Doctor Or Aesthetician - Skin Rejuvenation Procedures: Skin Health

Content provided by the Faculty of the Harvard Medical School

Doctor or aesthetician?

Some procedures that affect only a superficial layer of skin can be performed by nurses or skin aestheticians, while others require the skills of a dermatologist or other physician. Quite often these techniques are used in combination or along with surgery. Whom you trust to perform a procedure is a crucial factor in whether the outcome will be successful.

While less invasive procedures such as microdermabrasion can be performed by cosmetology professionals, cutaneous (skin) surgeries, including laser procedures, are performed by physicians from a number of specialties: dermatologists and dermatologic surgeons, plastic surgeons, facial plastic surgeons (otolaryngologists), oculoplastic surgeons (ophthalmologists), and other cosmetic surgeons.

Choosing a doctor

One way to start is with a dermatologist who can advise you about which procedures are best handled by a physician. Some physicians who perform cosmetic procedures also have aestheticians on staff to handle the less invasive treatments. To find a reputable physician, begin by asking your own physician for recommendations. Or contact professional societies that have sophisticated referral services and Web sites that contain information about physicians' training and experience, the articles they've written, and the procedures they perform (see "Organizations"). In some areas, city or county medical associations can provide names of physicians to contact.

You can also ask friends, co-workers, or family members who've had cosmetic procedures if they were satisfied with the results and whether they would go back to the same physician again. But remember that physicians who are popular or who advertise heavily may not be highly skilled, or they just may not be right for you.

Once you have the name of a physician, the next step is to check whether he or she is board-certified. Most consumers know to ask about certification, but many don't ask which board has done the certifying, or whether it's overseen by the American Board of Medical Specialties (ABMS). The ABMS oversees 24 approved medical specialty boards in the United States. A number of other groups may call themselves "boards," but they aren't overseen by the ABMS. Their certification requirements may be less rigorous than boards under ABMS purview. More than 100 of these self-designated boards exist throughout the United States, and there are virtually no legal requirements for their formation. Some may be no more than glorified public relations offices. To check qualifications, contact the ABMS's Doctor Verification Service at 866-275-2267, or online at www.abms.org.

The American Board of Dermatology certifies physicians to perform hair transplants, laser procedures, dermabrasion, sclerotherapy, liposuction, chemical peels, and soft-tissue augmentation. In fact, dermatologists developed most of these procedures. In addition to medical school, internship, and residency training, some dermatologists pursue an additional year or two of training to specialize in dermatologic surgery.

The American Board of Plastic Surgery certifies physicians to perform the complete array of cosmetic and reconstructive surgical procedures. Physicians who are ABPS-certified have a medical degree from an accredited institution, at least two years of residency training in general surgery, and at least two years of additional training in plastic surgery.

If you're going to have a surgical procedure in the physician's office, ask if the office is accredited by one of the following organizations: the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or the Joint Commission on Accreditation of Healthcare Organizations.

These organizations have referral services and can give you the names of physicians in your area (see "Organizations"):

• the American Academy of Cosmetic Surgery

• the American Academy of Dermatology

• the American Society for Dermatologic Surgery

• the American Society for Laser Medicine and Surgery

• the American Society of Plastic Surgeons.

Choosing an aesthetician

Not long ago, professional training in nonmedical skin care came under the umbrella of cosmetology. Anyone who wanted to specialize in skin care also had to learn how to cut, color, style, and perm hair and how to do nails. More recently, the health and medical aspects of skin care have been recognized with specialized aesthetician training and licensing.

Aestheticians perform a variety of skin care procedures — deep cleansing, facials, low-grade chemical peels, and microdermabrasion (true dermabrasion should only be performed by an experienced physician). While most aestheticians work in salons and spas, don't be surprised if your dermatologist or cosmetic surgeon has an aesthetician on staff. In addition to performing noninvasive treatments, an aesthetician may assist your surgeon in presurgical and postsurgical skin care and help you learn makeup techniques to cover redness or scars as your skin heals after surgery.

Licensing requirements for aestheticians vary from state to state. For example, aesthetician licensing in Massachusetts requires 300 hours of training. In Wisconsin, 450 hours of training are needed. Contact your state's department of licensing and regulation to learn about licensing requirements in your area. Many states offer this information online.

Last updated:	July 20, 2007