What's the Difference Between a Dermatologist and an Esthetician?

Find out who to see — and when.

In an ideal world, I'd never get pimples from stress and monthly hormone fluctuations. But until skincare Narnia exists, I'll keep turning to a trusted dermatologist and esthetician to help keep my breakouts under control.

Chances are, if you deal with a persistent skincare concern like acne, you've probably asked yourself whether you should make an appointment with a board-certified dermatologist or get a facial at your favorite spa for extractions — or both. The fact of the matter is that the answer will vary depending on the specific needs of your skin.

Person getting a facial by an esthetician
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While dermatologists and estheticians are both skincare experts, they each have different wheelhouses of practice and services they provide. Ahead, Dr. Sheila Farhang, board-certified dermatologist, Ashley White, licensed esthetician, and Sharlena Hassani, licensed esthetician and founder/CEO of Artisan of Skin, break down the key differences, along with how to know who to see.

What Is a Dermatologist and What Does It Take To Become One?

"A dermatologist is a medical doctor trained to diagnose and treat skin, hair, and nail conditions, over 3,000 conditions to be exact!" says Dr. Farhang. "In addition to general medical dermatology — eczema, acne, hair loss, rashes, skin cancer screening — dermatologists can sub-specialize in one or more fields such as cosmetics, Mohs micrographic skin cancer surgery, dermatopathology, and pediatrics."

Dermatologists also participate in some sort of research and public writing during their training or throughout their career, and may even focus on the topics covered in these studies and papers.

"Some dermatologists are more dedicated to innovation, cutting edge technology, and technique and become thought leaders and key opinion leaders in the field," Dr. Farhang elaborates. "These thought leaders help develop and test out new products and technology including fillers and lasers as well as lecture other providers at conferences."

As for training, dermatologists go through several years of schooling and residencies before they practice on actual patients. In addition to four years of college, four years of medical school, a one-year medical internship, and a three-year dermatology residency, Dr. Farhang says dermatologists need to "sit for and pass a final exam by the American Board of Dermatology (ABD) in order to be board-certified and may do an additional one to two years in cosmetics, Mohs micrographic skin cancer surgery, pediatric dermatology, and dermatopathology." Dermatologists also have to maintain their certification through the ABD's maintenance of certification program.

When Should You See a Dermatologist?

Depending on your specific skin issues, you may need to go straight to a dermatologist. For example, MDs can diagnose skin lesions, new rashes and sensitivities, and perform annual skin checks to determine if any changing moles are of concern.

Dr. Farhang says dermatologists can also treat new and existing skin concerns that are worsening, such as cystic acne that's scarring, with prescription products. "Estheticians cannot diagnose medical-related skin lesions and are not able to write prescriptions such as those for acne or melasma (e.g. prescription strength retinoids)," she explains. "They are also limited with the depth or strength of their chemical peels."

They can also determine whether these concerns are symptoms of another medical issue, such as polycystic ovary syndrome (PCOS) or thyroid disorders. "If patients are experiencing drastic texture changes or hair loss, a dermatologist may need to rule out thyroid issues or diagnosis associated scalp issues or autoimmune hair loss."

What Is an Esthetician and What Goes Into Becoming One?

"Estheticians are licensed professionals who can legally perform facials, hair removal, makeup application, and other treatments that cosmetically enhance the outermost layer of the epidermis," says White.

The exact requirements for estheticians vary from state to state, but generally, estheticians must undergo at least 400 hours of training, graduate from an accredited esthetics school, and pass a two-section state board exam, plus pay all fees required by the state.

"The first section is written, with the second being practical. The written portion of the exam really depends on the state, as each state's laws are different," Hassani says. "Questions are rather diverse but generally will take into account state laws, safety and health issues, skin conditions and disorders, how to analyze ingredients and skin care procedures. Once you pass the written exam, you can then schedule the practical exam."

What Does an Esthetician Do and When Should You See One?

Estheticians provide non-medical skincare services such as facials (including extractions), microdermabrasion, and peels, depending on the state they practice in. "In general, estheticians are trained in non-prescription topical skin care and basic anatomy with the opportunity to learn additional science that may be beyond their scope of practice," White says.

Once a dermatologist has diagnosed your skincare conditions or you have specific concerns you'd like to address in your routine, an esthetician can help you create a regimen. "Estheticians should be seen when you are trying to build a skincare routine, alleviate a range of acne and superficial concerns or enrich the overall appearance of your skin," White explains.

"The biggest difference between what we do and what dermatologists do is we are trainers for the skin, helping clients with their skin maintenance by doing resurfacing peels to renew and train the skin to function better on its own on a day-to-day basis and helping clients with their at-home maintenance routines for overall skin health," Hassani adds. "Dermatologists are doctors that come into play when there's something needing a prescription (like Accutane) or a medical treatment like lasers, injectables, and complicated scar revision treatments. Dermatologists are also there to handle medical conditions like eczema, psoriasis, skin cancer and perform cosmetic procedures like injections, fillers, and botox."

How Do Dermatologists and Estheticians Work Together?

Depending on the situation of your skin, your dermatologist may recommend you also see an esthetician or vice versa. "A chemical peel or microdermabrasion [can be] performed by an esthetician while treating and managing them medically," Dr. Farhang says. "While dermatology offices can offer facials, the dermatologist is usually not the one performing it and can refer out to a trusted esthetician or many dermatology offices have an in-house esthetician."

White adds that a smart esthetician knows their limitations and when to refer clients to a dermatologist in order to achieve the best outcome. "I refer clients to my dermatologist for hair loss/scalp concerns, nodules, rashes, and yearly skin checks in addition to monthly services with me for a holistic approach to their overall skin health," she says. "Estheticians can also work directly under the provision of a dermatologist, assisting them with skin analyses and non-invasive services."

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