What is a Medical Esthetician?

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Medical esthetics – often referred to as paramedical esthetics – incorporates a similar philosophy to that of traditional spa esthetics, and even involves many of the same approaches to developing and maintaining healthy, beautiful skin. What makes medical esthetics unique is that it is performed on patients in a clinical setting alongside medical professionals who may recommend non-invasive skincare procedures for medical purposes, or for strictly cosmetic reasons.

Whether working to promote healing of affected skin, or just helping a patient enjoy a renewed level of confidence after an appearance-changing injury or procedure, medical estheticians make a positive difference in the lives of the patients they work with.

The National Coalition of Estheticians, Manufacturers/Distributors & Associations (NCEA) recognizes estheticians that work in the medical field. However, like all major stakeholders in the esthetics industry, the NCEA has taken the position that the term “medical esthetician” can be misleading to clients as it implies some level of specialized medical knowledge.

Estheticians working in the medical field do not have medical training of any kind, but apply traditional, complimentary and alternative treatments under the on-site supervision of a licensed healthcare professional in settings that include:

Dermatology Clinics – Working in a dermatology clinic requires medical estheticians to understand diseases of the skin, such as acne, atopic dermatitis, and psoriasis.

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Cosmetic Surgery Clinics – In a cosmetic surgery practice, medical estheticians perform pre- and post-operative care to patients, which may include lymphatic drainage and wound care.

Medical Spas – In addition to standard esthetics treatments that would be performed in a traditional spa setting, medical estheticians in medical spas would perform specialized treatments designed to reduce scarring and hyperpigmentation.

Specialist Clinics and Units – Medical estheticians working in specialist clinics and units have the opportunity to work with trauma patients, cancer patients, or burn survivors. This type of fulfilling work may involve helping reduce patient anxiety following a traumatic injury or illness. In these settings, esthetic treatments often focus on restoring elasticity to damaged tissue and applying makeup that helps restore a patient’s self-esteem.

The Role of the Medical Esthetician: Duties and Job Description

Because medical estheticians perform their work under the guidance and instruction of healthcare professionals, their typical duties differ substantially from that of spa-based estheticians. Though the duties they perform depends largely on the type of clinical setting in which they work, in all cases medical estheticians must be knowledgeable of:

  • Potential pre- and post-operative complications
  • Medications commonly administered within the practice
  • Products and equipment specific to the practice
  • Protocols of the facility

Although medical estheticians work in clinical settings, they are still bound to perform only the services allowed under state licensing laws that govern the practice of esthetics. This means the work they perform is limited to non-invasive procedures.

Typical responsibilities for estheticians in a clinical setting include:

  • Educating a patient on proper skincare techniques, sun protection, home care, etc.
  • Advising a patient for an upcoming procedure/surgery
  • Advising a patient on pre-operative skincare, which may include oral or topical medicine applications
  • Obtaining a new patient’s skincare history, including a list of all products and medications used, as well as past services and procedures
  • Following up with a patient regarding physician-prescribed medical treatments
  • Answering patient questions about skincare concerns
  • Providing thorough instruction to patients on homecare
  • Maintaining proper patient charts, including HIPAA forms, informed consent and signed release forms, client care forms, and recommended homecare forms
  • Coordinating patient care with the physician
  • Providing complementary consultations regarding skincare services
  • Serving as a liaison with the patient coordinator during the pre- and post- surgery period
  • Maintaining treatment rooms and workstations in compliance with OSHA standards
  • Maintaining equipment through cleaning and maintenance
  • Confirming patient appointments and making patient follow-up calls
  • Maintaining inventory systems for professional and retail products

How to Become a Licensed Esthetician

Medical estheticians are held to the exact same state licensing standards as spa estheticians. This means all estheticians, whether they work as medical estheticians or spa estheticians, are required to hold the same state-issued license.

Becoming a medical esthetician typically follows a standard set of steps that involves getting the right kind of formal education and training, passing the exams necessary for state licensure, and pursuing advanced credentials through continuing education.

Complete a Formal Course of Study or Apprenticeship

Completing a formal esthetics program recognized by a national accrediting body is the typical route to initial licensure.

It is important that the program meets the minimum requirements for initial licensure, as determined by each state’s Board of Cosmetology and Esthetics.

Each state sets its own standards regarding the minimum number of practice hours, or total program hours, required for initial licensure. Practice requirements generally range from 300 to 750 hours. For example, in Texas, students must complete a program of at least 750 hours, while New York requires a formal program of just 600 hours.

Esthetics programs introduce students to the art and science of skin analyses, disease identification, and the many techniques that are used to address different kinds of skin conditions.

Classroom education in an esthetics program is supplemented with clinical experience, which many times takes place in a student salon setting. Student salons provide a closely monitored real-world environment in which students can apply what they have learned while working with real clients.

Most programs also provide students with guidance and specific instruction on how to successfully complete the state board examination process.

More advanced programs specific to esthetics procedures within the medical setting are generally reserved for licensed estheticians, and are not widely available. Areas of study in a medical esthetics program of this sort would often include:

  • Equipment used by estheticians in a medical setting
  • Advanced ingredient knowledge
  • Medical conditions affecting the skin

A number of programs also partner with medical groups and medical spas to provide students with the opportunity to gain valuable, hands-on experience in a medical setting.

A few states also recognize apprenticeship programs as a path to licensure in lieu of a formal esthetics program. In an apprenticeship program, aspiring estheticians take part in hands-on training under the guidance and direction of a licensed esthetician, although this path to initial licensure generally takes much longer to complete. For example, qualifying for an esthetician license in Georgia would involve a formal esthetician training program of just 1,000 hours, while going the apprenticeship route would require at least 2,000 documented training hours.

Those interested in achieving initial licensure through an apprenticeship program must first get approval from their state’s Board of Cosmetology and Esthetics.

Pass State and National Licensing Exams

Each state maintains an examination process as a way to qualify candidates for initial licensure. In general, basic exam requirements stipulate that examinees must be at least 16 years old. Most states require candidates to complete the 10th grade at minimum, although a few states require a high school diploma.

Many states now use the National-Interstate Council on State Boards of Cosmetology (NIC) practical and/or written examination, while in some states, candidates must take state-specific examinations for licensure.

The National Esthetics Practical Examination includes the following domains:

  • Cleansing and steaming the face
  • Facial makeup
  • Facial mask
  • Hair removal of the eyebrows
  • Manual extraction of the forehead
  • Massaging the face
  • Setup and client protection

The National Esthetics Written Examination consists of the following core domains:

  • Scientific concepts (chemistry, human physiology, sanitation, infection control, etc.)
  • Esthetics practices (cleansing procedures, extraction procedures, hair removal procedures, etc.)

Earning Top Credentials as a Master Esthetician

A few states (Washington State, Virginia, Utah, and Washington DC) have a two-tier esthetician licensing system that recognizes an advanced-level of expertise through the “master esthetician” designation. California is expected to follow suite, as the state’s Master Esthetician License bill was just recently introduced.

The master esthetician license in these states is achieved through the completion of advanced training and education. For example, the master esthetician license in Washington State requires 1,200 hours of study, 450 additional hours beyond what is required for the state’s standard esthetician license.

Just a few of the areas of study covered in a master esthetician program include:

  • Advanced skincare and advanced modalities, including microdermabrasion and dermaplaning
  • Practical application and consultation for enzymes, herbal exfoliations, and vitamin-based peels
  • Indications and contraindications for Jessner and Modified Jessner peels
  • Lymphatic drainage

Because of the specialized nature of performing skincare treatments in a clinical setting, many medical employers in states that recognize the master esthetician designation require their medical estheticians to achieve this advanced state license.

In addition to meeting state requirements regarding additional education and/or experience, states that recognize the master esthetician license also require candidates to take and pass the NIC advanced esthetician examinations.

The National Advanced Esthetics Practical Examination includes the following core domain services:

  • Setup and client protection
  • Cleansing the face
  • Manual lymphatic drainage
  • Ultrasonic exfoliation treatment
  • Jessner’s or 20 percent BHA chemical peel
  • Particle microdermabrasion
  • Advanced facial treatment – LED
  • Electricity and electrical equipment – micro current
  • Advanced body treatment –dry exfoliation and mud or seaweed mask

The National Advanced Esthetics Written Examination includes the following areas of assessment:

  • Scientific concepts (sanitation and infection control, human physiology, dermatological terms, plastic surgery terms, etc.)
  • Services (skin analysis, advanced methods of hair removal, lymphatic drainage, etc.)

What Medical Estheticians Can Expect to Earn

According to the US Department of Labor, estheticians nationwide earned an average annual salary of $33,810, as of May 2014, with the top 10 percent earning an average of more than $58,800. However, medical estheticians routinely earn much higher salaries than their salon-based counterparts

The US Department of Labor’s 2014 salary survey revealed that the top-paying industries and employment settings for estheticians are all clinical in nature. These figures represent the national average for estheticians working in the clinical environment across a number of patient care settings:

  • General medical and surgical hospitals: $47,600
  • Outpatient care centers: $46,260
  • Nursing care facilities: $42,760
  • Offices of physicians: $41,090
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