Part 2—building your aesthetic practice. Plastic Surgical Nursing, 34(1), 1–6. Diller, V. (2010). Face It: What Women Really Feel as Their Looks Change. Carlsbad, NM: Hay House. Franklin, B. (1706–1790). Brainy quote. Retrieved January 3, 2014, from http://www.brainyquote.com/quotes/quotes/b/benjaminfr383997.html Mandela, N. (2003). Lighting your way to a better future. Nelson Mandela Centre of Memory. Retrieved January 3, 2014, from http://db.nelsonmandela.org/speeches/pub_view.asp?pg=item &ItemID=NMS909&txtstr=education Reichheld, F. (2001). The loyalty effect. Boston, MA: Harvard Business School Press. Tomkin, B. (2010). Build your customer experience roadmap. Retrieved January 3, 2014, from http://www.forbes. com/2010/01/12/customer-experience-loyalty-cmo-networkbruce-temkin.html
www.psnjournalonline.com
69
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 69
5/17/14 1:41 PM
The “Nuts & Bolts” of Becoming an Aesthetic Provider: Part 3–Maximizing Your Aesthetic Practice and Client Outcomes Connie Brennan, RN, CPSN, CANS, CPC
The final installment of this 3-part series of articles on becoming an aesthetic provider centers on the steps necessary to maximize an aesthetic medical practice and tips for optimal client outcomes. We discuss the importance of education for the aesthetic provider, the staff, and the client, as well as how to create client loyalty. On the basis of years of experience, “pearls and pitfalls” are discussed, so the novice, intermediate, and advanced aesthetic providers can minimize mistakes and maximize their success in this exciting and growing profession.
I
n Part 1 of The “Nuts and Bolts” of Becoming an Aesthetic Provider series: How Do I Get Started? (Brennan, 2013b), we learned about the basic psychological, educational, business, and legal considerations involved with becoming an aesthetic provider. In Part 2 of The “Nuts and Bolts” of Becoming an Aesthetic Provider: Building Your Aesthetic Practice (Brennan, 2014), we discussed detailed legal (e.g., licensure, scope of practice, malpractice, and documentation) and business (e.g., establishing “your brand,” developing staff, networking, marketing, and revenue possibilities) aspects of building an aesthetic medical practice. This final installment of the series addresses a more comprehensive view for the education of the aesthetic provider, the client, and the staff;
Connie Brennan, RN, CPSN, CANS, CPC, is currently the Director of Medical Aesthetic Education at the Center for Advanced Aesthetics at Life Time Fitness and President/Founder of Aesthetic Enhancement Solutions, LLC. Connie is a licensed registered nurse in 10 states and has earned advanced certifications in aesthetic injectables, laser resurfacing, skin care, sclerotherapy, and perioperative nursing over the course of 25 years in aesthetic medicine. Connie has worked as an expert alongside the ASPSN task force in creating the first Certified Aesthetic Nurse Specialist (CANS) examination. The author is a consultant to Allergan, Inc., Medicis Aesthetics/Valeant Pharmaceuticals, and Nordson Micromedics, Inc., but has not received any funding to write or publish this article. Address correspondence to Connie Brennan, RN, CPSN, CANS, CPC, 5905 Troy Lane, N, Plymouth, MN 55446 (e-mail: [email protected]). DOI: 10.1097/PSN.0000000000000042
62
www.psnjournalonline.com
practical client care tips to maximize a practice; how to produce positive clinical outcomes; and steps to create client loyalty.
THE “JUNGLE GYM” OF A SUCCESSFUL AESTHETIC MEDICAL PRACTICE In Part 2, we introduced the “Jungle Gym” of a successful aesthetic medical practice to represent the interconnected aspects and to reinforce the importance of each facet (Figure 1). This complicated network of factors must be implemented in concert to achieve positive outcomes for both the budding aesthetic provider, and ultimately, the clients. More specifically, we explore “pearls and pitfalls” for effectively educating the aesthetic provider, the clients, and the staff. We also address client care, which includes client goals, solutions, and outcomes. Incorporating these important aspects into the aesthetic provider’s routine maximizes the aesthetic medical practice and potentiates client loyalty through the consistent delivery of a superior personalized experience.
Education The saying “an investment in knowledge always pays the best interest” has particular relevance when building a successful aesthetic medical practice. Education is so important for success that it figures prominently into the “Jungle Gym” of a successful aesthetic medical practice (Figure 1). Education is the most powerful weapon, which you can use to change the world. (Mandela, 2003)
The acquisition of knowledge through educational and training venues is a lifelong pursuit for an aesthetic provider. The ability to weave art, science, psychology, and business together during a perpetual educational journey enhances skills and increases the odds of achieving the status of a “top notch” aesthetic provider. We discuss the relevant types of training and rationale for pursuing each one, so the aesthetic provider can optimize lifelong education. Volume 34 Number 2 April–June 2014
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 62
5/17/14 1:41 PM
Aesthetic Department
FIGURE 1. The “Jungle Gym” of a successful aesthetic medical practice. AE, adverse event; HIPPA, Health Insurance Portability and Accountability Act of 1996; MOA, mechanisms of action.
AESTHETIC PROVIDER EDUCATION Anyone can be trained to puncture the skin with needles (e.g., venipuncture, insulin for diabetes management, and in vitro fertilization treatments), but it takes a unique knowledge of art, science, psychology, and countless hours of training to achieve superior aesthetic outcomes. Figure 2 highlights the multifaceted education of the aesthetic provider, the client, and the staff; it calls out the specific educational elements involved to create a successful aesthetic medical practice.
Art To truly be successful in aesthetics, one needs to appreciate and understand beauty. Some important aspects of beauty include the following: its history, culture, mathematics, symmetry, harmony, and divine proportions (Brennan, 2013a). All these aspects need to be considered when analyzing a client’s face during the initial and ongoing assessments. Many aesthetic providers have an artistic background, which can be very helpful. Artistry prominently factors into the aesthetic provider’s ability to help clients achieve their optimal beauty potential. Plastic Surgical Nursing
Science Sound knowledge of facial anatomy and physiology, including bone architecture, muscle strength, fat pad areas, and vessel and nerve locations, is paramount in aesthetic medicine. Knowing where blood vessels and nerves intersect, relative to targeted muscles for injection, helps define those critical “danger zones” to be mindful of before embarking on any rejuvenation strategy. A solid understanding of the consequences of skin aging and how this affects skin integrity increases the odds of success. Similarly, keen knowledge of the pros and cons of product choices-–where and when not to use them, mechanisms of action, rheology, safety profiles, duration, and how to prepare and inject them properly (Brennan, 2013a)-– ensures that the aesthetic provider is well equipped to deliver optimal outcomes.
Psychology Understanding the client’s rejuvenation goal(s) is an important first step when providing education (Brennan, 2012). Vivian Diller, PhD, describes the “beauty paradox” as the predicament created by two incompatible messages that our generation has internalized:
www.psnjournalonline.com
63
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 63
5/17/14 1:41 PM
Aesthetic Department
FIGURE 2. The multifaceted role of education in an aesthetic medical practice. AE, adverse event; MOA, mechanisms of action.
Message 1: Deny. Your looks shouldn’t matter. If they do, don’t let anyone know. Stay true to your real self. Let your looks take their natural course as you age.
and medical ethics, it is critical to manage client expectations and not to create false hope. “Under promise and over deliver” is a good mantra to follow.
Message 2: Defy. Your looks should matter, and don’t you forget that. Buy wrinkle creams, work out at the gym, and defy aging at whatever cost, in any way you can. Oh, and be sure to make it look natural! (Diller, 2010)
Training
The aging process can be a daunting concept to understand, let alone explain to clients when contradictory “beauty paradox” messages like these influence clients’ perceptions of themselves. As clients face the realization of their own aging, especially when they take inventory of their face in the mirror, the harsh reality that often sets in can elicit a profound psychological and emotional response. Be prepared for this potential emotional outpouring and redirect client concerns with education on viable options specific to their needs. This will provide hope while mitigating some of the stress that clients may feel during the initial consultation. Be on the lookout for red flags such as body dysmorphic disorder, depression, and other psychological distress. In the spirit of integrity
64
www.psnjournalonline.com
A successful aesthetic provider never stops learning and makes the most of specialized training. Tell me and I forget. Teach me and I remember. Involve me and I learn. (Franklin, 1706–1790)
There are many opportunities for continuing education in aesthetic medicine. As mentioned in Part 1, hands-on training, preceptorships, and Web-based learning can be very helpful to the aesthetic provider. In addition, some companies offer private one-on-one training options and private consulting sessions for continuing education. There are vendor-driven sessions (provided directly by some companies) and continuing medical education courses available online. Take advantage of any and all educational opportunities and create a network of peers in the profession, so you continually share tips and knowledge. Innovative products, techniques, and tips transform the delivery of superior Volume 34 Number 2 April–June 2014
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 64
5/17/14 1:41 PM
Aesthetic Department aesthetic outcomes, keeping educated injectors on the forefront of the industry as it continues to evolve. The aesthetic provider owes it to their clients to maintain a current knowledge base and razor-sharp skills; do not fall prey to complacency by relying only on initial training. Success dictates that aesthetic providers become habitual learners.
THE “LEARNING RELATIONSHIP” In aesthetic medicine, knowledge of anatomy and physiology is critical, but an equally important part of being good at one’s craft is knowing how to effectively treat clients. The foundation of a successful aesthetic medical practice lies in a concept called the “learning relationship.” It is a mutually beneficial consultation process, where the aesthetic provider learns about the client as he or she converses with them. The aesthetic provider should tailor the product, service, or elements associated with it to the client’s specific needs. In turn, clients invest their time and money to benefit from the aesthetic provider’s expertise and assessment of their aesthetic needs. Clients learn about the products, services, and procedures, whereas the aesthetic provider learns about the client. This partnership can set the stage for helping the client achieve personalized aesthetic goals. The greater the effort (i.e., time and money) the client invests in the aesthetic provider, the greater the stake they have in making this “learning relationship” work. Going to a competitor equates with “reinventing” the relationship-–a frustrating, emotional, time- and moneywasting endeavor. It cost five times more to acquire a new customer than to retain an existing one. (Reichheld, 2001)
Forrester Research defines “experienced-based differentiation” as a systematic approach to interacting with clients that consistently builds loyalty (Tomkin, 2010). The three key principles include the following: • Obsess about clients’ needs, not product features • Reinforce brands with every interaction, not just communications • Treat the client experience as a competence, not as just a function As clients look in the mirror during the aesthetic consultation process, prompt them to disclose what they want to achieve and how they want to look (Brennan, 2012). The aesthetic provider’s job is to select a product or procedure that fits the client’s goal(s) and face; it is also important to present the rationale behind the appropriate product or procedure under consideration and the relevant features and benefits of the product or service. The aesthetic provider should seize Plastic Surgical Nursing
this opportunity to credential themselves. A sincere compliment goes a long way in making the client feel at ease because the aesthetic provider identifies a client’s innate beauty while addressing opportunities to improve or maximize their appearance. Personalize the aesthetic experience by remembering and conversing about the personal things relevant to that client (e.g., what is the latest regarding their family, work, and vacation plans). A client who feels genuinely cared for is less apt to engage in negative legal action if faced with a future adverse event (e.g., necrosis). It takes 12 positive service experiences to make up for one negative experience. (R. Newell-Legner, personal communication, January 8, 2014)
A fundamental philosophy of aesthetic medicine is that client–aesthetic provider interactions are even more important than the actual transactions. In other words, rather than just recognizing the economic value of a client, recognize the value of every interaction with that client-–whether it is over the phone, discussions in the clinic with other staff, enrolling in different loyalty programs, or recommending a friend. The impact of client– aesthetic provider interaction activities translates into the following: • Increased level of involvement with the practice • Deeper client–aesthetic provider relationships • Improved level of client engagement • Enhanced client loyalty Expanding opportunities for client interaction and dialog creates more value for the practice because it allows the aesthetic provider to do more things at a lower cost and effort (i.e., it takes considerably more time and money to acquire a new client than to keep an existing one or to obtain a referral).
STAFF EDUCATION Educating the clinical staff is ultimately the responsibility of the aesthetic provider. As discussed in Part 2, the aesthetic provider’s investment of time, product, education, and training of the clinical staff is an important element of success. The clinical staff is the “voice of the practice” and an extension of the aesthetic provider’s brand (Brennan, 2014). Keep them informed of the team approach, and review product and treatment or procedure information with them routinely. Perform treatments on them, so they understand what services clients are receiving and how important the staff’s role is in the entire client experience. Educate the staff on every aspect of the business and the aesthetic provider’s credentials, so they feel appropriately empowered and informed to answer questions over the phone or in person. When the staff understand the www.psnjournalonline.com
65
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 65
5/17/14 1:41 PM
Aesthetic Department products and procedures and believe in the aesthetic provider, they speak firsthand to the talent and abilities of the aesthetic provider.
CLIENT EDUCATION The aesthetic provider’s job is to educate clients and offer solutions, so clients can ultimately choose whether or not to proceed with the solutions presented to them. Education is not selling the products or services provided, but rather it is simply “education with benefits.” “Education with benefits” means that the aesthetic provider is making an investment in their clients’ facial rejuvenation future by thoroughly presenting all the facts and options associated with the potential solutions. The more clients know, the more informed they will become; the more informed they are, the more confidently they will expand their “learning relationship” with the aesthetic provider. Aesthetic providers thrive and shine during the educational process by arming clients with pertinent information; this empowers clients to determine how to spend their money on the basis of solutions provided. Money is less of an objection when the clients are educated on the options that are specific to their needs and result in superior outcomes. It is important that the aesthetic providers give their clients a “reality check.” Lay it out for them-–plainly and honestly: • Total cost for a treatment • Units and syringes involved • Expectation in terms of bruising and discomfort • Duration of products or procedures • Risks and complications involved (i.e., potential adverse events that can occur pre- and posttreatment) • Recommended strategy for achieving particular aesthetic goals and how long this could take It is not the aesthetic provider’s job to determine whether a client can afford a treatment or not. The client may present to the appointment with a proposed budget, but providing recommendations and treatment options will ultimately lead to a more satisfied client. A mutually agreed-upon timeline of when it makes sense to embark on each step of the customized facial rejuvenation strategy goes a long way in managing a client’s budget and their expectations. Similarly, map out what changes may happen over time following each step in the aesthetic plan. The aesthetic provider should strive to provide additional education at every client visit. There is a direct correlation between the amount of client education and increased revenues per client. 66
www.psnjournalonline.com
For example, a client may initially approach the aesthetic provider to have their glabellar area injected with a neurotoxin. They return for their follow-up evaluation with the goal of further softening the static line in their glabellar region. This is the aesthetic provider’s opportunity to inform them about the value of dermal fillers to help support the deep groove. The aesthetic provider takes the time to inform this client about the safety, mechanisms of action, how long dermal fillers typically last, their safety, and so forth. By the next appointment, 3–4 months later, the client requests the addition of dermal filler to their treatment regimen to potentially address deeper wrinkles or folds. The aesthetic provider’s return on investment of time educating this particular client just quadrupled the revenuegenerating potential for him or her. Education = $ + satisfaction + loyalty
Client Care A critical client care goal should be to ensure realistic expectations. Figure 3 describes the aesthetic provider’s client care considerations. Comprehensive client education during the initial consultation is the first step toward ensuring realistic aesthetic expectations. Practical client education tips to enhance understanding and increase the potential of achieving realistic client expectations include the following: • Inform that undertreatment will likely lead to an unsatisfactory outcome. • Discuss their expectations, anxieties, distress, or possible misinformation that could influence their perceptions (e.g., the fear of looking unnatural and pain associated with the procedure/ treatment). • Review the pros and cons of surgical and nonsurgical options. • Discuss all the product choices relevant to their goal(s). • Differentiate the products on the basis of clinical outcomes (both published and provider clinical experience). Aesthetic providers are professionally obligated to recommend solutions to problems and concerns; this helps clients achieve their best look. It is important to educate clients about the difference between correction and prevention of rhytids and the appropriate treatments/products available. With respect to prevention, the aesthetic provider should exercise “L3 or LLL” during the aesthetic consultation process: • Look: Look at the client for symmetry, volume, hyperfunctional rhytids, and so forth. Volume 34 Number 2 April–June 2014
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 66
5/17/14 1:41 PM
Aesthetic Department
FIGURE 3. Client care considerations for the aesthetic provider.
• Listen: Listen to the client for concerns, complaints, and so forth. • Lay it out: Give solutions to their problems. Examples of prevention/correction points to discuss with clients might include the following: • Neurotoxins can be used to prevent lines in the younger adult population (i.e., dynamic lines that have not become static lines to date). • Neurotoxins can be used to decrease the gingival display commonly associated with “gummy smile.” • Dermal fillers can be used to fill the sagging lobe by restoring earlobe volume. • Neurotoxins are routinely used to treat facial widening because of robust masseter muscles. • Dermal fillers and volume enhancers may stimulate collagen for anti-aging purposes. • Combination therapy (i.e., neurotoxins and dermal fillers) may be needed to achieve desired outcome. It is also incumbent upon the aesthetic provider to be cognizant of their clients’ emotional, economic, and psychological well-being. During the aesthetic consultation process, probe how clients feel about themselves (Brennan, 2012). Similarly, determine whether clients have a budget to abide by, and then discuss full versus partial correction to comply with their financial situation. The aesthetic provider must strive to provide their clients with superior clinical outcomes, exceed their expectations, and give them the “best bang for their buck.” Clients also need to understand the Plastic Surgical Nursing
commitment to long-term maintenance with sufficient product. An exceptional experience during the initial phone conversation, the aesthetic consultation, and the treatment-–providing solution-based options—propel the client to a better understanding of the continuum of care, both surgical and nonsurgical. This ultimately results in client loyalty (see Figure 4).
CLIENT LOYALTY In aesthetic medicine, loyal clients represent the most defensible and enduring competitive asset. In Part 2, we described the merits of client loyalty programs (Brennan, 2014). To reinforce the importance of client loyalty, consider the following traditional sources of “fleeting” competitive advantage: • Product expertise can be duplicated. • Promotions and price specials can be matched or beaten. • Service can be duplicated. • Key knowledge keepers from the practice can be recruited away. Managing clients’ experiences is the best bet to building long-term relationships and ultimately loyalty. There are three key factors in the new era of client loyalty as follows: • Economic: Clients are attuned to calculating the value of price and quickly sizing up alternative selection offers. • Functional: This is the client’s desire for quality service and instant results. www.psnjournalonline.com
67
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 67
5/17/14 1:41 PM
Aesthetic Department
FIGURE 4. Button up the practice! The “Practice Building Continuum” for successful outcomes. FIGURE 5. “Client-centric” view of an aesthetic medical practice.
• Emotional: Clients without loyalty = minimal emotional bond. What are some tangible ways to instill loyalty in clients? Clients are looking for a superior personalized experience. Clients look for an experience that is: • Approachable (i.e., not stuffy or pretentious) • Connected (i.e., clients want to connect with the aesthetic provider, the staff, and be educated) • Customized (i.e., to their unique needs, their issues, and their concerns) • A results-driven investment (i.e., a superior personalized experience is a great value for the superior clinical results obtained) Once positive outcomes are achieved and the client is satisfied with their care, they develop loyalty over time. This eventually translates into the client telling their friends about their great experience, which eventually turns into referrals of new clients to the aesthetic provider’s practice.
PRACTICE BUILDING CONTINUUM The aesthetic provider will maximize their potential for success if they keep in mind how the following key “buttons” of an aesthetic medical practice connect and depend on each other to progress on to the next one (Figure 4). The aesthetic provider cannot just offer solutions; they must precede it by being an excellent educator to their clients. The aesthetic provider cannot achieve client satisfaction without first obtaining positive outcomes. Although Figure 4 may seem self-evident, it is, at times, easy to lose sight of the importance of the following
68
www.psnjournalonline.com
these “buttons” well at the same time to ultimately drive one’s aesthetic medical practice.
THE ABCs OF AESTHETIC MEDICINE • Assessment • Build client loyalty • Consents reviewed and signed by all clients prior to treatment • Discuss options and document • Educate • Facial rejuvenation is the goal • Give solutions • Harmony and balance • Injection technique is crucial • Joint collaborative efforts with continuum of care specialists • Know facial anatomy and physiology • Listen to client’s needs • Malpractice insurance/legal counsel • Natural results • Outcomes need to be excellent • Photographs are the best documentation • Realistic expectations • Symmetry • Training • Under-promise and over-deliver • Volumization is needed in most faces older than 40 years • Write out plan on paper • X-ceptional client experience • You are the reason the clients return to the office • Zero tolerance for error
Volume 34 Number 2 April–June 2014
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 68
5/17/14 1:41 PM
Aesthetic Department
CLIENT-CENTRIC PRACTICE Consistently high client satisfaction is the holy grail of every aesthetic medical practice, and this ultimate goal is easier to attain as long as the aesthetic provider keeps their clients’ goals, best interests, and positive clinical outcomes at the center of everything they do (Figure 5).
CONCLUSION Maximizing an aesthetic medical practice to deliver superior client outcomes involves education of the aesthetic provider, the staff, and the client. The aesthetic provider should take advantage of every educational opportunity, and consistently doing so throughout their career increases the odds of obtaining superior clinical outcomes. Educating the clinical staff—the “voice of the practice”—on the products and procedures and injecting them routinely will ensure that clients receive accurate and timely information about the aesthetic provider’s abilities and the services provided. Consistently investing time in educating clients on their options and what to realistically expect from the products and services is a proven way to manage client expectations. Making client care a core competency ensures delivery of superior outcomes and ultimately increases client loyalty. An aesthetic provider who consistently embraces the “Practice Building Continuum,” has a
Plastic Surgical Nursing
“client-centric” view of their practice and who engages in all the facets of the “Jungle Gym” of a successful aesthetic medical practice has the potential to build a rewarding career.
REFERENCES
Brennan, C. (2012). Art of the aesthetic consultation. Plastic Surgical Nursing, 32(1), 12–16; quiz 17–18. Brennan, C. (2013a). Dermal fillers and volume enhancers for facial rejuvenation. Plastic Surgical Nursing, 33(3), 118–130. Brennan, C. (2013b). The “Nuts & Bolts” of becoming an aesthetic provider: Part 1—how do I get started? Plastic Surgical Nursing, 33(4), 179–184. Brennan, C. (2014). The “Nuts & Bolts” of becoming an aesthetic provider: Part 2—building your aesthetic practice. Plastic Surgical Nursing, 34(1), 1–6. Diller, V. (2010). Face It: What Women Really Feel as Their Looks Change. Carlsbad, NM: Hay House. Franklin, B. (1706–1790). Brainy quote. Retrieved January 3, 2014, from http://www.brainyquote.com/quotes/quotes/b/benjaminfr383997.html Mandela, N. (2003). Lighting your way to a better future. Nelson Mandela Centre of Memory. Retrieved January 3, 2014, from http://db.nelsonmandela.org/speeches/pub_view.asp?pg=item &ItemID=NMS909&txtstr=education Reichheld, F. (2001). The loyalty effect. Boston, MA: Harvard Business School Press. Tomkin, B. (2010). Build your customer experience roadmap. Retrieved January 3, 2014, from http://www.forbes. com/2010/01/12/customer-experience-loyalty-cmo-networkbruce-temkin.html
www.psnjournalonline.com
69
Copyright © 2014 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
PSN-D-14-00010_LR 69
5/17/14 1:41 PM
