Medical vs Cosmetic Dermatology: Why Knowing the Difference Matters

The field of dermatology is as old as time, yet it continues to evolve rapidly. Ancient doctors treated skin problems with herbs and anesthesia-less incisions. But they did not have a system of classifying blemishes to guide their diagnostic and therapeutic decisions.

Centuries later, experts lumped dermatology together with other internal medicine subspecialties, knowing that various diseases manifested as skin injuries. But as it became a separate discipline, the demand for its cosmetic applications also grew.

How different are medical and cosmetic dermatology? And why is it important to know the difference? We discuss the answers and more in this article.

Overview: Medical vs Cosmetic Dermatology

What Is Medical Dermatology?

In a previous article, we explained that medical dermatology dealt with disease processes affecting the skin, hair and nails. We also mentioned that medical dermatology treatments consisted mainly of medications and various forms of photomedicine.

This definition emphasizes two things about the field. First, medical dermatology patients have a health need that, if left unaddressed, can compromise their quality of life or even lead to death. Second, it remedies skin conditions using a non-surgical approach, that is, without cutting tissues. 

That said, the medical dermatologist’s specialized knowledge of the skin and its structures allows them to treat skin disease while improving the appearance of the affected area. Not all physicians are trained to do this.

Medical dermatology therapies are necessary for maintaining a person’s health, so insurance can reimburse the costs.

Cosmetic vs Medical Dermatology: What Is the Difference?

Many cosmetic dermatology treatments are the same as those used in medical dermatology. For example, UVB phototherapy, the first-line remedy for moderate to severe psoriasis, can also even the skin tone. Salicylic acid, used for removing small warts, can also improve acne scars. And so on.

However, the skin issues that cosmetic dermatology handles are not caused by illness. The only problem with them is their appearance. But by themselves, they do not have serious health consequences even if left alone indefinitely.

Aside from drug therapy and photomedicine, cosmetic dermatology also uses surgical techniques to fix a skin condition. Surgical approaches differ from their medical counterparts because they use energy to remove or cut tissues in problem areas. For example, a dermatologist uses mechanical energy when taking out a cyst with a surgical scalpel. Light energy is involved in laser hair removal.

Meanwhile, simple drug injections into the skin, muscles or blood vessels are not surgical procedures. Phototherapy and other photomedicine technologies are likewise non-surgical—they curb symptoms by modulating cellular responses, not by slicing into tissues.

These subspecialties—medical, cosmetic and surgical dermatology—overlap considerably. Surgical procedures may sometimes be appropriate for a medical skin issue, as when Mohs surgery is used to take out skin cancer. Likewise, cosmetic conditions like skin tags can become a medical problem when infected.

None of them are less scientific than the others as they all require thorough patient evaluation and diligent performance. Board-certified dermatologists are experts in all three.

Insurance does not pay for cosmetic treatments unless they are also done for a health need.

What Procedures Fall Under Medical Dermatology?

The procedures performed by a medical dermatologist may be classified as either diagnostic or therapeutic.

Diagnostic procedures include the following:

• Dermoscopy

This entails using a hand-held device called a “dermoscope,” which allows the physician to closely examine skin lesions.

• Photography of the affected area

Pictures taken at different times let your doctor monitor the evolution of a skin blemish. This is vital in the detection of new or recurrent malignant tumors.

• Scrape, pull and swab

The dermatologist may take a sample of the diseased tissue by scraping or swabbing its surface. They may pluck some hairs from the roots if the condition is in a hairy area. They will examine the specimen microscopically for microbes, and if necessary, send it to a lab for further testing. If they suspect widespread infection, they may also swab mucosal surfaces like the mouth, nasal cavities and genitals.

• Biopsy

This requires cutting out small tissue samples in the superficial and deep parts of the lesion. It is done under local anesthesia. The specimens are then examined under a microscope for evidence of disease. Biopsies are essential in skin cancer diagnosis and classification.

On the other hand, the following are therapeutic procedures:

• Phototherapy

This treatment exposes vast skin areas to light energy of a specific wavelength, typically in the ultraviolet spectrum. Psoriasis, atopic dermatitis and vitiligo are some of its applications.

• Photodynamic therapy

Here, your doctor applies a photosensitizing drug on your skin before exposing it to blue or red light. Photodynamic therapy may be used on actinic keratosis and early-stage skin cancer.

• Radiotherapy

This procedure destroys abnormal skin cells using powerful light particles like x-rays and gamma rays. Its primary indication nowadays is advanced cancer treatment, though it was widely used on benign lesions before safer therapies were discovered.

In addition, medical dermatologists may prescribe drugs to solve various skin problems. They can also combine medications and light-based procedures if necessary. You may read our article on medical dermatology treatments to learn more.

What Procedures Are Considered Chiefly Cosmetic?

Cosmetic dermatology services are primarily therapeutic. But dermoscopy and photography can help your dermatologist rule out skin disease and monitor your treatment response.

Falling under this category are the following:

• Cosmetic laser treatment

This procedure uses powerful light beams to get rid of blemishes. Its vast applications include:

• Removal of unwanted hair 
• Treatment of aging or sun-damaged skin
• Improvement of vascular lesions like hemangiomas, spider veins and rosacea
• Skin tightening
• Acne treatment
• Correcting scars and stretch marks
• Removal of benign moles, tattoos, brown spots and other pigmented lesions

And many others. Some lasers are not suitable for skin of color. If you have a dark complexion, choose a laser dermatologist who has extensive experience handling every skin type.

• Chemical peel

This treatment uses exfoliating drugs like salicylic and trichloroacetic acid. It improves skin texture by smoothing out wrinkles, scars and other flaws. It can also treat acne and pigmentation problems.

• Dermabrasion

This cosmetic procedure involves the mechanical removal of the skin’s superficial layers. It has the same indications as chemical peeling.

• Body contouring

Cosmetic dermatologists can spot-reduce fat in several ways:

• Coolsculpting
• Radiofrequency or other light-based surgical technologies
• Ultrasound
• Diathermy
• Mesotherapy
• Liposuction

But their effects cannot last long without healthy lifestyle changes.

• Soft tissue augmentation

This procedure entails injecting dermal fillers to smooth out wrinkles and restore tissue volume in aging skin. Examples of dermal fillers are hyaluronic acid, collagen and your own fat taken from a plump body part.

• Botox cosmetic injections

Your cosmetic dermatologist may inject small amounts of botulinum toxin in areas with deep “dynamic wrinkles”—those skin folds created by repeated muscle use. This treatment is named after Botox, the brand of the first botulinum toxin formulation made available in the market. Dysport is another brand of this drug.

• Hair restoration surgery

Dermatologists can transplant hair and hair follicles from a dense scalp region to a thinning one. Hair loss treatment can restore one’s youthful appearance.

• Platelet-rich plasma injection

This procedure uses the substances in your own blood to correct cosmetic concerns like wrinkles, scars, stretch marks and hair loss.

• Mesotherapy

Your cosmetic dermatologist may inject bioactive substances into your skin to enhance your complexion or reduce cellulite.

• Medical microneedling

Microneedling passes rows of small needles on the skin to stimulate collagen production and skin renewal. Its applications include skin rejuvenation, hair regrowth and acne treatment.

• Cosmetic cryotherapy

Liquid nitrogen can destroy skin lesions with its extremely cold temperature. Your cosmetic dermatologist can use it to get rid of benign masses, keloids and pigmented lesions like moles.

You may read our article discussing cosmetic services to learn more about these procedures. 

Cosmetic treatments can be pricey since they are not covered by insurance. But be careful not to fall for dirt-cheap procedures offered by individuals without a license to perform them. Studies show that most cosmetic treatment-related injuries are done by unqualified providers. So choose wisely and entrust your skin care only to a board-certified dermatologist.

How Long Does It Take to Recover from a Medical vs Cosmetic Procedure?

The length of the recovery period from any dermatologic procedure, medical or cosmetic, mainly depends on the following:

• The procedure’s invasiveness
• The extent and anatomic location of the skin issue being treated
• Your physical status

For procedures that leave behind visible wounds, such as biopsy and cryotherapy, the downtime is usually 1-2 weeks. For those that produce only micro-injuries, such as microneedling and Botox injection, recovery takes a few days at most. Meanwhile, drug treatments normally do not disrupt patients’ routines unless they are expected to have strong side effects, as in cancer chemotherapy.

Large postop wounds generally take more time to heal than smaller ones. Additionally, skin repair mechanisms slow down in areas with poor blood circulation or those subjected to repeated trauma or constant heavy pressure.

People of advanced age generally recover more slowly than younger ones. But surgical wound infection and problems of the immune system, connective tissues, blood clotting function and blood sugar control thwart healing regardless of age. 

Why Is It Important for Patients to Know the Differences Between Medical and Cosmetic Dermatology?

Understanding the differences between these two subspecialties helps you for the following reasons:

• It lets you optimize your healthcare costs.

Knowing what treatments are medically necessary allows you to make the most out of your health insurance. For non-reimbursable procedures, it can help you identify and reduce unnecessary expenses.

• It enables you to detect and treat skin cancer in its early stages.

Some skin cancers resemble cosmetic lesions. For example, basal cell carcinoma can mimic skin tags. Beginning melanoma can look like an ordinary mole. Recognizing the early signs of malignant transformation—and thus knowing that a lesion is not merely cosmetic—can add years to a person’s life.

• It can help improve your quality of life at the soonest time possible.

Quality of life indicators include physical and psychological function, quality of interpersonal relationships, school or work performance and many others.

Most skin conditions do not cause serious health problems, so people may let them linger for some time before seeking treatment. But some skin issues can somehow reduce a person’s quality of life if not remedied right away.

For instance, eczema and acne are associated with poor self-esteem and school performance among kids. Knowing that these conditions are medical, and hence covered by insurance, may encourage parents to seek the best therapies for their children.

Expanding your skin health awareness helps you get more satisfying outcomes from your dermatology treatments.

Because Your Health Knowledge Empowers You

The most obvious difference between medical and cosmetic dermatology is that one deals with illness while the other does not. Consequently, the cases treated by the first, but not the second, are time-sensitive. This information, though only a snapshot of reality, is vital for many people as it can impact their decisions when dealing with a skin condition.

But no matter what skin issue you have, as always, trust only a highly trained, board-certified dermatologist for your treatments. Only a bona fide skin care specialist can guarantee that your therapy is safe and effective.

Not Sure Which Skin Care Products Will Work on a Blemish? Ask LA’s Award-Winning Dermatologists

Everyone develops a skin condition eventually. But only those who truly take care of their skin’s health can keep it looking enviably beautiful for a long time. 

At BHSkin Dermatology, our board-certified skin care professionals are some of the most trusted in the field. They can perform a wide array of procedures that work effectively on medical and cosmetic skin issues. Consult with them by visiting our Glendale or Encino clinic or using our virtual portal.

Book your appointment today!

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online