The COVID-19 Experience
We asked aesthetic practitioners throughout Australia how the pandemic has impacted their practice. Here are their insights on how to relate, rebuild and stay relevant during COVID-19.
We’re now more than six months into the COVID-19 pandemic, and many aesthetic practitioners have taken this time to take a closer look at their clinics – refining and streamlining business practices, building a stronger social media presence and improving safety protocols for both patients and staff.
We spoke with cosmetic doctors from across Australia about their experiences practicing during the pandemic. Many spoke of using the time to optimise clinic procedures and protocols, make a greater connection online with their patients, and to ensure staff are supported both financially and emotionally.
Interestingly, the jury on telemedicine is out – with many doctors noting its limitations and limited applicability to aesthetic medicine.
Many of the doctors we spoke to said, contrary to expectations for a marked decline, aesthetic treatments saw a large increase after the first restrictions were lifted in May, with many patients not wanting to be “caught out” again if additional lockdowns are mandated.
While different states have had different experiences, one thing is certain: it’s been a time to make lemons out of lemonades.
COVID WILL PASS, HOWEVER WE SHOULD ALL LEARN FROM THIS PANDEMIC: CONNECT WITH COLLEAGUES, UPSKILL YOUR STAFF AND MAKE YOUR PROFESSIONAL LIFE AND PRACTICE STRONGER.
Here’s what cosmetic doctors across the country had to say (note: responses were given mid-July):
Shape Clinic, Sydney
We decided to shut down Shape Clinic one week earlier prior to the mandated closure by the government. I felt this was the right thing to do for the safety of staff and patients but, most importantly, for the good of the entire community.
Since we reopened we have been extremely busy – growth has been exponential and this is one curve we don’t want to flatten. I jokingly tell my patients that I have never seen so many wrinkles in the past 10-15 years as I have now.
For many patients emerging out of lockdown and concerned about their appearance, I feel like they are extra appreciative of the treatments we provide them. The consumption of anti-wrinkle injections and fillers has gone through the roof, and patients who used to be ultraconservative are starting to request higher volumes. My feeling is that in the back of their minds they are concerned we will be shut down again and they don’t want to be “caught out”. They are also more open to the treatments we suggest. This has certainly been an interesting phenomenon.
In a fitting side note, studies have shown that the use of anti-wrinkle injections in the upper third of the face can elevate mood and feelings of wellbeing – if you physically cannot reinforce negative feelings by scowling or frowning, that physical loop of negativity is prevented.
From a surgical perspective, we have seen exponential growth in surgical procedures, especially facial plastic surgery. Most people are working from home so this is a good time for them to undergo surgery and recuperate without them having to go out and socialise or see their colleagues (they can wear a mask when on a Zoom call).
I feel that telemedicine is not very useful in my face and breast practice. I cannot see any skin issues clearly and with a lot of patients a physical examination is necessary to feel the tissue and individual characteristics of the patient. I find that my patients also prefer this physical rather than virtual connection, especially when they’re dealing with such an important and intimate type of surgery. Most of my Sydney patients have travelled to see me, with appropriate social distancing and wearing of masks.
For my interstate and overseas patients, I am continuing to see them via virtual consultations.
Of course, this is a new world, and wearing masks and face shields and hand sanitising is mandatory at Shape Clinic – not only for protection but also for the reassurance to patients. We also require our patients to answer a series of COVID-related questions prior to their appointment and also on the day, as well as a selfdeclaration confirming their answers are accurate.
At this stage, we are still holding off resuming aggressive ablative laser treatment due to the risk of plume generation. Recent studies of COVID-19 suggest the virus is transmitted by aerosolised particles.
Our marketing strategies have not changed – most of my patients are world of mouth and this has worked well for us during this time.
This is certainly a new experience and I’ve learned that everyone has responded to the pandemic differently. Personally, the first two weeks of my lockdown I felt fine and I was productive (I do realise I’m definitely a workaholic), but by week 3, I was rather flat emotionally and lacked motivation. As soon as I came back to work, my mood improved and I think this is due to the fact that I am a very creative person and I draw my creativity and energy from my colleagues, staff and patients. I’ve learned that my successes over the years is drawn from inspiration from the different types of faces and bodies that I see and examine every day.
My advice to other practices: be kind to your staff. All of us are dealing with this in different ways – some are anxious, some are concerned and some are going with the flow. This is a time to empathise with each member of your staff and to come together collectively as a group. At Shape Clinic we have a regular meeting to share how we are feeling, to see how well we have done as a group, how we can balance the increased patient demand while still maintaining COVID-safe protocols, and how we can prosper further.
With humans’ intelligence, creativity and togetherness, we will prevail and we will beat this. It’s just a matter of time.
Laser & Aesthetic Dermatologist,
Cutis Clinic & Cutis Medical, Brisbane
I decided to shut down the cosmetic arm of Cutis prior to the government restrictions on cosmetic practices. I felt it was the correct thing to do. All elective surgical, laser and injectables were cancelled until bans were lifted in Queensland in early May. The medical side of the practice, namely skin cancer and management of urgent dermatological conditions management, was still functional during the lockdown period, albeit attenuated lists.
We implemented a telehealth strategy in the case of a prolonged lockdown period, including development of a specifi c program for dermatology. In the context of medical dermatology, the use of teledermatology has been shown to be an eff ective method for both diagnosis and management of skin disorders. Our group briefl y utilised this service, however with the short period of shutdown in Queensland, medical dermatology picked up once restrictions were lifted. For cases that required a real-time consultation, we extended the consultation and procedural times to refl ect the cleaning requirements after each patient.
Telemedicine in the context of cosmetic dermatology is hard. The majority of our work is procedural; namely injectables, lasers, energy devices and surgical. The aesthetic side of the practice shut down for the period just preceding lockdown until when government restrictions were lifted.
With marketing, the usual Google Ads campaigns (which I am not a fan of anyway) were aimed at medical dermatology. It was during this time in March when I started my other Instagram account, 101.skin, aimed at education. To my surprise, this ended up as a great marketing tool as the account grew.
Contrary to expectations, the injectable market went up after restrictions were lifted in May. Given the projected economic growth, level of uncertainty and job losses, we predicted a marked decline in aesthetic treatments. The increased numbers of injectables was an unexpected phenomenon that still continues 10 weeks after restrictions were lifted. I suspect it may be akin to the ‘lipstick effect’, seen after an economic downturn such as after the Great Depression and the GFC.
This ‘injectable effect’ may possibly be attributed to patients wanting a quick rejuvenation fix with simple non-surgical procedures after a period of isolation. I also know that online sales for skincare had an all-time high during the months of May to June.
The event of COVID-19 and the impact on clinical practice could not have been predicted. The flipside is that every cloud has a silver lining.
The enforced downtime allowed our practice to review our treatment protocols and clinical management, in turn improving the way forward.
I remember starting off my first practice in 2007, during the time of the GFC. An ophthalmologist friend of mine gave me the advice to add a medical arm; his group was severely impacted during the GFC as they concentrated on elective LASIK procedures with minimal medical ophthalmology. I took his advice and split the company to Cutis Medical and Cutis Clinic (cosmetic/procedural). Looking back, it was a good decision.
I do think that retention of your staff is also paramount – everyone from reception through to clinical nurses and therapists. The Jobkeeper Allowance certainly makes it much easier. It takes 12-24 months to train clinical staff , and 3-6 months for administrative staff . My advice? Retain your staff at all costs! COVID will pass, however we should all learn from this pandemic: connect with colleagues, upskill your staff and make your professional life and practice stronger.
President, Australasian Society of Aesthetic Plastic Surgeons (ASAPS)
As the number of COVID cases rose in mid-March 2020, so too did public anxiety. We noticed a decrease in clinic visits and cancellation of scheduled surgery.
When the restrictions were imposed, things came to a halt.
For the months of April and May we opened on demand for Urgent Category 1 patients only, as defined in the Public Health Order. My staff were working from home and handling enquiries remotely, and we offered patients teleconsultations.
Overall, business activity shrunk by 90%.
During this period, I spent a lot of time working ‘on’ the business, which has been very useful. We have upgraded our digital infrastructure and refreshed our marketing strategy to remain competitive. I also took the opportunity to enjoy the slow-paced lifestyle and the joys of spending more time with family.
Every human interaction is a potential COVID-19 risk and we have taken additional precautions to ensure that our clinic environment is COVID Safe. ASAPS along with ASCD issued a COVID Safe injecting guide which lists risk-mitigating steps for all close proximity clinical interactions.
We have telemedicine as an option, which is a boon for my patients who are interstate and those who don’t feel comfortable to travel. For my local Sydney patients, we’ve had a gradual re-introduction and ramping up of elective surgery since 1 June. Thankfully, we are now operating at capacity.
Generally, people are more cautious and are taking extra precautions. Since the second wave in Victoria and the new NSW hotspots, we have noticed a slowdown in enquiries and a few elective surgery cancellations. The 15-20% reduction in activity that we are witnessing now will be the norm for some time to come.
My advice for other practices is to pay close attention to your cash flow and control business overheads. Also, be mindful that the COVID-19 situation may change without warning.
Flawless Rejuvenation Clinic, Melbourne
COVID-19 has had a huge impact on our practice. Obviously now that Melbourne is in stage 4 lockdown for the second time this year, we are essentially closed for all treatments.
It has reduced our net trading to 90% of what it should be. Prior to this lockdown we saw a huge increase in client presentations, with everybody trying to book for the treatments they had missed during the first lockdown, and we were only just keeping up with the volume but overall had a lot of financial ground to make up.
Prior to this second lockdown, there was no real shift in our patient trends; the only things we have seen an increase in is skin conditions and skin irritation connected with constantly wearing masks, especially amongst our clients who work in the healthcare industries.
COVID has altered the way we operate – everything from booking to entry into the clinic and exit out.
The changes we had to make all go towards ensuring that we create the safest environment for both our clients and staff.
While we were operating before the second lockdown, we had removed all makeup, skincare, magazines and brochures from the waiting room. In fact, our waiting room was shut as we request that patients only present at their allocated appointment time and are taken straight into their treatment room.
All staff wore scrubs which they changed into at work and out of when they finished their shift. For all patient contact, we wear a surgical mask, eye protection and gloves, and we have strict social distancing rules in all parts of the clinic where possible including the tea room and reception.
During this lockdown and our clinic closing again, we have focused on what treatments our clients could do at home. We put together some at-home treatment packs which our clients can purchase online, together with some instructional online videos guiding them step by step on how to use these unique treatments.
All of our social media marketing is focused on skincare and skincare products which can again be purchased through our online store.
The main things I’ve learned is that you need to build in financial redundancy to your business so that if you do have to close then you have enough capital to keep paying your staff as well as overheads. Also, during periods of lockdown it’s an ideal time to look at certain parts of your business, such as social media, online stores, staff education and review clinic policies and procedures to ensure all these facets of your business are optimised.
My advice for other practices is to keep your standards high with regards to prevention of transmission of COVID-19, and ensure that your staff are well supported both financially and emotionally. Have regular contact with your accountant to ensure that you make it through these very uncertain times.
We closed our clinic in Adelaide when cases were spiralling and there were shortages of PPE. We had police clearance to stay open, but ethically we decided we had to close.
The CPCA Board developed specific guidelines for cosmetic medical practices and we rehearsed these before reopening to ensure we could maintain COVIDsafe processes, including use of the COVIDsafe App. Apart from sanitisation and pre-assessment of patients, one-way traffic flow is one of our essential measures. Spacing between appointments for cleaning was increased, too.
In the time we were closed we would usually have seen 500 patients – so these patients plus those who were scheduled for the present time have meant long days to help our patients get in.
Complacency is a constant focus.
Audits of the processes we put in place are monitored to ensure we are complying with these measures and to identify any issues that were not discovered when we set up our COVID safe processes. Auditing is so important to keep us all focused away from complacency.
COVID-19 is not going to go away, as we’ve seen in Victoria and NSW. But keep planning, keep working, and stay informed as restrictions change. Until a vaccine, the virus lives with us.
ENT Specialist, Facial Plastic & Cosmetic Surgeon,
Academy Face and Body, Perth
We were closed for nearly three months for cosmetic work. We have been extremely fortunate in WA to now be fully open again and we’re busy catching up with the backlog.
We have always been very strong on hand washing as we have a licenced day hospital onsite, so using hand sanitiser regularly is not new for the medical and nursing staff. Now reception and patients are also following hand sanitising protocols.
Telemedicine was, for me, somewhat disappointing. I still do ENT surgery for the MidWest region of WA and did do some telehealth consulting, but limited. With the need for staff arranging bookings, checking follow-up, not having an electronic script system (amazing in 2020 Australia), the costs outweighed the returns. But now we’re back doing all procedures face-to-face in WA – for now.
In terms of new trends emerging out of lockdown, for the most part patients have continued with their regular treatments, however I have noticed an increased interest in buccal fat removal.
The main things I’ve learned throughout the experience is the necessity of having a great team to understand the changes with JobKeeper, COVID rules, etc, as well as the reminder that business relies on turnover – without it, the significant costs quickly swallow up your reserves.
Another important component is to maintain a strong social media presence and build on relationships with your patients.
The Cosmetic Medicine Centre, Brisbane
The Cosmetic Medicine Centre was closed for six weeks. I believe this was totally appropriate in order to protect both staff and patients and also to allow what PPE was available to be used in hospitals where it would be needed for staff to treat acutely ill individuals.
In terms of telemedicine during our closure, for most initial consultations I don’t believe telemedicine is a good alternative, however, for an “Is this OK?” post-procedure query, it may be adequate to talk to patients over the phone, or have them send a photo and respond after viewing it.
When we reopened, we were initially providing just short treatments for limited hours but have now returned to full time and full availability of treatments. As many treatments cannot be done while maintaining distance, all health practitioners are wearing disposable protective gear, including mask, gloves and jacket.
We’ve found that non-health practitioner administrative staff are not good at wearing masks. It may give them a false sense of security and they tend to touch and readjust them frequently which may, in fact, be a greater risk of contamination, so we’ve opted for maintaining distance for them.
At the time of writing, having myself gone for some routine health checks recently, I know that our own precautions in the clinic are greater than in the general medical community here in Queensland.
We are questioning all patients prior to arrival about contacts, travel and general symptoms, and we are taking everyone’s temperature on arrival and providing hand sanitiser on movement among all parts of the practice.
It is generally not practical for patients to wear masks as most treatments will be on the face, however this is available if practical and necessary. We are wiping down all hard surfaces between each patient and have removed all covers from treatment couches, etc, to facilitate this. Where it is uncomfortable to lie on plastic, we are using disposable paper covering in addition to sanitising the surfaces.
We have asked all adult patients to come alone, if possible, however our rooms are more spacious than most, so social distancing in the waiting area is not an issue. We also generally run to time, unless patients arrive late, so we don’t have a problem with patient numbers building up in the rooms.
We have removed all magazines, brochures and things that might be touched by multiple persons from all waiting areas. Staff no longer apply creams or makeup to patients after suitable treatments, however patients may apply their own, if appropriate.
Since we reopened, we have been incredibly busy – even more busy than before the virus hit and we’re seeking an additional nurse.
We’ve seen a lot of new patients as well as some we haven’t seen for a number of years, so it’s not just the backlog of patients who couldn’t get in while we were closed. We’re also seeing an increase in patients willing to undergo treatments which have some downtime, such as thread lifts and laser resurfacing.
I always ask my patients how the virus has affected them and, for the majority of patients, it has had little impact – they may be working from home anyway, or are doing so now, or have had to do some home schooling for a while but we’ve not had anyone who has lost their job or experienced financial hardship. Some who own gyms or other businesses have told me stories of the innovations they’ve made in order to continue. I guess that means that those who are doing it tough are not those who are having cosmetic treatments and that reflects that people are being sensible. I’m sure there are impulsive patients out there but they tend not to come to stable medical practices where an appointment needs to be made and there is normally a wait before being able to get in.
I will admit that I was highly anxious when it was initially thought that we might be closed for six months! Once we realised it wasn’t going to be that long, the enforced seclusion at home was not so bad.
Fortunately, my husband and I quite like each other! We managed to do some data collection for studies using our patient charts – best time to do it while we’re not being interrupted.
There were lots of webinars to be given and listened to (the world has gone webinar-mad, it would seem).
My advice for other practices is don’t be lax. As we’ve seen, it doesn’t take much for an outbreak to start and spread quickly. Don’t believe that anyone who hasn’t worked in an operating theatre understands hygiene, sterility and fomites.
Launceston Plastic and Cosmetic Surgery, Tasmania
We are doing comparatively well in Tasmania. Perhaps this is a good time to reflect and realise that life doesn’t have to be around big cities. There are so many advantages to being in a regional centre: the basics of good wholesome food, clean air, the chance to take the time to de-stress, and where we just don’t have crowds of people spreading all kinds of disease.
The message is really to make your practice bomb-proof. Make it diverse so that you are not dependent on any one source of patients and a narrow superspecialty.
Where possible, video consulting is helpful, especially for post-op visits.
As for the general safety precautions, we do much the same as is advised to everyone.
We also schedule patients accurately and have very few waiting in the waiting room; now is especially important to run on time.
Finally, have a second income like farming!
Entering the Virtual Realm
While we may be temporarily disconnected physically from the rest of the world, virtual connections have never been more crucial. Remote delivery of information though Zoom meetings, YouTube videos, podcasts and webinars has been a lifeline for the exchange of information, ideas and further learning.
‘With the global lockdown, there has been a huge explosion of virtual events – in particular, Instagram live, podcasts and webinars,’ says Dr Davin Lim. ‘Checking my IG account, there were at least a dozen ‘live’ sessions from all around the world at any given time.
‘Though clinical work was reduced, preparing for weekly webinars and podcasts kept me very busy. The great thing about virtual events is that one can connect with colleagues around the world and learn a few great tips.
With virtual meetings I was able to connect with my colleagues around Australia, as well as the United States, United Kingdom, Singapore, Indonesia and many other countries.
I do believe that this networking will continue to grow post-COVID.’