All ears

California native and clinical aesthetician Pamela Marshall co-founded Mortar & Milk in Fulham, London with her husband Nicholas in 2014. Mortar & Milk offers results-driven treatments for those with problematic, severely acneic or inflammatory skin. With exclusive use of clinical-grade skincare and an analytical, holistic approach to skin health, Pam advocates educating clients and aims to change the skin’s functionality from the inside out.

1. Singh Ospina, N. et al (2018). Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters, Journal of General Internal Medicine DOI: 10.1007/ s11606-018-4540-5.

Pamela marshall

California native and clinical aesthetician Pamela Marshall co-founded Mortar & Milk in Fulham, London with her husband Nicholas in 2014. Mortar & Milk offers results-driven treatments for those with problematic, severely acneic or inflammatory skin. With exclusive use of clinical-grade skincare and an analytical, holistic approach to skin health, Pam advocates educating clients and aims to change the skin’s functionality from the inside out.

My husband and I decided to open our clinic Mortar & Milk six years ago because, after being in skin for almost 20 years, I had this idea that we could make the journey and the way we treat skin better for our clients. Part of what I wanted to do was create this really long consultation, which is something that most people don’t do. I was told early on that no one would ever pay for a consultation and sit for an hour, but we have found that they will; in fact, they crave it. We have a wait list that’s very, very long.

People just want to be heard 

The ultimate ethos behind our business is that humans want to be heard. I read an article recently in the Journal of General Internal Medicine 1 that said when patients see their doctor, the doctor has either interrupted them or formed their own opinion within 11 seconds. 11 seconds doesn’t get you anywhere. What I often hear in the treatment room is, “No one has ever listened to me before”.

To me, the idea that we as clinics have a menu of services that gives a list of five or six different treatments just doesn’t make sense. There’s not one size that fits all, nor does the entire population of people we see fit into pre-determined treatment parameters. So, everything that we do in clinic is totally bespoke. Every consultation we do is an hour long, sometimes longer. If I know that I’ve got a client with some serious skin issues, I’ll book them at the end of the day and take a little bit longer.

Over and above the usual questions about medical history, allergies and products that they’re using, we let them tell their story, however long it takes. I basically say to the client, “You tell me everything you think I should know about your skin”, and I just let them talk.

We don’t tick any boxes; we just keep the dialogue going and I think if we look at their story, we can really work towards solving problems. There are no forms that we fill out, we just take copious notes. I will refer back to those notes and re-read them before I see the client again or follow up so I can put myself in their headspace.

Simple changes, big impact

I ask questions that may sound strange, but which can hold a lot of answers. If I’m dealing with inflammatory skin, I will always ask how often the client washes their sheets. The vast majority of the time, the answer is, “Once every two weeks” or “Once every month.” We’ve had some clients that have said, “Every three or four months”! Sheets should be washed weekly at a minimum. I cannot tell you how many times somebody’s skin has cleared up just by washing their sheets more. We sweat in the night, we produce oil, we have dead skin cells, there’s bacteria that builds up, there’s dust mites, whatever’s in our hair is getting onto the sheets; we’re rolling around in all that every single night, so it’s really, really important.

The other thing we talk about is, when they’re cleansing their skin, do they splash the cleanser off, or do they take it off properly with a warm, wet flannel? It’s so simple, but they’re not questions that are necessarily always asked. When you take your cleanser off with a flannel or washcloth, it removes everything. If someone is splashing their cleanser off, dirt, grime and old make-up will drag down the face and hang out down there and they will create a film on top of it when they apply their serums and moisturiser. I would say nine out of 10 times when someone comes to me with what they deem hormonal acne, it’s generally because they’re splashing, so if you can just get someone to go from splashing their cleanser off to removing it with a flannel you will almost always clear this up.

“We don’t tick any boxes... there are no forms that we fill out, we just take copious notes.”

I talk to a lot to clients about phones too. Pre-pandemic people were on the tube, going to work, texting or sending emails and then putting their phone up against their face, transferring an enormous amount of bacteria onto the skin. Many, many studies have shown how filthy our phones are. So I often say to clients, “You wouldn’t touch a public toilet seat and then touch your face, would you?” and generally that stops them from doing it. I get clients who have inflammatory skin to disinfect their phone on a daily basis.

Another easy one is, do they cleanse their face before or after they shampoo and condition their hair? Conditioner is formulated to adhere to the hair follicle, so if someone is putting their cleanser on while their hair is being conditioned and then they take the cleanser off and then rinse their conditioner out, all that product drips down onto their face. A lot of acne is cleared up just by literally washing the face and body after washing out conditioner.

“Over and above the regular questions, we let them tell their story, however long it takes.”

Empower and educate

During our consultation we take photos with our Observ 520 camera to give us our baseline. We can see six different views of the skin (although it actually ends up being 18 because we do side views as well). When someone comes back in, we periodically take additional sets of photos and then we analyse them so they can see the progress. This keeps a client compliant. I’ve never had someone not have positive results. I know sometimes it can be frightening to do follow-up photos, but if they’re following protocol, we will always see positive change in the skin.

The last important part of our consultations is education. I want my clients to not need me, which I know sounds crazy, but I want them to eventually be empowered and educated without me. I do it during the consultation but also during the treatment. I want them to understand how the skin functions, how ingredients work within the skin, so that when they’re shopping for skincare they know what they’re looking for, they know what their skin needs.

It’s really important clients understand that cosmetic products that are sold on the high street are limited in their ability to perform. That doesn’t make them bad, but teaching your clients to manage their expectations of what a high street or cosmetic ingredient can and cannot do will help them ignore the hype, and that’s what we want to do, we want to educate our clients so that they trust and respect our expertise.

We never push products onto clients, which seems contrary to what we’re told to do. I don’t have targets, I don’t hard sell, I don’t put products into people’s hands. I suffered from acne in my life before becoming a facialist and I know what it’s like to be hard sold to – nobody likes it. One of the things that we hear all the time is that our clients appreciate that we don’t push products onto them. We educate them so when we’re in the treatment room, I am talking constantly to my clients about what I’m using and why I’m using it.

The idea is to gain trust with your client, to build that long-lasting relationship, because if you can help their skin, if you can show them what you’re doing, if you can hold their hand through the process, if you can listen and hear what they’re saying; they’re going to stay with you.

We also follow up with our clients. Every one of our facialists has about an hour a day just to follow up. All of our clients go home with our email address – mine go home with my phone number – because we want to be there for them. The vast majority of the people that we treat are people with inflamed skin and there’s an emotional and mental health impact with that, so sometimes clients just need to be told that we’re there for them. That keeps clients coming back, because they know that you have their best interests at heart.

In summary, doing a thorough consultation will serve your business well. Yes, it means there will be less people in your treatment room on any given day, but you should be charging for that time. Your knowledge is one of your most prized assets as a facialist, so value it.