September 26, 27, 28 2008

Be sure you have reserved your seat, confirmed your acceptance and be prepared to learn within this competive working conference!!

1-888-769-3223

Anna D. Rinehart, Cidesco Diplomate

All workshops for September 2008 Austin Medical Aesthetics FACE ® Conference are opened for Physicians, Nurses and Aesthetic Instructors

Advanced Medical Aesthetics Clinical Skills, Presentations, Discussion,  Medical and Clinical Skin Care Cases Discussed, Workshops

All attendees must have registered, ID badge, Confirmation # of Seat to be permitted in classroom.

Every attempt is made to provide the physicians "Hands-On"  for specialized skin care  treatments

Standardized Medical Aesthetics Textbook

  Medical Aesthetics FACE®

Facial Aesthetics Cosmetic Education ™

New Prepared Books for  Austin 2008 Medical Aesthetics FACE® Conference

Medical Aesthetics Treatments, Procedures Protocols for Physicians Practice 2008

Copyright © 1994-2008 by Anna D. Rinehart,  Facial Aesthetic Nurse- Aesthetician , Facial Aesthetic Instructor, Cidesco Diplomate, Texas Approved CEU Provider

All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission from the author, Anna D. Rinehart.

No procedure may be duplicated without proper instruction. The material contained in all books are designed for clinical instruction. Acknowledgements of appreciation in no way state he/she developed any of its 300 protocols. The author recognizes and appreciates all individuals whom have ever participated with her within her clinic training programs. 

Ms. Rinehart does not seek to promote herself. Her main objective is to seek recognition for all aestheticians (skin care providers) to grow beyond routine facials. Once you meet Ms. Rinehart, you will find it impossible to forget her tenacious, persevering, and committed personality to the advance education for all licensed providers.

 Anna D. Rinehart is a licensed Facial Aesthetics Cosmetic Education Instructor, Cidesco Diplomat, Nurse-aesthetician, and TDRL CEU approved  instructor for aestheticians. There are no licensing boards for the practice of medical aesthetics. There are, however various programs offered for physicians and nurses to learn equipment/product based courses...Ms. Anna D. Rinehart is the only  educational program in the United States that does not endorse any product or equipment and is truly the the first author for the Discipline for Medical Aesthetics for Physicians, Nurses and Aestheticians.

FOREWORD

ACKNOWLEDGEMENTS

Medical Aesthetics for Physicians, Nurses and Aestheticians

To individually thank the educators, with whom I hold the highest esteem, respect, and appreciation would be impossible. So to all of you I say,

"THANK YOU!"

The following is a special thanks to the individuals who have given me support throughout the years:

Dr. Charles N. Verheyden, M.D., Ph.D.

College of Medicine

Dennis J. Lynch, M.D.

College of Medicine

Peter C. Grothaus, M.D.

College of Medicine

Raleigh R. White, IV, M.D.

Vice Chairman, Texas State Board of Health

Charles R Day, M.D., Killeen, Texas

Lawrence Frankel, M.D.

College of Medicine

Lee Ogburn-Russell, R.N., Ph.D.

Temple, Texas

Terri Rose, R.N., M.S.N.

Temple, TX

Mari Paz, S.C.S., R.M.T. (Aesthetician)

Director, European Massage Therapy Institute (EMTI), San Antonio, TX

Rosario Garza-Perez, B.S. Education, S.C.S., R.M.T. (Aesthetician)

Paul Plez Tinsley Jr., M.D.

John J. Conally, M. D. ( Deceased )

New York

James R. Anderson

Killeen, TX

Mari Meyer

Killeen, TX

Board Of Trustees

PREFACE

INTRODUCTION

                    Qualities of an Aesthetician 52

Purpose of a Consult 56

Quality Consultation 58

Initial Consultation 62

Practitioners Appearance 69

Common Problems 69

Practitioners and Self-Esteem 74

Pre-Cosmetic Care 76

Cosmetics and Cancer 78

Product Knowledge 80

Excipients, Emulsions, & Emulsifiers 86

Genetics and the Skin 93

Disorders of the Skin 94

Diseases of the Hair 104

Systematic Diseases 107

Methods of Treatment 114

Facts about Age 118

Senior Patients 119

Physical Changes 121

Pros and Cons of Age 126

Physiologic Changes 128

Ethnic Skin Care 135

Keloids and Scars 149

Ethnic Skin & Emollients 150

Ethnic Hair 150

Classification of Melanin 152

Facial Evaluation 159

Facial Indiscretions 160

Congenital Diseases 160

Stress Syndrome 162

Facial Symmetry 164

Pre-Acne Disorders 170

Acne Disorders 171

Factors for Acne 172

Acne Conditions 174

Degree of Acne 183

CHAPTER 9 OVERVIEW:

Benefits of Retin-A 208

Retin-A Trentinoin 208

Medications 209

Side Effects 209

Skin Conditioning 210

MLD

                History of MLD 215

Effects of MLD 216

Pre & Post Treatments 218

Reactions to MLD 218

10 Common Questions    220

Lasers in Plastic Surgery 224

Physics of Light 225

Organic Sunscreens 243

Inorganic Sunscreen 244

Aseptic Technique 249

OSHA Standards 252

Hand washing 253

Sterilization Practices 257

Exposure Control 266

Practitioners and Plastic Surgery 290

Facelift Post & Pre-Operative 394

Eyelid Surgery 302

Post Dermabrasion 309

Technical Skills 315

Understanding TCA 317

Complications 321

What TCA Can Do 322

S.E.R.T. (Medium Depth) 325

Control Procedures 329

Sterilization Procedures 331

Antiseptic Procedures 332

Practitioner Procedures 333

Universal Precautions 336

Pigment 343

Micropigmentation Machine 346

Choosing Pigment Color 348

Medication Review 352

Procedure Operation 358

Aesthetic Responsibilities 368

Consultations 369

Hyperpigmentation Procedure 376

Eyebrow Application 382

Brow Technique 385

Eyeliner Application 390

Eyeliner Top & Bottom 391

Lip Intro 394

Lip Color 396

Lip Size 397

Lip Liner Do’s & Don’ts 399

Allergic Response 401

CHAPTER 20 OVERVIEW:

Camouflage Techniques 403

Scars & Keloids 405

Scar Coverage 405

Areola Pigmentation 407

Touch-Up Application 409

Scar Reduction 415

Dermaplane 420

Vitamins and Skin Care 429

Basic Skin Care 431

Light Rejuvenation 435

Chemical Peels 436

TAPS 446

APPENDIX III SAMPLE FORMS 516

Medical Aestheticians are relative newcomers to the ever-expanding realm of Aesthetics, and aesthetic surgery. As newcomers, they often find themselves in the challenging position of defining their own identity, while still under the influence of the groups and individuals from which they arose. This is much like an adolescent struggling to establish his/her own identity while still under their parent’s roof. For those interested in this exiting and evolving profession, it is helpful to understand what makes this field unique and the "growing pains" inherent its maturation.

A BRIEF HISTORY OF MEDICAL AESTHETICS:

As with most new fields, an expanding need for services was the driving force for its creation. As the baby boom generation matured, the demand for aesthetic surgery and other aesthetic services is skyrocketed. Traditional aestheticians lacked much of the specialized training needed to help care for patients who were preparing for, or recovering from aesthetic surgical procedures. Many nurses and aestheticians obtained this specialized knowledge by working closely with aesthetic surgeons in their office practices. They soon became an indispensable element in maintaining top quality services in a busy aesthetic practice. Although rewarding, this practice situation limited delivery of care to a particular physician’s protocols and preferences. It also kept the medical aesthetician dependent financially on their doctor’s practice.

More experienced and entrepreneurial medical aestheticians were soon able to achieve independence by establishing their own practices separate from any one particular physician. As with many young adults who strike out on their own for the first time, this newfound independence drew mixed reviews from various groups of "parental" entities. After leaving a physician’s practice, many of the doctor’s patients left with the medical aesthetician to continue their skin care. This migration of patients added yet more competition in an already brutally competitive field. At the same time, other sources of a physician’s practice revenue were declining due to the advent of managed care.

Physician’s also had grave reservations about the quality of care offered by medical aestheticians that were operating without "physician back-up". Their very real concern centered on "scope of practice" issues, and the possibility of complications from procedures commonly practiced by medical aestheticians.

A less than friendly response was also evident from established aestheticians with more conventional "spa" services. By marketing services that included an intimate knowledge of pre-operative skin care, medical aestheticians represented a potent source of competition to salons offering less comprehensive services. Complicating this picture was the fact that many medical aestheticians received a substantial portion of their training in "spa" environments that maintained long-standing relationships with aesthetic surgeons. A negative reaction to training their own competition is easy to understand.

From an uncertain adolescence, medical aestheticians have moved to the stormy young adulthood described above. Happily, many independent medical aestheticians are building thriving practices despite daunting obstacles. Professionalism, a commitment to patient welfare, and high quality services always insure an opportunity for success. Market forces evident in the explosive growth of aesthetic surgery and skin care are also providing cause for optimism. As demand for services escalates, so will opportunity in the field of medical aesthetics, despite stiff competition.

For medical aesthetics to continue maturing into a vigorous adulthood, some important issues must be addressed. The most important single issue is to standardize the body of knowledge and experience that defines the field of medical aesthetics. In the past, knowledge and experience were gained through interaction with a specific aesthetic surgery practice. The information gained was limited to the scope and experience of each individual practice. Complicating matters was aggressive marketing of proprietary cosmetic lines sold in conjunction with these practices. Despite the high quality of many of the products offered, science frequently took a back seat to marketing individual product lines. This delivered information to aestheticians at large in a piecemeal fashion that was heavily tainted by special interests. For medical aestheticians to accurately evaluate new products and techniques, they must evaluate them from a firm foundation of scientific information, rather than marketing hype. In addition, information about procedures and techniques must be collected and organized so that standard of performance and outcomes may be set.

To some extent, information is being disseminated in a more objective way at national meetings, and in medical journals, organizing the basics of this body of knowledge and making it accessible to medical aestheticians is the focus of this textbook.

WHO CAN BECOME A MEDICAL AESTHETICIAN?

There is no commonly accepted path leading to the eventual goal of becoming a medical aesthetician. The vast majority of medical aestheticians reached their goal through a combination of formal education in aesthetics, and/or a period of broad-based exposure to "hands on" patient care. Much of the formal didactic component of training can be obtained in nursing school, cosmetology, and in traditional training as an aesthetician. The exposure to supervised patient care previously came exclusively through working in a physician’s practice. It is now also available by working with independent medical aestheticians that have close associations with aesthetic surgeons. Condensed courses are now available to obtain distilled experience with experienced medical aestheticians over the course of one or two weeks. Some forward thinking junior colleges is also now considering formal (for credit) courses of study. The key to quality training actually lies in working with patients in a supportive environment that emphasizes comprehensive high quality care.

L.P.N. (Licensed Practical Nurse)

R.N. (Registered Nurse)

P.A. (Physician’s Assistant) Medical Aesthetician Clinical Experience

C.S.T. (Certified Surgical Technologist) Continuing Education

Cosmetologist

It is easy to see that the path to medical aesthetics has many beginnings, but all must pass through the vital intermediate step of clinical experience.

For professionals and paraprofessionals involved in all aspects of the management of aesthetics, we are entering a vibrant period of growth in the field. At a time when the wealthiest generation America has ever produced is entering their mature years, the popularity and acceptance of aesthetic surgery is becoming increasingly widespread. This unique combination of increasing demand coupled with the ability to afford service is the catalyst for the field’s growth. Growth has in turn created a role for uniquely trained and qualified individuals who can meet the particular needs of patients who desire a "rejuvenation" of their appearance during these "golden years".

In the past, aesthetics was relegated to the department store cosmetic counter and the neighborhood beauty parlor. Surgeons who performed aesthetic surgery did so in secret, fearing the ridicule and condemnation of their colleagues. With time, attitudes have radically changed and public interest in aesthetics has mushroomed. Such interest has also fueled a tremendous proliferation in aesthetic products and procedures. Proper skin care before and after surgery, have become accepted as essential steps in the continuum of care for aesthetic patients. The huge number of skin care products, along with their increasing sophistication and complexity, is overwhelming for patients and most physicians. To maintain the highest quality care possible for their patients, increasing reliance is being placed on assistance from individuals who specialize in adjunctive skin care employing state-of-the-art products and services. Their knowledge base extends that of a traditional cosmetologist by including an intimate exposure to all aspects of aesthetic surgery, and how it interfaces with skin care in the pre-operative period.

Increasing demand, specialized knowledge, and specialized services have set the stage, and now we can become involved in the interplay among the characters in the aesthetic drama. As with all good productions, the aesthetic drama is one filled with demanding primadonnas, overlapping roles, complex subplots, competition behind the scenes, and a certain amount of treachery. An essential part of understanding the progress of the drama is to have a clear idea of each player’s role. Since many of the character’s roles overlap in various ways during the different "scenes" of the patient’s care, the roles are somewhat challenging to sort out - even for those who arrived when the curtain first went up. This challenge is further complicated by the fact that the importance of each role changes in each scene, and there is always a certain amount of improvisation taking place that is not in the original script. Let’s explore various parts of the drama so that we can understand the whole.

First of all, who decides if the production is successful? In the movies, there are critics galore, and each is working hard to become the pre-eminent authority in the public’s eye. Critics seek to develop a sphere of influence over a population center’s audience. If established, this influence can give them absolute power over the various productions in a given town. Rarely do they ever succeed in building this absolute power base. It is the audience that ultimately determines success. If they come away happy, success can assured no matter what the critics say. The happy audience tells their friends, who see the show, and also leave satisfied. When a production’s popularity is established, even the critics fall in line or, at least, keep a low profile. This analogy holds very true in aesthetics. Competition will create a host of harsh critics of everyone’s work. Ultimately, high quality work, with attention to detail, will win out over the negativity of critics. By making your clients happy, you have created your most powerful weapon against those who would target your expertise. Although quality and perseverance usually lead to success, the critics will always succeed in making your opening a living hell.

What makes an audience choose a particular show? Is it the advertising? Is it the featured stars? Is it the story? As with all popular productions, the answer lies in a combination of many factors. Many times the "hype" gets you into the theater, but you leave dissatisfied with your experience. Even seeing shows that the critics recommend, can leave you with the feeling that you have wasted money on the ticket. With enough disappointments, you become somewhat cynical about advertising, stars and critics. Competition has similarly permeated aesthetics with high-powered marketing. A quick look at any women’s magazine will easily demonstrate the level of marketing sophistication and expertise devoted to the aesthetics audience.

As with the movies, good "hype" in aesthetics may bring clients in the door, but will not necessarily make them loyal and satisfied customers.

A certain amount of marketing is necessary to establish a reputation for quality, but quality itself is the ultimate determination of success. Big "names," as well as big marketing dollars figure prominently in both aesthetics and movies. The "stars" play a leading role in high level aesthetic surgery, and competition among the stars can be brutal. The bigger the star, the bigger their billing (and the more the supporting cast is pushed into the background). In the movies, big stars can be paid big salaries for poor performances. They can also give superb performances in movies that are still considered awful. In aesthetics, the same holds true. "Star quality" can be an important part of the marketing "hype." It does not necessarily guarantee success without the vital contributions of an accomplished supportive cast. Award-winning solo performances are memorable in large part due to the quality of the supporting cast’s having "set the stage." Medical aesthetician’s can "set the stage" for a virtuoso surgical procedure, thus insuring success for the entire production.

Discussing "big names" and big dollars is somewhat intimidating to those who do not necessarily want to go to Hollywood. Productions can be highly successful even when "off- Broadway." In aesthetics, your local audience will support local efforts. The quality of performances in a small town can equal that found in the "big leagues". In fact, a more modest scale of aesthetic practice can give more individual attention to a client’s needs and result in a more rewarding experience for both client and practitioner. Also, big productions need big budgets. High overhead can interfere with quality by "pushing" the production schedule, and forcing poorly planned decisions. A large operation or a big name does not necessarily meet the needs of all clientele, or insure high quality.

Now we know that quality can insure success in a production, let’s talk about this concept of major and minor roles. Aesthetics is similar to acting, in that everyone wants to be the star. As was pointed out in the introductory paragraphs, high quality aesthetics in today’s world should be a "team" effort. The "star" no longer controls the production, or rules the set. This is easy to understand if you think of aesthetic surgery as different scenes in a production.

If pre-operative care is scene one, then the aesthetician can perform the starring role. This scene sets the stage for the following surgical action, and develops the characters that will be involved.

The next scene would be the high drama of a surgical procedure, in which the surgeon would necessarily star. The third scene would involve the post-operative care in which the aesthetician would again take center stage along with the surgeon and other supporting cast. Throughout each of the three scenes, all the players are present in vital roles, with the spotlight always on the patient.

A question frequently asked is "why can’t the aesthetician be center stage during all the acts?" Who writes the aesthetician’s script anyway, and why do we have to follow it? The answer lies in studying how the clinical aesthetician’s role has evolved. In the past, physicians who trained and employed aestheticians to meet their specific narrowly defined needs defined both knowledge base and role. As a greater number of medical and surgical professionals became involved in aesthetics, the knowledge base rapidly expanded. It was no longer possible to maintain top quality care by only employing a single physician’s concepts of proper skin care. As their expertise increased, sophisticated aestheticians began to chafe at restrictions placed on them by their physician employers. They were able to develop a large following of their own clientele, and transition into their own practice, independent of one specific physician. They became "stars" in their own right who were called upon to support many other prominent members of aesthetic teams. Still others were able to thrive while employed in-group medical practices. Their role was still closely defined by their physician employers, but they were able to make many joint decisions based on their uniquely developed knowledge and experience.

These aestheticians could star during some points in the patient’s care, and play supportive roles in others. The answer to how the aesthetician’s role is defined thus lies in understanding how they came onto the "scene" of patient care. Although initially subordinate to physicians, they have since evolved a role as an integral part of the "drama" of quality patient care.

The ambition of newcomers to show business is to ultimately achieve fame and fortune as "star." To reach this lofty goal requires a formal education in acting, as well as a wealth of practical experience in working with masters of the craft. An identical situation exists for medical aestheticians. Education is achieved through formal study, and work with accomplished aestheticians and surgeons. Working with surgeons allows exposure to patients who will, or have, undergone surgical procedures designed to improve appearance.

This teaches what can be accomplished by surgery, when surgery is appropriate, the changes involved in recovery from surgery, and when surgery is best avoided.

An experienced medical aesthetician teaches how to prepare appropriately selected patients for surgery, and help the patients through the physical and emotional aftermath of the procedure.

Their role is one of aesthetic science and psychology to help return the patient smoothly to their social environment. Mastering this craft requires exposure to surgeon and medical aesthetician as a team. No amount of reading or lecture will substitute for experience with actual patients who are facing the anxiety of impending surgery, and the trauma of post- operative recovery.

Although education through experience is vital, so is academic study to master the bewildering variety of products and services available is today’s market. Active experience in medical aesthetics has led to the accumulation of a large amount of information and experience by aestheticians, which was not necessarily shared. Efforts by some uniquely qualified aestheticians are now being made to accumulate and organize their unique body of knowledge into a comprehensive collection. This will provide a framework for the academic education of aestheticians and the exchange of information between them. As the body of knowledge becomes standardized, common ground can be found to allow for certification of the mastery of this knowledge base through exams and certification. Academic study thus includes working with, and sharing knowledge with other medical aestheticians.

We have illustrated how the medical aesthetician’s role is similar to that of actors and actresses in a dramatic production. Through study and experience they develop roles as part of a team to meet the expectations of their audience. The analogy is, however, limited in certain key respects. Most importantly, a stage production is make-believe. A bad performance does not necessarily close the show permanently. The consequences of poor outcomes in aesthetic surgery are a devastating reality to both the patient and all that are involved in their care. The emotional and physical scars are disfiguring, and sometimes permanent. Liabilities in these situations can indeed close the show permanently, and leave some permanent reminders to the practitioners. The high stakes involved in being a team member delivering aesthetic care cannot be overstated. It is important to realize that through high quality support of the patient, medical aestheticians are also supporting themselves and the other team members.

Unlike cosmetologist who care for clients, medical aestheticians help to deliver care to patients. The distinction between the two is a vital one that relates to responsibility. Responsibility for a person’s appearance is also responsibility for the way a person views themselves in relation to the social environment in which they live and work. Meeting the challenge of this responsibility requires an awesome commitment to the welfare of the patient. As with most other things in life, the higher the level of responsibility you are willing to accept, the greater the level of the material and emotional rewards you will reap from you work. Your level of professional focus and interest will be the principle determinate of the quality of your work in the analogy of a stage production; the spotlight is quality, which should be focused without fail on the patient, not the players in the aesthetic drama.

Extractions  Aesthetic Medicine, anna d. rinehart, SCS, Cidesco,  Medical Aesthetics FACE® Instructor