Patient Safety in the Medical Aesthetics Industry

Although Medical Aesthetics helps address patients' aesthetic concerns, at the end of the day, it’s built on the practice of medicine. And when it comes to practicing medicine, the golden rule is to do no harm. “It’s the Hippocratic oath,” says San Francisco facial plastic surgeon Corey S. Maas, MD. “And we remind everybody about that whenever we can.”

Keeping patients safe in the Medical Aesthetics industry requires extra vigilance because the field is constantly evolving—with new treatments, devices, tools, and medications. And even as practitioners continue learning and training to be able to deliver these new innovations, they must always hold fast to two core principles: taking good care of patients and focusing on their well-being.

“This is an outcome-driven business, and it always has been, so you’re not successful unless you have good outcomes,” Dr. Maas says. “But outcomes aren’t just a perfect facelift or rhinoplasty that was exactly what the patient wanted—it’s also about the patient journey through that experience.”

We asked a handful of esteemed colleagues in the industry to explain what patient safety really means and the best ways to help ensure patient safety in a Medical Aesthetics practice.

Patient safety starts with a fundamental mastery of anatomy.

“Anatomy is the most important thing,” says Kim Nichols, MD, FAAD, a Harvard-trained, board-certified dermatologist and cosmetic surgeon with her own practice in Connecticut. “When you’re getting into the industry, it’s vital to learn from mentors and other injectors so you’re making sure safety is a priority, and anatomy is where you start.”

After all, “almost anybody can put a needle through the skin,” notes national aesthetic education director Connie Brennan, MSN, RN, PHN, CANS, CPSN, CPC, ISPAN-F, of St. Louis Park, Minnesota. “But when thinking about the safety of the patient, it is important to think about what is below the skin (such as ligaments, arteries, vessels, nerves, muscles, and fat). Depth matters in placement of any aesthetic products,” she says. “If we don’t understand the anatomy, we cannot place products properly for that patient and achieve the desired outcome.” When injecting cheeks, for example, Brennan considers the lymphatic system underneath and what might get disturbed if she injects too much product. “So, understanding injection anatomy is a key component of what we do as aesthetic injectors,” she says, “and if we do not know anatomy, we should not be injecting!”

To truly master anatomy, Brennan, who is also founder and president of a Medical Aesthetics consulting/training company, recommends investing in industry textbooks, joining professional organizations and attending aesthetic meetings, following top credentialed practitioners for trainings and on social media to see their tips and techniques, researching the many options for introductory and advanced trainings, reading peer reviewed articles from aesthetic journals, and practicing techniques as soon as you learn them on your own. In training her daughter during COVID (when offices were closed), who is a Registered Nurse and starting in the Medical Aesthetics industry, Brennan ordered white Styrofoam® mannequin heads and, using colored dry erase markers, drew the anatomy of the face, including arteries, vessels, nerves, and deep fat pads. “It’s a great way to learn and practice what you are learning when you are studying anatomy,” she says.

Patient safety requires that practitioners never stop learning.

Dr. Nichols is constantly reading journal articles and attending professional conferences to improve her techniques and learn new ones. “I have an open mind about what my colleagues are doing,” she says. “And that has to be continual, or else your skills are going to get dated.” Dr. Nichols also meets with her staff biweekly to share topics and techniques they’ve seen from other experienced injectors in the industry.

Dr. Maas believes in harnessing the power of technology in continuing medical education. “We can do a lot of what we’ve been doing here [at my local society chapter] in California, which is videotaping live demonstrations of experts from around the world, and then having [the videos available] on a good platform that’s always there for people to watch and ask questions about,” he says. He hopes to get more practitioners to submit “How I Do It” videos, ultimately building a library of demos that show “how our facial experts address certain issues, and how we can continue to improve the quality of care and their patient experience,” he says.

"You want to sit down, take the time, and have the patient tell you why they’re there,” Racquel Frisella says.

Patient safety requires comprehensive patient consultations.

For board-certified nurse-practitioner and aesthetic specialist Racquel Frisella, MSN, AGPCNP-BC, the consultation is huge: “That’s where you’re making the personal connection,” she says. And it starts with listening. “You want to sit down, take the time, and have the patient tell you why they’re there,” she says. “If they’re one of those people who’s just like, ‘I want everything,’ get them to focus; ask, ‘what’s your number one priority?’” 

Comprehensive consultations are also important in understanding a patient’s health history. These conversations are a way of understanding their lifestyle, what kinds of medicines they take regularly, and supplements or over-the-counter medicines they imbibe that might cause an adverse reaction to surgery, injectables, or even skincare products, according to Frisella.

Patient safety requires proper patient selection.

Frisella believes in pre-screening patients before they come in to determine whether they’re good candidates for a treatment they’re seeking. “I can look at a photo and see that if somebody has a huge fat pad, for example, they can’t get filler,” she says. “It doesn’t mean I won’t see them, but I set those expectations ahead of time, so patients aren’t coming in and getting super disappointed, thinking they were getting filler that day.”

Patient safety involves offering patient education.

“Education is the biggest part of my consultation—I teach patients why they’re seeing whatever the issue is and walk them through the anatomy part of it,” Frisella explains. Then she suggests treatment options and explains what they involve. “If it’s a filler, I start with the basics: I explain what filler is, how it works, what kind of filler I want to use,” she says. “Then I go over all of the pre- and post-treatment instructions, what they can sort of expect before, during, and after.”

An integral part of this process, according to Dr. Maas, is offering patients open and full disclosure. That means making sure they’re aware of what the options are for their treatment and giving them ample opportunity to ask questions and discuss the risks and benefits associated with them. “Offering the variety of options that might address patients’ concerns—not channeling them into one area or one particular set of devices or drugs, I think that’s really important,” he says.

“And the more they understand, the better,” he adds. “It all works together to a common goal,” which, according to Dr. Maas, is safe, ethical care, desired outcomes, and patient satisfaction.

Patient safety involves having a plan for achieving patients’ goals.

After listening carefully to patients’ needs and concerns, Dr. Nichols lays out the plans she has in mind for achieving them. “I think the biggest thing is making sure there’s transparency from the start,” she says. “It tends to work out well in terms of achieving patients’ goals.”

Dr. Nichols and her team devote a full hour to patient consultations. The staffers explain the procedures they’re set to perform, how long treatment will last, the results they can expect, possible side effects, any measures patients should take in advance (such as stopping retinol for seven days), any measures patients should take afterward (such as avoiding exercise), and pricing all the way down to the sales tax. Perhaps most important is a recommended timeline that helps patients know how to plan. “It really is comprehensive, and again, it’s about taking the time,” she says.

Patient safety involves high standards of care—and oversight.

In the Medical Aesthetics industry, many practitioners work alone or in a small group rather than in a large group specialty practice. For Dr. Maas, that means extra care must be taken to uphold safety and ethics regulations. “You have to set tough standards because you don’t have a big institutional set of standards that are being met with oversight being done by that group,” he says. 

It also means asking tough questions about the new technologies, ideas, and services being offered to patients. “With some of these new things, I think we have to be honest with ourselves, in the best interests of our patients, as to whether they’re really helping,” he says. “Are we really seeing patient improvement? I think,” he adds, “that looking at our own work critically is a big part of learning.”