It has been realized that in this scenario, each professional can bring their expertise to the treatment room, thereby increasing the efficacy of each treatment and ensuring that clients receive the best care and advice possible for the health and beauty of their skin.
Plastic surgeons, dermatologists, and medical doctors who specialize in medical aesthetics will most likely be the physicians with whom the aesthetician will work. These physicians focus on the health of the skin and improvement of facial aesthetics. High priority is placed on the physician’s time and level of expertise. Their responsibility for the care of the client is paramount. When sharing a mutual client, the aesthetician’s role in providing care for the client’s skin before and after a medical aesthetic procedure, although highly significant, is supportive rather than dominant. If the aesthetician is an employee of the medical office, the job will depend upon the needs of the physician’s practice, which in part will be based on performing cosmetic services that can complement the medical procedures offered. Other duties may include assisting the physician in the treatment room or helping run the front office. For those who own or work for a spa, networking (by designing and implementing a referral program with a physician specializing in medical aesthetics) has proven to be advantageous for the client, aesthetician, and physician’s practice alike. 
In an alliance such as this, each professional works in their own business and refers the mutual client to one another as the need of the client arises. Sharing knowledge and resources cultivates a strong working relationship. In some cases, the physician may be contracted to visit a spa on a regular basis to provide the spa’s clients’ services such as Botox, fillers, and laser treatments. The aesthetician who works in the medical arena or networks with a physician should have at least a moderate understanding of the physician’s specialty. The ability to explain that to the clients and to know when it is appropriate to refer the client to the physician is ultimately important. For example, if you work with a dermatologist or if you specialize in acne treatments, having an understanding of diseases and disorders of the skin is a must. If you are working with a plastic surgeon, becoming moderately-educated in reconstructive surgical procedures, fillers, neuro-modulators, and so on, will be necessary to understand, so that you are able to speak the same language as the physician’s staff and be able to knowledgeably talk to clients about these procedures.
In order to provide an understanding of what physicians look for in an aesthetician, I have presented some pertinent questions to several highly-respected physicians whose expertise is in this area. If it is your objective to work in this area, you will not want to miss the opportunity to take note of their valuable answers. 
Dr. James Romano, a board certified plastic and reconstructive surgeon whose practice is located in San Francisco, Calif., has worked with aestheticians for more than 20 years.
What professional qualifications and personal qualities do you look for in an aesthetician? Professionally, an aesthetician should have the ability to engage with clients and have a strong sense of professionalism, as well as have a profound understanding of the skin. Personal qualities should encompass having a high level of humanity and understanding and respecting the license to touch. 
Is it important for an aesthetician to have an understanding of client charting and medical terminology? Absolutely! Every action in the medical office becomes part of the client’s medical record, which can become a legal document. It is important for the aesthetician to understand the importance of subjective, objective, assessment, plan (S.O.A.P.). 
Why is it important for the aesthetician to have an understanding of medications that the client is using? It is important to know about all medications that the client is taking. For example, if the client has herpes simplex one, performing a stronger-strength peel could trigger an outbreak. 
What type of procedures does an aesthetician perform in your office? The most common procedures an aesthetician performs are: cleansing facials, acne treatments, chemical peels, microdermabrasion, ultrasound treatments that help speed up tissue repair, suture removal, and wound checks after surgery.
How important do you think it is for aestheticians to continue their education and update their knowledge? Continued education is very important! The industry is moving at lightning speed. Taking advanced classes, reading aesthetics trade journals, and going to industry conventions are ways that they can keep themselves up-to-date and relative.
When hiring and/or working with an aesthetician, do you prefer that they have experience or training or are you willing to provide the training? I prefer to hire an aesthetician with a good amount of knowledge of the skin so that there is something on which to build.
Dr. Rebecca Small is a medical doctor who specializes in medical aesthetics and the author of several medical aesthetics books. Her medical spa and personal practice is located in Capitola, Calif.
What professional qualifications and personal qualities do you look for in an aesthetician? I look for an aesthetician license and diploma from an approved school. We look for individuals with excellent communication skills who put clients at ease and have a therapeutic touch.
In your office, what is the protocol an aesthetician uses for pre- and post-laser? One week before laser treatments, clients discontinue retinoids and alpha hydroxy acids. Treatments such as ablative lasers, which disrupt the epidermis, are managed with ointment-based moisturizers. Treatments that leave the epidermis intact, such as IPL, are managed with non-occlusive products to soothe the skin and promote healing. Clients are advised to use a broad spectrum sunscreen (SPF 30) and avoid direct sun exposure.
Do you sell retail skin care? Yes, I sell retail skin care. A home regimen, using high-quality skin care products support and augment the results of office procedures. We typically use skin care product lines that have research demonstrating clinical benefits.
Where do you find your aesthetician candidates? Aestheticians e-mail resumes or drop them off at the office unsolicited. We try to pick someone who has skills and is excited and open to learn about medical aesthetics.
What other job duties do your on-staff aestheticians perform? Aestheticians are important to the overall function of the office. In addition to performing chemical peels, microdermabrasion, waxing, and product consultations, they help coordinate client care. They have an understanding of other medical procedures and work as part of a collaborative team to give the best client care possible.
Dr. Bradley Greene is a board-certified facial plastic and reconstructive surgeon whose offices are located in the Los Altos and Bay Area in California.
What professional qualifications and personal qualities do you look for in an aesthetician? Professionally, I look for candidates to have an active license. Additional certifications are also important as it is evidence that the aesthetician has gone above and beyond what is required. Experience is helpful. Personal qualities include professional persona and the ability to converse effectively and listen attentively.
Is it important for the aesthetician to know about the procedures you perform? Yes, aestheticians need to be familiar with procedures so that they can counsel and educate clients. This helps lower client anxiety about procedures and fosters office teamwork.
What is a typical day at work? A typical day at work consists of preparing client paperwork and Botox, assisting physicians in surgery, performing skin care procedures, and performing administrative duties.
Is there a drawback of working with an aesthetician? When aestheticians do not possess professional and personal qualities, the client’s best interest is not met, and when they do not take pride and ownership in their practice, the quality of client care declines.
What pay structure does your office use? The aesthetician has the choice of receiving a salary or commission. Normally, if the aesthetician has an established clientele or is a very motivated person, they prefer to choose the commission structure as this normally lends itself to making more money in the long run. 
Aestheticians who are committed to their job always have their client’s best interest in mind, as well as strong interpersonal skills and a high level of professionalism. This may prove to be a good match for a physician/aesthetician working partnership.

Michele Phelan has been a licensed, practicing aesthetician for over 20 years. She has taught state board, CIDESCO, and post-graduate aesthetics. She has extensive knowledge of dermatological topics, cosmetic chemistry, electrical modalities, and physiology/anatomy. Phelan is an International CIDESCO diplomat, and a registered aromatherapist. Her articles have been featured in many industry publications. She has been interviewed by CBS for her extensive knowledge of eyelash extensions. She is the co-owner of Concepts Skin Care Clinic in San Francisco, Calif. and the founder and president of Concepts Institute of Advanced Esthetics located in San Francisco, Calif. Concepts Institute is an approved NCEA training facility.
www.conceptsinstitute.com