Consulting, Safety Procedures and Complications in Aesthetics – Interview

Key points of the episode:

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Agnes: Good morning. My name is Agnes Kuzniak. I’ve been in this industry for a very, very long time. I don’t even like talking about, you know, how many years, but it’s over 20 years. Um, what do I do? I’m the company owner. My company is named Aesthderm LTD. We are based in the UK, but I’m also an international training provider for cement aesthetics and other international companies.

I’m really, really happy to be, actually, to have my company in the UK because, As I train all over the world, you know, as I train in different markets, I must say the therapists are really nice here, and it’s absolutely lovely to work with people. There’s not so much, you know, a drama about things, you know, there’s no, uh, lot of disputes and, and it’s a nice environment to work.

So, so I’m really privileged to be here and to thank you for having me today.

Dawn: Well, thank you for coming on as well. I know, especially with aestheticians’ kind of schedules, it can be quite hectic, so I appreciate the time you’ve taken out of your day as well. So today, we’re gonna be talking about consulting, safety procedures and complications.

Please explain the process of injections and your training

Agnes: When it comes to injectables, there are two very important things.

First of all, it’s the technique which we are using when we work with microneedling; when we work with mesotherapy, we need to remember that the knowledge of the skin, that the knowledge of anatomy and physiology is vital. That we don’t need to cause too much injury, that we need to adhere to the protocols provided by the trainer for the company trainer or the manufacturer because they have all the data behind them.

They have made the trials. So we should not be changing things ourselves because there is a reason why we should be keeping those protocols. And as we were talking before, you know, with the choice of the training provider for the technical mesotherapy or microneedling parts; you can go anywhere, but if you would like to use a specific product, you actually need to go to the distributor.

Agnes: You need to go to the manufacturer because they are the only ones who are able to teach you the procedures. So you are going to be covered by your insurance. You’re going to be safe; your patients are going to be safe. So when you’re doing injectables. When you’re doing the consulting, you need to take many different things under consideration, first of all, which technique you’re going to be using.

Are you going to be using a gauge, just superficial injury? How the product is going to be applied to the skin? You would have the best effect for your client but also the safest effect. And we have to remember that safety is always the priority. So accurate training, proper training, and knowledge of the skin is essential.

Agnes: You really need to know where you are injecting. Why are you doing that? What can happen with the product if you’re choosing the product? Do you have an awareness of how long those substances are going to be deposited in the grand scheme of things? If you are injecting feelers, you know this is an actual implant; it’s not immunotherapy.

You are implanting something, and very often, it’s based in the skin for many, many, many years. I have had amazing luck in being able to work with the plastic surgeon in assisting with plastic surgeries. And we had fillers which we had to remove, and they were implanted over seven years ago, and the patients were unaware that those fillers could still be there.

Agnes: So, but that’s another sort of another area, you know, which is going to be regulated. And, honestly, I don’t have much opinion on that because of dealing with the infills. I don’t do fill some. I think there are other procedures like mesotherapy, which can have an amazing, absolutely amazing effect and a safe effect.

So with injectable safety, if you know the technique, if you chose a new product, that’s the priority. People are often asking, does the product have to be CE marked? And that’s a sort of a grey area I would say. C mark is very important, but CE Mark is going to be changed. That’s why many companies haven’t applied for ‘C’ at all.

Purchasing a Product…

Agnes: When you purchase the product, ask for the sterility certification. If the company has sterility certification and all the pharmaceutical ingredients, they will be able to confirm that in writing, and you will know that you are working with a safe product. As you may know, the law in this area is changing as well.

Coming to the consultation. You know, I mentioned a little bit about the safety. So of course, you know the knowledge of the technique, knowledge of the product, knowledge of your patient, but the consultation is very, very important. I’m using actually, you know, Insync Consent for my consult forms.

I’m always sending the medical form to the clients, and I’m always sending specific procedure forms to the client and post-treatment care and why those things are so important. First of all, it’s before the procedure. You will be able to find out. Any illness, um, pregnancy, breastfeeding, autoimmune disorders, these are all contraindications to the treatment.

If their client is telling you, oh, it’s fine. I had this treatment before; would you take the risk? I wouldn’t because you never know with autoimmune disorders, how the body is going to react. You can cause cytokine storm, and you can cause really bad complications, not because of the product, but because you inserted this needle.

You caused inflammation; you caused cross-reaction with the already existing condition. So it’s not the product or the technique; that’s why it’s so important. And if someone has, for example, been conditioned as a diabetic, the thyroid is very, very popular.

Um, popular, unfortunately. Uh, commonly sort of seen, um, condition, um, if it’s regulated. I always ask the consultant letter with the permission to perform the procedure. If I have a consultant agreement that I can perform the procedure, then yes, it is. It’s a doctor. He decided that I can cause this injury.

The patient is covered. I’m uncovered. That’s the most important. Uh, All other conditions, you know, where is someone working? You know, it’s all in the consultation from where are they working, what are they doing, what job are they doing? You know, it’s, are they going to go to the factory in the evening after you perform the procedure?

Yes, very good. But you can expect infection because you, you cause so much injury on the face or on the body, you know, it doesn’t matter why you do that. Injectables, uh, pathogens are going to penetrate again. It’s not going to be, it’s going to. Contraindications to the procedure. So fill in those forms.

Spend 20 minutes. I know it’s a lot of time to, for the, for the consultation. Always ask about medication. They are photosensitization medication. Uh, I’ve got the whole list. There’s like, I don’t know, over 70 hot sensitizing medications. And I have this list actually on the wall because, you know, I don’t remember all of the medications, but it’s, it’s really good to, to have it just to check it because then you are going to choose the peel, which is, for example, not photosensitizing, which is not going to cause reaction with those, um, medications.

You’re going to choose the products which are not photosensitizing. Um, so it’s all needs to be, you know, thought through. It’s, it’s not a quick process, but it’s absolutely necessary for the best results. And next thing. Is the client, is your patient able to purchase post-procedure products? If not, do you really want to do this treatment?

Complication Example:

Because what (medications) they have at home can have really bad complications. I had the lady who had the procedure recently. It was a chemical peel procedure, and after the chemical peel, someone is leaving the salon and you won’t be there to see if the complication happened. And their complication wasn’t, it wasn’t my client, it was just a consultation, but the complication wasn’t there.

And it appeared 48 hours after. Quite, quite bad burns on the face. And you need to know, even if the client tells you “oh, I haven’t used anything” you need to know your science. You need to know your chemistry, and you need to know that if you apply the peel if you do the peel, and then the client applies the product containing retinol or retinoids at home, the complication is going to occur.

Up to 72 hours after the procedure, but it’s you who needs to know that. So you need to inform them during the consultation on what they can and what they can’t do. They need to sign it. You need to give them extra notes to take home because people forget. Also ask about antibiotics. There was a case when the lady, she was my student, and she said, “Agnes, but I did ask about the, um, medication.” and I said, “and what did he say?”

He was actually having problems with his breathing. We were on the phone all the time and she was like, no, there’s no medication. He doesn’t take anything. I said, you know, give me the phone. And I asked him, do you take antibiotics? And he was, oh, just, I’m accessing it.But it was for my tooth and I was, you know, so for him it was a dentist who gave him a tablet. So it wasn’t medication.

I didn’t quite understand the thought process, but for him, it was prescribed by the dentist, so it was fine. It wasn’t medication. So be specific in your questions. It’s so we knew what to do then, but be very specific in your question. It was a very simple treatment. It was just an application of the salicylic acid, and the reaction was horrid because he was taking a high dose of antibiotics. So, consultation, consultation, consult. It’s vital, I can’t imagine any treatment without proper consultation. That’s up to you.

Dawn: No, no, that was really thorough as well because, um, you know, I’m, I’m a person outside the industry and I, I don’t, I didn’t actually realize actually how much you really do need to make sure that, um, they understand what they’re going through. Also to double-check everything because things could react with each other. It can have a negative impact.

So it’s really good that, you know, you guys are thinking about that kind of thing. Because me personally, wouldn’t even think about that or how, you know, if I just talk for the procedure. .

Agnes: Yeah, no, I, that’s why I don’t call any of my treatments. The procedure is a skin transformation because transformation involves the whole process.

So we talk about the diet, we talk about, you know, the lifestyle we talk about. What you are using before, what you’re using after we talk about how long you’re going to be using it for. Because if you know, you don’t have to know that you might need five procedures to have the best results. And probably you don’t know that if you start doing those procedures, you’re going to love it so much.

You’re going to continue for the rest of your life. But to keep the good skin, you actually need to go to see the therapist at least once a month. You know? So, and, and that’s, that’s it. Yeah. For a lifetime.

That’s completely fair. Um, okay, so moving on slightly. Um, I did have a question, but I think you’ve absolutely smashed that is why , why is it important to have safety procedures?

Why is it important to have safety procedures?

Dawn: This may seem like a silly question, but I’m thinking about those, um, maybe kind of just starting out in the industry or budding aestheticians that really wanna get out there.

Agnes: There are two things, uh, which can happen and I’m going just to touch base on the training. For me, the main safety procedure is good quality training. I mentioned that before. You know, there’s, uh, I was absolutely shocked when I saw an academy offering training in the protocols, which I wrote, which I provide.

Just after watching the Zoom webinar, it was, you know, the product knowledge, it wasn’t technical, but they started offering the training, which is, you know if they brave enough. But I don’t think that should be happening.

That’s why we managed to ensure that our training is trademarked. It’s all legal documentation now, so every single product I’m using, you know, for how long you can keep it, you know who can use it when can use it. It’s all trademarked. It’s all legal document now, so you can’t just watch it and do it, you know, because you feel like it.

Agnes: But why am I talking about the training? During the training, you are going to be taught how to do the consultation, which I mentioned. Why is it so important? You’re going to be taught another important thing, how to recognize which procedure to choose because every scheme will need a different procedure.

I haven’t seen two patients on which I would do exactly the same procedure. It’s again, consultation, the lifestyle, you know, what they do, how they plan to approach this skin transformation. So you going to be taught how to deal with certain product problems such as, you know, patients with psoriasis or clients with psoriasis or dermatitis, rosacea, not quite difficult to deal with.

And, the last thing which you are taught is, How to deal with complications because, as I mentioned before, I am not doing certain procedures because if I am unable to deal with complications, I shouldn’t be doing it. I don’t want to send anyone to the doctor. I don’t want to send anyone to another therapist.

I don’t want to send clients worrying. Oh, give me five minutes. I’m going to find out what to do. No, I’m going to know what to do, and I know what to do, and I ensure that those complications, which can happen to everyone. Only if you don’t do any procedures do you not have complications. If you don’t have any patients, you won’t have complications.

But if you are working, there’s always something which is going to type up always, even little things, but you need to know which product to use, how often to use it. Do you need to see your. or maybe you can just, uh, you know, tell them which product they should be using. Because remember, they have to have products at home.

You must ensure that the client purchases it from you. And I hear so many times, “oh, but our clients don’t want to purchase it.” They go to boots and buy something. So of course, you know they can do that.

Agnes: But those products, you know, which are bought off of the shelves are very often the reason for the complication and you haven’t given the right post-product treatment to your client, so you are reliable for those complications. You shouldn’t be doing the procedure if you know that it might have a cross-reaction with the product they use at home, but if you give them all the right products, and if they’re aware of what they can’t use after treatment, it should be all okay.

Dawn: No, that’s completely fair. It sounds like you need a whole different kind of knowledge base to build up really as well, isn’t it? Even just down to making sure to you can thinking of the right product to recommend to your client.

Agnes: Yes, of course. But it’s something you must know if you deal with the human being with the face, with the skin. You need to know it all because, you don’t go to the cardiologist, and he says, “Okay. Uh, I will do the scan of your heart, but then I’ll send you to someone else to read it.”

“Or if you have a complication maybe I’ll send you to a different hospital. Cause you know, I have a bit of a knowledge, but I’m still not there.” And we always offer support to our students because I understand that it’s a lot of knowledge. It’s a lot of knowledge which needs time to be absorbed. That’s why we have the group on Facebook.

That’s why people can message me. Of course, during the nighttime, I get messages, but I’m not answering them because I still need my sleep, of course. But we do, we do have the support group, and I do support my students For the first, you know, two or three months until they build up this knowledge, if they have complications, this is the time when they can always phone me.

Dawn: That’s really good. And you said you’ve got so many years of experience and your belts, so your knowledge base must be absolutely expansive.

We learn all the time. But you know, I absolutely love learning. So, you know, I attend webinars myself, uh, you know, in Casa Academy. I’m there, you know, every single day, basically. You know, uh, and I do recommend people to, to sign up for the different training with different webinars, different websites. I do recommend reading, um, you know, uh, PubMed.

Absolutely amazing. Resourceful for skin science. You know, read about the products you are using, what exactly they do, how they behave in the skin, what reaction you can expect, and how long they will stay in the skin. This is so important, and this will build your career. This will build yourself as an expert in the field.

You know, expert. I don’t like this word because I don’t think we can ever be, you know, calling our experts, we learn all our lives, but that will give you the knowledge to, you know, to perform the safe procedures. And, you know, if you wanna be the trainer, if you wanted to do training, it’ll give you the tools, uh, where you can pass this knowledge to your students.

Dawn: That’s absolutely brilliant. And yeah, I think that’s so key as well. You need to keep learning no matter what. Something new might also pop along, so you can’t always just be like, oh, so this is. So I think moving on to our last question, um, you’ve spoken briefly, um, about complications occurring and stuff like that.

Could you maybe give an example of two a complication and how best to work with it? Uh, that’s a very difficult one because you know that every single complication is a different one, honestly, of the person. It’ll depend on the skin. Um, I will tell you what to do when you have a complication.

how can we prevent complications?

First of all, when you’re contacting your insurance provider, you must have your notes; you must have your consultation forms because then you will be able to see that the client works in such a place, or maybe they work outside, or maybe they have taken this medication. It could have caused a reaction, or something might have happened.

So your consultation form, pictures before the procedure. Always after the procedure because quite often, uh, Well, very often patients don’t clients, I call them patients. Uh, patients, clients don’t remember what they did, what they didn’t have on this scheme.

So you take the pictures before, and you take the pictures after the procedure, and then you can also show them to your insurance provider. An example I had was a lady who complained that the procedure caused a scar on her face. And it wasn’t quite possible, but she was actually going to sue, and this practitioner phoned me, and she was like, “What do I do?”

“I did a mesotherapy treatment. Maybe I did cause this,” I was like, first of all, send me the consultation form. Send me exactly which protocol you have used. I know she trained with me, so I didn’t ask her for the training certificate. And sent me the pictures of before and after.

The pictures were luckily, good quality, and I said, “can you just make it bigger?” And this scar was really visible there. So the scar was there before, and the client didn’t remember that it was a little scar which looked more like a line, but it was actually a scar. And the client thought that the procedure had caused this scar.

But it doesn’t matter if it’s just a client not remembering that they had a certain scar or problem on the skin. It could be, for example, chemical burns. You would be really surprised when I ask the practitioners.

Please send me the consultation form. Send me which procedure, which product you used, and the numbered batch of the products so I know where you are purchasing it from. Because if you’re purchasing off email, Amazon, I’m not even going to talk to you. You know, so many fake products. Why would you risk it?

And send me the post-procedure product which you asked the client to use. And very often, this is where the conversation ends because they didn’t do any of that. So I said, you need to realize that I’m here for you, but if you don’t do everything by the book, I can’t help you.

And definitely, insurance companies will not even look at you to help you because you didn’t follow the procedures. So with the complications, have all the documentation and the know how to deal with them, that’s all.

Dawn: No, that’s completely fair. And especially in terms of your insurance, it’s really good to have that kind of paper trail and evidence that, you spoke about this and here’s the before and after pictures. And it’s very key to remember for anyone that’s listening is to definitely make sure you have the right paperwork going on.

Anything you’d like to add?

Agnes: Love what you do, be passionate about what you do, and always learn.

Don’t think that going for the training, that reading books, reading articles is a waste of time. It’ll only expand your horizons. It’ll improve your knowledge, improve safety, and also don’t try to do everything. There are so many clinics that try to specialize in everything, which can be a drawback.

Choose what you do the best, what you would like to do and become the specialist. Because what is missing in UK market are specialists, I know if I would like to do a Mesotherapy treatment for skin improvement, I’d rather go to a specialist clinic.

Or Russian lips; I’m going to go to this person because they only specialize in that. And, it seems like everyone is doing everything, and I know it’s money, but maybe in the long term maybe with the coming changes, you do want to become an expert in a certain field, and this is the path I have chosen, and honestly, I can recommend it.

Dawn: That’s absolutely brilliant. Well, thank you so much for coming on.

Agnes: Thank you for having me. It was an absolute pleasure and, um, all the best and have a wonderful day, everyone. Thank you.