Coping with COVID-19: Multidisciplinary Panel Offers Procedure-Specific Counsel on Reopening Aesthetic Practices
Certain minimally invasive aesthetic procedures including those that are lengthy, take place above the clavicle, and are considered aerosol-generating may be riskier than others in the post-COVID-19 world and will require enhanced precautions and a slower integration than procedures deemed less risky, according to a new set of guidance on reopening aesthetic practices.
The Project AesCert Guidance, which appears in Facial Plastic Surgery & Aesthetic Medicine and was spearheaded by the Skinbetter Science Institute, takes a multi-disciplinary, soup-to-nuts tack to re-opening aesthetic practices once it is permitted.
The guidance was developed in partnership with experts in infectious disease, immunology, public health policy, dermatology, facial plastic surgery, and plastic surgery. It includes such resources as a Daily Treatment Room Disinfectant Checklist, Common Area Disinfectant Checklist, Wellness Screening Checklist, and Post-Appointment Screening Checklist.
“No one has ever done a re-entry after a pandemic. Most of my colleagues are literally inventing the wheel,” says guideline author Jeffrey Dover, MD, FRCPC, co-director of SkinCare Physicians of Chestnut Hill in Massachusetts. “The key message is safety for you, safety for your staff and safety for your patient. These are aesthetic and not dermatologically or medically necessary procedures. We have to set the bar as high as possible.”
Some cosmetic procedures can be initiated earlier than others presuming all Project AesCert safety protocols are closely followed. “I’d be very hesitant about performing extended above-the-neck or mouth procedures, but off-face procedures are easier to reintroduce.” Dr. Dover says.
Energy-based body contouring procedures require limited in-room contact with the patient once the device has been applied and the procedure has started. Still, providers should wear a three-ply surgical mask, wraparound eye protection, gown, and gloves for all treatments. Patients undergoing body-contouring procedures below the clavicle should be masked throughout the treatment and particularly when a provider or staff is in the treatment room. “When contouring procedures are performed above the clavicle, consider heightened personal protective equipment, including an N95 mask, goggles, and possibly a face shield,” the guidance suggests.
Injections can also be introduced early on as they are quick, unlike other facial and skin procedures. Patients can remove their mask if they are getting injections around their mouth and should receive a new mask after the procedure, the guidance states.
Moreover, certain procedures such as deeper microneedling may produce blood-borne pathogens, and certain micro- and hydra-dermabrasion procedures are non-respiratory aerosol-generating procedures due to risk of emission of airborne particles or contaminants as a result of device features, according to the guidance.
In general, all aerosol-generating procedures should be performed in designated treatment rooms with appropriate air handling, containment, and evacuation systems. The guidance also calls for pain management through modalities other than cooling fans or handheld cooling devices wherever possible.
The whole experience will be different than it was in the pre-COVID-19 days, Dr. Dover says. “It’s not a social hour like it used to be. Patients get the procedure and they are out,” he says. All consultations and screening should be done over the phone in advance. Patients will have their temperature taken when they arrive at the office and will be escorted to a treatment room. Check-in and check-out can also take place in the treatment room.
At Dr. Dover’s practice, doctors and nurses won’t be moving around from pod to pod anymore either. “If a nurse moves around and gets sick, we have to shut down the entire facility and are back to square one.”
The guidance suggests removing chairs and spacing remaining chairs at least six feet apart in waiting rooms or creating “natural” barriers with potted plants, tables to prevent individuals from congregating in one area.
There also can’t be in-the-moment upsells or add-on procedures initially, he explains. And “If the patient is at all concerned, wait a month and revisit the procedure. The last thing patients should feel is pressure.”
“There was a great deal of uncertainty and a lack of confidence about reopening given the high degree of infectiousness and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),” Jonah Shacknai, Executive Chairman at the Skinbetter Science Institute, says. “The new guidance is unique because the infectious disease and public health experts came up with protocols based on research and their expertise on the front lines with COVID-19 patients.” Shacknai hopes that the new guidance will go a long way toward assuring patients that aesthetic procedures are safe and that practices are taking their safety very seriously.
“The risk of transmission will be minimized by following this guidance, but it will never be zero,” he notes. Practices can show the Project AesCert Guidance logo to indicate they follow these principles.