AesCert Guidance: Where Are We Now?

Jeffrey Dover, M.D., Chairperson for the AesCert Guidance Supplement, and the entire panel of national physician experts who collaborated on the project, achieved something previously unheard of.

“In two weeks, we wrote this 26-page manuscript. Four days later it was accepted for publication, and then a month later was actually in print,” says Dr. Dover, Co-Director of SkinCare Physicians in Chestnut Hill, Mass., Associate Professor of Clinical Dermatology at Yale University School of Medicine.

If that isn’t impressive enough, Dr. Dover says theirs were the first guidelines published, even before the professional societies developed their own.

“You can do it nimbly when you have a small group of people who are not associated with a big organization. But we use their expertise,” he says.

Case in point, second author, Mary Lynn Moran, M.D., is the current president of the AAFPRS.

“We put together a panel of national experts: The head of infectious disease at two of the Harvard teaching hospitals; the head of infectious disease at Stanford; the head of medicine at UCSF in San Francisco; facial plastic surgeons and plastic surgeons across the country; and public health experts at Harvard,” says Dr. Dover.

The guidelines, he says, have been well received, not just in the U.S. and Canada, but from all over the world.

“It’s truly for everybody in every specialty: dermatology, plastic surgery, facial plastics, oculoplastics, non-core — for anybody in aesthetic medicine, and even aestheticians,” says Dr. Dover.

When asked whether he was following the guidelines, Dr. Dover’s response was “to a T.”

“We're following the template exactly for reopening and of course since the publication in early May, and online in April, we have reopened. And we're using this as our guideline, but we then modified it for our staff.”

But is he doing anything extra?

“There's very little to add,” he says, reinforcing how comprehensive the AesCert guidelines are.

Importantly, and perhaps not as widely known, the guidance was also developed for the patient community. The aescert.org site also provides guidance for patients in terms of what they can expect when they visit a practice that follows the guidelines.

“We have practices who are using the AesCert emblem on their website and in their offices to say, ‘We’re following these strict guidelines,’” says Dr. Dover.

This, he says, provides the trust and credibility patients need and are actively seeking.

“I make it very clear. I say, ‘See the way I'm dressed? This is for your protection.’ You notice there's no nurse in the room. You notice there's no waiting room. You walked right in [and] sat down. It's just two of us. There's zero exposure. You cannot be in a safer place. We're following these special guidelines, and we are generating tremendous trust.”

What We’ve Learned

Today, many practices have processes and protocols in place and are currently providing elective treatments. What have we learned since the guidelines were first issued?

According to Dr. Dover, we’ve learned a lot.

“We learned, for example, that surfaces are not as important as aerosol. That this is an aerosolized virus that can spread from super spreaders, but you never know who they are… so while surfaces might be important, small, closed spaces for a prolonged period of time (10 to 15 minutes) without masks is the worst,” he says.

If someone’s positive, you won’t know it until a week later, he points out. “So, I think... we have to assume everybody's positive and socially isolate.”

Dr. Dover believes the current approach is going to be something physicians and patients must learn to live with.

“It's a serious disease and there’s lots of sequelae, and it's going to be around… for a couple of years at least,” says Dr. Dover. “It's not going away this fall. It’s not going away next winter. The vaccine will not be ready for primetime in December, and unfortunately our leadership has been lacking tremendously on a governmental level. So we have to do it on a grassroots level locally and physician-to-physician and colleague to colleague and set the standards. Because we know public health. We know, protect the cough, protect the spread; wear gloves, clean and do all these things. And when you do that it actually works.”