A Path to Resume Aesthetic Care: Executive Summary of Project AesCert Guidance Supplement—Practical Considerations for Aesthetic Medicine Professionals Supporting Clinic Preparedness in Response to the SARS-CoV-2 Outbreak

Executive Summary of Project AesCert™ Guidance Supplement

This Project AesCert Guidance Supplement (“Guidance Supplement”) was developed in partnership with a multidisciplinary panel of board-certified physician and doctoral experts in the fields of infectious disease, immunology, public-health policy, dermatology, facial plastic surgery, and plastic surgery. The Guidance Supplement is intended to provide aesthetic medicine physicians and their staff with a practical guide to safety considerations to support clinic preparedness for patients seeking nonsurgical aesthetic treatments and procedures following the return-to-work phase of the coronavirus disease 2019 (COVID-19) pandemic, once such activity is permitted by applicable law. Many federal, state, and local governmental authorities, public-health agencies, and professional medical societies have promulgated COVID-19 orders and advisories applicable to health-care practitioners. The Guidance Supplement is meant to provide aesthetic physicians and their staff with an additional set of practical considerations for delivering aesthetic care safely and generally conducting business responsibly in the new world of COVID-19. The Guidance Supplement is published as an Appendix to this article and can be read in full online at www.liebertpub.com/fpsam

Aesthetic providers will face new and unique challenges as government stay-at-home orders and related commercial limitations are eased, the U.S. economy reopens, and health-care systems transition from providing only urgent and other essential treatment to resuming routine care and elective procedures and services. Medical aesthetic specialties will therefore wish to resume practice in order to ensure high-quality expert care is available and, importantly, to help promote patients' positive self-image and sense of well-being following a lengthy and stressful period of quarantine. In a number of areas, this Guidance Supplement exceeds traditional aesthetic office safety precautions, recognizing reduced tolerance in an elective treatment environment for any risk associated with COVID-19's highly variable presentation and unpredictable course. The disease has placed a disturbing number of young, otherwise healthy patients in extremis with severe respiratory and renal failure, stroke, pericarditis, neurologic deficits, and other suddenly life-threatening complications, in addition to its pernicious effects on those with pre-existing morbidities and advanced age. Accordingly, the Guidance Supplement seeks to establish an elevated safety profile for providing patient care while reducing, to the greatest extent reasonably possible, the risk of infectious processes to both patients and providers.

While the Guidance Supplement cannot foreclose the risk of infection or serve to establish or modify any standards of care, it does offer actionable risk-mitigation considerations for general office comportment and for certain nonsurgical procedures typically performed in aesthetic medical settings. It is axiomatic that all such considerations are necessarily subject to the ultimate judgment of each individual health-care professional based on patient situation, procedure details, office environment, staffing constraints, equipment and testing availability, and local legal status and public-health conditions.

Federal, state, and local government legal pronouncements and public-health conditions will inform the gating decisions of when permissible and prudent to reopen practices and re-engage with patients, and whether to limit certain procedures that may present greater contagion risk. While such gating decisions are not the focus of this Guidance Supplement, it is advisable that practices should consider, at a minimum, whether in their local communities: (1) new COVID-19 cases are declining sequentially to eliminate or at least substantially control community spread; (2) testing is available at a meaningful scale to validate perceived prevalence reductions; and (3) adequate protocols and resources are in place in conjunction with local health departments to conduct effective contact tracing where necessary in response to COVID-19 incidents. Without robust testing, the ability to identify individuals with COVID-19, do appropriate contact tracing, and isolate and treat the infected is substantially reduced. Therefore, in the absence of these enumerated local conditions, practices must factor cautiously the attendant increased risk of transmission into their reopening calculus.

Significantly, the principal variables within the control of the practicing aesthetic medicine physician are office and staff preparation, and communication and transparency with patients. The Guidance Supplement is focused heavily on these subjects, offering consensus guidance from authors representing relevant scientific and clinical disciplines.

The Project AesCert Guidance Supplement provides specific recommendations and considerations for preparing to reopen a medical aesthetic office and begin to deliver aesthetic patient care in a COVID-19 environment, including:

Patient communication—establishing appropriate expectations for office visits and attendant risks;

Clinic schedule management—considerations for schedule modification to convert non-treatment interactions to telehealth consultations, separate patients from one another in the office and avoid unnecessary staff contact;

Facility management—physical modification of office common areas and treatment rooms, as well as check-in and check-out procedures, to promote safe practices and physical distancing;

Cleaning procedures—discussion of disinfection methods and practices in each office area, ranging from medical instruments and treatment rooms to administrative items and reception areas;

Personal Protective Equipment (PPE) for providers, staff and patients—recommendations for PPE types and use depending upon procedure-based risk assessment, and recognizing current global equipment shortages;

Employee health screening and training—procedures and methods for identifying staff members who may be unwell before, during, and after work, and training of staff to identify potential COVID-19 presentation in coworkers, patients, and other office visitors; risks associated with exposure to known or suspected COVID-19-positive individuals are also discussed;

Patient health and screening—procedures and methods for symptom recognition in patients before, during, and after office visits, with follow-up monitoring where appropriate;

Remedial measures following onsite symptom presentation—a framework for addressing isolation of symptomatic individuals, office containment and disinfection, and contact tracing;

Treatment room setup—preparing and securing treatment rooms for patient entry to contain office contamination and reduce overall potential COVID-19 exposure; and

Aesthetic treatment considerations—pretreatment preparation and precautions, and other suggestions for minimizing risk of transmission in performing the most common types of office-based aesthetic procedures, such as neurotoxin and dermal filler injections, noninvasive body contouring, lasers and other similar energy-emitting devices, and a range of medical skin care treatments.

The Project AesCert Guidance Supplement also contains summary charts and checklists designed in collaboration by both infectious disease and aesthetic experts, which can be utilized immediately to assist office staff in understanding and modeling sound safety practices.

Conclusion

Aesthetic medicine practices must navigate a daunting series of medical and business challenges occasioned by the COVID-19 pandemic. Most offices have been closed by operation of both common sense and legal requirement, as the public health community labors to comprehend both the magnitude and complexity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its sequelae. This crisis has created significant safety concerns and occasioned severe financial hardship for aesthetic physicians, staff, and patients alike. However, the authors posit that application of sound safety measures identified and considered in the Guidance Supplement will serve to assist aesthetic medicine specialties in returning to the delivery of patient care with reasonable risk-minimization strategies. It is critical that all disciplines of medicine, aesthetic and otherwise, share available information and work together to evolve effective approaches to practicing in a dramatically changed environment.