Typically, skincare is thought of as a collection of creams, serums and other topicals applied regularly. However, the skincare umbrella also includes any measures taken to enhance skin health and appearance, maximize barrier function and treat skin 
conditions, and is a key element of any successful aesthetic practice. Not only is healthy skin a millennia-old beauty ideal (as well as a frontline aesthetic concern today), the more robust and viable skin is, the better the canvas, explained Leslie Baumann, MD, founder of Baumann Cosmetic and Research Institute (Miami, Fla.). “Products can also help prepare skin beforehand and enhance recovery after a treatment session,” she shared. Skincare products also provide an additional revenue stream for the practice.
Today’s consumer is more eager and savvier than ever, according to Joel Schlessinger, MD, director of Omaha Dermatology and Cosmetic Surgery (Omaha, Neb.). In the eyes of skincare experts, this is a serious double-edged sword. “People are more focused than ever on the ingredients, benefits and opportunities for skincare products. It is even becoming popular among teenagers and preteens with social media videos, which may advocate for certain products that would never be prescribed for preteens, or in the suggested combinations. Some may have no proven value at all. For this reason, it is particularly important for dermatologists and any skincare provider to understand the reasons why a particular product or ingredient might or might not be helpful to that patient, and what it should not be used with. As odd as it may seem, we must also stay up with the TikTok trends, if anything, just to understand the next things we may see or hear from patients.”
Dr. Schlessinger is the founder and chief executive officer of LovelySkin.com, a premier skincare website serving over a million customers worldwide. The site offers science-based ski
ncare product lines such as afa and FixMySkin from Olive & Delmar (Omaha, Neb.), which Dr. Schlessinger and his son, Daniel Schlessinger, MD, helped to develop. He began carrying skincare products in-house in 1993 to counter such concerns and it grew from there. “The outlandish collections of products patients brought in and the issues with those pale in comparison to what is happening right now due to the Internet and social media influence. Trendy protocols may advocate leaving on products or oils that should be washed off after use, for example, which may cause side effects or simply do nothing good at all. Sometimes we see recommendations that are outright dangerous and carry a significant risk of irritation, skin damage or lack of efficacy but are still costly to the consumer who falls prey.”
You Get What You Pay For
Demand for skincare is high and you do not need statistics to prove it. “Your skin is your most important accessory, regardless of gender,” stated dermatologist Jeanine Downie, MD, medical director of Image Dermatology (Montclair, N.J.). “I have a sign in my parking lot to that effect. Patients invest all this money into toxin, fillers, lasers or skin tag and fat removal but do not take care of their skin.
“I tell patients that skincare is like many things in life, you get what you pay for,” Dr. Downie continued. “I do not recommend getting your skincare from department stores, but it is also about the original source. Is there any science behind it? Are the ingredients 
good for skin or potentially harmful, even if commonly used? Was the product shipped in good conditions to maintain product viability? I am not castigating online suppliers, department or drug stores, or any other place, because some do have decent products available, but patients should start with a board-certified dermatologist. Their favorite YouTube or TikTok beauty influencers may not be dermatologists or have any medical training.” It is the same with chemical peels. “What we in the industry have access to will be safer, more effective and have better quality ingredients than at-home peels,” Dr. Downie added.
The basic trifecta of skincare is moisturizing, repair and sunblock. While people generally seem to focus on the first two, the importance of sunblock cannot be overstated, according to Dr. Downie. “So, you want more even skin tone but do not wear sunblock every day? That is not going to happen. It would be like doing sit-ups for one day and expecting six-pack abs.” It is not just about ultraviolet A (UVA) and ultraviolet B (UVB), she noted. “Human skin reacts to both indoor and outdoor lighting, so your sunblock may not effectively block blue light from all those screens, your TV, lighting at work or similar high-energy visible light sources. Infrared – from your oven, a hot car or sidewalk – is a whole other spectrum that people do not talk about; infrared blocking will be part of dermatology- grade products but not over the counter (OTC).”
Skincare Analysis and Results
Although there is a cost outlay, advanced imaging systems may offer value because they provide a more detailed skin analysis than what can be obtained with the naked eye, according to Dr. Baumann. “These have gotten better over the years, not just in quality and capabilities, but in how they interact with your electronic medical records (EMR). They also give you more ways to measure 
change or progress,” she emphasized. “For example, they may analyze your images, often taken with specialized lighting, and provide a score which you can compare between visits over time. This theoretically can improve conversions and that drives return on investment (ROI) for the device because they provide valuable information to help practitioners and patients come together about skincare.”
Dr. Schlessinger agrees and sees the value of powerful imaging systems but also suggests there is more to the puzzle. “We offer frontline imaging systems in our office,” he shared, “but there is no substitute for the trained professional with a critical expert eye who has the patient medical history and their previous skincare experience in hand. These systems are not meant to be used alone. We also see websites and apps with automated quizzes that lead to self-serving commercial recommendations that are nowhere near as safe or potentially successful as those that are developed during time spent with an experienced clinician.
‘Prescribing’ a Skincare Regimen
To Dr. Schlessinger, it is all about the regimen or product line that best suits the patient in front of him. “I tend to recommend my patients find a product line they like and attempt to formulate a regimen from within that line if possible. Product lines tend to be formulated to work well together, so if you combine a hodgepodge of products from many different lines you may see interference, unexpected sensitivity or reduced efficacy.”
However, the main issue with successful practice-led skincare for patients is not the products, the analysis or the approach — it is compliance. “Getting patients to correctly and consistently use whatever products they choose is the number one concern,” Dr. Downie asserted.
“My regular joke is that skincare does not work inside the bottle. If you keep forgetting your sunscreen, put it with your deodorant and toothpaste so you remember to apply it. It is that important.”
Dr. Schlessinger’s practice maximizes patient compliance by regularly taking in-office photographs. “We have patients who come in regularly for medical office visits and we attempt to make sure they have enough product and take their pictures each time to chart progress,” he explained. “The ability to show results, whether they are great, good or bad, works to allow us to improve our regimens (both medical and cosmetic), and with our EMR system you do not need a special setup to take high quality pictures given the camera quality on your average iPad tablet and phone. We have consistent lighting throughout the office and consistent paint schemes in each treatment room, but it is still very simple. The tablets take pictures, which are then saved in our EMR system, allowing us to easily track their progress or offer areas of possible improvement upon future visits.”
To provide top level skincare to physician offices, Dr. Baumann created a skin typing system that is scientifically validated1 and wrote a New York Times bestselling book about it. “It has four categories of ‘barriers to skin health,’” she explained. “The presence or 
absence of these leads to 16 skin types. These four issues – dehydration, inflammation, hyperpigmentation and aging risk – are detected with a painstakingly validated patient questionnaire.” SkinTypeSolutions is meant to be a resource2 for physicians who want an e-commerce platform to simplify and streamline putting personalized skincare routines into patients’ hands. “The purpose is to help drive patients toward healthy interest in their skincare and to understand it,” explained Dr. Baumann. “This boosts compliance. It also guides clinicians toward quality products from more than 70 brands with legitimate product lines the physicians choose to offer based on their needs. We have spent the last 20 years refining this and it is a resource for physicians worldwide.”
What about in-house skincare lines? “I do not see the real benefit of them,” Dr. Baumann admitted. “There are so many well-formulated, effective products out there. Why create another ‘me too’ product?”
Product Watchlist
The LifeViz® Pro range of imaging products for face and body consultation from Quantificare, Inc. U.S. (Suwanee, Ga.) is built to improve care and ROI from the first visit, for effective and reassuring consultations that boost patient engagement and confidence. 
Powerful imaging improves understanding of treatment options and their benefits through clear visual aids. Decision-making is accelerated by detailed, high-quality images that facilitate informed choices. This enables patients to see and appreciate post-treatment results with clear, highresolution images. Monitoring and follow-up are enhanced with precise visual documentation of progress. Users may also increase conversions by demonstrating the tangible benefits of procedures, fostering trust and encouraging continued patient engagement.
Powered by advanced artificial intelligence (AI) tools, the VISIA® Facial Imaging System from Canfield Medical Imaging (Fairfield, N.J.) captures high-resolution, standardized images of the skin to deliver in-depth analysis of both surface and subsurface features. Proprietary RBX® Technology separates the unique color signatures of the underlying red and brown skin components providing unequaled visualization of subsurface skin conditions. Ultraviolet (UV) photography offers a comprehensive assessment of sun damage and porphyrins. Before-and-after images provide a visual timeline to monitor treatment efficacy. Standardized captures ensure meaningful and reliable comparisons over time, significantly improving the quality of care by minimizing human error and streamlining consultations. 
These images are invaluable for patient communication, offering a direct and objective representation of treatment progress. This instills greater confidence in patients, empowering them to make informed decisions and, in turn, leads to enhanced satisfaction and deeper engagement with your services for a stronger practitioner-patient relationship.
Launching October 2024, the Observ® 520x from Sylton (Ann Arbor, Mich.) is the fastest and most user-friendly skin consultation tool available for users to visualize the skin, build treatment plans and monitor progress. You can showcase before and after images to confidently promote your work, build trust, loyalty, client satisfaction and increase sales organically. The system provides an unparalleled view into the skin layers w
ith 10 light modes, and can be used to educate your patients on how they can achieve optimal outcomes. The Observ 520x is compatible with the iPad Pro, plus an easy-to-use iOS app with a built-in database to store images and notes. Expand your horizons with the Observ and capture images of not only your clients face, but their hands, neck and décolleté.
Crown Aesthetics (Dallas, Texas) BIOJUVE® skin biome care topical product line harnesses the power of probiotics to truly bring skin back to life. Unlike traditional skincare routines, it is designed to revitalize and optimize the ecosystem for skin health, with clinically proven improvements in the appearance of skin texture, tone, fine lines, wrinkles and photodamage on all skin types. The age-defying X-factor is proprietary Xycrobe™ technology, a patented true skin probiotic specifically designed to restore balance to the microbiome so that patient’s skin is a true reflection of science and health.
PRX Derm Perfexion from WiQo (GPQ Srl; Trieste, Italy) is a non-invasive Topical Collagen Biostimulator™ treatment with specific levels of trichloroacetic acid (TCA), kojic acid and hydrogen peroxide. Its unique structure and delivery system work to maximize 
results and minimize discomfort. Passing through the superficial epidermal layers, it penetrates the deeper dermis to activate collagen stimulation, involving the natural repair process without visible trauma or photosensitivity. The PRX Derm Perfexion treatment yields long-lasting results that tone, tighten and lift without the downtime of ablative lasers, microneedling or peels. It can be done in combination with radiofrequency microneedling, laser energy therapies and ultrasound to address a range of skin concerns, from skin texture and laxity to fine lines and wrinkles, pore size, acne and scarring. It is safe for all types and tones on the Fitzpatrick scale, and it can be used for desired results and ongoing maintenance.
References:
1. Baumann L. Understanding and Treating Various Skin Types: The Baumann Skin Type Indicator. Dermatol Clin. 2008 Jul;26(3):359-73.
2. Skin Type Solutions. Retail Medical Grade Skincare From 70+ Brands. Accessed September 13, 2024. Available at: www. sellmoreskincare.com
