Dermatology vs. Skincare: misconceptions about the role of your dermatologist

There are a lot of misconceptions of the role of dermatologists, however, Wikipedia has a great basic definition: “Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects”.

The skin is both an organ and a system, and it’s one of the most complicated and mysterious systems of the human body. A dermatologist studies disease and pathology of the skin, and is the foremost expert on diseases of the skin. The skin is the bodies largest organ, and actually has more diseases that any other organ of the body. Because of this, a dermatologist spends a great deal of their residency (typically over 3 years) studying these diseases in depth, and will still have more to learn about pathology of the skin for years to come.

In recent years, many dermatologists have expanded into treating cosmetic issues of the skin, and problems such as acne. Not every dermatologist pursues skin care education, many prefer to focus on “serious” skin issues like cancer and potentially fatal conditions, as these are ever evolving and of great interest to a doctor who has devoted a great portion of their life to being a doctor of the skin. This is why many people are confused when they ask their dermatologist for skin advice, and he tells them to use bar soap, hands them samples of a low-end drug store products, and prescribes tretinoin (such as retinol) for a vast array of skin problems.

Though the initial assumption is that every dermatologist must be extremely versed in skin care, the truth is that skin care from a cosmetic stand point is not the focus of study for a dermatologist- genuine disease is. This is why you may find that your esthetician seems more knowledgeable about acne, aging, dryness, large pores, sun damage and all sorts of other skin care issues. The point being, the most important factor in taking advice on your skin is to make sure that the professional giving it to you is a) well educated and practiced in skin care issues and b) not driven entirely by commission on products or services.

One obvious benefit to seeing a dermatologist is having access to receiving prescription skin care products, deeper peels, extractions with a lancet, and injections. It’s important to see a dermatologist who understands the intricacies of skin care, and will listen to your needs and concerns with care. Stronger is not always better, and medical skin care approaches aren’t necessarily more beneficial or effective. Just as with anything, balance is often the key to long term results.

renovaI am a huge supporter of using prescription retinol, as retinoic acid is still the most effective collagen stimulating ingredient on the market. With that said, it’s important to find the proper balance of strength with retinol, as too much can leave you extremely red and sensitive and prone to more damage. The same is true with peels, extractions, and products in general. Just as crash diets do not give sustainable long term results, going too strong or “more is better” is not going to ultimately get your skin in the best shape it can be in. Your skin has a cell metabolism just like the rest of your body, and you must work with the reality of that metabolic pace, in order to get the best looking, and healthiest results possible. Dermatologists who are well versed in skin care take this into account, and will tailor their recommendations for you based upon this. In many cases, if not most, a dermatologist will refer to an esthetician in their practice, to handle skin care concerns.

Estheticians area of study is entirely focused on “cosmetic” skin issues such as cystic acne, aging, sun damage, acne, dryness, and beyond. Though many of these issues can become severe and venture into the realm of medical conditions of the skin, these are actually not a point of study for a dermatologist until they become severe (skin cancer, severe cystic acne), considering the numerous true diseases of the skin they are required to focus on. Estheticians are licensed by their state, and study the skin and client safety from 600 to 1200 hours, and typically pursue post-licensing education. A problem I have seen with the education for estheticians, is that many of us will go to a school that simply focuses on passing our licensing exam. The licensing exam for estheticians focuses more on client safety and sanitation more than truly performing an effective service, so many estheticians graduate with a fairly basic knowledge, and are not as well versed in proper extractions and peels. A great portion of the post licensed education we receive may be entirely sponsored by a skin product line, and provide skin education based upon promoting their products and lean facts towards their favor, rather than truly being educational. This is why clients may feel like they have been steered a completely different direction in each facial they receive, and that each facialist seems genuinely enthusiastic about the products they carry. You may find that the more high end you go into the spa world, the fewer extractions you get and the more products you are recommended. This is because luxury spas often put a lot of pressure on their estheticians to have high sales numbers, and will discourage anything uncomfortable like deeper extractions, as luxury spas and hotels often see clients who get the infrequent facial as a “treat”, rather than as a routine in order to see results.

Finding a great skin professional, be it an esthetician or dermatologist, is about questioning and doing research. Do not allow someone’s title to make you feel immediately trusting of their recommendations for your skin, be it an esthetician, dermatologist, or even a well informed sales person at a department store. Just as someone in a department store may be motivated by commission, a dermatologist is also trying to make income for his practice and pay for investments like lasers and various costly equipment. Read reviews of the products, services, and treatments any professional recommends, and steer clear of anything that seems to have false reviews, as these are a sure sign that the product or treatment cannot stand on it’s own real reputation. Many estheticians, like myself, choose the products they have available to you, and genuinely believe in them and use them. This is true with many dermatologists as well.

Different dermatologists have different cosmetic specialties, as do cosmetic surgeons. I am always happy to refer you in the best direction if you contact me privately for recommendations.