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Needs-based Anti-aging Treatment Plans

By Rob and Carol S. Trow
Posted: April 14, 2008, from the November 2007 issue of Skin Inc. magazine.

The majority of photodamage—the primary cause of aging skin—is already present by the time a person reaches 18, due to extrinsic aging caused by environmental factors such as sun exposure; atmospheric pollutants, including nicotine, sulfur and carbon dioxide; and acid rain. Many clients who consult a skin care professional are seeking ways to address their anti-aging concerns.
       There is no single perfect treatment, procedure or ingredient that will meet every person’s needs, although there are some universal basics to ensure healthy skin. Individuals need an appropriate treatment plan based on their own situation and lifestyle—a needs-based assessment, and resulting protocol, through in-spa and home care. Selecting a plan is no longer as simple as determining if the skin is dry, oily or combination, and if the client experiences fine lines or wrinkles.

Needs evaluation
       Human skin is exposed to a variety of potentially damaging factors. It was only recently that people began to understand the harm they caused their own skin. Do you remember the days of sitting with a sun reflector and using baby oil mixed with iodine to obtain that fashionable tan made popular by the media and fashion divas such as Coco Chanel? Even walking to and from homes and offices, in and out of stores and sitting in cars can lead to skin damage. No one is immune.
       Skin damage is primarily visible as discoloration, pigmentation, actinic keratosis, fine lines and wrinkles. These symptoms develop at an individually defined age, depending on the client’s skin type. Everyone ages in a pattern and at a rate that is distinct. Historically, skin care professionals have looked to the Fitzpatrick Skin Type Classification system, as well as clients’ health, heredity, lifestyle and sun exposure for clues about how to determine treatment regimens.
       Due to the expanding knowledge of skin science and newly emerging treatment options, analysis is no longer that simple. Yet it can be one of the most significant elements in establishing an overall plan that can define success or failure.
       Begin with an initial analysis of a client’s skin based upon close examination, followed by a supportive question-and-answer session that concerns overall health, skin health, allergies, heredity, and former and current skin care habits. These discussions highlight past problems with specific products and treatments, as well as the client’s willingness to invest in their own skin health. Remember to inquire about their goals and objectives for improvement. Comment about whether these are realistic and highlight what will be involved in achieving successful outcomes.
       The next step is for you to propose a treatment plan. A sound approach must include multiple steps, including professional services, at-home protocols, and a series of procedures that could include peels, facials, IPL, LED, lasers and injectables. Some of these may be done in-spa and others via referral, as appropriate. Many times the best approach is a series that involves multiple modalities.
       Your clients’ skin did not age overnight and it will not be repaired overnight. Set achievable expectations. Remind them that there is no such thing as hope in a jar or a magical treatment that fixes everything. This is where your recommendations must be thoroughly explained. It is extremely important to inform them about exactly what they can expect, why you are recommending these protocols, how the services work, along with any potential side effects, downtime and costs.
       If clients understand their treatment plan, a trusting relationship will be established with the skin care professional, resulting in a more successful collaboration. Ask them to repeat the highlights of your conversation in order to ensure that everyone is on the same page.

The Glogau Scale
       One of the most effective systems for choosing services is the Glogau Photodamage Classification Scale, developed by Richard G. Glogau, MD, a clinical professor of dermatology at the University of California, San Francisco, and a leader in the field of cosmetic dermatology and dermatologic research. It was created in order to objectively measure the severity of photoaging—particularly wrinkles. See Glogau Photodamage Classification Scale.
       The Glogau designation can vary from one part of the face to another. For example, the eye area may be a higher classification than the rest of the face. As helpful as the scale might be in describing aging by categories, the presence of age ranges produces concerns for many skin care providers. You cannot simply focus on the age range of the client and proceed immediately. This is only a guideline. Instead, the treatments should be chosen by the appearance of the skin’s surface.
       Remove the age ranges from the chart and primarily examine the skin. For instance, a client is 28, has obvious discolorations, some actinic keratosis and established lines around her eyes, even when not smiling, and some around her mouth. Is she a Type I or II, or low III? She may smoke or refuses to use sunscreen. This individual is aged beyond her chronological years and her treatments should be based upon a higher classification.
       Conversely, with the plethora of professional treatments, cosmetic procedures, injectables, peels and home care products available today, many people appear more youthful than their actual age. Consider a 48-year-old who has a few fine lines, only around the eyes when smiling, a few tiny discolorations, but no keratosis, and her skin is taut and resilient. Is she a classification II or III, or a high I? The esthetician must ignore her age and examine only the overall appearance of the skin when planning the appropriate services according to her needs.


Correct treatment type
       The Glogau scale can help point to professional choices of appropriate treatments and home care regimens, allowing the esthetician to choose services according to clients’ classifications. It will aid in choosing proper care and should prevent the use of needlessly aggressive spa treatments or home care regimens. It is wise to consider the age-old adage: Less is more. 
       Think carefully when recommending products. It is not wise to tell clients to throw away everything they have and purchase multiple products. Prioritize their needs and begin with the most effective products you can provide. After time, add in pre-cleansers, cleansers, toners and the like. They will appreciate your honesty and return it with loyalty. Eventually, they will add more products to their routine. For instance, a client with no wrinkles and mild aging doesn’t need a trichloroacetic acid (TCA) peel; she needs prevention and maintenance. Causing her high irritation can actually result in hyperpigmentation and damage.
       It is vital that you have access to products that are available in varying strengths for home and professional use. See Glogau Type Treatments.

Enhance without damage
       It is important that your skin care line has treatments that are appropriate for the different Glogau classifications. An anti-aging product line must enhance results without causing damage and discomfort; it’s the professional and ethical thing to do.
It is entirely possible that estheticians have the potential to turn back the clock for clients, but to do so, the client and the skin care professional must work as a team. Committed treatment can correct the skin to its best ability if the plan is closely followed and adjusted when necessary.