In the summer of 2008, I wrote an article entitled The Dreyfus Model of Skill Acquisition, going from novice to expert as a skin care specialist. I hope that some of you were able to utilize that article to think about your next level of achievement in your practice.  What I would like to achieve with this article is to get each and everyone of us to talk about some of those achievements we have made in our clinical skin care treatments.

Over the years, I have attended many plastic surgery and dermatology conferences. During these conferences the physicians always have a presentation on the “Pearls in Medicine”. These pearls cover various subjects such as special tips for a rhytidectomy, a treatment plan that has worked for a skin condition, tips on fillers and the best placement, to name a few.

After working with the SPSSCS for 15 years, I know that we have many skin care specialists that have their own clinical pearls of wisdom to share. I would like to see us as a whole increase our expertise and education through publishing those clinical pearls of wisdom in our new column, Ask the Specialist. If you have always wanted to become part of your newsletter, but do not know what to write about, here is your chance and you are the expert. If you need help, call me and we can brainstorm your ideas, treatments and rationale. For those of you that have your Pearls of Wisdom ready to share, please e-mail your completed articles to missy@surgery.org

Pearls of Wisdom: Where Do They Come From?
Wisdom is the ability to think and act with understanding, judgment and insight acquired through knowledge and experience.

• Words of wisdom from experienced physicians and skin care specialists through years of experience in practice.

• Clinical trials

• Brainstorming with colleagues to raise vital questions and problems, then putting those thoughts, treatments or technologies into action through trial and error to reach the desired outcome.

• Critical thinking  which is a process of analyzing and evaluating information that is gathered from observation, experience, reflection, reasoning, scientific evaluation and communication.

Clinical Pearls
Clinical pearls of wisdom for me have come together over the years, working with some of the top physicians and skin care specialists. This has allowed me to discuss difficult skin care issues, brainstorm over treatment plans, and sound rationale. The following is an example of one of my clinical pearls, created in a flow chart without going into detail. This will give you an idea of the progression of treatments that were used is a stubborn case of hyperpigmentation. All these may not be needed but it shows just how far we can take our treatments to resolve this skin care issue.

Client is a 48 year old Caucasian woman who presented with stubborn areas of
hyperpigmentation across her forehead and cheek area. She is a Fitzpatrick IV and has combination skin with some dryness on her cheek area. She is on no prescription medications at the present time and wears a sunscreen every day.

When I first started in skin care my initial thoughts for a treatment plan would be to get her on a good skin care regime incorporating something to help with the pigmentation, and do a series of chemical peels. As I have learned over the years, hyperpigmentation can be very stubborn and may need more than one modality of treatment to resolve the issue. This treatment plan is the culmination of ideas, observation, clinical trials and brainstorming, coming up with the best treatment protocols.

Skin Care Treatment Options
Glycolic
Salicylic
Azelaic
Kojic
Hexylresorcinol
Hydroquinone
Retinol

Lightening Peels
Alphahydroxy Acid
Salicylic Acid Peel
Retinol Peel
Kojic/ Hexylresorcinol Peel
Trichloroacetic Acid

Lightening Treatments
Microdermabrasion
Intense Pulse Light Therapy

Stubborn hyperpigmentation can be difficult to treat, therefore in your teaching plan put together a flow chart for the patient showing the progression of treatments that will occur over a time period. This will give the client a good understanding of the time it may take to see these results.

Treatment Plan 

Product:                                 Rationale:

Cleanser
Glycolic Cleanser                 Follicular cleansing agent, and resurfacing agent

Lightening Agents
Kojic Acid                               Tyrosinase inhibitor
Hexylresorcinol                     Brightens skin, and helps to clear stubborn
                                                 discoloration.
Retinol                                    Discourages and assist in excess melanin production

Hydration and Treatment
Estradiol, Progesterone     Hormonal components may help to improve the
                                                appearance of cumulative sun damage

Sun Protection
SPF 30 with Parsol             A minimum SPF30 with UVB/UVA
                                               Protection.

Lightening Peels
Glycolic Peel                        Series of six Glycolic Resurfacing treatments to help
                                               to loosen up pigmented areas

Kojic Acid /                            Series of three treatments to accelerate the
Hexylresorcinol Peel          de-pigmentation process
Retinol Resurfacing Peel  Series of three helps to assist in resolving excess
                                               melanin production

Lightening Treatments
Microdermabrasion             Following a series of treatments patient can expect a 
                                                lessening of hyperpigmentation

Intense Pulse
Light Laser                         Targets to resolve melanin in the epidermis

Possible ideas for Ask the Specialist
Eye Rejuvenation
Neck Rejuvenation
Facial Rejuvenation
Acne
Facial discoloration
Rosacea
Rejuvenation of hair/lash/eyebrow
Lip Rejuvenation
Hand Rejuvenation

Conclusion     

The Society of Plastic Surgery Skin Care Specialists as a professional organization is to promote and educate plastic surgical skin care professionals worldwide; this vision is a continuous commitment.   

Many of the members take advantage of the Society’s annual meeting.  The education, tips, techniques and product suggestions provided at these meetings are valuable in building your skin care practice.

Sharing your pearls of wisdom in Ask the Specialist is a great way to continue your commitment for excellence as a Skin Care Specialist, as well as provide for those members that cannot attend the annual educational meeting.

Laura LeRoy, RN, BSN, CMA, has spent over thirty years with skin care researchers, manufacturers and physicians in the position of Director of Education.  Her primary duties included curriculum development for client training of product use, writing training manuals planning, directing and evaluating business development and marketing plans, and directing and evaluating skincare and aesthetic make-up services.