Perform rejuvenation and/or regeneration of the skin using no needle dermal fillers

This standard coexists alongside, SKANSC1: Implement and maintain safe, hygienic and effective working practices during elective non-surgical cosmetic procedures, SKANSC2: Consult, assess, plan and prepare for elective non surgical cosmetic procedures and SKANSC15 Complication management of non-surgical cosmetic procedures. This standard is for aesthetic practitioners performing procedures using no needle dermal fillers to temporary disguise signs of ageing, modify facial symmetries and structures. You will also be required to do a post procedure evaluation and reflection for continuous improvement. The aesthetic practitioner must have a First Aid at Work qualification or equivalent and be able to carry out the functions within SFHCHS36: Provide basic life support and have access to life support equipment as identified in the emergency plan. Users of this standard will need to ensure that their practices reflect up-to-date information, policies, procedures and best practice guidance.

1. carry out a concise and comprehensive consultation face to face with the individual
2. maintain your responsibilities for health and safety pre, during and post the dermal filler procedure

3. discuss to establish the individual's objectives, concerns, expectations and desired outcomes to inform the dermal filler procedure plan to include:

   • 3.1 skin classification and skin characteristics
   • 3.2 alternative treatment options

4. discuss and agree the skin priming programme or recommendations required, prior to the dermal filler treatment

5. develop an emergency plan with the identified healthcare professional trained to deal with adverse reactions to dermal filler

6. establish the dermal filler procedure plan in accordance with legislative requirements and organisational policies and procedures to include:

   • 6.1 advice, support and guidance
   • 6.2 emergency plan
   • 6.3 pain management strategy

7. reiterate, confirm and agree with the individual, they have understood the proposed dermal filler procedure and pain management to include:

   • 7.1 contra-actions
   • 7.2 adverse reactions

8. obtain the individual's signed informed consent for the dermal filler procedure and pain management, allowing an adequate time scale for the individual to make an informed choice

9. select an effective hygiene preparation product to meet the individual's needs in accordance with the manufacturer's instructions

10. prepare the individual's treatment area in accordance with the dermal filler procedure protocol and associated risk avoidance strategies to include:

    • 10.1 mark out pre-procedure markings if applicable

11. source and select the dermal filler, to meet the individuals needs and area to be treated, including associated risks

12. administer the dermal filler with the sterile single use hydraulic pressure device in accordance with the procedure protocol to include:

    • 12.1 adaptation of hydraulic pressure techniques, depth and placement
    • 12.2 in accordance with the pre-procedure markings if applicable

13. monitor the individual's health, wellbeing and skin reaction throughout the dermal filler procedure in accordance with legislative requirements and organisational policies and procedures

14. in the event of an adverse reaction or incident take prompt corrective action as set out within the emergency plan to include:

    • 14.1 seek and implement immediate medical intervention from the identified healthcare professional trained to deal with complications as set out in the emergency plan

15. Conclude the procedure in accordance with the dermal filler procedure protocol, legislative requirements and organisational policies and procedures

16. take and store consensual visual media of the individual's treatment area in accordance with insurance requirements, organisational policies and procedures
17. complete the individual's non-surgical cosmetic procedure records and store in accordance with data legislation
18. use reflective practice to evaluate the dermal filler procedure and take appropriate action

19. provide and obtain confirmation of receipt of the instructions and advice given to the individual pre and post procedure to include:

    • 19.1 the aesthetic practitioners contact details
    • 19.2 emergency plan
    • 19.3 contingency plan in the event of absence

20. record the outcome and evaluation of the dermal filler procedure to agree and inform future procedures

21. discuss and agree future procedures with the individual

1. the importance of collaboration with competent professionals to support effective and safe working practices
2. your role and responsibilities in performing non-surgical cosmetic procedures and the importance of working within your competence
3. why you must comply with ethical practice and work within the legislative requirements to include:
   • 3.1 the responsibilities under local authority licensing regulations for yourself and your premise
4. the importance to engage in, and document continuous professional development to include, up-to-date information policies, procedures and best practice guidance
5. the anatomy and physiology relevant to this standard
6. the chronological skin ageing process and the relationship to intrinsic and extrinsic factors
7. the relative and absolute contraindications relevant to the treatment, to include:
   • 7.1 the legislative and insurance requirements for obtaining medical diagnosis and referral
8. the importance of recognising suspicious skin irregularities and lesions, and referring to a relevant healthcare professional
9. how a skin priming programme and pre-treatment recommendations can benefit the dermal filler treatment outcomes
10. the types, composition and pharmacological effects of chemical compounds in dermal filler solutions to include:
    • 10.1. the physiological effect of dermal filler solution has on facial anatomy, skin tissue and blood supply
11. how to adapt hydraulic pressure techniques to place dermal filler solution safely beneath the skin tissue into underlying structures to meet the individual's needs
12. the adverse reactions associated with a dermal filler procedure to include:
    • 12.1 knowledge and avoidance of danger zones
13. how to implement the correct course of action in the event of an adverse reaction or incident to include:
    • 13.1 why and when immediate medical intervention is necessary
14. the risk avoidance strategies
15. the importance of obtaining and following instructions from the identified healthcare professional in the event of an adverse reaction
16. the purpose, use and limitations of dermal filler procedures in relation to:
    • 16.1past and current medical history
    • 16.2 previous non-surgical cosmetic and/or dental procedure history
    • 16.3 relevant lifestyle factors
    • 16.4 contraindicated medication and medical conditions
    • 16.5 the individual's physical and psychological suitability for the non-surgical cosmetic procedure
    • 16.6 individual's expectations
    • 16.7 hyper-immune response management
    • 16.8 anaphylaxis management
17. the regulatory and legislative requirements for medical devices
18. the regulatory and legislative requirements for sourcing, recording and administering dermal filler to include:
    • 18.1 product name
    • 18.2 batch number
    • 18.3 expiry date
    • 18.4 material data sheets
    • 18.5 storage
    • 18.6 disposal
    • 18.7 audit and accountability
19. the types of pain management and associated risks
20. the legislative requirements and restrictions for sourcing, storing and using licensed topical anaesthetics
21. the health and safety responsibilities in line with legislation before, during and after the dermal filler procedure
22. the legal requirements for providing non surgical cosmetic procedures to minors and vulnerable adults
23. why it is important to discuss and establish the individual's objectives, concerns, expectations, desired outcomes and agree the non-surgical cosmetic procedure plan
24. the importance of using visual aids to inform the individual of the physical effects .
25. the fee structures and treatment options
26. the legislative and indemnity requirements of gaining signed, informed consent for the dermal filler procedure
27. why it is important to allow time for the individual to reflect before confirming and agreeing to receive the elective non-surgical cosmetic procedure
28. the importance of obtaining signed consent for the dermal filler procedure and pain management strategy
29. the types of hygiene products for the skin and the importance of following manufacturer's instructions
30. the importance of adhering to the dermal filler procedure protocol
31. the importance of monitoring the health and wellbeing of the individual during and post procedure
32. the importance of adhering to the emergency plan in the event of an adverse reaction
33. the legislative, insurance and organisational requirements for taking and storing visual media of the individual's treatment area
34. the legislative and regulatory requirements of completing and storing the individual's non-surgical cosmetic procedure records
35. the expected outcomes from a dermal filler procedure
36. the purpose of reflective practice and evaluation and how it informs future procedures
37. how to collate, analyse, summarise and record evaluation feedback in a clear and concise way
38. the importance to record the outcome and evaluation of the dermal filler procedure
39. the instructions and advice pre and post the dermal filler procedure

Contra-actions

1. hyperaemia
2. wounds
3. bruising
4. oedema

Risk avoidance strategies

1. emergency plan
2. risk assessment(s)
3. acquired medical history
4. procedure plan(s)
5. restrictive treatment areas
6. pre and post instructions and advice
7. avoidance of off license use
8. inoculations
9. first aid at work qualification and basic life support or equivalent
10. general health and safety working practices
11. infection prevention and control
12. working environment
13. collaboration with healthcare professional/regulated independent
    prescriber/appropriate professionals
14. legislative prescription protocol
15. medicine management
16. informed consent
17. data management
18. audit and accountability
19. understanding of the pharmacology
20. working knowledge of facial and neck anatomy
21. waste management
22. assessment of the individual's physical and emotional suitability

Anatomy and physiology

1. the structure and function of the body systems and their interdependence on each
   other
2. skin and systemic pathologies
3. severe adverse event pathologies
4. basic knowledge of pharmacology
5. effects of medications have on the skin
6. effects of bone reabsorption and understanding of complex facial and body anatomy and venous and arterial blood supply

Adverse reactions

1. infection
2. pigment irregularities
3. nausea
4. allergic reaction
5. anaphylaxis
6. medicine toxicity/incompatibility/ contraindications
7. vasovagal syncope
8. asymmetry
9. palpability of the filler
10. blindness
11. necrosis
12. nodules
13. vascular occlusion
14. tindal effect
15. arterial occlusion
16. compression occlusion
17. migration of the dermal filler
18. reduced lymphatic drainage
19. granulomas
20. stroke
21. pulmonary embolism

Visual aids

1. Illustrative images
2. Illustrative diagrams
3. pre-procedure markings

Dermal filler procedure protocol

1. working environment
2. health and safety
3. risk management plan
4. infection prevention and control
5. identified healthcare professional/appropriate professionals
6. emergency plan
7. procedure plan
8. informed consent
9. appropriate professionals
10. data management
11. audit and accountability
12. instructions and advice
13. waste management
14. evidence based and reflective practice

Instructions

1. the individual, regulated independent prescriber and aesthetic practitioner's legal rights and responsibilities
2. emergency plan
3. post procedure expectations and associated time frames
4. pre and post procedure instructions and care
5. restrictions and associated risks
6. future procedures fillers
7. complaints procedure or concerns protocol

Adverse reactions
Adverse reactions are also known as adverse incidents or associated risks. An adverse reaction is an unexpected physical or physiological reaction from a procedure carried out.
Contra-action
Contra action is an expected temporary reaction from a procedure.
Emergency plan
The emergency plan is the responsibility of the aesthetic practitioner that includes use and access to the emergency kit. An identified healthcare professional will act as the regulated independent prescriber if a prescription only medication is required in the event of an adverse reaction. The regulated independent prescriber has a duty of care to their patients to follow regulatory guidelines set by their Professional, Statutory and Regulated Body.
Pre-procedure markings
Pre-procedure markings should be carried out using a sterile single use surgical pen. Pre-procedure markings are used to create guidelines to identify injection sites as set out in the non-surgical cosmetic procedure plan.
Treatment area
The indicative area to be treated, can also be referred to as treatment site or the anatomical name.
Universal precautions and standard precautions
Universal precautions are relevant if the practitioner is exposed to blood and/or some bodily fluid. It is the responsibility of the practitioner to implement infection prevention and control measures to prevent exposure to blood borne pathogens or Other Potentially Infectious Materials (OPIM). Standard precautions are the basic level of infection control that should be used at all times within the working environment, such as hand hygiene, personal protective equipment, prevention of needlestick and injuries from sharps, risk assessment, respiratory hygiene and cough etiquette, environmental cleaning and waste disposal.
Visual media
Visual media is evidence generated through photography or video.

SKANSC1, SKANSC2, SKANSC3, SKANSC4, SKANSC5, SKANSC6, SKANSC7, SKANSC8, SKANSC9, SKANSC10, SKANSC11, SKANSC12, SKANSC13, SKANSC15, SKANSC16, SKANSC17, SKANSC18, SKANSC19, SKANSC20, SKANSC21, SKANSC22