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The Esthetician of the Future Esthetics is a growing field and is attracting nurses, teachers and even physicians to become skin care specialists. The scope of esthetics is becoming broader and now includes anti-aging and general wellness. These two areas alone are sufficient to drive esthetics into a more demanding discipline. To be able to understand and provide services in these areas will require a considerable amount of both new knowledge and skills. And that means more education. How much education? If we use the relatively new profession of the Physician’s Assistant as our model we can see what is in the future for estheticians. Physician assistants, or PAs, are health care professionals licensed to practice medicine under a physician’s supervision. The PAs are a recognized profession with their own organization and their own professional requirements (National Commission on Certification of Physician Assistants (NCCPA). Training involves at least 26 months in an approved course (Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Many applicants have college level training and experience in the health care fields, such as nursing. Training is intense and based on the medical school model, covering basic science, diagnosis, treatment, pathology and other related medical subjects. For the esthetician to become a professional skin care specialist it will require at least two years of intense training that covers detailed anatomy, pathology, microbiology, and chemistry, including inorganic biochemistry and cosmetic chemistry. Diagnostic skills and a number of basic and advanced treatment skills will be needed. While the new esthetician will be able to work with a physician in most related specialties, her skills will allow her to be a stand-alone professional. Business skills, including management, bookkeeping, sales and advertising, along with speaking skills, will also be required. Here is a glimpse of the future esthetician and the knowledge and skills needed. First, they will need a solid basis in chemistry, sufficient to understand the metabolic processes of the body, the physiology of aging and the pathophysiology of skin disorders. Next, they will require knowledge of the biochemical composition of the skin and the nature of the complete skin barrier. The complex interplay of sex hormones on a woman’s body are critical, and particularly on the skin, including the effects of hormonal changes during aging, especially on the skin’s physiology and how this affects treatment programs. A strong grounding in nutrition and weight control is essential and a grasp of how diet relates to general health and specifically to skin health. And it is important to understand the role of exercise and stress in daily living, along with new preventive measures. In a short article we can not cover all the subjects in detail, but to illustrate how far the esthetician needs to travel from where they are now to achieve a professional position in the future, let us look at how estheticians diagnose skin conditions. Leaving out acne and rosacea and just looking at aging skin, the esthetician is trained to diagnose three or four “types” of skin: dry, oily, combination and normal. Based on this appraisal by the esthetician, treatments and products are selected. How and why? Everyone has dry skin and oily skin. There are no oil-free noses, no oily elbows and no “normal” faces, whatever that may mean. Skin is a living mosaic; some areas on the face are growing actively and others are resting, and will not respond well to treatment. Products are made for these “types” of skin. Consider that genetically there are countless millions of skin types, and biochemically the types are astronomical. If we consider only two hormone levels in skin, testosterone and estrogen, I can think of four basic types and eight subtypes, not related to age, on which to base rational scientific treatment programs. So there is a lot of learning and a lot of re-education that needs to done; the question is when and how? New schools will be needed, along with new teachers, new laws and new skin care centers to be developed. This movement will take time, many years for sure, but it is under way now. Experienced estheticians know the need for advanced education and training. Hopefully the new estheticians will be offered at least a two-year course. This will be the start of the new generation of estheticians -- the professional esthetician. Peter T. Pugliese, M.D |
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