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In this episode of Skinside Out, host Dr. Zain Husain, MD, Heather, Courtney, and special guest Crystal discuss the importance of knowing who is performing your aesthetic treatments. They discuss the various qualifications and training of professionals in the aesthetic industry, including board-certified dermatologists, physician assistants, nurse practitioners, and aestheticians. The episode highlights the significance of proper training, board certifications, and the potential risks of receiving treatments from unqualified individuals. The conversation emphasizes being a savvy consumer by researching and understanding your provider's credentials to ensure safety and quality in aesthetic procedures.
00:00 Introduction and Guest Introduction
01:15 Understanding Physician Credentials
02:20 Importance of Board Certification
05:04 Med Spa Supervision Issues
06:07 Ethical Concerns in Aesthetic Practices
14:20 The Role of Advanced Practicing Providers (APPs)
20:29 Eye Check-Up Alert
20:55 Certification and Specialization in Dermatology
21:30 Journey from Family Practice to Dermatology
22:13 Importance of Primary Care Experience
22:55 The Value of Asking for Help
24:24 Transitioning into Aesthetics
25:42 Understanding Aesthetician Training
27:52 State Regulations and Laser Techs
33:12 The Importance of Knowing Your Provider
34:25 Final Thoughts and Next Episode Teaser
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
017 Skinside Out - Who is performing your aestetic treatment?
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[00:00:00]
Dr. Zain Husain, MD: welcome to Skin Side Out Where Science Meets Beauty. I'm your host, Dr. Zane with Heather Courtney, and special guest Crystal who's joining us. She's a licensed aesthetician and a former med spa manager, so it'll be unique to see her perspective working in different environments such as a med spa versus some medical offices. Um, related to our topic today, which is who is performing your aesthetic treatment?
So in the aesthetic industry, there are a lot of different professionals in the space. [00:01:00] Um, so we're gonna go into the various professionals you may encounter, what their credentials and training mean and how. Having that knowledge will help us be savvy consumers in choosing who we choose for these specific procedures.
So I am a board certified dermatologist, so I will speak upon physicians. Um, so physicians are medical professionals who have. Completed four years of medical school, um, either at an allopathic or osteopathic medical school, and then further have training, um, in residency in a specific specialty.
, They can also go on and do fellowships as a subspecialist within those specialties. So as a dermatologist, I did four years of medical school. Then I did a year of internship in internal medicine. Then I did three years of residency in dermatology. Then I did a fellowship in cosmetic dermatology as well as most micrographic surgery.
So a lot of years of training. [00:02:00] 13 to be exact after. Wow. After graduating high school. So it's a long road, but I thought that I received excellent education and training. We really do see a lot in those years and it really made me a better clinician that way. So I do think that training does matter.
Education does matter. And if you're seeing a physician, you know, at a minimum they've had four years medical school and some subspecialty or specialty training afterwards. So, and you have to pass a lot of tests and show competency and there's a lot of. Testing and you know, rubrics that we have to follow and in order to be board certified.
So that's another thing that. You know, a lot of people don't understand what does board certification mean? So you can be a physician and not be board certified, meaning that you did not sit for, or you did not pass, um, a test that certifies you in that specialty. So I've taken two boards, um, [00:03:00] one in you know, for dermatology, one for MOS micrographic surgery.
But prior to that, you actually have to take board exams throughout medical school and during training to even qualify for that. So there's a lot of testing, a lot of education involved, but that ensures that the public is receiving qualified treatment from a professional who's gone through that vigorous training.
I.
Courtney Carroll, LE: I think that's super, obviously important. , What we find, you know, in the medical field sometimes that's funny from a per, from our standpoint, rather than the patient's standpoint, is that yes, someone will be a doctor, but maybe they have not gone through and done these certifications. For example, I know there's, um, a moss surgeon close to us who has not board certified.
And um, so even though you do have this like you know, I guess. Community of physicians, everyone has had their own separate training and you know, I think it's so important to,
, go on their website, check out [00:04:00] their bio. Mm-hmm. Your physician should be saying where they studied school, what fellowships they've done, all of these things so that you know what they have specialized in.
Because technically any doctor can open a practice and say that they're a specialist in that, but without those credentials, you have no idea.
Dr. Zain Husain, MD: And bringing it back to aesthetics. You know, there are physicians who are not trained in what is called the the core four. So these are specialties that have training in cosmetics during their residency training.
So that includes dermatology, plastic surgery. I. Facial plastic surgery, oculoplastic surgery. These are individuals who have gone through training and have had supervision and actually performing cosmetic procedures while in training, like these folks did not go through a weekend course and learning, um, you know, how to inject Botox and filler and all this stuff.
Um, like we had to really learn the anatomy, learn the procedures, [00:05:00] and learn how to avoid complications. And that's a really big part of the education.
Heather Murray, PA-C: Yeah. Going off of that, especially in aesthetics, a lot of med spas that are being kind of supervised by primary care physicians.
Mm-hmm. Yeah. Or you know, I think a lot of people are trying to get into aesthetics. Mm-hmm. There are bariatric surgeons who are now doing aesthetics, and so I think really that credentialing makes a huge, huge difference with the background
Courtney Carroll, LE: and supervised by a doctor is a very, yeah. Loose. Term very loose.
Like we could be talking about a doctor who's never on outta state. Yeah, he could be outta state. He's not even on the premise. So if something goes wrong. What, you know, what we're gonna call and say, oh, what do we do? It's a very loose term. Yeah. Yeah. And
Dr. Zain Husain, MD: Crystal, I mean, you're a med spa manager, like who was your supervising physician?
Crystal: Yeah. No one there would be, that's scary. We shouldn't be laughing. There would be no one there. You know, there was someone that we could call that, you know, was the person mm-hmm. That's supposed to be supervising, but no one was [00:06:00] actually present to supervise. So,
Dr. Zain Husain, MD: yeah. Um, it blows my mind. Yeah. And it's scary because.
First of all, some of these owners or these supervising docs don't have any training in the procedures that they are hiring someone else to do. Some of them are not even the owners, they are just renting out their medical license, getting a little paycheck, which in my opinion is crazy. Mm-hmm. Because my medical license is worth way more than any little stipend.
Mm-hmm. And potentially losing that and my livelihood because of any like lawsuit that can happen, it, it blows my mind. Mm-hmm. Um, so I always check credentials and education. And I would always question, Hey, why is an ER doc running a med spa? Why is a general surgeon doing this? You know? Is it for passion for skin?
I don't think so. What do you think the motive is, guys? I. [00:07:00]
Courtney Carroll, LE: Money.
Dr. Zain Husain, MD: Money, it always comes down to the dollar. So follow the money and you know, like people think that aesthetics is just easy money. It's not, it requires, and you know this too, like it's, it's, it's a difficult and there's a lot of competition.
You have to be good at what you're doing and provide results because, you know, consumers are really savvy. Mm-hmm. They have a lot of different options and what I focus on in my practice is expertise. Safety.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: I think you can't compromise on that. And unfortunately, like a lot of these facilities really don't care.
They're just trying to draw patients in with their group on deals and you know, like, you don't even know who's treating you and what their credential are. That's a scary thing. It's like sometimes people just walk in and, Hey, I'm gonna get my face injected and mm-hmm. Yeah. It's, it's, it's crazy.
Heather Murray, PA-C: There's definitely a lot of people who use like Groupon to get different deals.
Mm-hmm. But I think in the long run that I. People who can keep their patients, I think makes a huge difference. Mm-hmm. Because if you're seeing [00:08:00] results
Courtney Carroll, LE: mm-hmm.
Heather Murray, PA-C: And you're doing these treatments effectively and appropriately, you're gonna get those Yeah. You know, results that you're looking for. And so maybe technique plays a different role too.
And yeah, as far as. Keeping those patients and keeping them satisfied. Yeah.
Courtney Carroll, LE: On the flip, you know, you don't wanna cheapen your care either. Mm-hmm. I mean, you're talking about procedures that can have long lasting complications if done incorrectly. And, um, when you. Value your health.
You don't really wanna take the cheap end, the Groupon, that's a a hundred dollars laser hair full body. I mean that like That's crazy. That's crazy. Hey guys, this
Dr. Zain Husain, MD: is your face,
Courtney Carroll, LE: right? Yeah.
Crystal: Yeah. And I know in the med spa, you know, running the med spas. There has been many times where the patient care isn't even a priority at all.
Mm-hmm. Like the focus. I know managing the focus was always revenue and sales. Mm-hmm. The money period. It's a business at the end of
Dr. Zain Husain, MD: the day, right? Mm-hmm. Yeah. Yeah. But the thing is, you know, as a physician. [00:09:00] I've taken an oath to do no harm. Mm-hmm. And to treat my patients and do what's right for their health.
And you know, I don't know if some of these other clinicians even took an oath.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: Whoever they are. So sorry for all the shade, but that's how I feel. I'm very passionate because I get so angry when I see a patient who has been harmed.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: And they're coming to us for help. And it was preventable, right?
Mm-hmm. So, I mean, a lot of these complications stem from, you know, poor training or no training, lack of education, and really looking at profits over health. And I do think that, you know, it's, it's, it's an ethical dilemma. Um, and I feel unfortunately like yeah, it is a business and at the end of the day, they have to keep their lights on.
I get it
Courtney Carroll, LE: right?
Dr. Zain Husain, MD: But. At what cost?
Courtney Carroll, LE: Right? Pick a different business, like do hair or something. Hair grows back.
Crystal: I mean, even with the credentialing aspect, um, call it a medical oversight, but I mean, there was [00:10:00] a time that we had a patient that got a laser treatment done. Um, her face got burnt. And come to find out that the person that did this treatment wasn't even actually certified.
Wow. You know, they never actually checked during her hiring process. So I'm sure the attorneys
Dr. Zain Husain, MD: had a field day with that one.
Crystal: Yes, very much so. Yeah, and
Dr. Zain Husain, MD: I'm not trying to say that all aesthetic, you know, physicians are bad if they're not trained in the core.
You know, there are some excellent practitioners out there who are artists. They invested the time they went to do that extra training. Um, so I'm not going to speak poorly about them. It's those people who just kind of get in there, take shortcuts. Mm-hmm. And it is complex. It's not an easy skillset, you know, being able to make sure that, you know, the anatomy inside out, um, how to manage complications.
Mm-hmm. You should not be doing any procedure that you cannot manage their complications. Mm-hmm.
Courtney Carroll, LE: Yeah,
Dr. Zain Husain, MD: end of story. Yeah.
Courtney Carroll, LE: Especially toxin filler, I mean, not only [00:11:00] are you. Are you concerned with, obviously technique and anatomy and where you're injecting and why and how, but the artistry of it?
Not everyone has an artistic eye. I've worked with providers who have technique down pat. They know how to inject steady hand. They know the planes, but that artistry is not there. Mm-hmm. And they don't know necessarily where they should fill in what looks. You know, symmetrical. So it's not for everyone.
Yeah. I have
Crystal: experienced this myself. I've had, I've had
Courtney Carroll, LE: the, the duck lip.
Dr. Zain Husain, MD: Ooh, yeah. Not the duck lip. Right.
Courtney Carroll, LE: Clap. Clap.
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE: And again, that's another example of just, um, technique and, you know, filling out instead of being able to. Kind of fill in. I mean, we've utilized, they, what do they call it, like the Russian technique with the mm-hmm.
Um, insulin syringes to really get in there and get a nice, um, control on where that is being injected, the filler. So yeah, not everyone has been trained, um, you, you can't just stick a needle in and put how much product to push in at a time. I mean, [00:12:00] these are all little key things that I think people don't realize are.
Or understand, and especially people who are hoping to make a quick buck.
Dr. Zain Husain, MD: Yeah. People think it's so easy. Yeah. And it's like a commodity almost.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: And they don't realize that what took me like, you know, 15 minutes to transform someone's face. It took me over a decade to learn.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: And it is not in a vacuum.
And like when patients, you know, like say that anyone can do this. I can go to any med spa and do this. I'm like, sure. I mean, take your chances. But, um, at the end of the day, you pay for expertise.
Courtney Carroll, LE: Mm-hmm. Yeah. And you know, there's so much variability. I think that's what a lot of patients don't understand too.
I mean, um, besides just the credentialing, um, variability on, on lasers, you know, we've talked about it before, not one laser fits all. Um, you wanna make sure you are going to, someone who understands your skin type is gonna use the right laser on you to gonna use the right settings on you. Mm-hmm. Um, you know, again, someone's.
That's [00:13:00] gonna know what to look for for any complications. Oh, maybe this is too high, maybe it's too low. Um, there's just so many things that I think play a part that people don't realize.
Dr. Zain Husain, MD: Yeah. And even within the field of dermatology, not everyone receives the exact same training, right? Mm-hmm. So there are some programs that are really medical focused and have very little cosmetics training, and some that are heavily focused on cosmetics and, you know.
There are times where you have to seek out opportunities to learn while you're in training. Going to conferences. I used to be one of those residents. I used to go to all the conferences. I wanted to learn as much as I could about cosmetics and surgery, and I ended up doing another year of fellowship in New York.
Um, so that I could master my craft. And it was probably the best year of my life in terms of my education because I really got to perfect my craft. Mm-hmm. And see a lot of patients get a lot of experience in a short period of time. So, I mean, I did a dual fellowship, um, because I wanted to be the [00:14:00] best at what I did.
And, you know, not everyone has that. So, you know, I think that, you know, seeking. The best care requires a little research on consumer's part. Mm-hmm. So that's also important.
Now that we've kind of discussed what physicians do, let's talk about apps and Heather is our expert in that.
Heather Murray, PA-C: So yeah, I'm an a PP, an advanced practicing provider. So that is typically a pa, so a physician assistant or can be called physician associate or a nurse practitioner or an np. And so there are a lot of.
Similar things that PAs and NPS do, but there's a very different way to approach how to get there. Nps for example, um, you have to be a nurse first before you can become a nurse practitioner. Um, I think there are a lot of schools that require, you know, a certain amount of years of being a nurse before you can even apply to a nurse practitioner program.
that really kind [00:15:00] of develops this like bedside manner. As a nurse, you're always, caring for that patient and that's, um, kind of the, the forefront of your care. And then you go to nurse practitioner school. That can allow you to learn how to diagnose and treat different conditions. There are different types of nurse practitioners, so there's um, family nurse practitioners, um, women's health, geriatric, and I think a lot of.
Family nurse practitioners can even then specialize additionally and go into other, you know, specialties like dermatology or any other field. PAs, um, you have to have a certain number of, um, clinical hours or a clinical experience, whether that's.
Being a nursing assistant or an EMT or a phlebotomist before you go to PA school. And, um, the nice thing is there is a wide range of experiences that you [00:16:00] can get before you go to PA school. Um, but during PA school, it's typically a two year master's program. And PAs are generally set up to be generalists.
Um, meaning that you have this. Overall kind of view on the body. You're trained to look at every organ together versus just being focused in women's health or just being focused in dermatology. Have that kind of total body mindset. Um, kind of going back to nurse practitioners, I think. There are some schools that are online, and so that can play a huge role in how you're learning.
And you can even still be working as a nurse while you're getting your, um, education in nurse practitioner. Um, whereas with a pa you're pretty much working full-time in school. There's no way that you could [00:17:00] ever have a job. While you're in school for pa. Um, and then I think the credentialing after schooling is very different.
There's different exams that you can take. , A specific one for PAs. There's specific ones for nurse practitioners. but I think the biggest difference in terms of practicing is that level of supervision. So PAs are always. Licensed under a supervising physician. So Dr. Zane is my supervising physician.
nurse practitioners don't necessarily have to have that. They can practice independently. they can have somebody that they go to like a, like a physician, but they don't always necessarily need that. They could open their own practice if they wanted to. And so I think that's why I like being a pa 'cause I like having that supervision.
I like having that. Person that I can go to for those expertise and um, kind of that knowledge and, and opinion on different things.
Dr. Zain Husain, MD: And that's philosophically why I chose to have a physician assistant in my office as [00:18:00] opposed to a nurse practitioner. I know that there is a fund of knowledge that they have acquired.
It's standardized. they will be working alongside me to do patient care. I. Um, you know, the thing that scares me a little bit about the nurse practitioner, like you even mentioned, you can do your schooling online. There's a lot of variability and you know, many of these online programs are like diploma mills, everyone passes.
Um, you're just, essentially the schools are just collecting their tuition fees. Mm-hmm. And there's really no standardization. And the fact that you can practice independently in many places, um, it's a little scary. Um, and. As a physician, I have come to respect how much I don't know. It is scary and I'm always on the conservative end and, and treating my patients, and I feel like if you don't get that full training and scope on in a systematic way and like things are done virtually, like I, I [00:19:00] really don't think you even know what you don't know.
Heather Murray, PA-C: Yeah.
Dr. Zain Husain, MD: And that's scary.
Heather Murray, PA-C: You don't have that hands-on experience as much. Mm-hmm. And I think that's what PAs definitely get throughout their training is a lot of hands-on. Mm-hmm. Um, I think also too, you have to be careful. You wanna make sure you're going to a certified PA versus just a pa. So we have to take a certification after, um, schooling.
By the N-C-C-P-A, the national certification or the National Commission on Certification for PAs. if you don't pass that you can't practice as a PA or you shouldn't practice as a pa. I think that kind of helps solidify that medical model. PAs are trained with that medical back background to help kind of diagnose and treat.
Mm-hmm. Whereas NPS are more focused on that nursing background with that bedside.
Courtney Carroll, LE: Mm-hmm. I'm glad you mentioned that about also taking the test. I, it just brought up this point, separate, um, of dermatology. There's a dental [00:20:00] practice in this area where the owner was letting his son, um. Practiced dentistry, and he hadn't done his test yet to make him like officially a dentist, but he had completed school and whatnot.
Anyways, they're billing, like insurance, they're taking money, they're all, this sounds illegal. All this. And they got caught. And someone had just posted on Reddit, of course, that's where I had everything that they posted, that they had received a letter from the, um, from the office saying if you've been seen, um.
Oh is the eye doctor. It was the eye doctor. If you've been seen at this practice mm-hmm. Please go get your eyes rechecked. 'cause we can't guarantee that.
Crystal: Oh wow. And you
Courtney Carroll, LE: won't
Crystal: know.
Courtney Carroll, LE: You wouldn't know. Like you wouldn't know. You wouldn't know. I had
Crystal: this like saved. Yes. Had, you know, some No way. Said something.
Yeah. You know what I mean?
Courtney Carroll, LE: Yeah. And because he was his son, I guess, and. He felt, oh, he's done school, but he hadn't finished, he hadn't gotten his certification truly yet. He just was practicing. It's, it's insane to me. It's insane. Yeah.
Heather Murray, PA-C: They actually now have, so through the N-C-C-P-A, they have certification of [00:21:00] added qualifications or cqs, which, um, PAs can actually go in and take another certification test.
In dermatology or in orthopedics. And so that is something that's very new for PAs and I think it's really gonna help change that, especially for PAs who are in specialties.
Courtney Carroll, LE: Mm-hmm.
Heather Murray, PA-C: Um, just having that additional education and being able to say, yes, I am certified by mm-hmm.
Dr. Zain Husain, MD: You
Heather Murray, PA-C: know, the CIQ and dermatology makes a huge difference too.
Dr. Zain Husain, MD: Definitely. Um. And just highlighting your path, you did not start in dermatology, right? You started in family practice, right? Yeah. Got experience, saw some dermatology, and then eventually got more experience in dermatology. And you know, by the time you joined my practice, um, you had a strong fund of knowledge.
Courtney Carroll, LE: Mm-hmm.
Dr. Zain Husain, MD: But the thing I like about you is that you still ask for help. Mm-hmm. And you don't know things because obviously I've seen things that you may have not. Um, just based on my training. Mm-hmm. And you're not. So proud to [00:22:00] come up to me for help, which I think is collaboration, right? Yeah. We should definitely be working together for patient care.
So I really do like that model where, you know, I still have that ability to communicate with you, make sure that we're on the same page for patient care.
Heather Murray, PA-C: Yeah, I think working in primary care was really helpful for me, and I think anybody who is graduating as a PA definitely work in primary care first because it gives you that foundational knowledge that you need to just.
Know how everything works. Pretty much, and I think even though there are a lot of PAs in specialties, it's also important to know what they have done before because a lot of PAs, there are PAs in dermatology that used to work in orthopedics and so it's very different. They don't have that primary care or that generalist background to help.
You in dermatology or in the specialty that you're currently in. And so I think that makes a huge difference.
Courtney Carroll, LE: I think going back to what Dr. Za had said also about like being able to ask for help. I, [00:23:00] I always say this, that like, I feel like a good provider should live with a little bit of fear in them.
Mm-hmm. Like you never want a provider, you want obviously confidence, but mm-hmm. As like a provider, you should always have this little bit of just fear so that you know that you are within your limits. Like, and not taking on things that you can't handle or not doing things that you, I, I think when you run into these providers, they're like, oh yeah, I can do it.
Like I do everything. I can do it. They take on more than they can handle, and that's where you start seeing those complications and it's like their ego was just. You know, in the way of like, this patient's treatment, rather than saying no, like, I, I don't think this is in my scope. Um, let me refer out to this or that.
Yeah. Yeah. They just take on and I think it's such a dangerous thing. Yeah. Um, to, to have such a ego. I have no
Dr. Zain Husain, MD: problem with referring out if I don't feel comfortable with something like, say something. It's affecting like, you know, the, the eye, the lower blast, the structures like lower, you'll recommend Exactly.
If, if
Courtney Carroll, LE: you think something neat, if it's laxy and it's [00:24:00] not gonna be fixed by filler or by a jelly roll or whatever, I've seen him numerous times say, you need a lower blepharoplasty. Go see ocular plastics. Mm-hmm.
Crystal: I know. I feel like I'm gaining so much more. Like a wealth of knowledge being in dermatology mm-hmm.
Versus being in just the med spa, which has been great for me because, I mean, every day is a learning experience for me. Yeah.
Courtney Carroll, LE: And you know, kind of transitioning into, um, you know, estheticians and laser techs and their roles and, you know, crystal just coming out of school as well, I mean mm-hmm. Can vouch for this even.
There's so much variability in. In school for aestheticians. Now, when I started, I started as a medical assistant in dermatology. And so I'd gotten a little bit of that medical foundation. Okay, how does rosacea work? What treats it? What prescriptions are used for acne? Um, if someone's on a topical chemotherapy for pre-cancer spots, do they need to come off for appeal?
Like how to incorporate that together. And then I started doing glycolic peels with my first [00:25:00] practice, and that's what kind of transitioned me into aesthetics. If I had not had any of, let's say, let's just say I went to school, didn't have any of that prior knowledge, I only learned how to do a facial, right, which is not rocket science, how to wax not rocket science.
Um, and maybe some like really mild peels, but we're talking like mandelic acid, lactic acid. Mm-hmm. Nothing of a true deep peel. Yeah. So. Mind you also in class patient or my peers are coming to me asking, what's glycolic acid? What, like, can you use glycolic with a retinoid? I mean, they're, these are things they don't really teach you in school.
Mm-hmm. You're literally learning the, the bare minimum. And so when you think about your aestheticians. I think it's so important to know where that training has come from, because if you've only been in a med spa or only been in Massage Envy doing facials for four or five, it doesn't matter that you've been doing it for five, six years.
Yeah. You don't have experience with Peral [00:26:00] dermatitis. Mm-hmm. You don't have experience with psoriasis. That weird pimple that's not going away that we talked about last time. Yeah. Basal cell. I mean they, there's no, um. Knowledge in that field to be able to say, Hey, I can't treat this. Mm-hmm. Go see a dermatologist.
Mm-hmm.
Crystal: And it's nice 'cause like, um, I know Dr. Sain is really great about, he'll be like, do you know what that is? Do you know what that means? And then I'm just like, um, and he'll just explain it in very detailed. So I'm like, oh, okay. I learn something new. I, I learned something new. I wouldn't have known that had I not been here.
Dr. Zain Husain, MD: And similar to Heather, Courtney also knows when to ask for help mm-hmm. When she's not sure about something. And it's always better to ask mm-hmm. Than potentially treat a patient and cause an issue. So I do really respect that, um, from both of you, that you guys are willing to come to me for help, um, you know, to make sure that we get the best care for our patients.
Shows how. Confident you are in asking for help when you do not feel [00:27:00] comfortable. And not everyone has that. I have worked with people who literally will not ask for help. Their ego is in their way, and then we run into an issue and then I lose trust in that provider.
Mm-hmm. And I never wanted to get. Into that position where I lose trust in my body. I don't wanna send my patients to them. They're in my practice. I have to get rid of them. So it, it is really important. That's why I have such high standards, um, for who I bring into my practice and making sure that my patients are well taken care of.
Because at the end of the day, my practice, my patients, and if they get hurt, ultimately the buck falls with me. Right.
Crystal: Exactly it with me. You actually care. I do. Yeah,
Dr. Zain Husain, MD: I do. So I do think. Um, you know, having a team that really is invested in their patients is so critical. I've worked in environments where that is not the case.
Courtney Carroll, LE: Mm-hmm. Mm-hmm. Yeah. Yeah. And, you know, adding onto that with laser tech, which again, is like a, a very generalized term now, I think [00:28:00] also worth mentioning is that different states. Have different requirements. Okay. So for example, as an aesthetician who is not an rn, um, I cannot inject Botox filler, um, things like that.
There are things, there are things, North Carolina is kind of weird. There are things that even though I legally can do CO2, I would never, because I don't feel comfortable and I think it's beyond my scope. That being said, in other states, for example, in Texas, you have legality of these aestheticians who can in inject Botox In filler.
Yeah. In Colorado. Colorado as well. So that's why I think it's so important, you know your state's regulations too, because if you live in a state where these things are allowed and okay. Mm-hmm. And you're getting injected by someone who, again, like I'm telling you, I don't, I'm assuming aesthetician schools the same across the us.
I did not learn any anatomy. I, I learned the epidermis, the dermis, and the, you know, I did not learn anything else. So, no, and the hours are different too. And the hours are [00:29:00] different.
Dr. Zain Husain, MD: Totally different between different schools. Yeah. Yeah. Um, and. I used to practice in New Jersey and that is like a, the state with like the strictest laws.
Mm-hmm. So like even my medical assistants could inject lidocaine from my surgical patients. They couldn't do, um, like procedures such as lasers, light-based technologies, energy-based technologies. Like I literally have to do everything 'cause of the strict rules, which is not a bad thing, but. In North Carolina, the laws are so different.
So I was just floored with like how much more relaxed it was here. Mm-hmm. Um, compared to up north.
Heather Murray, PA-C: Well, there's also, like you mentioned laser tech, but there's also people calling themselves like aesthetic therapists. Yeah.
Dr. Zain Husain, MD: What is that? Is that even a certification they have? No, I
Courtney Carroll, LE: don't think so. Yeah, because laser tech, like I said, is a generalized term.
It's not, you did not go to school for your laser tech. A degree. That's not a thing. It's not real. So how you learn lasers is you learn with a [00:30:00] provider. You do go to these trainings with these companies who provide these really qualified, um, you know, tech providers, whether they be RNs, doctors, um, pa, whoever that is, they've been trained by the company, they train you.
It's a very structured process. So it's just insane. Yeah. To call yourself a laser tech, but then, but what's, what additional education did you do? Yeah. Like what, what else is there? Yeah.
Dr. Zain Husain, MD: And that's crazy. Like some people that I've met who are laser technicians. I just asked them basic things about the physics, like the wavelength, and you know, the UPH poll ation, the JUULs and everything.
They're like, oh, this is like the preset instructions. I was just told to do this for X, Y, Z condition. Uhhuh, they have no idea what they're doing. They're just literally, I. Pushing buttons that they've just been instructed by someone.
Crystal: Oh, this is bringing me back to trauma. Oh my gosh. I actually had a laser treatment done on my face and I, [00:31:00] we ended up finding out later on that the settings weren't correct for my skin type.
Yeah. Thankfully it was under versus over. Okay.
Courtney Carroll, LE: Yeah.
Crystal: But yeah. We've seen a lot of that too. Imagine. Yeah. Yeah.
Courtney Carroll, LE: We've seen a lot of undertreatment, I would say. Which again, I would rather be undertreated
Heather Murray, PA-C: any day. All day. Yes.
Dr. Zain Husain, MD: But yeah. But
Heather Murray, PA-C: that's kind of a waste of your money too. Yeah. You know, you pay for all that treatment and then you don't really get a.
Great outcome. Yeah.
Courtney Carroll, LE: Cough. Cough. Ideal image. Cough, cough. Um, let's get lays away. Cough. Cough. You know, Milan. But,
Dr. Zain Husain, MD: but you know, on the flip side, like when you are overtreated or like very aggressive with settings, I've seen literally a girl her entire legs. It was like zebra stripes. Mm-hmm. Mm-hmm. Yeah,
Heather Murray, PA-C: me too.
Dr. Zain Husain, MD: Because they forgot to switch from an Alex wavelength to an nd ya. In a skin of color patient.
Courtney Carroll, LE: Yeah.
Dr. Zain Husain, MD: Big. No-no.
Courtney Carroll, LE: Yeah. Yeah. And to speak on that, I mean, there's so many things that go into when you're deciding, um, what settings to use or mm-hmm. [00:32:00] You know, I mean, you wanna know what's their sun exposure history like, what do you, do you tan easily?
Do you burn easily? Um, you know where your
Crystal: ancestors from. Yeah. Where your ancestors
Courtney Carroll, LE: from. I mean, you wanna ask the nitty gritty. I am not afraid of asking. So like, what's your ethnic, where are you from? Like, where were you born? Where are your parents born? You know? Yeah.
Dr. Zain Husain, MD: Because even if you're fair. You still have the propensity to tan like what your ethnicity is, right?
Mm-hmm. Mm-hmm. So especially like even in South Asians, right? There are some dark South Asians and there are light South Asians. Some of the light South Asians, you can't really even tell between Caucasian patients. Mm-hmm. Yeah. And if you treat them the same way, you will get hyperpigmentation or burn.
Right. Like I've seen that happen time and time and again, same thing with Hispanic patients. Yep. Same thing with Middle Eastern patients. I have a cousin, African American right here. Yeah. Perfect genetics. Yeah.
Courtney Carroll, LE: It's the racially ambiguous, you know, and that's why you wanna be forthcoming, um, you know, with your provider and then as a provider with your patient to say, okay.
And
Dr. Zain Husain, MD: as the world becomes. More diverse. Mm-hmm. With more mixing, more [00:33:00] biracial, multiple ethnicities or whatnot. You really can't tell. Depends on patients. Yeah. Yeah.
Courtney Carroll, LE: That's true.
Dr. Zain Husain, MD: It's always better to be safe.
Courtney Carroll, LE: Yeah. Mm-hmm.
Dr. Zain Husain, MD: Yeah. Especially in the us, like where we just are a melting pot. Mm-hmm. I think it's so important.
Yeah. Yeah. I think this was a great discussion. I feel like the public really doesn't have a firm grasp about the medical providers, um, that they're seeing and what certification educations they have, especially in aesthetics. It's very ambiguous.
Courtney Carroll, LE: Yeah. So
Dr. Zain Husain, MD: hopefully we, um, you know, shed some light on, you know, the various different providers that you may see what their qualifications are and, you know, some parting words.
I think that. It's really important to do your research, do your due diligence. I mean, this is your health. It's your skin, it's your face. I do think it. It doesn't take that long to do a Google search and kind of find, you know, information about the provider, like it's all public knowledge.
Courtney Carroll, LE: Mm-hmm. And ask I a hundred in 10 times will never mind a patient [00:34:00] asking, how long have you been doing this?
This, how did you get your training? Do you feel comfortable? How many times have you done this? A good provider should not blow you off. A good provider should not get annoyed that you are asking those questions. Mm-hmm. A good provider should say. This is how long I've been doing it. I feel confident. I've trained in this way and that way.
So if you're feeling like someone, if you're having that uneasy feeling, leave, you are not obligated to stay.
Dr. Zain Husain, MD: Yeah. And ultimately it's not worth getting a complication. And that's gonna segue into our next episode. We're gonna be talking about complications and aesthetics. So until next time, skin side out.
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