Ep 38 - Licensed vs. Medical Esthetician—What’s the big difference?

Maggie Staszcuk, ASCP Advanced Modality Insurance Specialist

Have you ever thought about the real difference between a Licensed Esthetician and a Medical Esthetician? What makes one more desirable than the other? Is it more money? More capabilities? More “street cred”? In this episode, we explore the difference between the two titles to get to the bottom of what each are allowed to perform, and the capabilities of each.

Author Bio: 

About Maggie Staszcuk

Maggie has been a licensed esthetician since 2006 and holds a bachelor’s degree in business administration from Stephens College. She has worked in the spa and med-spa industry, and served as an esthetics instructor and a director of education for one of the largest schools in Colorado before coming to ASCP as the Advanced Modality Specialist.

About Ella Cressman:

Ella Cressman is a licensed esthetician, certified organic formulator, business owner, and absolute ingredient junkie! As an educator, she enjoys empowering other estheticians and industry professionals to understand skin care from an ingredient standpoint rather than a product-specific view.

She has spent many hours researching ingredients, understanding how and where they are sourced, as well as phytochemistry, histological access, and complementary compounds for intentional skin benefits. In addition to running a skin care practice, Cressman founded a comprehensive consulting group, the HHP Collective, and has consulted for several skin care lines, including several successful CBD brands.

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0:00:49.8 S1: You are listening to ASCP Esty Talk, where we share insider tips, industry resources, and education for estheticians at every stage of the journey. Let's talk 'cause ASCP knows, it's all about you. 




0:01:06.0 Ella Cressman: Hello and welcome to ASCP Esty Talk. I am Ella Cressman, licensed esthetician, owner of Ella Cress Skin Care, the HHP Collective, and a complete aesthetic enthusiast and esthetician cheerleader. So today, I am so happy to be joined by Maggie Staszcuk. Hi, Maggie. 


0:01:24.3 Maggie Staszcuk: Hey, Ella. Thanks for having me. 


0:01:26.6 EC: I am so appreciative of you being here, because I have something I wanna talk to you about. Two things. I've noticed this trend lately, I'm not sure if I've just been unaware of it or what, but one of our colleagues on the East Coast actually sent me a message about a month and a half ago, and she said, "Oh, my friend is wanting to get her daughter into a program. What do you think of the school?" And she sent me a school that I had been aware of, but never really had a reason to really investigate, but when I went in, it is a medical aesthetic program, a medical esthetician program. And so it was implied that this school would provide a licensure, and once this program was complete and they got their license, that they would be a medical esthetician. Well, you and I know that where we live, we live in Colorado, that there is no designation of medical esthetician so this got me thinking. And also the price, the tuition was, what I feel is predatory, I feel like it was with the listing, with the syllabus, having been in school before, or having worked with schools for years, I thought that is crazy, and then also preying on naivety of people. 


0:02:37.7 EC: So I thought this is the perfect timing for a discussion, opening of the door on what is the difference between a medical esthetician and a licensed esthetician, because I've also seen on social media groups, more and more people asking, "Yeah, but I wanna be a medical esthetician. How do I become a medical esthetician." So I thought you were perfect because those of you who don't know Maggie, should. She is also a co-host of the ASCP Esty Talk series, and she's been a licensed esthetician for years, since 2006. As well, she holds a bachelor's degree in business administration from Stephens College, and she has worked in both the spa and med spa industry. In addition, she was also an instructor and a Director of Education for one of the largest schools in Colorado, before she now, drum roll, it's been a couple of years, but still, is ASCP's Advanced Modality Specialist. So you'll see her, she has articles and she's also a podcast co-host, or host, I guess. So a perfect person to talk to. Let's get into it Maggie, shall we?  


0:03:44.3 MS: Yes, Ella, let's do. 


0:03:45.2 EC: Okay, so you have some awesome experience. You worked in spa setting, you worked in a med spa, and then you were Director of Education. So tell us about that journey. 


0:03:55.5 MS: Yeah, it's been really interesting, really fun. You and I were chatting earlier, I was telling you a little bit about my experience as an esthetician and moving into medical, and it always just happenstance, really. I started out in the spa industry as most estheticians do, and at that time, between 2006, 2008, economy was kind of moving into a recession, but I also was feeling a little bit of burnout and that there has to be something more. And the doctor that I ended up working for, he has a boutique practice, he's boutique medical, so he doesn't take insurance and he dabbles in a lot of holistic things, as well as he also has this other side of it, which is he offers laser, he offers Botox, so it's a really interesting dichotomy. But how I came to work for him is that I knew him, and so it's all about who you know. And it was great because at that time laser was just kind of coming on to the market, and so I had the opportunity to get that in-house on-the-job training, which for a lot of estheticians out there is an awesome benefit as opposed to now what we're really seeing is it's worked into aesthetic programs, such as the story you were just mentioning. 


0:05:14.9 EC: Okay, on that point, then you ended up as the Director of Education for a school that also had a medical program. 


0:05:23.6 MS: Yes, a "Medical." [chuckle] 


0:05:26.5 EC: "Medical." So what that really meant was, correct me if I'm wrong, but that meant there was this course required by the state, in this case, Colorado, and then there was additional course work that would qualify them to be this different status or this implied different status. Is that correct?  


0:05:44.6 MS: Yeah. Well, and the term medical aesthetician is, like you were saying, it's not really recognized anywhere. So in most states, you have licensed esthetician, and then there's a few states that also have master esthetician, which really broadens the horizon for an esthetician, and it allows them to do some of these more advanced procedures. But in most instances, you still need that medical director, that doctor who is overseeing that procedure and delegating that procedure to you, not just medical esthetician, but you also have that term paramedical esthetician, and that term as well, really, is not recognized, but it's something people use. It's almost like a marketing term. I'm a medical aesthetician, which implies I can do medical procedures. Is laser a medical procedure? Or is radio frequency and body contouring a medical procedure? That's debatable, I guess, and we'll chat more about it, I hope, in this podcast. But I think where some of that question lies, is that these are procedures that are performed by doctors, but they're now bringing in aestheticians that they hope can assist or perform those procedures. 


0:06:58.5 EC: And that is a good point, and in the State of Colorado in particular. And I think this is very similar. And you mentioned master aesthetician, so I believe there's only four states that hold that distinction between a licensed aesthetician and then the advanced course work that qualifies as a master aesthetician. But where we're at, it's not the case. But the designation or the difference in our state, which I know is similar in other states, is once you are working in that environment, once you have a medical director, you are no longer working in the scope of practice as an aesthetician. At that point, you are a delegatee. So you are working as an extension of the MD, of the medical doctor. And so, saying medical aesthetician, you're not working as an aesthetician at that point, and it's really, really important for insurance reasons, if for nothing else, for liability. 


0:07:48.8 MS: Yeah, absolutely. And you said it, especially here in Colorado, that's certainly how the law is written. Once you're working for that medical doctor, you're now falling under his scope, what his license allows and what he chooses to delegate to you, and no longer what the cosmetology and barber board allows within the scope of practice for an aesthetician. 


0:08:11.8 EC: When you were working as Director of Education and you have these new aestheticians, these fresh aestheticians that didn't quite understand this. What were some of the main reasons that they were wanting to be a medical aesthetician or coming in for this medical program?  


0:08:27.9 MS: Yeah, I think just the word medical comes with this idea or this stigma that perhaps more money is involved, or that they are more educated, just its prestige. That's perhaps not always true. And certainly nothing wrong with being a medical aesthetician, and that is the trend in the industry. We're seeing all these devices and all of these procedures come out that are all about non-invasive advanced aesthetics, and certainly every aesthetician should be about continuing their education and be aware of those trends to set themselves apart. That doesn't mean that coming straight out of school, that's the only opportunity for you or that that's the only way that you'll be able to make money in this industry. 


0:09:18.5 EC: If I'm hearing correctly, and this is my understanding from my very, very scientific research of social media, it's that they want more money, they want more of fact, they wanna be able to do deeper changes in the skin, or that they want more clout, more street cred. So let's get into it, more money. Let's talk about the difference between a licensed aesthetician and medical aesthetician. So I'm gonna throw out a few stats, and then I'm gonna ask you if this was your experience as well. So if we're looking at the United States Bureau of Labor and Statistics, what we've got here is, we're looking at a licensed aesthetician, which is actually a beauty professional, and then a medical aesthetician, which at this point, we looked at medical assisting. So what we've got is an average annual salary for a licensed aesthetician is $35,320 per year. This is on an average of 28.5 hours per week. In comparison to a medical assistant, or what we're gonna call medical aesthetician, there was an average of $34,740 a year, with an average of 32 hours per week. So pretty close to neck and neck, would you say?  


0:10:35.5 MS: Yeah, yeah, definitely. I think in terms of aestheticians ability to make money, whether they're a basic aesthetician or a "Medical aesthetician," really more so has to do with how hard are they willing to work and their ability to market themselves, whether they're an independent contractor or they're an employee, they still have to be able to build that client base and get the word out. 


0:11:00.0 EC: So they're in control of their paycheck. We should also note that these statistics are taking it at a total average. I find this to be very low, based on my experience, but it's looping everyone into that. And also, in the aesthetician category, they're not talking about gratuity. Gratuity is not considered in these numbers. So there is a difference between a licensed aesthetician and a medical aesthetician, in that, it's my understanding that licensed aestheticians qualify for gratuity, where those working in a medical office don't. Is that correct? Was that your experience?  


0:11:32.7 MS: Yeah, definitely. And just to clarify too, when we say medical aesthetician, we are speaking here specifically about those in a medical office. And there are plenty of aestheticians out there that are working in a spa setting performing medical procedures. But definitely, when you're in a clinic environment, you're working in a doctor's office, you don't often have those patients who then are tipping for their medical procedure or their medical aesthetic procedure. And like in a spa, where there is a tip line or even a tip jar or something to that effect, you're certainly not gonna see that in a doctor's office. 


0:12:13.7 EC: Where there's probably some unique circumstances, but it's not the standard. 


0:12:17.7 MS: Correct, yeah. 


0:12:19.5 EC: So licensed aestheticians are in control of their paycheck, they've got, it depends on their hustle, what they're willing to do. And this is for those working for a spa or those who venture out on their own. In a medical aesthetician office, what is the growth path? Is there opportunity for advancement?  


0:12:36.1 MS: You know, I guess, that probably depends on the environment they're working in. I would never say never, but I think when you're brought into the medical environment, you're there to be the aesthetician, assist the doctor, to work with the MAs. And there's always that potential to move up as the expert within that business, but I think, probably, the ability to do so is limited. 


0:13:08.1 EC: Where the growth path for licensed aesthetician would be eventually owning their own practice or something like that. Changes flexibility too, I imagine. Alright. Well, let's get on to more facts. Deeper changes in the skin. So it's an implied thing that, I've seen this before, "I wanna make real changes in the skin, so I wanna go to a medical program." And when we're looking at more effect, we're talking about... We're not talking about... And I hate even the word fluffy facials 'cause fluffy facials implies that you're not making a difference in the skin when you absolutely could be, especially if you're doing lymphatic drainage and so on. But let's look at three categories here. Let's talk about chemical peels in a licensed institution space versus a medical office, laser versus other hair removing depilation opportunity, and then of course, something that will absolutely should not be in an aesthetic practice, and that is injectables. So let's check out those. 


0:14:00.5 EC: So chemical peels. How deep do you really need to go? We look at the history of chemical peels and we see where... And it's fascinating when you check it out, when you see that, really, the birthplace of modern peel started with phenol, and phenol is getting into dermis, potentially. And then in the 1950s and '60s, we saw Jessner's TCA. And then it was the '70s and '80s when we saw the introduction of alpha-hydroxys, which really revolutionized our industry as we know it, but from that time till now, from '70s and '80s until 2020s, we know that there's a lot more to it than just burning the skin and starting over because we've seen... I don't know if you guys have seen. I can definitely tell who was an early 2000s peel enthusiast [chuckle] because their skin is thin and tired, and hanging on, like... 




0:14:53.9 EC: Stretched out, like, "Help me." So not always do you have... Now, there is a time and a place, I feel, for those deeper peels but what is your stance, Maggie? Do you feel like there's always... Once or twice a year, you have to do a deep peel or is it going to be more beneficial to do more superficial peels more often? What is your stance?  


0:15:12.9 MS: I have always been about less is more and I think that in our industry, we weigh over exfoliate the skin, and I think that goes with laser as well. Just too much abrasion all the time, and we are seeing that, like you said, the skin that is just barely hanging on. And I think, part of it is just a misunderstanding by the consumer, but that also translates to students going into school. They have that misunderstanding as well. So it's just all about education. You don't have to peel like a snake to get great results, but people have this idea that if I don't feel it or if I don't see it, then nothing's happening. So it's just changing the mind of the consumer, changing the mind of the student and really being able to educate and understand the products that you're using. 


0:16:10.7 EC: I agree, and also, I will say that there is a time and a place for some of those laser peels. I had a cherry angioma. I was a product rep at that time and I was working in an event for my best account, and their practitioner was like, "Come in here." She just zapped that thing and it's never been back. I'm like, "Wow, that's amazing." And at some point... I had a blast in my 20s and 30s. I was outside, splashing in the water, having a blast, and at some point, there may be a time when I do one deeper laser jumpstart but I'm going to have my skin prepared before that and I will take care of it afterwards. I'm not relying on that for my corrective, my only option. 


0:16:53.1 MS: I was gonna say, don't get me wrong, I worked in a doctor's office. I'm all about laser and definitely, time and a place but you do have those clients that feel like a series every quarter or coming back every month, and that's way too much. 


0:17:09.3 EC: I think some of the medical officers are moving more towards that, away from turn it and burn it twice a year, because that also limits your earning potential, if you're only seeing them twice a year into having these little more maintenance protocols too. The other thing... Now, this is one side where I see laser for hair removal is great, [chuckle] instead of waxing, and that might just be my own personal because, I tell you, I laser all my bits and it's so much easier 'cause my pain threshold is not much. So this is one place where I think, if you're passionate about hair removal, then this might be a great avenue. What are your thoughts?  


0:17:52.9 MS: Yeah, I agree. There are a lot of estheticians out there that are making good money where all they do is wax, but same with laser hair removal. It's like, where do you find your passion. And certainly, if you are a waxer, consider laser hair removal as being another gateway into this "Medical aesthetic industry" if that's one way to advance your education and vice versa, because you're gonna have those people that can't laser and people who can't wax, and it's just adding to your repertoire. And so I think, definitely, I agree with you. And a little funny side story, if I may. Maybe I shouldn't even admit this on the podcast but... 


0:18:38.4 EC: That's okay, we won't tell anybody. [chuckle] Just between you and me. 


0:18:43.3 MS: Wink, wink, wink. Hopefully, this clinic that I worked for, they're not listening in, but I have learned laser hair removal on the job training. And the doctor had said, "Yeah, if you ever want a hair removal, I'm happy to do it for you." And I'm thinking, "Well, I do but I don't want you to do it for me, especially my bikini line. That would just be way too weird." So on days that I was working late and nobody was there, I would go into the laser room and literally be spread-eagle lasering myself. [chuckle] I wanted to clean up that bikini line. 


0:19:20.5 EC: Oh heck yeah. I would too. I considered this one... A colleague of our senior, she was getting rid of a laser and all. I was like, "Oh, you can definitely store it at my shop," almost foaming at the mouth. "You can definitely store it here." [chuckle] 'Cause I wanted to... 




0:19:36.9 MS: I had everything then. But I was like, I could do that. 


0:19:39.8 EC: I considered buying it. You know, I can be... Oh, and I guess I could do my clients too, [laughter] for selfish reasons. And then lastly, another reason that institutions wanna be a medical aesthetician is because of their opportunity to provide injectables, whether it's dermal fillers or neurotoxins, I really don't wanna get too much into this other than drive it really far home that once you're doing injectables like that, you are not an aesthetician, you are working under the medical director. 


0:20:09.3 MS: Correct. I agree, definitely. There are a lot of aestheticians that are very successful with that, but you really need to have a good solid foundation and know what you're doing. 


0:20:20.2 EC: Absolutely. And it's not always easy. You can take these courses. I saw that one school in particular, this was part of their basic course, was this injectables portion, but that doesn't mean... First of all, once you get out of school, you're not gonna be able to do this freely, you're gonna have to find a medical director, and with finding a medical director, that means you incur additional costs. Insurance is an annual, you pay that annually, and then the cost of a medical director... You pay monthly, yeah, there's all kinds of things you have to then deal with local board of health, make sure that your space is set up in a certain way, so there's a lot more to it than that, so check that out before pursuing some of these medical programs, check it out first, make sure. So number one, more money, number two, more effect, and we've discussed the different ways for that, and then number three is more clout, because you somehow there's this idea that a medical esthetician is worth more or knows more than a licensed aesthetician. What are your thoughts?  


0:21:20.9 MS: I just think the word medical comes with that clout, that prestige, it sounds good. As opposed to, I'm just an aesthetician. You know when I first came out of school, I had so many people think, "Wait, you're numbing people. I don't get it." You know. 


0:21:38.2 EC: Oh yeah. An aesthetician, put people to sleep but in a different kind of way. 


0:21:42.1 MS: Well, not only am I doing that, but I'm a medical aesthetician. [laughter] 


0:21:49.6 EC: It's so fancy!  


0:21:50.2 MS: It's fancy. [laughter] 


0:21:52.2 EC: I think also to be it somehow implies that you should... Working at a chain, for example, that's somehow invaluable or not valuable. That that's just basic aesthetician. You're not gonna learn anything there, that's way different, but the truth is new estheticians coming out of these medical esthetic training programs or certifications, which are not certifications, 'cause they don't qualify under the state regulations that... First of all, they're not always gonna be able to get into a med spa. They're not always gonna be able to enter the workplace environment that way. 


0:22:26.8 MS: Yeah, I think when you are first graduating as a student and starting your career, that's when you're gonna make the most mistakes. And this idea that I must find a doctor's office or even a med spa for that matter and begin my career as this medical esthetician. You know, that's not true, necessarily, take advantage of chains or franchises, even if you're feeling like that's not your ideal job, and thinking back to when I was an aesthetician, I ripped off so many eyebrows by accident and accidentally burning people... Knock on wood, I had insurance and nobody ever sued me, but those things are gonna happen, it doesn't matter how good your training was, so I'd rather it would happen when I'm waxing rather than when I'm lasering. 


0:23:16.3 EC: My first bikini wax was... 'Cause we went to the same... No, you went to a different school, but you were the Director of Education for my alma mater, and when I came out of that program, I immediately went into my own business renting a room, but I had never ever waxed a bikini in that program. I had witnessed, but we had never waxed. Of course, that program was way different before you were the director, and after you were the director was amazing. But my first bikini wax was, I would [chuckle] put a little bit of oil on a cotton ball and then try to dissolve the wax that was left on, 'cause I did remember that. And this poor thing looked like she had Santa Claus in a head lock afterwards because there were just little dabs of cotton balls all over trying to dissolve the oil. I was like, I'm not gonna charge you. 


0:24:02.2 EC: But anyways, so I think that's an important thing is that there is a reason to have pride, whether you are a licensed aesthetician or medical esthetician, you should be proud that you went to school, you should be proud that you got through the program, you should be proud that you passed a licensure, and either way, it's commendable. So we've talked about the medical esthetician, the reason why people wanna be a medical esthetician, and that is more money, and we've kind of went over it, it's pretty apples to apples there, more effect, and we talked about that, and then more clout. And I guess, you know what, Maggie, there's one more reason that people might wanna be a medical esthetician, and that is because they want to, and in that case, that makes perfect sense. Do it. [chuckle] 


0:24:40.4 MS: Yeah, do it, more power to you. Absolutely. 


0:24:43.8 EC: And with that being said, that sums it up for any other information, please check out the show notes for information on how to get in touch with Maggie or myself. And I do want to add a little disclaimer that there are exceptions to these averages and don't be offended. Just be proud. Thank you, Maggie, thank you for joining us. 


0:25:02.2 MS: Thank you for having me, Ella. 


0:25:03.6 EC: Until next time, everyone. 




0:25:06.4 EC: Thanks for joining us today. If you like what you hear and you want more subscribe, if you wanna belong to the only all inclusive association for estheticians that includes professional liability insurance, education, industry insights and an opportunity to spotlight your six skills. Join at ascpskincare.com, only $259 per year for all this goodness. ASCP knows it's all about you.

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