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Physicians and Estheticians: A Rewarding Partnership

By: Carl Thornfeldt, MD, FAAD
Posted: January 28, 2011, from the February 2011 issue of Skin Inc. magazine.

In the ever-expanding field of medical esthetic services, licensed estheticians have come a long way since the days of working as beauticians for Helena Rubenstein in the early 1900s. Traditionally employed by day spas offering pampering facials or makeup artistry services, estheticians are finding a wealth of career opportunities with the worldwide growth of medical spas and other health care offices. Because only about two-fifths of skin conditions are evaluated by dermatologists, estheticians have the opportunity to be an essential facet of the skin care team.1

Career options for estheticians who wish to focus on clinical esthetic treatments include positions in cosmetic surgery or dermatology practices, outpatient clinics, hospitals, laser centers or medical spas, in addition to starting their own private esthetic practice or day spa. The latter two options are limited by state laws for a variety of treatments, such as the strength of chemical peels that are performed without medical supervision. It is important to check with your state’s board to confirm the scope of your license. (Editor’s note: For more information about what your state requires, log on to to obtain contact information for your state’s board.)

Although not a requirement to obtain employment within a medical practice, a licensed esthetician who also has a medical assisting or nursing degree is more likely to get hired. Some states allow medical assistants to administer injectables, such as botulinum toxin and fillers. Because regulations vary in each state, some physicians and medical spas will train a licensed esthetician to perform these types of procedures under their malpractice insurance umbrella. However, regardless of insurance coverage, estheticians are not legally allowed to inject anything into anyone. Lack of knowledge regarding state law limitations for your scope of practice does not protect you from litigation or criminal prosecution, so be sure to know your legal limitations before agreeing to perform any type of questionable treatment.

In a clinical setting

A typical day for an esthetician in a clinical environment includes skin care consultations and analysis, assessing each patient’s personal skin care goals and recommending a plan of action to reach those goals. Often, estheticians are a patient’s first point of contact, because patients will often see estheticians for services before seeing the physician. With a trained eye, the esthetician is able to recognize—but not diagnose—certain skin diseases and abnormalities that require medical attention. Because 21% of children1, 2 and 39% of adults3 are afflicted with skin conditions, at least intermittently, recommending home care products to improve the skin and fortify its health will strengthen the esthetician’s business and patient loyalty.

Surgical consultations may be provided by the esthetician to help develop patient relationships and to communicate realistic expectations. Estheticians also offer pre- and post-operative skin care, corrective skin care or makeup artistry for patients with burns or disfigurements, and they often serve as liaisons between physicians and patients. The esthetician helps to reinforce home care protocols and the proper usage of medications while providing education to the patient, as directed by the physician.