What To Know About Aesthetic Procedures Resuming During COVID-19

July 16, 2020

We've covered what it's like to visit a hair salon and get your nails done during the COVID-19 pandemic, but what about visiting your plastic surgeon, dermatologist, cosmetic dentist for an elective surgery or procedure?

Whether you had a procedure scheduled that was cancelled due to the moratorium on elective surgery, want to resume your quarterly Botox® appointments, or are like the many people who have a new interest in cosmetic treatments after examining their reflection in the front-facing camera lenses of Zoom and FaceTime calls, aesthetic practices are trying to navigate the 'new normal' and figure out how to best serve their patients.

To better understand what to expect when you visit your provider, we're rounding up the new rules and speaking with board certified plastic surgeons about the protocols they've put in place at their own practices.

The New Guidelines

Some plastic surgery, dermatology, and dentistry practices began reopening as early as mid-April, while others resumed services later either because of regulation or preference. With most parts of the country now allowing non-essential businesses to operate with limited capacity, the Centers for Medicare and Medicaid Services (CMS) has established rules for non-emergent and non-COVID cases (NCC), which include:

"Non-emergent, Non-COVID care (NCC) should be offered to patients, as clinically appropriate, in localities or facilities that have the resources to provide such care, as well as the ability to quickly respond to a surge in COVID-19 cases, if necessary. Decisions should be consistent with Federal, State, and local orders, and CDC guidance and made in collaboration with State and local public health authorities."

Those decisions also have to be compliant with the executive orders for medical, dental, and surgical procedures placed by state and local governments (see what that means for your state HERE). In California, where elective surgeries resumed on April 27, Beverly Hills-based facial plastic and reconstructive surgeon Jonathan Cabin, MD, says the inner workings of plastic surgery practices are being transformed. "We changed the office configurations so everyone is in their own space," he explains. "We also have schedules for multiple cleanings per day with medical-grade disinfectants."

And the changes go deeper than disinfecting and distancing. "Reopening my practice has been challenging but also enlightening," Gregory Buford, MD, a plastic and reconstructive surgeon in Denver, CO. "As we enter what is truly a new iteration of the medical practice, we are forced to change the way that we see the patient-physician interaction and adapt accordingly."

Practice Protocols

In conjunction with local and regional health regulations, the American Society of Plastic Surgeons (ASPS) has established recommendations for aesthetic practices to keep their staff and patients safe:

  • Universal masking procedures
  • Mandatory gloves for both patients and staff
  • Mandatory temperature and screening checks upon entry
  • Patients must be asymptomatic
  • Limiting of patients per day
  • Availability of COVID-19 testing
  • Mandatory staff education
  • Limited in-office consultations in favor of telemedicine
  • Online patient portals and e-communication for registration and paperwork
  • Eliminating waiting rooms
  • HEPA filters placed throughout the facility
  • Increased decontamination protocols for anesthesia machines
  • Frequent cleanings for all high-touch areas
  • Contactless payment

Some practices have taken these guidelines a step further. "Everyone from the office changes into scrubs when they come in and back to their street clothes when they leave," Dr. Cabin shares. "We also have HEPA filters in all the rooms, and a UV sterilizing lamp to use between patient visits."

Patient Protocols

For patients, there are similar guidelines in place. While they may vary slightly by practice, anyone going in for an elective procedure or cosmetic appointment may be asked to:

  • Consult with their provider via telemedicine prior to appointment
  • Fill out all necessary paperwork online
  • Wait offsite before entering
  • Be screened for COVID-19 symptoms or fever
  • Wear a mask and gloves when arriving for scheduled appointment
  • Limit the number of visitors per appointment

Making sure patients feel comfortable is the number one priority of providers. "We want to make our patients feel psychologically safe, so when they enter our office they feel comfortable," Dr. Cabin says. With that in mind, below are five ways aesthetic practices are trying to give patients peace of mind:

1. Telemedicine

Before the outbreak, patients were more likely to consult with their surgeon pre- and post-op in person, but providers are now opting for virtual appointments as their primary form of communication. "Virtual encounters with both new and established patients have become more of the norm than the exception," Dr. Buford says.

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HOW TO PREPARE FOR A VIRTUAL CONSULTATION

By doing as many appointments virtually as possible, Dr. Cabin is able to limit the number of patients who require in-office visits. That switch allows for greater social distancing and safety. "Initially, we saw only one patient an hour," he says. "Now we're bumping it up to two patients an hour. And, unless 100 percent necessary, we are not allowing visitors to come in."

2. WAITING ROOMS

Flipping through magazines in a waiting room is largely a thing of the past (at least for the time being). Many have been eliminated in favor of patients waiting in their cars or outside until the doctor is ready to see them. If a waiting room does exist, you'll likely be the only one in it. "We are only allowing one person in the waiting room at a time, and that also applies to consultations," Dr. Buford explains. "While there have been one or two hard feelings about this, most patients are understanding and willing to abide by the new rules."

At Dr. Cabin's practice, patients are also asked to use separate doors to enter and exit in order to limit contact. "We have an entrance in the front and a separate exit to limit the amount of time a patient is in the office," he shares.

3. MASKS

At this point, you're probably used to rocking a face covering when you're out and about, and a trip to your provider's office won't be any different. "We've had some resistance from some patients refusing to wear masks, but we're not compromising on that," Dr. Cabin says. "They're not allowed to come in without a mask on."

4. PROCEDURE PROTOCOLS

You should know that many providers have prioritized medically necessary procedures and those that were cancelled as a result of COVID-19 first, though new patients are welcome. When it comes to the types of procedures being performed, Dr. Cabin says it's important to consider how masks and other safety precautions may impact recovery and results.

"I would be careful with [facial] treatments, if you have to wear an N95 mask constantly. It can restrict blood flow causing swelling and bruising," he explains. Neurotoxins, dermal fillers, microneedling, laser skin resurfacing, or really any kind of facial procedure will likely come with recommendations regarding mask-wearing. "One of the concerns with these types of procedures is the micro-aerosolization of the virus, which can spread it which is why we do screen everyone prior to coming in," Dr. Cabin says.

5. RECOVERY RECOMMENDATIONS

As far as post-operative consultations go, the ASPS recommends doing any follow-ups and wound checks virtually, unless it is absolutely necessary to go into the office. Patients are also encouraged to self-isolate for seven days post-procedure to reduce the possibility of infection or exposure.

The Takeaway

Stepping into the OR is not what it used to be. Aesthetic providers aren't just thinking about the safety of themselves but their patients and staff, too. Increased measures are being taken even in already highly sanitized medical spaces. When going in for a cosmetic treatment or plastic surgery procedure, consult with your provider to stay atop of the rules in place.

"We have emphasized to our patients that while there is no way to guarantee zero exposure to COVID-19 or any other pathogen for that matter, we are doing everything that we can to abide by CDC guidelines as they pertain to re-opening a medical practice," Dr. Buford shares. "Other than that, we are using our common sense and ask our patients to do the same.

https://aedit.com/aedition/plastic-surgery-dermatology-cosmetic-dentistry-practices-reopening-during-covid-19

 


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