Will Kirby, DO, FAOCD, Interviews Nurse Practitioner Sarah Higgins on Aesthetic Dermatology

Sarah Higgins, DNP, APRN, WHNP-BC, is a board-certified nurse practitioner who, for nearly a decade has been specializing in aesthetic dermatology with an emphasis on clinical practice expansion and patient safety. She completed her Bachelor of Science in Nursing at the University of Pittsburgh and Master of Science at the University of Cincinnati, going on to complete her Doctor of Nursing Practice at Grand Canyon University. Sarah has served as an Expert Practice Consultant for aesthetic treatments at the California Board of Registered Nursing and is currently a member of the American Nurses Association (ANA) and American Association of Nurse Practitioners (AANP).

Hello Sarah! Can you please tell us a little about your backstory?
I grew up in the suburbs of Dayton, Ohio, and had a fairly traditional Midwest upbringing. I loved sports and started running track and joined the swim team in elementary school. I also played on the field hockey team in middle school and by the end of high school, I was added to the athletic achievement wall after earning nine varsity letters. The social aspect of being on an athletic team was appealing to me but I didn’t have my heart set on a specific career path that would incorporate this passion.
The medical field was in my blood as I have many relatives that are nurses and physicians, but when it came time to choose a college, I decided to go to business school at Ohio University. Eventually, I shadowed a friend’s mom in the emergency department of a local hospital and immediately decided to change my college major to nursing. Ohio University did not have a nursing program, so I had to quickly pivot: I’m sure my parents thought I was crazy making the change just before graduating, but I ended up at the University of Pittsburgh to start the undergraduate nursing program in 2003!

What initially led you to an aesthetic career path?
My nursing career started at Magee Women’s Hospital in Pittsburgh, Pennsylvania on a high risk antepartum and postpartum unit. This area of nursing drew me in because I loved being able to build relationships with my patients who were ultimately healthy but happened to be in the hospital with a pregnancy complication. After a few years in Pittsburgh, I took a travel nursing assignment in Los Angeles in 2011, right around the time when aesthetic dermatology treatments were starting to become more mainstream and less taboo. Since I had been in Los Angeles for a few years (ground zero for aesthetics), and learned more about aesthetic career opportunities for nurses and nurse practitioners, I decided to make the jump from women’s health to aesthetics. The fact that I could work with healthy patients and develop a patient-provider relationship was really exciting to me.

What's the best piece of aesthetic career advice you have received?
It is okay to say ‘no’ to a patient if you don’t believe a procedure is in their best interest, and it imperative that you discontinue the patient-provider relationship with patients who are unreasonable, unrealistic, or overly demanding.

What aesthetic patient demographic do you believe is the most coveted? Has this always been the case? Is this shifting?
I believe the most coveted patient demographic has shifted from the 50+ age group to those in their early to mid 30s. These patients are just starting to notice subtle aging changes and get great results with aesthetic treatments. This demographic is often established in their career and has a great network of friends and coworkers in the same age range. The patients in their early 30s also have a unique experience with brand loyalty when it comes to where they spend their money, being the first generation to have such a wide range of technology and social media at their fingertips. So, there is great long-term patient potential when focusing on and tapping into this patient demographic from a loyalty standpoint, as well as the need for aesthetic treatments over a long period of time.

Telehealth exploded during the pandemic. Is it here to stay?
Absolutely. Health care in general has seen a huge shift towards telehealth and if aesthetic providers don’t jump on board, they will fall be behind in the next few years. We live in a time where with a few clicks we can have whatever we want delivered to our doorstep in less than 24 hours. Any sector of health care that can offer patients immediate answers via telehealth will be sure to experience exponential growth in the next few years.

What is the biggest myth in the aesthetic industry?
The idea that only physicians can provide safe, high-quality aesthetic treatments. Unbiased data simply doesn’t support this notion. I have listened to so many anecdotal podcasts and read countless unsubstantiated articles where physicians claim that only treatments performed by board-certified plastic surgeons and dermatologists are safe. Meanwhile, in their own practices, treatments are being implemented by teams of allied health care professionals including RNs, NPs and PAs. We can all agree that it is imperative to have aesthetic procedures performed by educated, highly trained, and competent health care professionals and it is also time to recognize that unfounded degree exclusivity undermine industry integrity.

I have to push a little hard on this front. Why do you think some physicians who specialize in aesthetics might be threatened by the allied health care professionals in aesthetics?
It’s a myth that there aren’t enough aesthetic patients to go around and what I think some physicians fail to recognize is the incredible benefit that allied health care providers can bring to the business. Let’s crunch some simple numbers: If a physician can see 20 patients per day and works with a nurse that can also see 20 patients a day, the number of patients coming to that office has now doubled, which of course improves the finances but, more importantly, bringing in this nurse casts a large net, potentially improving the diversity and patient demographics of practice for the long term.

What can the aesthetic industry do to increase diversity and inclusion?
This seems like such a simple answer, but frankly, those in leadership positions need to make an active effort on the hiring front. Clinicians and managers need to be open to incorporating staff from different ethnic, religious, and cultural backgrounds. I have walked into aesthetic offices (and non-aesthetic offices for that matter) where every employee looks the same. The future is diverse and the faster that fact is recognized, the better off we will all be.

Why are we seeing new aesthetic products fail to launch properly?
It appears to me that many new aesthetic procedures and products fall into a ‘fad’ category. When a company launches a new treatment without proper market research, without evidence-based practice, and without the support of legitimate practices, well, by the time it hits the market, patients have already moved on to the next new trend.

Moving on, what can we do to promote integrity, rectitude, and transparency in aesthetics?
All healthcare professionals should make collaboration their top priority and cease the pettiness of putting other aesthetic providers down. No one ever accomplished anything by complaining so clinicians who grumble about the academic degrees of others lose credibility, create confusion for patients, and undermine the field of aesthetics. Working closely in concert as a team and putting an emphasis of cooperation is a time-honored tradition in healthcare that helps increase industry integrity.

If you weren’t an aesthetic expert, what would you do for a living?
I would be a stockbroker because I’m a nerd and love finance and numbers!

What’s the funniest mistake you made in your aesthetic career?
Agreeing to treat a boyfriend’s mom. Long after we broke up, she continued to see me for her Botox cosmetic treatments, and it was always an awkward situation when she came in for her appointment!

Funny? That sounds terrible! So, what is your favorite aesthetic treatment to personally receive?
This is such a hard question because every treatment provides such unique benefits. But I must say I love neuromodulators. If I had to give up everything else in the aesthetic space, neuromodulators are the one thing I would keep.

What advice do you have for someone not in the industry who wants to enter the field of aesthetics but doesn’t know where to start?
Work with a company that takes the time and has the resources to train their employees in-depth on aesthetic procedures. If a nurse works in a new area of the hospital, she will have preceptors and resources to ensure competence in treating that specific patient population. The same standard should be upheld in the aesthetic industry. You want to enter the field of aesthetics somewhere that has a long-standing reputation for proper training and providing safe procedures.

What changes would you like to see take place in the aesthetic industry?
The aesthetic industry is one area of medicine where I see health care providers talk poorly about their colleagues on public social media platforms. One area in particular would be adverse reactions to filler treatments that go viral. Any competent health care provider in aesthetics understands that filler treatments come with well-known risks including vascular occlusion, just as any medical procedure comes with certain risks for adverse events. In the comments on these posts, I can’t tell you the number of times I’ve see posts stating this wouldn’t happen if you went to someone reputable, or this is what happens when nurses do filler injections. I find it unprofessional to comment on a social media post where you know nothing about the backstory of the patient or provider, especially knowing that an adverse event can happen to anyone doing filler. The important piece is knowing how to manage the patient when these rare things do happen, and often that information is not shared on viral social media posts.

What does your aesthetic legacy look like?
I hope that my aesthetic legacy is one that is known for raising the bar on patient safety in aesthetics. While serving as an expert practice consultant for the California Board of Registered Nursing, I saw too many adverse patient reactions and situations where nurses put their patients in danger and risked their professional licenses. I obtained my Doctor of Nursing Practice degree through completing research on implementing safe laser treatments to decrease adverse reactions. It is my goal to continue patient safety research and education and have it widely known and practiced in the aesthetic space.

As an expert in the aesthetic industry in a powerful position, people are looking at you to lead. If you could inspire a movement in our industry, what would it be?
It would be to focus on becoming an expert at the basics before moving on to advanced practice techniques. I think it has been a common theme in our industry for trends to pop up driven by social media and it’s easy to lose sight of the fact that aesthetic procedures that have been around the longest still provide some of the most effective and life-changing results. It’s easy to get distracted by shiny new things but we can’t lose sight of the value of well-developed and studied aesthetic procedures.

Name drop three individuals that represent the future of our industry and maybe they will be the subject of future interviews!
Cynthia Lazzaro, D.O., Chelsea Nathie, R.N., and Scott Heckmann, CEO. LaserAway.

Sarah, thank you for all this thoughtful insight! How can readers get more aesthetic expert information from you?
Find me on Instagram at @shiggs32!