The History of Professional Regulation of Estheticians

By Susanne Schmaling, Director of Education, Associated Skin Care Professionals (ASCP)

The skin care profession has a long history of regulation outside of the United States. In Europe, estheticians are called “beauty therapists” and can achieve an ITEC or CIDESCO certification when they complete their initial program. In the United States, estheticians—often called facialists—were not regulated until 20 years ago when six states offered a separate license for estheticians. In 1978, California started to license esthetics as a separate profession with a 600-hour curriculum; before this, an esthetician could receive additional training through a basic cosmetology program. In some states, no training at all was required and anyone could open a skin care studio or spa. One state, Connecticut, still does not have a separate license for estheticians.

In the late 1990s, the medical spa boom started. Lasers for hair removal and skin resurfacing, as well as Botox, began to be widely used. Physicians saw an additional cash revenue source and began to expand their practices. Having estheticians work for them prompted a closer look at the profession as a whole. In 1999, after much controversy, Utah was the first state to offer a two-tier licensing model with 1,200 required hours as the standard. These licensing requirements mimic the CIDESCO certification, without the full body massage component that is a worldwide standard.

During the late 1980s and early 1990s, an innovation in cosmetic chemistry also happened, along with members of the baby boomer generation beginning to age. The introduction of glycolic acid and retinol as miracle ingredients ushered in a new group of products called “cosmeceuticals,” coined by Albert M. Kligman, MD, and not recognized by the U.S. Food and Drug Administration (FDA). This group of cosmetics were considered to be more powerful and to create better results. Superficial chemical peeling became a new modality that could be accessed by estheticians with minimal standards or training. This new modality offered side effects, which translated to a public safety concern to be addressed by each state’s cosmetology board.

School curriculum has not kept up with much of the technology today’s estheticians are using. Although advanced esthetics textbooks exist, state board testing still does not reflect the advanced knowledge needed. This has created a perfect storm for state boards with the medical profession wanting a reduced scope of practice, technology advancing faster than regulation can happen and some schools not advancing their curriculum in order to just teach to pass the state board test.

This evolution of the skin care profession has created a situation that has made challenges to the existing scope of practice inevitable. The medical profession has an economic interest and state boards have a public safety concern.

It is crucial that skin care professionals get involved with their state boards in order to represent the best interests of your profession. Take the extra step to make sure you know what issues are going on in your state. Log on to for complete contact information for your state’s board, and start becoming active and making a difference in your state today.