Medical aesthetic practitioners have historically shied away from procedures other than injectables, preferring to focus on toxin and dermal filler procedures to give their patients the results they are looking for. There are several reasons for this: some practitioners feel that they wish to stand out by offering only medical procedures, which most agree injectables are (or should be—but let us not digress), others prefer the high profit margins that can be achieved with injectables, and some simply lack confidence in treatments that may not have fast, tangible results. But are practitioners doing themselves a disservice by limiting their treatment portfolio to injectables only?
A diverse treatment portfolio
In the increasingly competitive market that is aesthetics, it is important for practitioners to have their own unique selling point to stand out from the crowd and draw patients in. One way for a practitioner to do this is to diversify their treatment portfolio in order to offer their patients a holistic approach to their treatment. Non-injectable treatments, such as chemical peels, microneedling and skin care, offer a way for practitioners to do exactly this.
Chemical peels
Chemical or acid peels, as the name suggests, involve the application of chemicals to the skin to dissolve the bonds between skin cells so that they exfoliate over the following days. The length of the exfoliation process is determined by the depth of the peel (McGloin, 2018). This has a range of benefits, but most importantly, when the exfoliation is complete, it reveals newer, more youthful looking skin. Although all chemical peels offer a holistic approach to skin rejuvenation, the practitioner needs to be aware of the dangers associated with chemical peels. It is imporant that the aesthetic practitioner performing the treatment is qualified to do so, and that the peel is left on for the correct amount of time. Using a self-neutralising peel, which stops the penetration of the peel at the correct depth, can help to avoid complications.
Responsible practitioners should offer aftercare for 5–7 days following a superficial peel. At the very minimum, this should include the use of a medical-grade sunscreen, but most include other products, such as a gentle moisturiser and facewash to avoid the patient using anything harmful while the skin is repairing. Aftercare is of course another cost to providing this treatment, but it is essential, and so should be taken into consideration when pricing chemical peels.
Microneedling
Microneedling, sometimes referred to as dermal needling or collagen induction therapy, involves the use of a roller with multiple thin needles to penetrate the skin and stimulate collagen production. Microneedling is a development of skin needling technology, which was first pioneered by Orentreich and Orentreich in 1995 for use in treating scars (McCrudden et al, 2015). Since then, an increasing evidence base has developed which supports the use of microneedling in an expanding number of dermatologic conditions (Cohen and Elbuluk, 2016), including acne scarring, surgical scarring, fine lines, wrinkles, stretch marks and cellulite (Zanna, 2016).
Microneedling is the controlled mechanical stimulation of the wound healing process. It works by disruptng skin cell architecture and inducing collgagen production in order to remodel tissue.
Microneedling is a relatively simple and inexpensive treatment that can provide positive outcomes in patients, providing that they are carefully selected by the practitioner. It is imperative that aesthetic practitioners have a thorough understanding of the process of collagenesis and adopt effective treatment protocols in order to obtain optimal results. Some of the most well-renowned products for this treatment are the Nanopore (Sesderma) and Demapen (Natura).
Microneedling can be used as a standalone procedure, but can also be used in combination with serums or mesotherapy. Mesotherapy is the injection of vitamins into the skin in order to improve skin quality and texture and promote a dewy-looking complexion. Clinical data are limited, but some studies have shown a statistically significant improvement in the appearance of the skin when serums are used in conjunction with microneedling therapy, compared with using a serium alone (Fabbrocini et al, 2011).
The benefits of offering no-needle approaches to skin rejuvenation
These procedures tend to be reasonably quick and cheap to train in, meaning that the practitioner is able to add to their treatment portfolio quickly and inexpensively. These treatments also require little in the way of equipment, so have a minimal start-up cost and are suitable for those who do not own or rent a room exclusively. Chemical peels, in particular, can be used to address a long list of concerns, including ageing, acne, hyperpigmentation and dull lifeless skin (Kunde, 2018). The fact that this treatment can be used to treat patients with a variety of skin complaints increases a practitioner's potential patient base. Most aesthetic practitioners will agree that word of mouth is the best way to build your business, so the more patients you can attract, the more potential your business has to grow.
A more holistic approach
From a patient perspective, these treatments allow a practitioner to offer a more holistic approach to their patients' concerns. Patients looking for anti-ageing effects will often benefit from a combination of treatments to replace lost volume, reduce kinetic wrinkles and improve overall skin texture. This allows the practitioner to create a bespoke package for their patient, so that they feel their concerns are truly being addressed. Toxin treatments will help to smooth and prevent dynamic wrinkles, but the overall result will be much more pronounced if there is also improvement in skin texture following a course of peels, with both good aftercare post-chemical peel and good over-all skincare at home. Using peels as an add-on to other treatments can significantly increase a practitioner's profit margins while enhancing patient results, ensuring that patients are satisfied and therefore come back time and again for treatment.
Treatments like chemical peels are frequently sold as a course, with multiple treatments required to address most concerns in the first instance. For optimal results, this should be followed by maintenance treatments 4–6 times a year. This increased frequency, particularly at the beginning of a treatment programme, means that a patient will return for treatment frequently, at short intervals. There are several benefits to this, including the ongoing financial income, but most important is the way that this gives you the opportunity to build a relationship with your patient, ensuring that they will trust you to deliver treatments for years to come. By seeing a patient every few weeks, you keep your name in their mind, so that you will be the first port of call for the next treatment they wish to try. This helps to prevent shopping around, and also gives the practitioner the opportunity to remind the patient face to face when top ups of toxin or filler are due, so that the whole process becomes part of their personal care routine, maximising their results.
Admittedly, chemical peels and the like are cheaper treatments than the traditional injectable procedures and will usually have lower profit margins, which can be off-putting for practitioners. In some ways though, having an ‘entry level’ treatment with a low initial cost can be an excellent way to start a relationship with new patients who are considering aesthetic treatments but may not be ‘ready’ for injectables. It also enables you to cater for a wider variety of budgets; if people want a lower cost alternative to injectable treatments, for example for anti-ageing.
Advertising regulations
Another benefit to the addition of non-injectable treatments to your armamentarium is that these treatments are not subject to the strict advertising regulations that injectables are. The majority are non-prescription, which means that they can be advertised to potential clients and can also be offered as prizes in competitions or raffles, which can be used to spread word of your clinic in your local area. For non-prescribing nurses, it may be helpful to have an additional treatment available that does not require a consultation with a prescriber (and therefore does not attract a consultation fee).
Conclusion
In conclusion, there are benefits and risks to introducing additional, non-injectable procedures into your clinic. Non-injectable treatments, such as chemical peels, microneedling and mesotherapy are a growing market, and enable you to offer combination treatments to enhance patient results, while building relationships with your patients. The peel itself may not have the per-patient profit margin of an injectable treatment, but the overall benefit to your clinic should be considered in terms of opening up your potential reach, building and maintaining relationships and being able to treat a wider range of complaints.