How aesthetic clinic owners keep their businesses running amid COVID-19

An interview with Candela Center of Excellence from Korea and Australia

The COVID-19 pandemic has had far-reaching effects on businesses and medical clinics around the world. Some companies have halted operations; others have reduced hours. Hospitals and clinics have had to adopt new protocols in order to continue operating safely.

A survey¹ of 1,360 aesthetic practitioners between March 22 to March 24 found that from March 24 a total of 81% reported the closure of their clinic, 67% had a reduction in revenue and 63% reported a reduction in enquiries. As a doctor or aesthetician, you may be wondering what the best course of action is.

Dr. Bekhor (Australia) and Dr. Lee (Korea), two key opinion leaders from Asia Pacific Candela Center of Excellence have shared some of their own insights about running a clinic during the pandemic, plus shared some of their own best practices and tips.

Both Dr. Bekhor and Dr. Lee believe that prospects post-pandemic will be positive. Dr. Bekhor shares, “It pays to be optimistic and deal with life as it comes.” In Korea and many other countries,³ businesses are already on the mend as people become more trusting. Rather than panicking, it’s better to double down on hygiene, cut costs where possible, and prepare for better days.

In your experience, what have been the most challenging aspects of dealing with the COVID-19 pandemic?

Dr. Lee: For us, the biggest problem is that patients have been afraid to leave their homes. Although patients are not under any quarantine, in Korea we saw a 50% to 70% decrease in the number of patients at the initial period.

Dr. Bekhor: I think the first big problem is the worldwide shortage of personal protective equipment, such as N95 masks, face shields, and disposable gowns. Ideally, we could use a new mask, a new face shield, and a new gown with every patient. Another issue is the lack of clarity regarding aesthetic services. The in my State of Victoria the Government has asked non-essential businesses to close, but they haven't defined what medical services are essential.

How have you mitigated these challenges?

Dr. Lee: In Korea, there was no forced quarantine. The decision to leave the home was in the patient’s hands. So I focused solely on patients with urgent cosmetology or dermatology needs—such as removal to general blemishes, acne, itching, and such.

Dr. Bekhor: I've always been one to try to think from first principles because it's clear that each individual practice is going to have to work out what's right. So the first question you have to ask is: “Is it legal?” Because clearly, you cannot be breaking the law. My understanding is that the State of Victoria has not defined what is essential. I firmly believe it's up to the patient to decide what's essential to them.

In Australia, we have very, very low case counts. And that's something else I want to stress. I think there are less than 200 active cases² in Victoria, which has a population of five or six million, so we are in a relatively low-risk environment here at the moment. We can do the best of what we're able in context with what is legal, with the risk level, and with the amount of disease in your city.

Are there any positive changes that have happened during the downtime?

Dr. Lee: Well because there are fewer patients, I have more free time. It's my chance to think again about my business, my family, and of course, my life.

Dr. Bekhor: I think we all had a big wake up call on hygiene which will last—things like cleaning the hands, not touching your face—simple things that in the long run have to be good for us.

Another thing is the better way to organize patient waiting. As a patient, I hate sitting in a waiting room. Since COVID-19, we’ve instituted a virtual waiting room—you wait in your car, and by text, we tell you when to come in. I'd much rather be sitting in my car than being stuck in a waiting room with a whole lot of other people who might have the flu or cough and colds. Hopefully, now that my staff are comfortable with that process, we can continue to use this process.

What changes have you made to your services or packages, and what was the reasoning behind them?

Dr. Lee: We did not close at all during COVID-19. Our normal operating hours are from 9:00 AM to 8:00 PM every day except Sundays. During this time, patients could come to our clinic freely. Generally, none of the services or packages have changed, but we’ve focused on general cosmetology and on patients with skin problems.

Dr. Bekhor: We have avoided treating the mouth area—our first rule is we will not treat around the lips, nares, and we will not treat around the eyes if we haven't got gauze and eye shields in place.

ISO protocols have always required skin cleansing prior to aesthetic treatment because things like sunscreen or makeup are barriers. We’re of the opinion that, if we're treating skin that we have cleaned, and it’s not an area where saliva, tears, or nasal secretions are flowing, I'm not worried about using the Candela medical equipment because I've cleaned any potential virus off that skin.

We’re also trying to keep our interaction times as short as possible—from 15 minutes to half an hour.

Lastly, like many other clinics, we have implemented specific safety measures. Patients who come in have to sign a risk agreement. Each clinic owner has to decide what risk level they're comfortable with.

Have you been able to stay connected to your clients during this time?

Dr. Lee: Because we didn’t close, we didn’t have any breaks in communications with clients. We use SNS (social networking site) and website marketing and have a KaKao Talk account for the clinic, which we have used to regularly send updates and broadcasts.

Dr. Bekhor: We do have a social media presence and we explain our policies there. But you know, we're heavily booked out ahead. So we contact the patients that have bookings. And we tell them: “Yes, we're open. If you feel it's essential for you to come in, you're welcome to come in.”

If it's something we think we could do by telehealth, we offer them a telehealth appointment. We explain our policies, and they understand that for longer procedures, say somebody wants an extensive procedure. We reschedule them and by way of compensation for the inconvenience, we offer them a discount.

How have you protected and maintained trust and communication with your clients?

Dr. Lee: As you know, we’re operating normally in Korea. Any interested patient can contact us by phone or social media. Because the number of patients decreased, we have pushed more heavily on social media marketing. Last year, we would send a message every month. In this season we send messages twice a month.

The message does not focus too much on COVID-19 itself, though, like many clinics, we do share reassuring statements and reminders such as “Please wear your masks”. One thing that is related to COVID-19 is that when people wear masks, there's a chance they will develop acne—so we have tailored our marketing slightly to address these possible issues and concerns.

Dr. Bekhor: I think when people come and see all of the things we have in place for their security, they naturally feel safer. They can see that people are wearing masks. They see that when they come in, they're given hand sanitizer, and the doctors and nurses put on hand sanitizer. When the doctor comes into the room they are wearing a mask. They put hand sanitizer on when they leave. We organize the waiting room so that patients don't cross paths. I think seeing that level inspires confidence and makes them feel that we are looking out for them.

What advice would you give fellow clinic owners on maintaining operations during this pandemic?

Dr. Lee:The doctor needs to pay attention to their personal health. And remember—as the number of coronavirus patients decreases, the number of patient visits in the clinic will increase again. It is not a permanent change. At our own clinic, the patients have begun to come back. So it's just a matter of waiting and taking care of your own health in the meantime.

Dr. Bekhor: Back to first principles—you have to understand the facts. Unfortunately, there may be two days where the asymptomatic spread is possible. Don't assume that just because the person's ticked all the boxes and you've let them in, they don’t have COVID-19.

I also believe that good ventilation is important. So in my practice, every morning we partially open all windows, and all exhaust fans are switched on. Each owner needs to look at what they can do to make sure they're getting airflow in their practice.

Can you share some of the must-have hygienic steps/practices that you feel clinics should implement immediately?

Dr. Lee: I believe wearing a mask is most important. So every patient and doctor must wear a mask. We check the patient’s body temperature at the entrance desk and also ask them to fill out a COVID-19 questionnaire

Dr. Bekhor: Aside from being aware of the law and the current regulation status, being able to do telehealth is important. You should look through your appointment list one or two days beforehand, you should educate your secretaries and staff, you should offer telehealth to anyone that seems suitable.

It’s important to plan how patients will interact in your clinic. Consider:

• An appropriate pre-entry questionnaire
• How you’ll take temperatures
• How patients will be notified that it’s their appointment
• Where they will wait so that you don't have any patient coming face-to-face with another
• How you can maximize ventilation in the rooms
• Enforce strict hand hygiene protocols
• Make sure that there is sanitizer on entry on leaving and near all the doors/li>
• Clean every keyboard and surface every night.

If you’re preparing for re-opening, it’s best to work out how much PPE you need and secure that first. We've managed to source some PPE from hardware suppliers. We've also managed to get some good face shields. We've worked out ways of reusing masks. You know, there's evidence that 30 to 60 minutes of heat re-sterilizes the masks.

What local resources do you rely on to get information about new hygiene rules?

Dr. Lee: The first one is certainly the government guidelines. I also ask a friend who is an infectious disease specialist for the latest updates. And of course, now everything can be found on the Internet.

Dr. Bekhor: The internet is an amazing thing. I also receive emails from many, many sources—like Physician’s First Watch. I’m signed up to federal and state government departments of health and receive bulletins every day. There’s a bulletin at the hospital, and my colleagues and I have a group chat as well. Anybody who sees anything interesting, or has a comment, can make posts there.

Keep it in perspective—we all have to focus on our own health as well and make sure that we're not obsessing about it, make sure that we get relaxation time. Exercise has really never been more important because, you know, it's important that we stay well.

Lastly, as doctors, our primary [concern] is what is best for the patient. Not what is best for us. If somebody's got anxieties about a procedure and it’s not urgent, encourage them to wait.

What should aesthetic clinic owners incorporate into their business continuity plans in case of another pandemic?

Dr. Lee: Maintaining good cash flow is highly important. During times of pandemics and emergencies, cash flow is naturally stifled. Do forecast cash flow and determine how much you need to operate safely during low periods.

The second is a patient database. It is very difficult to recruit new patients, but we can frequently invite existing patients to come back in. Databases make it so much easier.

Additionally, don’t focus on the revenue. At our clinic, we focus on caring for patients who need help. It doesn’t matter if they are not high-paying patients—what’s important is giving them the care they need.

Dr. Bekhor: I believe PPE is the critical thing. In an ideal world, we know which PPE we need and how much we need to hold. That way, in the case of another pandemic, there won’t be a rush, and clinics will be able to stock the supplies they need. And of course, thinking about the importance of ventilation, maybe even working out how you can open a window in the room.

Associate Professor Philip Bekhor

Associate Professor Philip Bekhor is the Foundation Director of the Laser Unit at the Royal Children’s Hospital established in 1989. This unit treats vascular and pigmentary birthmarks using the Candela V beam GentleYAG and CO2 and Q-switched YAG lasers. Dr. Bekhor is also on the Expert Advisory Committee of the Australian College of Dermatologists, and is a Mohs skin cancer surgeon at the Skin & Cancer Foundation of Victoria. He has published numerous papers in peer-reviewed literature including studies in the treatment of birthmarks and vascular anomalies.

Dr. Sang Ju Lee

Dr. Sang Ju Lee is the Director of the Yonsei Star Skin & Laser Clinic in Seoul, Korea. He has been on the Board of Directors of the Association of Korean Dermatologists since 2009, and also served as the International Fellow of the American Academy of Dermatology. Dr. Lee has written over 8 books and published over 100 articles in medical journals. He was the instructor of the Department of Dermatology at Gangnam Severance Hospital in Seoul Korea.