The Client Who Wants Growths Removed, Her Own TCA, and No Paperwork
A long-time client points to two small skin-colored growths on her neck and asks you to 'zap them off with that high-frequency wand - you did it for my coworker.' She then pulls a bottle from her bag, 'a 30% TCA peel I bought online,' and asks you to use it so she doesn't waste the money. She wants to pay cash and asks you not to 'bother with the forms - no intake, no notes.' While looking at her neck you notice an irregular, pearly-edged spot near one growth that she says has been there 'a few months and sometimes bleeds when I scratch it.' Your salon owner is within earshot and says, 'Just do what she wants, she's a good client.' Your license permits superficial chemical exfoliation only; high-frequency is allowed for skin stimulation, not lesion removal.
1. Sort each request - zapping the growths, using her TCA, cash with no records, and the pearly spot - into permitted or not permitted, and explain the reasoning.
Read the worked answer
- 'Zap' the growths: not permitted. High-frequency in esthetics is for stimulation and for reducing surface bacteria via heat and ozone. It is not a lesion-destruction device. Removing a growth is a medical act, and identifying what it is, is too.
- Her 30% TCA: not permitted. Three separate reasons: 30% TCA is a medium-depth peel, outside a superficial-only license; the product's identity, concentration, and storage cannot be verified; and professional liability and informed consent do not extend to unverified client-supplied product. I apply only products I selected, labeled, and can stand behind.
- Cash with no records: not permitted. Cash as a payment method is fine. Skipping the intake and treatment record is not - those documents support contraindication screening, informed consent, and continuity, and are the only defense if a reaction occurs.
- The pearly spot that bleeds: refer out. A lesion present for months that bleeds with minor trauma needs medical evaluation. I describe what I see, recommend a dermatologist, and document the recommendation. I do not name a diagnosis or treat it.
2. Write your response to the client and to the owner, and list what you document.
Read the worked answer
To the client: 'I'll be straight with you about what I can and can't do. My license covers superficial exfoliation only, so a 30% TCA is out of scope, and I won't use a product I didn't purchase and can't verify - that protects you, not me being difficult. The growths need a doctor; high-frequency won't remove them. And I do need the intake and notes, because if something reacts, that record is how your doctor knows what touched your skin.'
To the owner, privately: 'Removing lesions and a medium-depth peel are outside both our licenses. If there is a reaction, the salon's coverage and both our licenses are exposed. I'll document the referral and what I did instead.' Keep it factual, not personal, and do not debate it in front of the client.
Document: each request made, each refusal and the reason given, the referral for the neck lesion, what was performed, and that the client was informed. If the owner pressures you to comply, escalate to your liability insurer or the state board rather than proceed - a job is replaceable, a license and a lawsuit are not.
3. What general policy would prevent this situation, and how do you handle a client who refuses the intake form?
Read the worked answer
- Client-supplied products: have a written policy before it comes up - only professional products with known ingredients, lot numbers, and manufacturer instructions are applied. Offer a comparable in-house service and explain why; the client keeps her bottle.
- Refusing intake: intake and treatment records are non-negotiable. They support informed consent, flag contraindications, and protect the client's continuity of care. A client who refuses can be politely declined service - refusing is a business decision you are allowed to make, and it is cheaper than the alternative.
- Referral habit: keep a short log of referrals (date, what you observed, where you sent her). It shows a consistent pattern of practicing inside your scope.
- Menu language: audit your service descriptions. Words like 'removes,' 'cures,' or 'corrects' invite scope creep. 'Improves the appearance of' is both accurate and safer.
- The pattern to notice: when a client asks for treatment plus a discount plus no paperwork, the real request is usually to skip the safeguards. The answer is the same every time, stated plainly and written down.