to be aware of the need to decrease the actual flow of patient visits, and to space or stagger all treatment-related and inoffice visits such that a minimal number of patients are in the office at one time. Office appointments should be kept brief with all in attendance wearing sufficient PPE and performing adequate handwashing practices. In addition, the staggering of appointment allows sufficient time between appointments for room disinfection. Unfortunately, this often results in limiting the total number of patient appointments per day and may require an extension of office hours. The use of telemedicine appointments and the ability to supply patients with products via a website or call-in ordering is helpful in reducing in-clinic patient visits.
Patients seen in the office should be advised of the stringent precautionary measures that include everyone wearing PPE (see above section) and the use of temperature monitoring (if applicable). During procedures that require PPE removal, patients should not be allowed to talk, with some clinicians noting that they provided patients with a small piece of wet gauze to hold over their lips as a reminder. There should also be guidelines that limit unneeded patient escorts (while still permitting patients with a disability or need for assistance as well as minors to have someone accompany them) and directing these individuals to wait in the car or another location. Office practices should be prepared to accept credit card payment prior to the appointment completion to minimize the back desk/ check out process or use a "touch-free" system.
Practice changes among those undergoing office-based treatments may include precautions to protect the injected areas post-treatment. This may include the use of proper skin preparation or other antiseptic preparation on the surrounding areas. In cases of treatments to the lip area the patient should be advised to remove the mask after they are in the car to avoid further bacterial exposure from the mask and the occurrence of biofilm.
Contact tracing through patient records, a smart-phone app, or other means should also be implemented. This involves identifying individuals who were exposed to a contagion or infected person and notifying them of the contact and the recommended course of action. In the case of the COVID-19 crisis, this consists of tracing all individuals who came in contact with the “positive†person; promptly notifying them via email, text, or phone call of the potential exposure; and relaying the testing recommendation. The clinic should be completely decontaminated to avoid further exposure(s).
Patients seen in the office should be advised of the stringent precautionary measures that include everyone wearing PPE (see above section) and the use of temperature monitoring (if applicable). During procedures that require PPE removal, patients should not be allowed to talk, with some clinicians noting that they provided patients with a small piece of wet gauze to hold over their lips as a reminder. There should also be guidelines that limit unneeded patient escorts (while still permitting patients with a disability or need for assistance as well as minors to have someone accompany them) and directing these individuals to wait in the car or another location. Office practices should be prepared to accept credit card payment prior to the appointment completion to minimize the back desk/ check out process or use a "touch-free" system.
Practice changes among those undergoing office-based treatments may include precautions to protect the injected areas post-treatment. This may include the use of proper skin preparation or other antiseptic preparation on the surrounding areas. In cases of treatments to the lip area the patient should be advised to remove the mask after they are in the car to avoid further bacterial exposure from the mask and the occurrence of biofilm.
Contact tracing through patient records, a smart-phone app, or other means should also be implemented. This involves identifying individuals who were exposed to a contagion or infected person and notifying them of the contact and the recommended course of action. In the case of the COVID-19 crisis, this consists of tracing all individuals who came in contact with the “positive†person; promptly notifying them via email, text, or phone call of the potential exposure; and relaying the testing recommendation. The clinic should be completely decontaminated to avoid further exposure(s).
SUMMARY
The COVID-19 crisis has emphasized the need for practitioners
to be prepared for sudden emergency situations that require
closure for an extended period of time. The implementation
of some or all of these suggested emergency preparedness strategies will ideally minimize the detrimental effects on the
practice and ease the transition back to seeing patients and
resuming aesthetic visits and procedures. The authors consider
this a best effort at an approach for future disasters rather than a
comprehensive all-inclusive document and emphasize that the
approaches to emergency preparedness will vary according to
the type and magnitude of future circumstances.
DISCLOSURES
Joel L. Cohen is a consultant for Allergan (an AbbVie company).
Steve H. Dayan is a researcher, consultant and/or on the speaker board of the following companies: Aesthetic Biomedical Systems, Alastin, Allergan (an AbbVie company), Croma, Evolence, Galderma, Merz, Revance Therapeutics, and Venus.
Mathew M. Avram serves as a consultant to Allergan (an AbbVie company), is on the Advisory Board of Soliton, Inc. and Sciton, Inc., has stock options in Cytrellis, Inc., and La Jolla Nanoparticle.
Renato Saltz serves on the advisory boards of Allergan Aesthetics, Coolsculpting, and Dominion Aesthetics, and has received royalties for book editing and publishing.
Suzanne Kilmer is on the advisory board and has received research support from the following companies: Aesthetics Biomedical, Alastin Skincare, Allergan (an AbbVie company), Cutera, Cytrellis, Dominion-Aesthetics, Galderma, Lumenis, Lutronic, Merz, Pulse Biosciences, Revance, Solta/Valeant, Syneron/Candela, and Venus Concepts. She is a shareholder of Accure, Alastin Skincare, Avava, Cutera, Cytrellis, Dominion Aesthetics, and Revance.
Corey S. Maas is a consultant for Allergan (an AbbVie company).
Joel Schlessinger is a consultant and a shareholder in Allergan (an AbbVie company).
Steve H. Dayan is a researcher, consultant and/or on the speaker board of the following companies: Aesthetic Biomedical Systems, Alastin, Allergan (an AbbVie company), Croma, Evolence, Galderma, Merz, Revance Therapeutics, and Venus.
Mathew M. Avram serves as a consultant to Allergan (an AbbVie company), is on the Advisory Board of Soliton, Inc. and Sciton, Inc., has stock options in Cytrellis, Inc., and La Jolla Nanoparticle.
Renato Saltz serves on the advisory boards of Allergan Aesthetics, Coolsculpting, and Dominion Aesthetics, and has received royalties for book editing and publishing.
Suzanne Kilmer is on the advisory board and has received research support from the following companies: Aesthetics Biomedical, Alastin Skincare, Allergan (an AbbVie company), Cutera, Cytrellis, Dominion-Aesthetics, Galderma, Lumenis, Lutronic, Merz, Pulse Biosciences, Revance, Solta/Valeant, Syneron/Candela, and Venus Concepts. She is a shareholder of Accure, Alastin Skincare, Avava, Cutera, Cytrellis, Dominion Aesthetics, and Revance.
Corey S. Maas is a consultant for Allergan (an AbbVie company).
Joel Schlessinger is a consultant and a shareholder in Allergan (an AbbVie company).
ACKNOWLEDGMENT
The authors recognize the contributions of the Cross-Specialty Allergan Aesthetics Preparedness Advisory Panel that Included the following physicians:
Gaurav Bharti, Charles Boyd, Connie Brennan, Steven Davis, Lisa Espinoza, John Fezza, Leslie Fletcher, Allen Gabriel, Irene Gladstein, Justin Harper, Corey Hartman, Carmen Kavali, Will Kirby, Ellen Marmur, Mike Nayak, Rand Rusher, Chris Surek, and Julie Woodward.
Medical writing support, under the direction of the authors, was provided by Susan Garabedian-Ruffalo, PharmD of Med Write, Inc., in accordance with Good Publication Practice (GPP3) guidelines. This assistance was funded by Allergan Aesthetics (an AbbVie Company).
Gaurav Bharti, Charles Boyd, Connie Brennan, Steven Davis, Lisa Espinoza, John Fezza, Leslie Fletcher, Allen Gabriel, Irene Gladstein, Justin Harper, Corey Hartman, Carmen Kavali, Will Kirby, Ellen Marmur, Mike Nayak, Rand Rusher, Chris Surek, and Julie Woodward.
Medical writing support, under the direction of the authors, was provided by Susan Garabedian-Ruffalo, PharmD of Med Write, Inc., in accordance with Good Publication Practice (GPP3) guidelines. This assistance was funded by Allergan Aesthetics (an AbbVie Company).
