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The Real Answers Behind Esthetics in a Medical Setting

Terri A. Wojak August 2014 issue of Skin Inc. magazine
The Real Answers Behind Esthetics in a Medical Setting

Working in a medical setting is the goal for many skin care professionals today. Practicing esthetics with a physician is a great career option and definitely has its advantages, including continued learning; clinically proven treatments and products; the ability to help all clients through direct referral; and opportunities for client interaction. Although having a career in the medical field may seem glamorous, there are several details estheticians may not be taking into consideration. Following, four common misconceptions about working in the medical field as an esthetician will be disputed.

Myth No. 1: “I can perform medical services as an esthetician while working with a physician.”

Truth: An esthetic license offers the same scope of practice, regardless of the place of employment.

Estheticians are meant to cosmetically enhance the skin, and medical professionals are meant to treat conditions or abnormalities. Estheticians are licensed to perform skin care to whatever extent their state license allows—for most states, this includes beautifying the outermost layer of skin. The misconception that estheticians are able to perform medical treatments often comes from the physician’s ability to delegate procedures to nonmedical professionals. Medical delegation differs by state—just like esthetic regulations do—and some states are more strict than others. Treatments can only be delegated to trained professionals following a medical examination by the physician.

The confusing part is that estheticians are often the first team members a physician will delegate to, because they are knowledgeable about the physiology of the skin and how to care for it. However, in Illinois and several other states, estheticians cannot legally perform laser procedures, or any other medical procedures, while working under their esthetic license. Therefore, if a physician were to delegate a procedure outside of an esthetician’s scope of practice, she would technically no longer be working as an esthetician, but rather as an assistant to the physician. These regulations should not be taken lightly—failing to follow them can result in a loss of licensure.

Myth No. 2: “I do not need additional training to work in a medical setting; the office team will provide on-the-job training.”

Truth: This may occur in some cases, but most employers now want experience or advanced training on skin care and cosmetic medicine.

Working in a medical setting is vastly different from working in a spa. Even if the esthetician is hired to provide skin care services and recommend products to enhance and maintain results of medical procedures, support team members—including estheticians—will likely be involved in some aspect of client care. An esthetician may be asked to speak to clients about skin care as they are waiting for their procedure, or lend a helping hand in a clinic room.

It is important that those looking for work in a medical office are aware of some of the unpleasant things they may witness. Team members will likely see blood, skin infections, wounds and even surgical procedures. Although medical procedures are often viewed in videos and on the television, it is much different experiencing them first-hand. In fact, some students pass out while observing clinic procedures during their training programs.

Cosmetic medical services must also be broadly understood. It would be difficult to be successful in any job in which other aspects of the direct business were not learned ahead of time. To manage skin effectively before and after any medical procedure, estheticians must have detailed knowledge of what it entails, including the clients experience, indications, contraindications and possible adverse reactions. After proper training, it is in the best interest of the practice to have new team members shadow the physician for several weeks in order to gain first-hand knowledge of client experiences. The vast offering of cosmetic procedures available makes it hard to keep up; however, it is important for all estheticians to know the latest techniques and technologies in the industry, regardless of place of employment.

Myth No. 3: “I will be handed a client list when I work with a physician.”

Truth: There is an enormous opportunity to build clientele working with a physician; however, it is ultimately up to the esthetician to make it happen.

Although there will likely be plenty of opportunities to build a client list in a busy medical practice, it still takes work. It is the responsibility of the esthetician to introduce skin care services to the physician’s patients. The physician’s time is ultimately the most valuable to the practice; therefore, it should be spent consulting and treating medical conditions, during which the esthetician utilizes her time to provide recommendations for enhancing and maintaining the services the client has undergone.

There may also be times when clients make an appointment with the esthetician for a skin condition that is better suited to be addressed medically. For example, a client comes in to see the esthetician for microdermabrasion to treat deep-set wrinkles between the eyes, known as the corrugator.

Myth No. 4: “Medical services are expensive; therefore, I will make a lot more money.”

Truth: Working with a physician offers opportunities for growth, but it is not always realized as quickly as it is in a spa setting.

Just because medical treatments typically have a higher price tag does not mean that a business offering these treatments is more profitable. In fact, the overhead associated with many medical services can make it difficult for a start-up practice to see profit for quite some time.

For instance, one of the most commonly delegated procedures is laser hair reduction. Lasers alone can range in cost from $60,000 to well over $100,000. Plus, lasers need maintenance on a yearly basis and may have disposables for each use. Besides the equipment, the physician—whose time is the most valuable aspect of the practice—must be available for medical consultation for all delegated treatments and, in most cases, be on site during services. These overhead costs must be taken into consideration when negotiating salary.

Estheticians working in a spa are often accustomed to making commission on services and retail, as well as receiving tips. This gives the motivated esthetician an opportunity to see an immediate benefit to building and retaining clients. However, sharing commissions on medical services is not allowed in several states due to fee-splitting laws. Fee-splitting is taken very seriously in the medical field. It is based on the premise that no one other than the physician can receive revenue on medical services. This regulation was put into place to ensure ethical client care and can be discouraging to an esthetician who works hard to build a clientele with no immediate value. However, hard work does eventually pay off, and it is likely that, as the practice sees in an increase in revenue, hardworking team members will, as well. Although commission cannot directly be paid, many medical offices provide an hourly wage or yearly salary with bonuses, depending on overall performance. The up-side to this is, along with following regulations, regardless of who is treating a client, the staff works as a team instead of competing for clients. This keeps the ultimate focus on clients’ well-being.

Follow your passion!

Skin care is often taken more seriously in a medical setting; to succeed, maintaining the highest level of professionalism is required. There are core professional ethics that must be followed—and it is of the utmost importance to always do what is best for the client. Recent advancements in education and strides made by industry organizations working toward clearly defined roles have led to medical providers and estheticians working together to establish a high standard of care. There are several career paths the esthetician can take; to make the best decision, it is important to learn as many aspects of that career path as possible. Although there may be obstacles to overcome, a career in the medical industry is a great professional goal. When you follow your passion for the right reason, it will lead to prosperity in all areas.

Terri A. Wojak, licensed esthetician of 20 years, is an authority on skin care in a medical setting, education and business. She is director and educator at True U Esthetics in Chicago, the co-author of Mastering Medical Esthetics (True, 2009) and author of Aesthetics Exposed: Mastering Skin Care In A Medical Setting and Beyond (Alluredbooks, 2014; She is also a member of the 2014–2015 Skin Inc. Editorial Advisory Board.


Editor’s note: To learn more about medical spa technologies, check out Terri A. Wojak’s new book, Aesthetics Exposed: Mastering Skin Care in a Medical Setting and Beyond (Alluredbooks, 2014). Order today at!