In a perfect world, our skin would be all of the following at all times: clear, glowing, and healthy. However, until that world actually exists, we must figure out how to make our skin happy on our own—and when to call in the big guns if necessary, like a dermatologist or an aesthetician.
If you've ever gotten a facial or an eyebrow wax, you've probably seen an aesthetician. And if you've ever gotten a skin check, you've probably seen a dermatologist. But what exactly does each one do? And when should you see one over the other?
Luckily, seeing either one will usually help you improve the quality of your skin in some way, but there are a few instances in which it really pays to see one or the other. Here, we’ll take a closer look at the qualifications for dermatologists and aestheticians, and when you ought to visit each.
Here’s what it takes to be a board-certified dermatologist.
Any board-certified dermatologist will have completed a four-year undergraduate degree, a four-year medical school degree, a one-year internship in a medical subject of their choice, and a three-year dermatology residency program, Anne Chapas, M.D., clinical instructor of dermatology at Mount Sinai Hospital, tells SELF.
At the end of their residency program, they take a final exam through the American Board of Dermatology (ABD), and if they pass, they’ll be considered board-certified in dermatology. “About a quarter of dermatologists then pursue additional training after residency,” Dr. Chapas explains, and this training usually takes the form of fellowship programs in such subspecialties as cosmetic dermatology, pediatric dermatology, or dermapathology.
In order to maintain their certification, dermatologists who got their certification after 1991 must participate in the ABD’s maintenance of certification program, which generally consists of continuing medical education, a series of self-assessment activities, and exercises around professional self-improvement. (Anyone who was board-certified prior to 1991 has been granted a lifetime certificate.) The maintenance of certification program culminates in a major recertifying exam every 10 years. Although there are certainly dermatologists who don't pursue board certification, it's one way for providers to demonstrate their expertise and commitment to practicing dermatology.
Independent of the ABD is the American Academy of Dermatology (AAD), which aims to educate, unify, and represent all practicing dermatologists in the United States (its membership is currently at 20,500 derms). While dermatologists who don’t have their board certification can join the AAD as fellows, only those who are certified by the ABD can join as associates.
Here’s how aestheticians get trained and licensed.
The exact requirements for aestheticians differ between states. But in most states, aestheticians must undergo somewhere between 300 and 1,000 hours of training at an aesthetics school or school of cosmetology, or as an apprentice, and then pass a state exam—often with both practical and written components—in order to earn their license. After that, most states will require them to regularly renew their licenses or take a few hours of continuing education every year. Aestheticians may also have undergraduate degrees from two- or four-year colleges, but that’s not required.
The aesthetic training curriculum generally includes skin-care basics, skin anatomy and physiology, safety and sanitation guidelines, infection control, and procedures such as facials and waxing. Three states—Utah, Virginia, Washington—as well as Washington, D.C., currently offer a master aesthetician license, which indicates that the aesthetician has received additional training in more intensive procedures, such as deeper chemical peels or ultrasound or laser procedures.
In addition to their state licensure, aestheticians can also pursue national certification through the National Coalition of Estheticians, Manufacturers/Distributors & Associations (NCEA). For the record, this certification does not license an aesthetician to work anywhere they want—rather, it provides them with a higher credential in their profession, plus more comprehensive training. At the moment, about 5,000 aestheticians are nationally certified.
Consisting of 1,200 hours, the national certification takes a more in-depth look at skin pathology, dermatologic terminology and disorders, and more advanced treatments including laser and light services, microcurrent facials, and ultrasounds and drainage techniques.
“There [are] various safety considerations for these advanced modalities, which the national certification goes more into,” Susanne Warfield, executive director of the NCEA, tells SELF.
Sometimes, you should definitely go straight to the derm.
For the record, the U.S. Preventive Services Task Force concluded in 2016 that there isn’t enough evidence for those without symptoms to get a full body skin cancer screening every year. But you should definitely talk to a dermatologist if you notice anything that might be a symptom, such as a mole that’s large or evolving, and the AAD recommends screening yourself to make sure you know what’s normal for you.
There are certain other issues that can only be addressed by a dermatologist. Specifically, deep and painful acne lesions, cystic acne, acne that’s already started to scar, redness, or anything that’s scabbing and crusting would warrant a visit to your derm, Dr. Chapas says.
Additionally, anything that hasn’t already been diagnosed—rashes, dryness, sensitivity, and brown spots, chiefly—should be seen by a derm first, Carolyn Jacob, M.D., a clinical instructor of dermatology at Northwestern University, tells SELF. Even if all you want to do is get rid of it, she says the risks involved with seeking out a quick fix before knowing exactly what you’re dealing with are far too great.
If you have a new brown spot, for instance, you’ll want to check with a dermatologist before getting it addressed by an aesthetician. Instead of a harmless freckle or acne-related dark spot, it could be a melanoma, Dr. Jacob explains. A cancerous mole is addressed very differently and could be deadly if left untreated.
Plus, even aesthetic treatments—which can include chemical peels and lasers—may have risks and side effects associated with them, so it’s crucial to know both what you’re treating and why you’re treating it. Simply put, “you can’t go zapping away without a diagnosis,” Dr. Jacob says. Any specific concerns or uncertainties you have about your skin should be brought to your dermatologist.
If you’re looking for pampering or routine maintenance, an aesthetician can help with that.
As Dr. Jacob puts it, aesthetic procedures like facials and extractions can be soothing, relaxing, and downright fun parts of one’s skin-care routine.
Even though an aesthetician won’t be able to offer treatments for severe or medical skin conditions, they may be able to improve the appearance of your skin overall. Anyone who’s simply looking for glowier skin (read: thoroughly moisturized, exfoliated, massaged, and calmed) will probably be best served at an aesthetician’s office, Dr. Chapas says.
Once you’re squared away with any diagnoses you need and have your derm on call in case you notice any changes in your skin, you can go forth and enjoy a monthly facial at your favorite spa with ease.
Aestheticians and dermatologists can—and do—work together.
It’s possible that an aesthetician may refer you to a dermatologist, and vice versa. Warfield explains that, technically, aestheticians are not allowed to treat any diseases of the skin. So, if they notice a lot of sun damage on the top of a client’s ear, for example, they can educate them on the importance of sun protection, but they will need to recommend that the client go see a derm for further evaluation.
Or perhaps they’ll see a client who wants help managing acne but find that the client’s skin may actually benefit from prescription-strength treatment. Because aestheticians cannot prescribe medications, they would, again, encourage the client to make an appointment with a dermatologist.
“I definitely see that the referrals go back and forth between our professions,” Dr. Chapas says. For instance, some people with serious skin conditions see an aesthetician before a dermatologist simply because it’s more convenient for them. “People start simple with what’s close and what’s easy,” she says. “And then, depending on whether or not they’ve resolved their problems, they may seek out the next level of professional advice.”
This is why Dr. Chapas advocates for an “open and fluid” line of communication between dermatologists and aestheticians (and other care providers, for that matter). Sometimes, word-of-mouth is the most effective way to get people who genuinely need dermatological care to see her.
On the other hand, there are times when dermatologists call upon the services of aestheticians. In particular, Dr. Chapas may refer younger patients, especially those who are more concerned with maintenance and prevention than any particular skin condition, to see an aesthetician. And for some of her patients with acne, Dr. Chapas will suggest that they see an aesthetician for a peel or microdermabrasion treatment, all the while treating them medically too.
“We work as partners, communicating back and forth,” she says. While Dr. Chapas may see a patient every few weeks or just once a year depending on what they're dealing with, an aesthetician may see that same individual even more frequently—and when they stay in touch with each other, they can cross-check their recommendations and ensure that the patient is compliant with the treatment.
The bottom line: Both dermatologists and aestheticians can be fantastic allies for your skin, but keep in mind that they aren’t interchangeable.
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