We are living essentially in an Amazon Prime life and skin care has become no exception to this. Our clients come to us wanting results now with little to no downtime. They see before and after pictures on Instagram and want the after photo, without understanding there was a time frame of several months to possibly even a year in between those photos. Their desire is to have one treatment and use a few products – for one week, with the hopes it will reverse all their concerns.
As we know, that’s not an attainable mindset when working with skin. But as aestheticians, it is our job to evolve with the world and industry around us as it is constantly advancing. If the client is not satisfied with what we are offering they will continue their search and go to the next spa. So, what can we do to deliver results in a quicker time frame and gain the long-term loyalty of these clients? The answer is creating a customized treatment plan that includes multiple modalities in a single session. This will deliver results for the various concerns the client may present to the office with.
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CONSULTATIONS
The consultation is the most important step when preparing a client for combination treatments. It is important to make sure the potential client has realistic goals, and as the provider we are taking all considerations into effect. Below, are some things we want to acknowledge while doing a thorough skin analysis to ensure the client is compliant and the treatment will be effective.
Areas of Concern: This will start to give you insight on what modalities to combine.
- Expectations: Is what they are seeking, achievable and realistic? If they start pulling their skin up and pinning things back, it could be an indication that they might be a better candidate for surgery. Always be honest. The worst thing to do is overpromise and under deliver.
- Lifestyle: Is this a client who is doing hot yoga or running eight miles a day out in the sun?
- Time Frame: Are they a bride, do they have a high school reunion, or are they seeking self-care to brighten their spirits? Do we have two months or six months? This will play a huge part in how many treatments can be done and how many modalities we may need to combine in the sessions.
- Current Product Regimen: Do we need to pre-treat their skin with a retinol and skin lightening product because they are of a higher Fitzpatrick or prone to post-inflammatory hyperpigmentation? Is their barrier compromised and we need to build it up with specific products to repair before it is safe to combine these modalities in a service?
- Downtime: What kind of downtime are they looking for? When combining modalities, you are not extending their downtime, you are just maximizing their results in the few days they would have already been “down.”
- Photos: Photos are crucial when it comes to aesthetic procedures, if you are not in the habit of taking photos on every client, start now. It is so easy to forget where we started for both the provider and client and this will track your progress.
CHOOSING THE TREATMENT
Once the consultation has been completed and it has been determined if pre-treating is necessary the fun can begin. When combining modalities, it is recommended to first do the laser treatment that is going to cause the most heat in the superficial layers of the epidermis first, followed by the laser that will be stimulating the deeper layers of the dermis. From there you can layer on the next treatment(s). If combining a laser with microneedling, microneedling will follow the laser treatment. Typically, when performing combined modalities bulk heat is being delivered into the skin and we need to be mindful to not create too much inflammation; doing so can do the reverse of what is trying to be achieved. Treatments must be delivered carefully to not break down the collagen, Although, the goal is maximizing results in a short time frame it is still important to have a progressive approach. This may look like only doing one pass of a peel or turning down the laser settings to ensure the safety of distributing active ingredients and energy into the skin. Always document, if the response is good, increase settings on the next session. Here are a few examples of what combining modalities may look like.
Microneedling Layered with Peels
This combination can achieve results for antiaging, acne scarring, and melasma. Microneedling would be performed first, followed by a peel, once the skin has been effectively cleansed of any residual product and pinpoint bleeding. A mild TCA peel can be applied after the microneedling and will absorb more efficiently into the skin due to the hundreds of microchannels being open. The peel will enhance the results of microneedling by stimulating even more collagen production, brightening and evening skin tone, and smoothing texture. A modified Jesnners peel with hydroquinone is an excellent option to help suppress melanocytes and assist in the lightning of current pigmentation of melasma.
Intense Pulsed Light and Non- Ablative Laser Resurfacing
This combination is going to be for the client who is wanting to address fine lines, wrinkles, telangiectasia, redness, and pigmentation, or surgical scars. In this case, Intense Pulse Light (IPL) would be performed first to address pigmentation, redness, and telangiectasia. Secondly, you would clean the skin of all ultrasound gel and start the treatment with the non-ablative resurfacing laser. If necessary, you can always cool the skin with ice or a handheld fan for a few minutes in-between the application of lasers. Intense Pulse Light uses high intense pulses of visible light that is attracted to chromophores of red and brown, which is brought to the surface of skin over five to seven days resulting in micro-crusting or a coffee ground appearance on the skin. The non-ablative laser will address deep dermal stimulation resulting in collagen production but leaving the epidermis intact.
Non-Ablative Laser Resurfacing and Microneedling
Non-ablative laser resurfacing and microneedling is a great combination to offer clients who are wanting to address aging concerns not only on their face, but on the as neck and décolleté as well. The laser would be performed first followed by microneedling. If the client has any concerns with their under eyes, you can also add a TCA peel under the eyes to complement the service.
Radiofrequency, Microneedling, and Superficial Peels
This is going to be for the client who is concerned with volume loss, acne scarring, and fine lines. This combination will deliver modest volume enhancement, as well as address collagen in a couple of different ways. First by delivering heat into the dermis from the radio frequency, triggering dermal remodeling followed by the controlled trauma from the microneedling. Radio frequency with microneedling typically has a reduced chance of post-inflammatory hyperpigmentation then some of the other lasers out there, so it may be a more fitting option for clients who fall into that category. For this treatment radio frequency would be performed first, followed by numbing. It is not recommended to numb the skin prior to performing radio frequency as you need to ensure the client can express any hot spots. Complete the treatment by performing microneedling and choice of superficial peel.
Skin care and Injectables
This is the ultimate powerhouse couple for the client who is pursing quicker results. As the aesthetician you can truly build the foundation for the client. You will be stimulating the collagen production, elastin, and working on the overall tone and health of the skin – also known as, the long-lasting changes. The injector can give the client the instant gratification treatment, they were originally seeking. If treatments are being performed in the same day, always have the aesthetic service first, followed by the injectable treatment.
For optimal results, the use of essential at-home products is key. Such as collagen promoting ingredients, skin brighteners, retinols, and sun protection factors, along with the recommendation of two to four treatments will ensure maximized success when combining modalities.
Now get out there, use your knowledge, creativity, and intuition to create new, effective, and result-driven treatments for your clients.
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Holly Sheppard has been involved with the medical field for over 13 years, five of those years as a licensed aesthetician and laser technician. She also holds certifications in oncology aesthetics and eyelash lift services. She enjoys continuously expanding her knowledge and skills with advanced training. Sheppard takes pride in creating unique customized treatments with the latest technology that are both corrective and relaxing. She sees beauty in every individual and believes that taking the time to invest in your skin is a decision that lasts a lifetime. Sheppard performs all the various aesthetic treatments; some popular treatments include Intense Pulsed Light, laser resurfacing, peels, and facials, microneedling, Emsculpt Body Toning, Hydrafacial, and more.
