Aesthetic Nursing: Evolution and Challenges with Brenda Cumming

In this episode, Les Encres welcomes Brenda Cumming, a seasoned registered nurse with nearly 40 years of experience, to discuss her journey from critical care nursing to aesthetic nursing. Brenda shares her career transitions, challenges in the aesthetic industry, and her thoughts on advancing technologies and procedures. She also highlights the importance of patient safety and regulation in the field, and offers advice for new injectors. This insightful conversation also covers the impact of social media on the industry, the importance of continuing education, the significance of creating personalized patient care plans and PDO Threads.

Transcript

Hi Stacey. Thanks for having me on your podcast today. I am honored. My name is Brenda Cumming.  I am a registered nurse, and I've been a registered nurse for many decades going on 40 years, and critical care trauma  PAC-U moved to Colorado in 1994 from Texas, and we moved up to the mountains, the pay was substantially less in Colorado for nurses than Texas. So there was an urgent care in this rural community that I live in Evergreen, Colorado. And  one day I was just looking at their little tiny newspaper and they were looking for an ER nurse to staff urgent care. So that was in the 1994, and I got the job and I did that for a while so I didn't have to drive down the hill and it was basically maverick medicine. Big time.  Still is a little bit, but the big hospital systems would buy these clinics and then they would leave the clinics, leave family practice guys, would be stuck holding, all this overhead and finally, the last time that happened, they just said, I'm done.

So I was looking through my nursing spectrum magazine in 2002, and there was an ad that said, learn how to do chemical peels, microdermabrasion, which got FDA approved like in the late nineties, spider vein therapy and Botox, and I was like.  Who's going to get Botox? Close the magazine threw it on the bed.

When that last clinic closed, I said, you know what? I might try this in the meantime. I went back down to Denver, went to the hospitals, watched all these other girls, did what I did, like the ICU and the PAC-U and ER, and I was like.  I dunno if I want go back to this and the hours are bad.

So I told the OR director at one of the hospitals, I'm going give this aesthetic nursing a go and it was brand new. And she goes, good luck with that. So I sent her Christmas cards for four years. Hey, I'm doing great. Okay. Remember back in 2002 there was no social media, there was nothing.

I had to call the board of nursing and go, Hey, I'm going do Botox. And they're like, what? And I said, Botox.  What do you mean? And I said for wrinkles. Oh, is in your scope of practice? Yeah. Okay. So I started, but sadly in my town up here, nobody would get Botox. because we were  very natural looking up here then it's changed a lot.

So I went to Denver, I traveled, and then I when I was taking that course in California, I learned about a skincare line. That I'm not going name, but I ended up being the rep for them for a long time and I built like a $2 million territory here in Colorado. So I got to, meet a lot of people and I still kept working on my business, my little med spa here in, Evergreen and I just kept building and building and 25 years later  here I am still.

I've mentored a lot at nurses coming out and, helped for sure.  What do you think is one of the biggest myths about the aesthetic industry right now? There's always been an undercurrent of,  are you in your scope? Certain states allow non-licensed people to do what I do and all of us that go to nursing school or PA school or nurse practitioner school or get, go to medical school, we all learn what we're supposed to learn to pass the boards.

Getting certified in aesthetic medicine or nursing is like a postgraduate class and we're all very familiar with anatomy and things like that and then you focus down into more specific anatomy, like with Botox, injectables, body, whatever. So a lot of states allow unlicensed people. There was an account that I used to call on in Pueblo who let the front desk inject Botox.

As long as you find a doctor who's okay with that and gets money for it. So do I think that we need to reel in this industry a little bit after 25 years that I've been in it? Yes.  I think it gets a little haywire and now, there's rules coming out. We fought a rule here in Colorado where they were going take away they always want take it away from the nurse, but the doctors will, let unlicensed people do it.

How's that fair that's happening in Texas right now. They're trying to pass a bill and I don't think it will pass. because that would be, you have gotta follow the money, number one, and they'll say patient safety.  That's an oxymoron because if you're having unlicensed people do advanced procedure procedures with filler that doesn't make any sense at all.

Like, where's the logic? It's not even a myth, it's just sad, because I've fought this like certain  groups of physicians, don't think anybody but them should do it and, and now is that patient safety or is that money  right.  But I'm blown away with all the advance advancements of aesthetic medicine and anti-aging and wellness and, most people who are like 40 and above want look good for their stated age or they don't want look their stated age and they want feel good as well.

So if we're all still working, because I'm not planning on retiring anytime soon. I don't want look my stated age. I don't feel my age and, which age group has the means and the wherewithal to do all this. 45 and up basically. I have patients that are 80 that I still do Botox on.

I don't do much, but it makes them feel good, makes them happy and they're still working them. I might still be working when I'm 80. I don't know. Hope so. So I'm impressed with everything that comes out, but I think that we have to reel it in, like exact science versus not exact science.

So there's, that's going take some time before we say that exact, like exosomes.  Which, is a very hot topic right now. I'm not a fan of human growth exosomes and products. I'm just not. I like the plant. I like what you offer a lot. I like it for the anti-inflammatory benefits quite a bit.

Anything that's going calm down, inflammation  is a win. Absolutely. And just like your PDO Threads, I just had dinner with a colleague who's a plastic surgeon here in Denver, and he does a lot of PDO Threads and we had a big talk about PDO Threads last night, and I told him I was doing a podcast with you and he goes, I, he really likes 'em.

And I think if you know how to do 'em and know how to you know how to place them and you know they work. If you have patients who are absolutely against having a surgical procedure, having a facelift or whatever, then that's your next step.  Yep. Absolutely. So we like the benefits.

Yeah. With all of the technologies coming out from skin boosters, biostimulators different thread companies, how do you stay on top of all of the protocol and  treatments? Like how do you perfect your skill? I think because I've been around for so long I'm approached a lot. People come to me and tell me what's going on or I'll read something and, I'm interested but when you say that word, skin booster, I'm obsessed with skin boosters because I have patients who have been seeing me for 20 years and I can't really put any more filler in them. I can't they get less Botox because it's been working for so long and what we do here in my practice is we get the skin in shape. So when they come in and we live at altitude.  A lot of sun damage, but they come in and I, we have quite a few lasers and my Esthetician, my Laser Specialist, we get that skin ready or we peel 'em or laser them.

The skin is ready. And then what I do PDO Threads filler, Botox, that's like the frosting I.  And the cherry on top. So she does, she bakes the cake and then I fill it. Everybody's going get a better result that way. Now you've come out with skin boosters and I have patients who they love it, like it fills in fine lines.

I like it a lot for underneath here for texture, probably more than than doing tear troughs with a filler because I have to dilute that.  But I love your liquid PDO under the eyes. Love it. It's amazing, isn't it? It's liquid gold. I love. That's what we, that's what we call it. I've got a couple of different cocktails  that we make with it, and patients love it.

They just, they look airbrushed. It helps up here when you're starting to get some fat loss in your forehead after we hit a certain age, no amount of Botox is going, fix that crepeness. So taking liquid PDOs or maybe a diluted skin V and tapping it in. With a device that has the gold needles in it, I'm not going drop names.

I've seen great results with that. Excellent. What do you think from your experience, is some of the biggest challenges that we are facing as an industry today?  I'm going blame social media. Like I blame social media all the time. Like I've got patients coming in talking to me and I know you've heard this, but I'm losing my mind beef talo on the skin.

Just because somebody on TikTok said it doesn't mean it's true and I've had to undo that, debunk that for the last month. Some of these influencers have no business.  Any kind of recommendations in our world. So definitely social media is a challenge. Just keeping up with the trends and again, going back to is there science behind this or are we excited about it?

And there will be science behind it, right? Also over injecting people letting the patient dictate what they want versus we're licensed and educated to do. I think some people struggle with that  and you've probably seen it. We sure have. Yeah.  What do you do differently in a patient consult to really try and help understand their aesthetic goals?

That's easy, because if they come in and they're a new consult, and I learned this from a plastic surgeon a long time ago. because I made the mistake, it was a rookie mistake. I bring 'em in my room, sit 'em on the bed, and say why? Hi, introduce yourself. What are you here to see me for today?

And they're like I want you to look at me and tell me what you would do. I've made that mistake once or twice and I point out a brown spot and it's game over. Like what brown spot? I never saw one. So I hand them the mirror and I said, let's start here. The top of your head and work our way down, and we're going come up with your complaints, your concerns,  create a care plan  and start addressing them one by one.

Up to where, you know what we can do at medical aesthetics. Some patients need to be referred out. If they've got a ton of loose skin here  that needs to be cut and pulled, then that's going be their best correction. They may agree to that. They may not want to agree with it. So we just break it down.

We take control, we make a care plan and patients love that. Okay, they know, I just come in and they do what they're doing.  It's not hard and if you don't address their concerns, no matter what they're going go somewhere else. Yep. So other than the, pointing out people's subtle flaws.  What other lessons have you learned in your career that have been game changers?  Really like networking with peers a lot because we all  can share ideas. I love the profession. I never thought that as a critical care nurse I would ever be sticking needles in somebody's face. I would've laughed in such, you're crazy and my mother, who's from Ireland, who talked me into being an RN because she's one.

Now I feel like we just have to be on top of our legislation and we have to fight for our right, to be able to do this and then also make sure that we are addressing patient safety..  I wish I would've had social media and some peers that I could have called on.

When I started, I was trained by Sasha Parker. I don't know if you know her, but she started the Aesthetic Skin Institute like in  2000  and she was probably one of the badass nurse I've ever met in my whole life. She was fierce.   She was cool and she trained me. She changed my life. She totally set me on a career path. She was always available. The first time I had a patient my very first Botox patient, I paid $374 for a hundred units of Botox. It's double that now and that's a lot of money back then and I had one patient, an Allergan saying, you have to use this bottle in four hours and they scare you and I'm like I forgot everything she taught me. It was a Saturday. I called her and she goes, hold the needle like a cigarette and I was like, oh, thank you.  And then I was fine, but I could always get ahold of her. I was an instructor for her for a long time and she passed away a year ago, and it's absolutely devastating.

She was a warrior. She went before Congress. She went, stood up against the dermatologist. She gets most of the credit for getting this industry, especially with nurses. Going  tons of respect for her.  She had  injectors training all over the United States and I did that for her for a long time.  Trained on Botox and filler.

It's a little tough right now, because I think the economy has slowed and so I'm glad that I've been in business for a long time and I'm glad I'm not brand new. I have given advice many times too, nurses and physicians starting med spa, especially when I was training, and a lot of people probably call me because of

how I came through this industry with nothing. I'm maxed out a credit card. But 25 years in, the one advice I would tell anybody, a nurse or a doctor, is start small  because there's so much competition now. So what are you going do different? Or who are you to make somebody come into your place of business?

Don't go in big and buy 10 lasers and get caught up in all these lease payments and you don't have any patience, right? I didn't buy my first laser until I was in business for five years,  I didn't have enough to justify. I live in a small community, but I have one that was the first machine I bought and I still use it.  Wow. That's a testament of time with the  insurgent of med spas popping up in the marketplace and with the economy being slow,  what do you do to set yourself apart?  We have a pretty active social media page. We try to do no downtime specials and I, that is the biggest trend, and it has been a trend for a long time, and I've been saying it for 10 years.

Social downtime. What is your patient's definition of social downtime? A bruise is social downtime for some patients. Being red, nobody wants to walk around with their face falling off anymore. They want us to see the results, get results quickly with a very little downtime and that's, where I like those liquid PDO  Threads.

Like they're gorgeous. I'll tell you what, yeah, I this would probably get cut, which doesn't matter. I just did my face two days ago so I could, did you really? That's why you're glowing. Yeah. I had my eyes, I got a blepharoplasty on my upper lids a week and a half ago, and I went for my one week follow up with the plastic surgeon and he said, Stacy, what did you do?

He said, I have been a plastic surgeon for 40 years. I have never once had a patient come into my office with the lack of bruising that you have and the lack of redness. What did you do? And I was like.  It was Tendu, and I'm not suggesting that people do that, but topically I just put it on over my little eyelids where it was the incision point and then underneath. We just did a CO2 laser yesterday on a patient and put the Tendu on her and her before and after pictures are really impressive.  Yeah. She doesn't want Botox. She doesn't want filler. She was Colorado girl. Pretty glycated, pretty photo damaged and I can already see the difference.

That's incredible. And what is a nice angle with the Tendu, it's all natural. It's got two ingredients in it. It's all natural and it's going give you a very natural, healthy glow.

Where do you see yourself or where do you see the industry five years from now? Oh, I don't think it's going go away.  None of us want get older. Even though it's a little tight right now, people still want their Botox.

They might give up some other things, or we might get creative and do our liquid PDO or Tendu, do some kind of a treatment, to keep 'em going for a couple months, but it's not going go away. I think there's going be different procedures. I think a lot of surgeons, plastic surgeons are going to awake anesthesia where they're doing.

I don't know how you had your eyes done, but. I was awake.  Two guys of mine, friends of mine, don't do general anesthesia. You're asleep,  but you're sedated, on like ergen and Halon and then you wake up, you have less recovery time. You have less downtime. You can, probably less bruising, less swelling.

That is going get to be a bigger trend, I think.  Interesting. I actually agree with you. And still a body because. You can get your face looking one way, but all this is still going on and people, if they work out hard and they eat healthy, the GLP and TLPs have really changed the industry, the weight loss medicine.

And, that is the new narrative in healthcare, like fighting diabetes and taking down prediabetes and taking down heart disease. But if you lose weight too fast. You're going to have rapid weight loss in sarcopenia, saggy skin and now people are like I don't like these and I don't like these.

And I've played a little bit with your PDO here, but I haven't tried to Tendu in there yet. Interesting. Yeah.  I probably do more Botox in neck now than I do in the face, because all my patients that have been seeing me consistently for a long time are not moving. Like I rarely get Botox anymore.

I think I need it, and I'll go to my girls and they're like, get outta here. We don't overtreat in my practice ever. We just don't because that's our billboard. We want people to look good. But, the neck is still aging and so doing those platysmal lines, doing along here helps a lot.  So that's different.  Yeah, that is different. When I've had patients that are seeing me for 20 something years and now I gotta find another place to, make them look good. 'em look good.  Yep. Absolutely.  What motivates your team right now?  I think they're proud of their work. They're, everybody's highly skilled in here. It's a happy place. Everybody's healthy. Most, we all come from hospitals and people want come in. We're nice. They, we have a good reputation. We've been around for a while.

We make everybody feel special. It starts with the experience of when you walk in to when you check out and remember.  It is a small town. It's not as small as it used to be. I don't know if you live in a small town, so you might understand that. But yeah, it's the experience  not being rushed. We're not one of those clinics that just turns and burns people out or we give 'em time because I want, I want them to look good.

Not just Botox, but get that skin in shape and then putting them on a professional skincare line because that's 80% of their success. It's an 80/20 rule. I do 20%. You do 80%.  I like that. I like that a lot. I generally like to ask everybody this question, if you were sitting next to an industry expert right now, what would you ask them?

I don't know. A lot of people ask me I. Probably the question that you asked me, even though I already answered it, is, where do you see this trend going? I think it's more anti-age aging. I see people morphing into doing these wellness clinics where they're doing like PRP and the joints and now we're doing a lot of B 12's and vitamin D's and glutathione and NAD is huge right now and just this overall wellness, so not just looking good and the no downtime surgery. I think that's a huge trend that we're going be seeing and then dealing with the body and skin laxity after being you on a weight loss program.  Yeah. Yeah. People want be healthier, which they should be.

We're not a healthy nation. We need to be.  We definitely need to be. I'm a dual citizen, I see, everybody in Europe walks and they might smoke and walk, but they're thin. Yeah, it's true. It's very true and I would imagine you being out in Colorado, you've got a lot of very fit people, but man you leave that you used to environment.

Oh really? I'm from Texas, so I always thought we were really healthy down there and every time I go home I'm like, oh yeah, we are definitely seeing some obesity here in Colorado, but not like we normally would. If you're living at 8,000 feet like I do you're working hard, everybody moves here to have a fit lifestyle. That's the other challenge is how do you balance people's outdoor activities and them wanting correction.  Like I had this conversation with a guy friend of mine last night and he loves the sun, and I said, you're killing me  because you come in, you like the work I'm doing and then I see you outside without a hat on.  Just to wrap this up for the sake of time, we touched on this in the very beginning, but are there two or three points of advice you would offer a new injector out there? Start slow,  learn like three things really well.

So be good at three things. I asked this plastic surgeon I spoke to last night, I'm like, what are the, because he does all body stuff, he does everything and I said what are the three things that you really like? And he said, blepharoplasties lower neck and mommy makeovers and I said, good, because, I'm a huge referral source, so I need to know, my guys what they're good at, and I'll refer.  But he has three things. He could probably do 10 things. I could do 10 things. My favorite is Botox, filler, PDO Threads  yeah. Excellent. And where can people find you and learn more about you out there?

On my Instagram, it's Medical aesthetics, LLC, it's Evergreen, Colorado and that's my website as well. Wonderful and thanks for your time today. Thanks. It was very fun. Thanks for inviting me.  Congratulations on your success with all this.  Thank you. It's as a business owner, it is not easy and it never ends.