In Part I of this article, skin care professionals learned how to collect sufficient personal history information about the client. Now, they should begin the most important part of the consultation, which consists of the skin examination. The prognosis of this in-depth examination will determine the treatment objective or goals and should be guided primarily by the client’s main concerns.
The correct skin diagnosis is the most important part of a skin care professional’s work because the treatment objective, as well as the products and equipment used, are based on it. It begins with simple communication with the client.
Use your fingers to probe and stretch the skin during the examination. Feel the texture, and observe the conditions that may not be apparent by simply viewing it under a Wood’s lamp. Unless the skin is impure and contagious, do this without gloves. The most important details to check for during this step include the following.
- Blemishes—These indicate that the skin may be oily or breaks out easily. It is possible that the client has a habit of picking the skin, as well.
- Blotchiness—This is indicated by redness or high color. Determine whether the skin feels hot by using the backs of your palms on the client’s cheeks or forehead.
- A dull, devitalized complexion—This usually is found on skin that is thick or belongs to a regular smoker.
- Elasticity and tone—Check this by flicking the skin and viewing how quickly it returns to normal.
- Enlarged pores—These indicate that the skin is oily. If the client is mature and there is no apparent shine, this also could mean that it was oily during adolescence.
- Excess hair—The client may benefit from hair removal services.
- Hydration—Dehydrated skin or fine lines suggest a lack of moisture.
- Minor skin irregularities—Different skin types also correlate with the presence of minor skin irregularities. In general, Fitzpatrick skin types I and II are prone to telangiectasias and angiomas. In types III and IV, green or yellow undertones are more likely to be seen, and hyperpigmentation problems during aging are common. Because types V and VI carry a large amount of melanocytes, they blemish easily and pose high risks for post-inflammatory hyperpigmentation, so it is important to avoid using heavy pressure during manual extraction. Although all skin types suffer from skin tags or fibromas, they seem to be more prevalent in types V and VI, as well as in mature clients.
- Pigmentation—Note any hyperpigmentation or hypopigmentation, as well as its location. These conditions can be addressed with add-on services.
- Scars—The presence of scars on the facial area indicates active acne during adolescence that left scars due to tissue damage. It is important to note the location and age of the scars. The surrounding areas will be more sensitive and prone to fluid accumulation, so avoid working around them.
- Sebum—Find out if the skin is oily or dry and, if either condition exists, how much damage—including scars and blemishes—it has caused.
- Sensitivity—Test this by lightly tracing the edge of a spatula on the décolleté. If the skin remains red for a long time—even after a skin cleansing—high sensitivity is indicated.
- Skin thickness—Modify touch and pressure according to the skin’s thickness.
- Telangiectasias or broken capillaries—These indicate sensitivity, so use less pressure in the areas where these conditions appear. An excessive amount of telangiectasias is a marker for poor circulation.
- Wrinkles and lines—These appear due to age, sun damage or excessive facial expressions.
Fitzpatrick skin types
In addition to ethnicity, today’s skin care professionals must be knowledgeable about the Fitzpatrick skin type classification scale for effective skin analysis. There are six levels that are organized according to their reaction to the sun’s rays.
- Types I and II—Type I individuals have very pale complexions with little melanin formation, which burns and turns red quickly but never tans. This is the typical Caucasian skin. Type II individuals burn first and later will acquire a little tan. These types need to use sunscreens, or else they will burn in the sun.
- Types III and IV—These skin types tan and do not burn easily. However, they still need to use sunscreen. These include Asians with lighter complexions, as well as South Asians with darker complexions. Certain Mediterranean skin types fall within this group, as well.
- Types V and VI—Due to a large amount of melanocytes in both the upper and subcutaneous tissues, individuals with these types do not burn in the sun. Black skin falls within this category.
Once an intensive scrutiny of the skin has been performed, the skin care professional must determine the most important problem to treat. The first choice should be the client’s main concern, but judgment and professional knowledge must be used when identifying the primary issue to address in the first service. It is important to take into consideration that the individual must see some results in order to be motivated to return for further treatments.
What is the client’s main concern? If their skin is oily and acne-prone, the priority should be deep cleansing. If it is dry, the main objective should be providing moisturizing or hydrating treatments. Sagging skin requires toning, while dull, devitalized skin needs stimulating massage movements. Sensitive telangiectasia-prone skin should be strengthened. If there are any minor skin irregularities, such as skin tags, telangiectasias, cholesterol deposits, hemangiomas or pimples, offer add-on services. These can enhance skin texture and increase income potential.
Nutritional guidance. Adding nutritional guidance to a skin or body treatment enhances the skin care professional’s reputation as a knowledgeable wellness therapist. Make recommendations about improving lifestyle behaviors, and instruct how to select better foods by explaining how unhealthy foods affect the skin and body. For example, those who suffer from breakouts before menstruation should be advised to increase their intake of anti-inflammatory foods, decrease or avoid inflammatory foods—such as animal-based varieties, as well as stimulating foods—such as coffee or fried foods. The client should adhere to a more fiber-rich diet and consume more water in order to help eliminate toxins. They should take more vitamins—especially vitamin B, for stress, and antioxidants, such as vitamins A and C. (For more information on nutrition and skin care, see Nutrition: The Healthy Aging Solution (Allured Publishing, 2004), by Pat Lam.)
Lifestyle advice. If clients exercise frequently, they should shower immediately afterward. If they have oily skin, suggest that they wear their hair away from their face. For blotchiness, recommend that they try using cool water to wash their face instead of warm water, and encourage them to use sunscreen regularly.
Product home care. This section must be filled out by the skin care professional in order to suggest home care products. If clients return to purchase items later, anyone at the reception desk can assist them because this information will have been recorded previously on their form. Potential product sales have been lost in situations in which clients return to buy products recommended by the skin care professional, but the information was not recorded on the form.
Skin changes. The fact that skin can undergo changes in different seasons must be taken into consideration. If the client has not had an appointment for a long period of time, their skin should be reanalyzed and a new prescription form should be completed.
Remarks. Write anything about clients that you need to remember for their next treatment, such as whether they fear or enjoy certain pieces of equipment involved in a particular procedure. Possible add-on treatments also could be recorded here, such as a recommendation for microdermabrasion.
Waiver form. A waiver form signed by the client should explain the nature of the procedures being performed, as well as the possible risks involved.
Treatment progress and sales. This section on the prescription form, which can be located on the back, records the service steps, products used, electrical equipment used, products purchased, cost of services and remarks about the treatment.
Take your time
Your spa should design its own form to include the previous information. Ultimately, the prescription sheet shows a complete résumé of services provided, menu items applied, results achieved, contraindications, problems encountered during services and new treatments to be discussed for the future. Taking the time to design a form that provides more in-depth information enables skin care professionals to increase their income potential, as well as to become more efficient and organized. Clients are becoming more educated and demanding, so you must be prepared to meet their needs.