A Holistic Approach to Skincare: Partnering with the Aesthetic Patient

When it comes to an aesthetic consult, it’s tempting to simply focus on the primary cosmetic concern and provide a treatment, such as hyaluronic acid fillers or poly-L-lactic acid biostimulator. You may offer a solution to satisfy their immediate concerns, but to forge a long-term relationship with an aesthetic patient, you must truly get to know the person in the treatment chair. Experts in the field of aesthetics say that to obtain the best possible results, you need to address underlying skin conditions or concerns and educate on the best approaches for skincare to cement your role as the expert in overall skin health.

Like these aesthetic providers, Galderma as a company understands that everyone’s skin is unique, and we each have our own skin story for life. With a deep history in dermatology, Galderma offers a broad range of cutting-edge, premium brands across the full spectrum of dermatology needs through aesthetics, consumer care, and prescription medicine.

“As a dermatologist, I am very focused on total skin health, and that includes medical and cosmetic skin conditions. I am not a fan of the distinction between medical and cosmetics, because it’s really about skin health. When your skin looks healthy, it looks beautiful. And when your skin shows sign of sun damage, pollution, life, and aging, it doesn’t look as healthy as it could,” says Deirdre Hooper, MD, a dermatologist in New Orleans.

Sabrina Fabi, MD, a dermatologist in San Diego, points out that the skin isnt a standalone to one’s overall aesthetic—bone structure and muscle and fat loss all play a role. With so many in-office aesthetic options for minimally invasive facial rejuvenation—from energy-based devices to injectable neuromodulators and fillers, leading experts know they can offer patients great outcomes. However, if they don’t address all their patients’ skincare needs, they may not be getting optimal results.

“I assess their overall bone status and how it’s participating in the aging appearance of that individual. I look at their fat pads, to what extent muscles are contributing to the wrinkles that we see in the downward pull of the face. Then I look at the quality of the skin. Is there pigment? Is there redness from rosacea? Are there blood vessels? Or are there lesions like acne or sebaceous hyperplasia?” Dr. Fabi says. “You could have a perfectly full face or one that has no lines and wrinkles, but if the skin doesn’t match a more youthful-looking contour, there is still a discrepancy. The person is not necessarily benefiting from the overall global enhancement you’ve performed if you haven’t treated or incorporated the skin as well.”

Patients appreciate the attention to their skin health. “They appreciate the value of their injectables and fillers more when their skin quality—the skin that is draping all of their injectables—looks better, too,” Dr. Fabi says. “Treating acne is extremely important from an overall confidence and skin health standpoint. Ultimately, people often want neuromodulators or fillers to increase their self-confidence, but one of the biggest deterrents for self-confidence is having noticeable acne. You must treat the acne as well.”

Young Cho, MD, PhD, a Spring, TX-based plastic surgeon, endorses a multi-modal approach. He always offers an overall consult to help develop a treatment plan that consists of one or more of the 5Rs of his approach to facial rejuvenation:

• Relaxation of muscles that cause wrinkles, such as frown lines, using a neuromodulator
• Revolumization/Replenishing lost volume associated with the aging process using dermal fillers, such as hyaluronic acid fillers or a poly-L-lactic acid facial injection
• Repositioning of tissue with thread lifts or surgical lifts (e.g., forehead lift, face, and neck lift)
• Reducing volume in unwanted areas, such as the jowl fat or submental fat (double chin area)
• Resurfacing of the face using lasers and radiofrequency and supported with skincare

Alastin Skincare®, which Galderma recently acquired, offers a collection of scientifically proven products for daily skincare regimens and peri-procedural use. The products are formulated with patented TriHex Technology, a proprietary blend of peptides and botanicals to support the appearance of rejuvenated skin.

A Global Approach

Understanding all your patient’s skincare and aesthetic needs is a key first step, says Julie Woodward, MD, an oculoplastic surgeon at Duke University in North Carolina. “I like to take time to get to know the patient first. ‘Who referred you? Where are you from? Where do you live? What kind of work do you do?’ Then I ask what their main concern is. I like to make a point of mentioning one of their pretty or positive features, then I tell them that I like to evaluate them systematically from their hairline down to their chin. Evaluation of the patient’s face from different angles and in different forms of facial animation is important. I make sure to point out subtle asymmetries and assure them that they are within normal limits.”

Heidi Prather, MD, a dermatologist in Austin, TX, agrees. “The most important thing with starting a consult is understanding the patient’s goals.” She begins by asking patients what brought them to her office and then asks if they are interested in anything beyond that concern. She asks if they are interested in skincare recommendations or learning about her three-step approach to overall skincare.

Her practice is primarily aesthetic with a focus on liposuction, lasers, and injectables, but as a board-certified dermatologist, she always wears her medical hat as well. She says it’s important to make sure patients are up to date with skin checks and to assess if they have active rashes, lesions, or concerns. “I like to be able to engage with and support patients globally. When a patient comes in for a consult, that global approach is essential in terms of caring for the patient as a whole,” Dr. Prather adds.

Some clinical practices take a transactional approach. If a patient comes in for acne, they leave with an acne treatment, such as trifarotene cream 0.005%. Someone who comes in for a neuromodulator leaves after receiving that treatment. “With a global approach,” she explains, “a patient may come in only asking for neuromodulator and leave with that as well as an acne treatment plan or a referral to another doctor for a skin check. They leave with a full skincare analysis and a treatment plan that could include both prescription and non-prescription brands, such as Cetaphil® or Differin® OTC. Treating the patient globally is about meeting all of their skin goals. By listening and educating, we can provide customized patient care with targeted treatments for that patient.”

Education is Key

It’s important to let patients talk to get a full understanding of why they are coming to the office, says Corey L. Hartman, MD, FAAD, a dermatologist in Birmingham, AL. Often patients don’t really understand what they need—they have an idea in their minds, but they really don’t know. “Getting an idea of what is bothering them gives me a chance to educate them about possible solutions,” Dr. Hartman explains.

Suneel Chilukuri, MD concurs, explaining that often patients come for an initial appointment saying they know exactly what they want done. “Realistically, though, does the public really know what they need done? They know what Instagram, Facebook, or TikTok tells them,” says Dr. Chilukuri, a dermatologist in Houston, TX. “But you don’t go into your heart surgeon and say, ‘I want you to use this type of valve because that’s what I read about on Instagram,’ When we talk about an overall evaluation, it goes beyond the age of the person—it includes assessing their overall skin health, bone structure, and changes that they have noticed over time.”

Dr. Chilukuri asks patients for photos from their childhood so he can assess those changes. “Is it the skin texture that has changed? Is there more redness? Is there acne in certain areas? I partner with wonderful companies like Galderma, to make sure that we have a portfolio that can address all of those changes.”

Dr. Hooper agrees. When her patients tell her they already “have a plan” for their skincare concerns, she reminds them that her main goal is to make their whole skin look beautiful. Referencing her training as a dermatologist, she tells patients she likes to have holistic input into their overall skincare plan because everything—from what they’re eating to the OTC and prescription products they’re using—impacts the end result of any aesthetic procedure. She explains that if she’s injecting them with a neuromodulator, but they’re using subpar skincare, their skin quality is going to deteriorate and they’re not going to look their best. Or if she’s using an injectable to treat their fine lines, but they have untreated acne, they are not going to achieve optimal outcomes.

“I think when you take care of that for your patient and you really brand yourself as the person who is going to be their complete skin advisor, that really locks that patient into you. My frequent refrain is, ‘I’ll see you about three times a year to inject your neuromodulators. I’ll discuss your skincare at every appointment and make sure that I’m managing any problems you have with your skin,’” says Dr. Hooper. “I tell patients, ‘There’s no reason for you to manage this on your own. You have my expertise. I’m here to do it.’ I think that helps to solidify the patient as your patient for life.”

Disclosure: Drs. Suneel Chilukuri, Sabrina Fabi, Corey L. Hartman, Deirdre Hooper, Heidi Prather, Julie Woodward, and Young Cho are all consultants for Galderma. None of the participants has received any financial consideration for their participation in this series.