human resources manual
MISSION STATEMENT Hevia Cosmetic Dermatology is a luxury, boutique style practice with patients’ needs and comfort in mind.
Core Service Values 1
I am always responsive to the expressed and unexpressed wishes and needs of our patients.
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I am empowered to create unique, positive, memorable experiences for our patients.
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I continuously seek opportunities to innovate and improve the Hevia Cosmetic Dermatology experience.
I own and immediately resolve patient problems.
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I create a work environment of teamwork so that the needs of our patients are met.
I have the opportunity to continuously learn and grow.
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I am proud of my professional appearance, language, and behavior.
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I protect the privacy and security of our patients, fellow employees and the company’s confidential information.
HEVIA COSMETIC DERMATOLOGY HEALTHCARE PROVIDERS Oscar Hevia, M.D. Board Certified Dermatologist, practicing for over 18 years. + Specialty: Cosmetic Dermatology. Expert Injector. + Dr. Hevia’s practice is based exclusively in the treatment of non-surgical facial rejuvenation by using injectables. + Sub-specialty: Injecting in the following areas – nose, ear lobes, under eyes, hands. University of Miami professor. + Dr. Hevia’s philosophy: to achieve a natural, fresh look that is youthful, healthy and age-appropriate; “Restoration, not Alteration”. + Treatment therapies performed: All injectables
Ana R. Hevia, A.R.N.P.
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Board Certified Nurse Practitioner, graduated with a Master’s Degree from the University of Miami. Specialty: Cosmetic Dermatology. As a nurse practitioner with an advanced graduate degree and training, Ana Hevia diagnoses and treats dermatological medical conditions. Treatment therapies performed: All lasers Sclerotherapy Injectables Acne/skin issues Peels Cyst injections Minor surgical procedures
Bernard Cohen, M.D. + + + +
Board Certified Dermatologist. Office hours: Part-time Specialty: General Dermatology Treatment therapies performed: Surgical dermatologic procedures General dermatologic treatments Skin checks
Note: Please refer to our website for biographies of providers at www.oscarheviamd.com *WE DO NOT ACCEPT HEALTH INSURANCE
Treatment Formulations utilized at Hevia Cosmetic Dermatology: NEUROTOXINS (expression relaxers)
Botox (developed and manufactured by Allergan)
temporarily reduces the appearance of wrinkles by restricting the muscle actions that cause creasing and frown lines.
Used in: frown area, crow’s feet, forehead, neck (platysmal bands), nose.
Takes effect in 5-6 days; lasts 3-4 months, depending on patient.
If the treatment is done aggressively (many syringes) the effect lasts longer but the patient does not look natural (their facial expression has a “frozen” look).
Dysport (manufactured by Medicis)
A new formulation made from the same active ingredient as Botox.
Temporarily reduces the appearance of wrinkles by restricting the muscle actions that cause creasing and frown lines.
Used in: frown area, crow’s feet, forehead, neck, nose.
Takes effect in 2-3 days; lasts 3-4 months, may last longer than Botox.
If the treatment is done aggressively (many syringes), the effect lasts longer but the patient does not look natural (their facial expression has a “frozen” look).
Dysport is less expensive (about 10%) than Botox.
Xeomin (manufactured by Merz Pharmaceuticals)
Not FDA approved as yet.
Made from the same active ingredient as Botox, however, there is a difference in the protein to which it is bound. Unlike Botox and Dysport, it needs no refrigeration prior to mixing.
Used in: frown area, crow’s feet, forehead, neck, nose.
Takes effect in approximately the same time as Botox and has a duration similar to that of Botox and Dysport.
FILLERS Fillers can restore a healthy, youthful appearance, enhance your existing features and help you defy age and gravity – all without invasive surgery or scarring.
Radiesse®
Made of calcium-based microspheres suspended in a water-based gel.
Areas used: face, under-eye area, hands, NOT lips.
Mixed w/ Lidocaine
Lasts approximately 6-8 months; in some patients, up to 12 months.
Hyaluronic Acids Restylane An injectable gel made from hyaluronic acid, a natural component in the skin that is lost over time with aging.
Used to restore volume in the face, lips, nose, under-eye area, ear lobes, neck rings, acne scarring, hands.
Lasts approximately 3-4 months.
Perlane An injectable similar to restylane, made from hyaluronic acid but made from a larger molecule intended to be injected deeper.
Used in face, nose, under-eye area, ear lobes, lips, acne scarring, hands, any depressed area of the body.
Lasts approximately 3-6 months.
Prevelle A hyaluronic acid gel and more superficial filler, temporarily fills in fine lines. Used in the face, lip lines and other fine lines, neck rings, under-eye area. Lasts approximately 4 months. Juvederm® A smooth consistency gel made of hyaluronic acid, a naturally occurring substance in the skin that helps to add volume and hydration.
Used in the face, lips, nose, under-eye area, ear lobes, acne scarring, neck rings, hands.
Lasts approximately 4-6 months.
FILLERS Poly L Lactic Acid
Sculptra速 (manufactured by Dermik Pharmaceuticals)
A synthetic, biocompatible material made of poly L lactic acid that is injected below the surface of the skin in the area of fat loss.
Results are delayed because it stimulates the formation of new collagen (every person has varied results) and requires multiple treatments 1 month apart.
Usually 3-4 monthly treatments are necessary.
Used in the face for restoring volume and facial contours, not used in lips.
Lasts approximately 6-9 months.
Silikon (manufactured by Alcon)
A silicone oil substance (purified polydimethylsiloxane) that is a permanent filler.
To achieve optimal results, may need 2- 6 treatments total.
Must be layered to avoid overcorrection.
Silikon 1000 is FDA-approved for the treatment of retinal detachment;
dermatologists use it for cosmetic enhancement.
Used for facial volume loss, lip augmentation, wrinkles, acne scarring, under-eye area.
Lasts permanently.
LASERS Lightsheer
Used for hair removal.
How it works: A beam of light is used at a specific wavelength on the skin and is absorbed by the pigment in the hair follicle.
Where it is used: Treats any area with hair: bikini, under-arms, legs, back, arms, face, upper lip, ears, nose, side-burns, head, fingers, toes, areolar region of the breasts.
Who it can be used on: Safe for women, men, teenagers.
Skin types that can be treated: Any skin type from Asian to African American.
The hair must be black or brown. Does not work on blonde or white hair.
LASERS(continued)
Be Aware: Patients can not be suntanned if they are to be treated.
Patients who have been on Accutane/Sotret must wait 6 months to start hair removal treatment.
Before treatments, the patient should come in with area to be treated shaved. If it is the first visit and the patient is not sure if the hair is dark enough, she/he can come in and the nurse will shave the area to be treated at the office after the patient has been seen.
A topical anesthetic cream is first applied to the area to be treated; a waiting period of approximately 20 minutes allows the cream to anesthetize the area, after which, the treatment is performed.
After treatment, sun block will be applied to the area if exposed to sun. The patient is educated on avoiding sun and using sun block (at least SPF 50). If not, the skin in the treated area could develop hyper-pigmentation.
Do not apply skin care creams or lotions to area for 24 hours. Treated area may be slightly red and some swelling may occur for a few hours.
Some hair will shed on its own and on the next cycle of treatment less hair will be visible.
Laser hair removal significantly diminishes hair but permanent hair removal may not always be attained.
Patients will need 4-6 sessions of laser, spaced 3-4 weeks apart.
Gemini (Laser Toning) Used For:
+ Improvement in skin texture and appearance + Collagen stimulation
+ Pore reduction + Treatment of broken capillaries
+ Treatment of brown spots/age spots
Hair removal
How it works: It focuses on a specific target (blood, pigmentation or collagen).
Where it is used: Treats the face, neck, hands and other areas of the body.
For treatment of broken capillaries, 2-3 treatment sessions are necessary for complete removal, 4 weeks apart.
For treatment of hair removal, this device is utilized specifically for patients with medium to darker toned skin. It is not indicated for light skin tone.
Aluma (Skin Tightening)
Radiofrequency technology leads to collagen contraction and regeneration.
Used For:
+ Collagen stimulation + Skin tightening
How it works: Collagen fibers in the dermis are heated.
Where it is used: Treats the face, neck, arms, chest, stomach.
V Beam (Pulse Dye Laser)
Used to treat discoloration of: + Scars, Broken Capillaries, Bruises, Port Wine Stains
PEELS TCA (Trichloroacetic Acid)
Used to improve and smooth the texture of the skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, fine wrinkles and uneven skin pigmentation.
Can be done in one of several strengths: mild, medium or strong.
After the peel treatment, it takes 5-7 days to complete the therapy process depending on the strength of the peel. Usually on day-3 the skin will start to peel.
Regular night creams must not be applied until peeling is fully completed.
The patient must stay out of the sun or the treated area will develop hyper-pigmentation.
The patient may only use sunblock (SPF 50 at least) and if a moisturizer is needed, Aquaphor, a very in-activate moisturizer, may be used.
SCLEROTHERAPY (Spider Veins) This is one of the most prevalent treatments for spider and varicose veins. We use a tiny needle that has a sclerosing agent that is injected into the vein. Upon the injection, the solution replaces the blood in the vein, generating irritation and corrosion to the walls of the vessel. The body then initiates the natural healing process and the vein begins to shrink and eventually disappear.
Complete elimination may require 2-3 sessions, 3-4 weeks apart.
After treatment, the patient is wrapped in the area treated for 24 hours.
The patient can then remove the wrap at home.
The patient should not have pain or swelling of extremities after treatment.
Excessive standing and heavy exercising is not recommended for 24-48 hours after treatment.
Following the visit the treated areas will become darker and may appear bruised. The patient does not have to wear support hose. After injecting the larger vessels, the affected area may become pigmented but this is temporary and will fade over time.
HAND REJUVENATION
A combination of fillers, lasers and peels are utilized.
Fillers are injected between veins to add volume, diminishing depressed areas between veins. This results in a more even look to the fullness of the skin on the hand.
Lasers help stimulate collagen production to firm the skin at the dermal level and minimize or eradicate hyperpigmentation (brown spots).
Peels help remove uneven skin pigmentation, fine lines and damaged outer layers of skin. The result allows for more even volume and skin tone, and a smoother, more youthful look to the hands.
SCAR TREATMEMT
It depends on type of scar; raised, flat, depressed.
Lasers and injections are utilized to minimize discoloration; flatten, if scar is raised, or raise to an even level with skin, if scar is depressed.
* Pre-Treatment Instructions to Patients - Procedure by Phone: If making an appointment, be sure to tell patient to not take aspirin, Motrin, Aleve, any NSAID (nonsteroidal) or Vitamin E for 7 days prior to treatment.
MEDICAL ASSISTANTS New patient visit: Questions to ask: a. Allergies? b. Medications? c. Past Medical History (PMH)? d. Any possibility you can be pregnant? e. Past History with any Injectable? Follow up visit: Questions to ask: a. Any change in your PMH or new allergies? b. Medications? c. Any possibility of pregnancy?
MEDICAL ASSISTANTS
(Continued)
Check List to complete for a patient visit: Patient Questions Photograph Consent Forms
Follow up Instructions
While in the room with the Doctor or ARNP:
Take notes of medications that will be given at the end of the visit to write prescriptions and then have the Doctor or ARNP sign the prescription.
Document what is done in the room, i.e., name and amount of Filler, laser, settings, etc.
Make sure Dr. Hevia has someone with him at all times during the visit (unless he specifically asks to be alone).
ALL STAFF MEMBERS Uniforms: All black scrubs
No other jackets, only black.
No exposed tattoos
In winter months, black turtle necks can be worn under scrubs.
Shoes: black moccasins preferred, black tennis shoes.
Please maintain a groomed appearance, hair should be pulled back, especially if working directly with patients.
Please cover visible tattoos.
Telephone Policy You can not have your cell phone with you during working hours. It must be in a drawer or purse.
No personal calls or texting during working hours.
If there is an emergency, your family member can call the office.
Bathroom Break If you need to use the rest room, please make sure someone is covering you!
human resources manual