AAMSSA Recommendations during COVID-19 Level 3 Lockdown
Issued 1 June 2020

Please refer to the detailed recommendations outlined in the AAMSSA COVID-19 Level 4 document, for information on staff safety and training, practice preparedness, patient screening, use of PPE’s and policies and procedures required for your practices to operate during the pandemic. As always, safety of our staff, patients, and ourselves is central to our every consideration.

Doctors should be aware of the different risks of infection posed by the various procedures performed in an aesthetic practice. Precautions and PPE donned should be appropriate to the level of risk of the

The procedures performed in an aesthetic clinic have been categorized as low, moderate and high-risk based on the likelihood of transmission of the SARS-CoV-2 virus while performing the procedure. This
categorization is based on the assumption that all the patients seen in the aesthetic clinic could be asymptomatic carriers until proven otherwise. It would be wise to presume that every person entering
the clinic is a potential source of infection.

When assessing the degree of risk of any procedure the following needs to be considered
• Type of procedure – aerosol generating or non-aerosol generating?
• The site at which the procedure is being performed – upper face, lower face, body?
• Is the patient able to wear a mask during the procedure?
• Duration of the procedure – over or under 15 minutes?
• Is there contact with mucosa/saliva/ blood/ body secretions during the procedure?
• Level of invasiveness – Is the procedure non-invasive or minimally invasive?
• Level of conversation required during the procedure. Be aware that speaking, laughing, or taking deep breaths generate aerosols.
• Level of assistance required for the procedure. Only the absolute minimum number of healthcare professionals required for the procedure should be present

Treatments that generate a plume, aerosol, or spray
• CO2 laser resurfacing and other ablative or cauterising devices
• Ablative plasma sublimation devices
• Microdermabrasion and microblading
• Jet infusions and facials

It is well known that plumes from these procedures can contain toxic substances, including viruses. We recommend that all procedures which create a plume should be considered high risk and be undertaken
in line with recommendations for aerosol generating procedures, including relevant use of PPE.

Removal of mask
Prior to any procedure requiring a patient to remove their mask e.g. lip injections, it is advised that patients rinse their mouth with 1.5% hydrogen peroxide or 0.2% povidone-iodine for 1 minute right
before the procedure. Patients should be advised not to talk during the procedure.

Aerosol or plume generating procedures: Laser and ablative plasma
Practitioners performing ablative laser therapy should undertake patient/treatment specific risk
assessment which takes into account the following factors:
• The extent of plume
• The use of mechanical ventilation for extraction
• Treatment length
• Any additional risk factor identified

Practitioners should allow extra time periods for room ventilation before the next patient arrives. It is still unknown if COVID – 19 can spread by laser plumes. Practitioners should consider the option of avoiding all higher risk, plume generating procedures until such guidance becomes available.

Possibility of delayed hypersensitivity reactions after influenza infection
There is evidence that dermal fillers given in the presence of a recent viral infection (or where a virus is contracted after treatment) can increase the risk of delayed hypersensitivity reactions. This should be
reflected in medical history taking and must form part of the patient’s understanding and consent.

Furthermore, the practitioner must make allowance for this possibility in terms of post-procedural care, particularly in the event of future lockdowns. Although there is a low risk of late onset adverse reaction
with hyaluronic acid fillers, practitioners must be aware of the possible filler reaction following the influenza infection.

Support and assistant staff
Staff who assist aesthetic doctors with medical procedures should do so only after the patient has been assessed by the doctor and a diagnosis made with applicable ICD-10 code. Staff assisting with medical procedures during level 3 Lockdown should be under medical supervision and on the practice payroll.
Beauty therapy, Permanent make-up, Hair and Nail therapy is NOT allowed on Level 3.

What to do should a staff member be exposed, become ill or test COVID-19 positive

It is inevitable that at some stage one or more of your staff become ill or exposed to a Covid-19 positive

We understand that for practitioners this is an incredibly worrying and unsettling time, and we do not yet know the medium- and long-term impact of the pandemic on the aesthetic industry. However
AAMSSA is committed to working hard to ensure the safety and security of our members and their staff.

As an industry we need to balance and protect both our lives and our livelihoods. We need to be versatile and innovative while adhering to best practice principles and the highest patient safety standards.