Wendy Lewis looks into how aesthetic practices are shifting to meet the new regulations and addressing patient concerns
The COVID-19 outbreak has disrupted the world, generating new demands and realities practically overnight and accelerating some trends that have been in the works for a while. Now that many of us have spent the past few months living in workout clothes, sprucing up just for Zoom calls from the waist up, and trekking to a grocery store to wait on long lines six feet apart, we’re anxious to get back to some semblance of our former lives. But what our new reality will actually look like and how long it will take us to adjust remains uncertain.
According to McKinsey Featured Insights of May 15th, ‘Businesses around the world have rapidly adapted to the pandemic. There has been little hand-wringing and much more leaning into the task at hand. For those who think and hope things will go back to the way they were: stop. They won’t. It is better to accept the reality that the future isn’t what it used to be and start to think about how to make it work.’1
It will take some time before people really feel comfortable going back to their former lifestyle and activities. So, we need to strike some sort of balance between what we were doing pre COVID-19 and what needs to happen now to flourish.
The consumer mindset
Consumers seem to be willing to adopt some changes that may last beyond the health crisis in the interest of staying safe. For the most part, we have generally accepted that wearing a mask may save lives, our own and others. Persistent hand washing has become a frequent activity that we are comfortable doing in plain sight.
There is also a contingent that takes solace in the belief that a vaccine will be developed with lightspeed by Q3. If this is what gives them hope and helps them sleep through the night, so be it. But what happens when Q3 morphs into Q4 and 2021, and so on? Those who are impatiently waiting for a panacea are more likely to resume large crowded activities like sports, malls, concerts, airports, and cruise ships earlier. The rest of us are prone to wait for trusted medical authorities, the CDC, WHO and other bodies to give their blessing.
Several developments have potential benefits for aesthetic practices. For example, health and wellness are trending. More consumers are in touch with their health and motivated to take better care of themselves to stay healthy and less likely to succumb to the virus. Self-care is also on the rise. Simply taking an hour out of your day for a Peleton® class, walk in the park or yoga has taken on new meaning. Meditation is reported to be at an all-time high2.
Preventive health care products, like immunity, are also trending as consumers are eager to do whatever they can to prevent illness. These trends give consumers a feeling of being in charge of their own health, rather than leaving it to chance. Stress, anxiety, sleeplessness have become rampant among every age group, and people are embracing apps, home health devices, intimate wellness brands, Netflix® and podcasts to help calm their emotional highs and lows.
Bridging the gap between online and offline
The transition to telemedicine and e-commerce has been on the rise for the past decade, but the virus has catapulted it to the forefront. We have actually adapted relatively quickly to the concept of live vs. virtual in many areas. Practitioners, as well as consumers, seem to be embracing these new methods in light of the clear advantages of greater efficiency and ease of use.
Streamlining methods of patient communications is one of the keys to surviving and thriving during this period. Therefore, telehealth or telemedicine has taken centre stage and virtual visits have finally gone mainstream.
Aesthetic practitioners of all specialties are benefiting by implementing virtual consults for new and current patients. Virtual consults should be handled just like in-person consults for new patients. The fee structure may depend on your scope of practice and the market you are in. Most practitioners will require intake forms to be submitted in advance and photos, as needed. These can be scheduled at intervals of 30 to 60 minutes. Some practitioners charge a full fee for virtual consults, while others may offer complimentary virtual consults performed by a staff member or the doctor. In many cases, the fee will be applied to the first treatment the patient has in the practice.
There is a plethora of platforms that can be used for this model. Among the most popular are ZOOM, SKYPE, and GoToWebinar. Some practitioners may also use FaceTime. New models offer additional customized features, such as Doxy.me and Medici.md. Many software programs are now incorporating these capabilities in their offering for practices as well. Many of the dedicated telemedicine platforms are encrypted for HIPAA and GDPR, for example.
The additional benefits include the ability to screen patients in advance and establish a personal connection. If you manage this process effectively and get comfortable using your system of choice, virtual visits can be a tremendous practice builder and well worth the effort.
When employees return to offices, they need to be assured of their safety. Inspiring confidence among employees, customers, consumers, suppliers and other key stakeholders will be grounded in whether they feel that you are doing everything you can to protect them.
According to New York City plastic surgeon Bryan G. Forley, ‘We have to be prepared to maintain a safe environment for our staff and patients at all times. The coronavirus is primarily transmitted by respiratory droplets that are inhaled from the cough or sneeze of an infected person. It can also spread when a contaminated hard surface is touched followed by contact with the nose, mouth, or eyes. Since the virus can be transmitted by people who are asymptomatic, universal precautions are mandatory. Masking, hand hygiene, and physical distancing are essential practices that must be maintained to control the spread of COVID-19. Patients need to feel that their safety is a priority, or they will be fearful of returning for elective procedures.”
It is important to instruct patients on how to wear masks correctly. According to Theda Kontis, M.D., a facial plastic surgeon in Baltimore, MD, and AAFPRS board member, ‘They should cover the nose and mouth; sanitize hands before and after placement of the mask. Masks can be irritating to the skin, can cause friction injuries and increases acne, rosacea, and other skin conditions. We encourage patients to wash their face well with warm water and antibacterial soap and pat dry and apply a dimethicone-containing product to protect the skin and use a moisturiser about 30 minutes before applying a mask.’
She also doesn’t recommend that patients wear gloves. ‘Most people think of gloves as a means to keep hands clean. We use gloves to do one task then throw the gloves away. I see people wearing medical gloves who are touching potentially infected surfaces, then touching their face, cell phone, or steering wheel, which can make the situation worse by spreading infection,’ she says.
It sounds simple enough, but it is still easy for patients to get it wrong or forget. Facial plastic surgeon Patrick Byrne, M.D., M.BA., FACS, and AAFPRS Board Member explains it to patients in clear terms; ‘You’ve got to develop a strategy to prevent the virus from moving from your hands to your mouth, nose or eyes. This is how the vast majority of infections are likely acquired. When you venture out of your house: be prepared. The mask is key because it serves as a reminder not to touch your face.’
Your goal should be to provide accurate information in the most empathetic way possible. You have the ability to help people understand the unfolding situation compassionately, so they can make the right decisions for themselves and their loved ones.
Reopening and rebuilding
As many cities, regions and countries around the world are emerging from lockdown and entering the reopening phase, not every business or institution has figured out how to keep people safe. For example, some schools, malls, theatres, stadiums, restaurants, bars, gyms, fitness centres, and museums may not be ready or able to welcome people back in the same numbers anytime soon. The same rules apply to the majority of aesthetic clinics and medspas that are tight on space.
It is wise to take a top-down approach to fully understand your strengths and weaknesses, what could hold you back in this new normal. Maintain what you need and get advice on the necessary steps to ensure that your practice is set up to get back to a healthy state. Having access to cash when you need it is critical. Meet with your bank manager to find out what options are available for a loan or line of credit that may be needed to keep you going if short-term cash flow problems arise. You may also be able to renegotiate credit card terms.
Take a hard look at all of your monthly expenses, categorized into fixed and variable expenses. Try to convert some of your fixed expenses into variable to free up extra funds every month. Cancel subscriptions and service contracts you don’t need and slash any marketing services and advertising contracts that are not delivering results. Next, look at your payroll to consider ways to cut back temporarily without losing valuable staff members who are loyal and hardworking, and who your patients really love. Right now, as patients are feeling vulnerable, they will want to see familiar faces when they come back to your practice.
Talk to your landlord to try to delay rent payments and if you own your space and have extra room, consider adding a low volume tenant to offset your operating costs. Reach out to all your vendors and try to get extended payment terms where possible. Consider trading up equipment or products that are not making money for your practice. Get your operating costs down for the initial rebuilding period to take some pressure off. To properly reopen your practice, you will need to make an investment in equipment and supplies to meet safety regulations in your market.
Los Gatos, CA dermatologist Steven Swengel, whose practice is an 8,000 sq. foot facility, has approached reopening with a comprehensive strategy. ‘In a nutshell, we are trying to make the best out of a moment of crisis. We lost about 50% of our support staff, and although this was a shock, it has given us time and the flexibility to look at job descriptions and qualifications. I think we will bring on more licensed aestheticians as they are aesthetically focused and understand product, procedures and skin types due to their training.’
He continues, ‘We have added advanced HEPA filtering to the entire facility and have slowed the pace so we have fewer people in the waiting rooms and more social distancing at all points of contact. All staff get a PO2 reading and temp every morning, and every patient is told they must wear a mask and have their temperature take before being allowed into the office. We now have a cleaner whose only job is to clean up, wipe down and disinfect all public spaces, room after each visit, and restrooms. It is a lot of extra work and more prep time wrapped around each patient visit, but it is worth keeping everyone safe and feeling secure about the steps we have taken on their behalf.’
New York City facial plastic surgeon Michelle Yagoda who is waiting to open her practice, has her plan in place; ‘Appointments are booked only after COVID related questions are answered. Patients are asked to call when they are nearby and to wait to entire the office until it is their turn when the prior patient has left. New patients’ paperwork must be completed prior to appointments. Consent forms will be sent to the patient’s phone during appointments via DocUsign. Payments will be made via tap and go credit card payment or virtual merchant services. Patients, doctor and staff will be required to wear a mask for the entire time in the office. Fifteen minutes between patients will be allotted for air purification via central air conditioning device and aerosolized sprays between patients. Deep disinfection will be performed on all surface tops and equipment between patients.’ As for close contact surgeries and procedures, these will be done at Dr. Yagoda’s discretion without patient masks but will require COVID testing 48 hours prior to the procedure and antibody testing on the day of the procedure she says.
Plastic surgeon Nikolaos Metaxotos MD, PHD with three colleagues, Henry Delmar (FRANCE), Angelica Kavouni (UK) and Georges Stergiou have created a comprehensive programme entitled, ‘Sanitized Protocols.’
‘We have developed four main objectives: Protect, Test, Instruct and Reassure. ‘The non-surgical field will explode over the next years and it is our duty to raise our standards accordingly. This represents a tremendous opportunity for doctors who share the same ethos, to define a new norm in respect to quality and safety. I intend to keep raising the bar not only in terms of our services but also in regards to health and hygiene protocols to keep all those we care for safe and sound,’ he explains.
Aside from the myriad issues surrounding the complex process of reopening, restarting your aesthetic practice involves taking a closer look at everything you do. This should include revisiting your marketing plan.
Although the rules for communicating with patients still apply now, the tone should be adjusted to meet the current environment. Patients want to feel cared for more than ever. Communicate openly and often about every step you are taking to keep them safe. Be honest and direct. Listen more, talk less, and show your empathetic side. You should expect to spend more time with each patient now and it will take extra time to turn over the room due to cleaning.
Patients will want to know the details of how you are sanitizing the office and what systems and methods have been changed before they schedule an appointment. The last thing you want is to have miscommunication between your practice and anxious patients. For example, they need to know what will be required from them before they come to your office, what to expect during their visit, and new systems in place for scheduling, treatment appointments, product purchases, waiting time, social distancing, etc. All of this should be conveyed digitally so they can refer back to it.
Everything should be outlined in cohesive ‘For Our Patients’ guidelines addressing their top concerns to put their minds at ease. This can be created in a PDF format to be sent to all patients prior to scheduling an appointment to keep them in the know. Explain that reopening will evolve, and your practice will stay up to date on local health authority regulations.
To address staff concerns, start by listening to their personal challenges and fears. They will need to be reassured too that they will be safe coming back to work. The whole team should be trained to respond to patient questions with consistent messaging to establish and maintain trust. Patients will want to know if personal protection items will be available for them as well as staff and the usage requirements. Make sure employees are comfortable and up to speed on everything you are implementing in the practice.
Marketing messages should be refined to meet patient expectations and sensitivities. It is not business as usual right now. An aggressive sales pitch or overly flippant tone may turn off the patients you really want in your practice. Take into account what may be going on in their lives and adjust your verbiage accordingly. You may need to adopt a more educational approach and tell the story through real patients who have had a great experience and are open to talking about it. Calming images, softer wording, and a kinder approach may suit you well, depending on where you practice. This strategy can work to engage patients and create deeper long-lasting relationships.
In your marketing, try to communicate in a way that will help your patients get through this period by uplifting their self-esteem. Keep in mind that they may be facing many challenges from losing friends and family, unemployment, health concerns, budget worries, in addition to depression, sleeplessness and anxiety. They may be feeling especially vulnerable right now and a bit of neuromodulator or a skin tightening treatment may actually help to lift their spirits.
Consider the most important factors that have brought patients in the door previously and run with those. For example, empathy, a caring environment, superior results, innovative treatment menu, value for money, high touch service, helpful staff, etc.
The aesthetics industry has weathered many storms in the past and this too shall pass. We will soon get acclimated to the new health and safety measures and forget the way we used to do business. As I see it, loosening up on these protocols is unlikely to happen any time in the near future for aesthetic practices, regardless of how other service businesses may operate. Patients expect medical aesthetics practitioners to set a higher bar. They will not easily excuse getting infected while visiting a clinic for a filler injection or having some unwanted fat dissolved.
‘The future of a vaccine is still not a certainty and has no timeline, so we may be practising with these precautions for a long time,’ says Dr. Forley.
- Sneader K, Singhal S. From thinking about the next normal to making it work: What to stop, start, and accelerate. May 15, 2020. McKinsey & Company. Available at: https://www.mckinsey.com/featured-insights/leadership/from-thinking-about-the-next-normal-to-making-it-work-what-to-stop-start-and-accelerate [Last accessed 26 May 2020]
- Wernet K. 5 Wellness Trends to Look Out For in 2020. Mindbody. Available at: https://www.mindbodyonline.com/education/blog/5-wellness-trends-look-out-2020 [Last accessed 26 May 2020]