Dermatologist or an Esthetician? What’s the difference?
One of the most common questions in the skincare industry is what differentiates a Dermatologist from an Esthetician. While there is some overlap between the two professions, there there are differences as well. Let’s walk through them below!
A Board-Certified Dermatologist is a specialist in skin disease. He or she 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, plus a three-year dermatology residency program. Beside their regular medical practice, many dermatologists also offer cosmetic procedures such as dermal filler, lasers, and Botox injections and often have estheticians on staff in their offices to support the recommendations they make to their patients.
When you should go to a Dermatologist:
If you have a questionable rash, mole or skin tag, new (or old), deep acne scars, or severe cystic acne, a dermatologist is the right choice.
If you are interested in aesthetic medical treatments such as lasers, dermal fillers, Coolsculpting or Botox, a medical spa’s MD, PA, NP, or RNs would also be a good choice to see.
An Esthetician (also spelled Aesthetician) is a person licensed to provide skincare treatments, also known as a skincare specialist Training varies from state to state, but aestheticians typically take a 6-12 month course that focuses on skin care, facials, and noninvasive procedures. In the US, the majority of states require a “State Board” exam to assure safety and knowledge to gain a license.
Many estheticians will continue their education with specific brand or facial treatment device training classes or other advanced facial technique courses.
When you should go to an Esthetician:
If you are healthy and have not had any skin complications or skin issues in the past, seeing an esthetician in a medical spa or a dermatologist’s office is most likely the correct choice. You’ll get the luxury of a “spa “along with medical expertise – with supervision from an MD + team of nurses that specialize in aesthetic medicine.
At a medical spa, the estheticians are more likely to have a better idea of when a dermatologist is needed for skin conditions that are out of the scope of their license.
With so many endless treatments, products and endless advertisements promising perfect skin, how do we choose?
- Learn your skin type: Your esthetician can help you in figuring out what your skin type is. Learning if your skin is oily, dry, combination or normal can determine how different products will work for your skin.
- Create your daily skincare regimen: The path to success with your skincare products is repetition. It is best to build a daily routine, especially with active treatment products – ones containing acids, stem cells or peptides. With many facial products, they may take six to twelve weeks before seeing significant changes. Your esthetician will help build out a custom routine suited to your skin needs. Be upfront with how many products you are looking to use – if you want a super simple routine, let your provider know so they do not overwhelm you with too many options.
- Avoid buying products without researching them first: If there are unfamiliar ingredients, look them up to find out what they are and why they would be in that product. If you find minimal or no supporting information on the specific ingredient in question, that’s a good sign it is just a new “trendy” product and one to skip. Some essential oils—citrus and bergamot oils in particular—can have phototoxic properties – avoiding daytime products that contain these essential oils can be helpful. The International Fragrance Association recommends using citrus oils in concentrations of no more than 4% in products meant for use on your face. Vitamin C serums are good for AM applications and typically do not contain citrus extracts. Bergamot oil can also be “bergapten free” making it safe for skincare use. If you crave the citrus smell in your routine, keep it for your night-time regimen.
- Don’t hesitate to ask a professional: If any doubts remain regarding your skincare products or they’re just not giving any results, a consultation with your esthetician or dermatologist will be helpful – they can go over each product with you in-depth and weed out what is and isn’t helpful. *Tip – take a photo of your products rather than bringing them all with you.
- Be cautious of the “miracle” or “does it all” skin products: A skincare product that seems “too good to be true” is probably “too good to be true”. Reputable product lines typically are the best bet and likely to be most effective, tested, tried by many and safer than something made in a kitchen somewhere. Product lines that have validated claims or clinical studies that show they are truly working the way they promise is usually a good choice. VMV Hypoallergenics is a great option for someone just starting to take care of their skin. The basics they offer from the 3 SuperSkin lines are quite effective. All products made by the brand are clinically tested in-vivo and in-vitro (never on animals, only on humans) and has a rating system that validates how “hypoallergenic” each product is. From their site: The “VH-Number” rating system “grades” a product’s safety based on how many allergens it does not contain, as referenced by the list of allergens compiled by objective, independent institutions the North American Contact Dermatitis Group + European Surveillance System on Contact Allergies.
Authored by: Holly Byerly, LE
Let’s talk about Acne…
Acne can be tough on teenagers, but in reality, acne is difficult at any age. As an aesthetician, I see clients with both classic teenage acne, as well as adult acne. As we grow older, our bodies go through many changes, including changes to our voice, height, hormonal cycles, behavior, and yes… this equates to changes in our skin. With age, some people see an overproduction of oil (or sebum) in their bodies for the first time. Then with this increase of sebum, their hair follicles become clogged with dead skin cells. These clogged follicles are unable to secrete oil normally, and can then become infected or inflamed. The result of which is what we see as acne.
“Acne Vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts often as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). Acne develops on the face and upper trunk. It is most common in adolescents.” – Jonette E. Keri , MD, PhD, University of Miami, Miller School of Medicine.
Acne can be challenging to manage and treat on your own. Most people don’t understand the difference between the stages of acne, and try to remove Pustules or nodules by extracting an infected follicle themselves at home – this can cause it to spread the bacteria deeper, resulting in infection or potential scar tissue, hyper-pigmentation, and/or hypo-pigmentation. It can be very hard for someone who is going through acne or acne complications to understand what should be extracted by a licensed Esthetician (or in acne stages 3-4, a licensed medical professional such as a doctor) or left alone completely.
Who should you see for your acne? How do you know if you are right for an acne treatment regimen with a licensed esthetician?
A licensed Esthetician can evaluate a patient with any stage of acne and determine the right regimen of care to direct them to. Our knowledge as estheticians allows us to properly educate an acne client, and if appropriate begin a comprehensive treatment plan. With my clients with stage 1 or 2 acne, I like to teach them how they can start taking proper care of their skin. I will often begin the first consultation with evaluating the easily adjustable triggers to their acne and discuss a basic treatment plan to start working with their skin. Then once I have worked with the client for some time, often after 2-3 visits, I will have a better idea of how the client’s skin responds to treatments (such as acne peels) and manipulation (such as facials). At that point, I like to revisit what I see as causes of acne flare-ups for the client. I can give my clients the right scheduled treatment plans,and will recommend home care regimens that they can do in between visits to minimize their acne outbreaks and shorten the duration of flares if they do occur.
If the client has severe acne, I will always refer them to their dermatologist for treatment first. Only a licensed medical professional such as a doctor can prescribe medications to treat stages 3 and 4 of acne.
Curious about the 4 stages of acne? Let’s discuss the differences:
Grade/Stage 1 Acne: Mild Acne, consisting of tiny or dark bumps of open comedones (blackheads), and a few closed comedones. They tend to be minimal and are not always present.
Treatments for mild acne can be started with a good skin regimen, OTC (over the counter) products with ingredients containing benzoyl peroxide, salicylic acid, and azelaic acid (among others) that a licensed Esthetician can recommend. Regular facials are important and a facial regimen can be incorporated alongside your products at home.
Grade/Stage 2 Acne: Moderate Acne; more open comedones, closed comedones (also known as whiteheads – a yellowish/white substance comes out when extracted). Aside from open and closed comedones, there is often some minimal presence of papule and pustules. Papules, also known as pimples, are inflamed reddish bumps that feel hard and excrete no fluid when squeezed, but may develop pus. Pustules have a yellowish/white center, referred to as the head of the pimple or “whitehead”, and excrete pus when they are squeezed.
Treatments: Moderate acne can be treated with the same approach as Grade 1 acne. However, if Grade 2 acne worsens in 1-2 months it is best to approach it like a Grade 3-4 acne and talk to a medical doctor.
Grade/Stage 3 Acne: Moderately severe acne; red, inflamed, papules and pustules will be present, and inflamed nodules are possible. Papules and pustules can merge with each other. Never squeeze or break a pimple, as this will spread the bacteria and worsen the acne. Grade 3 acne can lead to skin damage and scarring (even without touching it) – this is known as PIH or Post Inflammatory Hyperpigmentation. This typically indicates that the lesion is deep within the skin and that is why there tends to be more redness and swelling in the affected areas.
Treatments: Unlike Grade 1 and 2 acne, moderately severe acne can’t be treated with OTC products. At this level it is best to be seen by a Medical Doctor. A Medical Doctor will prescribe a course of oral antibiotics or prescription topical therapies for about 1-3 months. The amount of time depends on how much bacteria is present, as the antibiotics will be used to control the infected areas. At this point in your acne care, topical products such as benzoyl peroxide are still necessary to control oil production.
Grade/Stage 4 Acne: Severe acne; cysts, papules, pustules and nodules are present. At this stage, the acne is painful to the touch. Craters, scar formation from tissue damage, are very common to occur. This type of acne is found on the face, neck, décolleté, shoulders and even on the back. Grade 4 acne can be very stressful, which can actually worsen the acne. The best way to deal with the stress is accepting the fact that there is acne present, and deciding to get treatment help. When I see clients with such severe grades of acne, I will always recommend a medical professional consultation. One hallmark of grade 4 acne is the sebaceous cyst. This doesn’t occur in all clients but can be mistaken for a pustule. Sebaceous Cysts form underneath the layer of skin and it cannot be easily removed. It is best to leave all cysts alone. If abscess if suspected, clients must consult their doctor for drainage. Self popped cysts can lead to scaring and further spreading the infection. It is important to acknowledge the severity of this stage of acne and approach carefully.
Treatments: The Grade 4 Cystic acne can be treated with an intralesional steroid injection
or Retinoid adjacent prescription medications like topical tretinoin, tazarotene, adapalene, or isotretinoin
. At this point, I highly recommend soothing cleansers and moisturizers for a patient using topical retinoids to help calm any lingering skin inflammation. VMV Hypoallergenics Red Better Cleanser
is a great option for soothing and repairing skin barrier functions.
So now that we have overviewed the types of acne, I would like to share my experience as someone who also went through acne in my teenage and adult years! This was one of my biggest insecurities, forget about not being popular in middle school and high school, I had acne!!. This is the reason I became an esthetician.
Now as an esthetician, I have gained experience working with hundreds of acne clients over the past 9 years. I became interested in treating clients with acne very early on in my career as they provided a challenge to treat. They were also such a reward to follow as I saw their progress over months and years of treatment.
My favorite acne regimen to recommend a first time client is a simple 3 step process, I found during my consultations with my acne clients that they are overwhelmed with their acne and anxious to see results. If I recommend my clients a cleanser, exfoliation, mask, toner, serums, moisturizers, eye cream, and SPF in their first visit, the majority of clients will use the products incorrectly or even worse- overuse the products, even after I have provided them a step by step written regimen. I get it, I’ve done that too. Recommending a simple 3 step process to start off has been the best choice to start a client’s acne skin journey. My first product recommendation will be a cleanser.
Cleansing products that have worked well for my clients are Dermaquest dermaclear cleanser
$32, performance ingredients are Mandelic Acid, A.C. Net (Nordihydroguaiaretic Acid+ Oleanolic Acid), and Retinyl Palmitate
. I like how it helps minimize oil production but also soothes the skin from any inflammatorion it is great to use on Grade Acne 1-3.
Mario Badescu Acne Facial Cleanser
$15 I love how Mario Badescu cleanser contain sodium hyaluronate, which helps restore moisture into the skin and improves skins texture. Understanding the differences between being oily and still being dehydrated is important. I’m not a fan of deep exfoliation like scrubs containing harsh microbeads, face luffas, harsh clarisonic brushes, causing striping of oil production. The skin is a smart organ and over exfoliation can lead to more oil because the skin is trying to protect its barrier causing excessive oil, irritation and breakouts. Sure, exfoliation is good for Grade Acne 1 and 2 at least 2-3 times a week is better to separate the exfoliation day for example Monday night, Wednesday night and Saturday night, in conjunction with your daily cleanser. I do recommend some exfoliatiors containing Jojoba beads for example Skinmedica AHA/BHA exfoliating cleanser
$47 Jojoba beads are very gentle to the skin and are not irritates .
Second product recommended will be a spot corrector. Two of my favorite spot correctors are Dermaquest dermaclear serum
$67 great for Grades 1-3 of acne, and VMV Hypoallergenic Red better spot corrector
$27 also great for Grades 1-3 acne. Dermaclear serum is used by massaging the product on the breakout, while Red better spot corrector is a cream so it can be applied by tapping directly onto the breakout without massaging it. Both spot treatments are correctors that speed up the exfoliation process of oil and minimize bacteria. They are both non-drying and both also calm angry red skin. Dermaclear serum can be used all over the skin, I don’t recommended unless it is needed. If you’re not sure, consult your Esthetician.
Last but not least, the third product I recommend is an SPF
(sun protection factor). This is EXTREMELY important!! Every person in the world needs an SPF. You should have a minimum SPF 30+ to protect your skin from the sun’s ultraviolet UVA and UVB rays. As much as 85-90 percent of all skin damage comes from the sun. Only 10-15 percent comes from age. Unbelievable right?!!! The regular daily use of SPF can reduce your risk of squamous cell carcinoma
. There are so many sunscreens on the market, so which one do I recommend? It depends on your skin.
They are two types of sunscreens, chemical sunscreens and physical sunscreens. I have seen throughout my profession that chemical sunscreens cause more irritation by absorbing the UV and converting into heat causing skin irritation, whereas the active ingredients in a physical sunscreen work by reflecting the rays of the sun. Overall, I prefer and recommend physical sunscreens over chemical sunscreens for myself and my acne clients.
Another favorite of mine is the Dermaquest Sheer zinc SPF 30 which provides defense and is gentle enough for acneic skin and even a retinol user.
So these are the products that I would suggest to a first time client. Now keep in mind “first time” is for most clients. It is very possible that during the second visit they will need an even tone corrector to help with hyperpigmentation after the breakout has subsided. Or a moisturizer to help hydrate dehydrated skin, a mask to soothe or speed up the process of acne, topical collagen, Vit C, and hyaluronic acid serums to prevent from scaring. It is important to follow up with your esthetician two weeks after your first visit to communicate or take pictures of your process.
My regimen that I have set for my first time clients are as follows. First visit comes with consultation and product recommendation or review of client’s current products, a facial, a regimen to follow at home, my email address and phone number if they have any questions. Communication with your clients is the key to a healthy skin achievement, overall we are the skin therapists and need to be in contact with our clients skin. Follow ups are extremely important to us, not so for the clients but for the Estheticians to document the process of the outcome. Acne is very sensitive to treat, those two weeks are for the clients skin to get familiar with the products and or facial that was done the first day they came to visit you. It is a possibility that your skin may purge. This is normal- it just means that everything is coming up to the surface, that’s why I recommend a follow up. If the skin purges, there are still products to follow to speed up the process and calm down the inflammation. After those two weeks, our visits become less frequent, usually once every three to four weeks until we can maintain the breakouts under control. I like to customize every facial as needed, not all acne is the same. For Grades 1 and 2 of acne, on the first visit I might do a minimal treatment depending on how severe the acne is. On the second visit I will incorporate a more mechanical approach, for example; extractions, microdermabrasion, LED, TheSaltFacial,
high frequency, galvanic, steamers, and ultrasound, or more aggressive like a chemical peel, all depending in how your skin reacted in those two weeks.
Yes, Acne can be tough on teenagers, but lets not forget that you’re not alone! Talk to an Esthetician to evaluate your skin concerns. If you’re on Grade acne 3-4 most Estheticians have Medical Doctors that they will recommend you to, there is a way and results starts with you.
This is Joanna
reporting to you live from MedBeautyLA
Authored by: Joanna Garcia, LE