Aestheticians are not only about skin care—they can be a major asset to any surgery practice

Facial rejuvenation and the war against the aging face have been important issues since the beginning of time. Countless historical documents describe surgical remedies, holistic applications, skin-care regimens, and diverse specialists working together to wage battles in this war. There is substantial evidence that, over the centuries, physicians and their colleagues developed a wide range of modalities to help combat the onslaught of wrinkles and the undesirable effects associated with aging.

Hippocrates, the father of medicine, taught that these treatments and therapies, which were not normally associated with conventional health care, were beneficial to the health and well-being of his patients. Little did he know the extent to which his teachings would flourish in medical care in the 21st century. The popularity of facial rejuvenation is undeniably responsible for a new generation of health care specialists who augment the plastic surgeon’s skill in the war against the aging face.

Today’s progressive aesthetic plastic surgeons complement their skills by integrating the services of medical aestheticians into their practices. These individuals have become valuable assets within plastic surgery practices: They are not only support systems for physicians, they are also advocates for patients and work to achieve the best possible surgical outcomes for them.

Professional Collaboration

This professional collaboration has become an integral part of preoperative and postoperative care to help prepare the patient for surgery, enhance the healing process, and, in general, ensure a happier patient. In other words, this well-qualified professional reaches beyond the normal realm of skin care to assist the physician in the hospital, outpatient surgery center, clinic, or medical spa.

Enhanced service, which leads to greater patient satisfaction, is one of the principal benefits of incorporating a medical aesthetician into the surgery environment. Service and support are key elements for people who seek facial rejuvenation. Studies indicate that if complications arise after the surgery, the patient is less likely to seek litigation if he or she has received strong support from the beginning of the process.

Prior to surgery, the medical aesthetician can provide support and “tender loving care” to patients who become anxious in anticipation of the outcome of facial-rejuvenation procedures. The aesthetician can also teach the patient how to care for the skin before and after surgery to help optimize the healing process.

The Authority

The medical aesthetician must function as the consummate professional skin-care authority within the plastic surgery environment. In addition to traditional medical support, the medical aesthetician should provide patients facial-rejuvenation services such as:

• clinical skin treatment before and after surgery;

• home skin-care maintenance with progressive supervision;

• postsurgical camouflage makeup to hide bruising;

• preoperative and postoperative body and facial lymphatic massage therapy; and

• nutritional guidance.

The medical aesthetician must be thoroughly familiar with the patient’s skin type and history, and should be knowledgeable about facial ultrasound treatments, microdermabrasion, bioactive peeling agents, cosmeceuticals, and aesthetic and reconstructive procedures in general.

Educating the patient before surgery is critical. Medical aestheticians must provide instructional support for both the patient and the physician. To understand treatments used by the medical aestheticians, especially unconventional ones, we must first review the skin-aging process and its impact on the face.

It Begins with the Skin

The skin is where facial rejuvenation begins. Human skin is a highly specialized form of connective tissue. It contains several cell types, the most important of which are melanocytes, fibroblasts, keratinocytes, immunocompetent cells (Langerhans cells), migrating mononuclear cells, and mastocytes.

Skin also contains connective tissue that is rich in extracellular matrix (ECM). The macromolecular components of the ECM are mainly responsible for the rheological properties of the skin: its mechanical resistance, suppleness, and elasticity. Other physiologically important functions include hydration, thermoregulation, and permeability regulation. All of these functions depend on differentiated cells as well as the composition of the ECM.

Most patients who elect to have facial-rejuvenation surgery for age management are thoroughly convinced that there are no other alternatives to control the aging process. They are desperate to erase the biomarkers of time. Aging is accompanied by a slowing down of cell proliferation, as shown by the morphometric evaluation of the number of epidermal cell layers and dermal fibroblasts in aging skin. Age-related cell loss and cell-function loss are two of the major challenges for both the surgeon and the medical aesthetician.

Skin peels and ultrasonic treatments performed by a medical aesthetician prior to facial-rejuvenation surgery can stimulate cell proliferation in the skin, enhancing the integrity of the skin’s internal structure and external texture. Alpha-hydroxy acid peels have been shown to increase the synthesis of collagen, proteoglycans, and glycosaminoglycans such as hyaluronic acid—a high-molecular-weight polysaccharide that can retain a large volume of water. Its molecular weight is on the order of several million.

Hydrated skin heals much better than dehydrated skin, which illustrates why clinical treatments prior to surgery can enhance skin healing. The application of peels before surgery also enhances the surgical result by reducing pigmentary disorders, fine lines, and wrinkles associated with aging skin.

The Lymphatic Massage

Lymphatic massage therapy is a very important phase of preoperative and postoperative care. The medical aesthetician performs this specialized massage prior to facial-rejuvenation surgery to ease bruising, reduce postsurgical edema, and expedite healing. Complete lymphatic treatment routines should be scheduled before and after the surgery. The office staff should make the appointments at the time facial-rejuvenation surgery is scheduled. The first postoperative lymphatic treatment can be performed within 24 hours after surgery, with appropriate medical clearance from the physician.

After a lymphatic treatment, a dramatic reduction of edema and pain can be observed in a matter of hours. Results will vary from patient to patient, depending on their health status and commitment to the program. Consistency in lymphatic massage is important to support the healing process. Lymphatic therapy performed properly by the medical aesthetician can ease the patient’s recovery and enhance his or her overall health.

The practice of aesthetic surgery is described as both an art and a science; many aesthetic surgeons are in reality accomplished artists. Medical aestheticians can also fall into this category. Blending the expertise of the surgeon and the medical aesthetician can produce results that far exceed the patient’s expectations.

Prior to facial-rejuvenation surgery, patients form mental images of what they will look like after the surgery that can often lead to overexpectations. The medical aesthetician can support the aesthetic surgeon in the preoperative consultation to avoid unrealistic expectations.

When swelling and discoloration set in after the surgery, the skin morbidity usually frightens and sometimes disappoints the patient. The medical aesthetician is needed to help the patient overcome postoperative feelings of frustration, and to teach the patient how to hide these surgical after-effects.

With the use of a postsurgical camouflage makeup, patients can minimize swelling and discoloration and immediately improve their self-image. This, in turn, reduces their postoperative stress and reinforces their immune systems for combating the possible complications. It is important that the medical aesthetician teaches patients how to use cosmetics to hide the trauma and enhance their appearance.

A major concern for patients is how long it will be before they will begin to look normal again. Having a medical aesthetician incorporate peels, ultrasound, lymphatic treatment and camouflage makeup before and after surgery will allow the patient’s body to heal more quickly and look normal in less time.

Future Business

Adding a medical aesthetician to your practice is also an investment in your future facial-rejuvenation referrals. It is a sound business decision that can contribute to your income long after the patient has healed. The incremental income can include the sale of skin care products, skin treatments, and other ancillary services that will provide a higher patient-retention rate, leading to greater profitability.

In the highly competitive world of aesthetic plastic surgery, the determining factor for the patient in selecting a surgeon, other than skill, could be the surgical support system. In addition to your office and nursing staff, this means your ancillary offerings: skin care treatments, skin care products, camouflage makeup, massage, and so forth.

It is always important to remember that your patient’s decision to have facial-rejuvenation surgery has been one of the biggest decisions in his or her life. In many cases, your patient has taken years to research and select the best plastic surgeon for this procedure. The patient’s decision to undergo the surgery was most likely based on trust and confidence in you and on the perception of his or her new appearance.

The minute your patient schedules the operation, the anxiety begins. Among the factors that can influence this emotion is the lack of positive feedback from friends and family who are well-meaning but tell your patient that facial-rejuvenation surgery isn’t really needed because “We love you just the way you are.” This sort of response increases the anxiety due to the patient’s concern about the outcome of the procedure. The anxiety can even develop into more severe symptoms, such as mild to severe depression, anger, hostility, and sleep disorders.

Borah et al conducted a study regarding the psychological complications concerning patients who were about to undergo surgery.1 The study indicated that patients were generally stressed about possible consequences of the surgery that included death, pain, disfigurement, economic loss, and alteration of social roles. The psychological outcomes of surgery often far outweigh the surgical complications in the patient’s mind.

The medical aesthetician is invaluable to you and helpful to the patient during the preoperative jitters and the critical recovery period directly following facial-rejuvenation surgery. With common-sense skin-care instruction, lymphatic therapy, and sound medical advice, your patient will emerge from surgery with a positive mind-set that directly affects the healing process.

The medical aesthetician can provide pearls of comfort and encouragement during postoperative visits. It should never be taken for granted that the patient understands the healing process. In many cases, it is a frightful time that requires a skillful medical aesthetician to provide patience and understanding to help disarm their fears.

The Treatment Room

The clinical room, where the medical aesthetician performs all treatments, should be a refuge for comfort, stress relief, and release from postoperative trepidation. The room should be quiet, comfortably warm, and softly lit. Background music should consist of sounds, harmonic sequences, and rhythms that express an environment of healing and well-being.

It has been substantiated that our immune system can be affected by sound. Pilot studies on the therapeutic effects of music therapy have provided new data that suggest a link between the positive emotional effects of music therapy and the immune system.

Another important element in the treatment room is postoperative aromatherapy. From Hippocrates, we know that the Greeks had some awareness of the therapeutic properties of aromatic oils. As these highly volatile essences evaporate, they are inhaled and pass by the millions of sensitive cells that line the nasal passages. These cells send messages straight to the brain and affect the emotions by working on the limbic system. Thus, using aromatherapy in the treatment-room environment can enhance the patient’s physical and psychological well-being.

In an aesthetic surgery environment, the medical aesthetician must have good people skills, have advanced knowledge about a variety of treatments for all types of skin associated with facial rejuvenation, and be able to effect positive changes in the traumatized skin to encourage healing.

The Aesthetician in Your Practice

A medical aesthetician whose personality reflects your mission to your patients is one of the most important assets in your medical practice. The aesthetician must understand the medical business and be proficient enough to assist other personnel in the office, if necessary. The aesthetician should “own” the practice in the sense of taking pride in it, but not lose sight of whose practice it really is.

To help attain the long-term goals for the practice, you should keep the aesthetician informed about new techniques in facial-rejuvenation surgery. The aesthetician can in turn teach patients about new procedures and products. Informed patients are continually seeking the latest treatments to be used at the time of their facial-rejuvenation surgery or later for a “tune-up.” Failing to provide this valuable information could hurt profits—or worse, create a dissatisfied patient.

The surgeon and the medical aesthetician have become a specialized partnership that complements the surgeon’s talent and enhances the outcome of the facial-rejuvenation surgery. For this synergy to “work,” both must completely trust and believe in each other. Each of these dedicated professionals brings a unique skill to the surgical procedure, affecting a positive patient result.

Whether the aesthetician is contracted to work on the plastic surgeon’s premises or is in another facility and is referred by the surgeon, there is no doubt that this new professional is here to stay as an integral part of the medical team. PSP

Christine Heathman, Medical Master Aesthetician, CME, LMT, is the founder and CEO of a clinical skin care company. She has more than 25 years of clinical aesthetics experience, the author of several skin-care manuals, and a contributing author to articles in medical journals. She can be reached at (800) 676-9667, or via her Web site,


1. Borah G, Rankin M, Wey P. Psychological complications in 281 plastic surgery practices. Plast Reconstr Surg. 2000;105:2636–2637.