Aesthetic Medicine: Doctor or Cosmetologist? Our Position

Content author: Piotr Rak, MD, oncologist · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: Piotr Rak, MD, PhD · Date of creation: 07.08.2026 · Date of review: 07.08.2026 · Updated: 07.08.2026

The article is educational and presents the position of the Island of Friendly Medicine regarding the organization of treatments. It does not replace consultation or qualification for the procedure and does not constitute legal advice regarding professional qualifications. Sudden swelling, severe pain, blanching of the skin, visual disturbances or fever after the procedure require immediate contact with a doctor.

The most important information at a glance

• A cosmetologist and a doctor are not competitors, but two different professions with different competences.
• The cooperation of a doctor and a cosmetologist is natural and brings more to the patient than the work of each of them separately.
• In our opinion, some treatments must be performed by a doctor: laser removal of skin lesions, botulinum toxin, lipotransfer, thread lifting, liposuction.
• The reason is not prestigious, but practical - these procedures require medical qualifications, assessment of contraindications and the ability to deal with complications.
• Peelings, care treatments, cleansing, epilation and skin management are areas in which a cosmetologist is simply better.
• Mesotherapy is a controversial topic in the industry - in our clinic it is performed by a doctor or nurse.
• Many cosmetologists have additionally completed nursing studies and thus expanded the scope of their qualifications.
• The pigmented lesion is not removed with a laser - there is no material left for histopathological examination.
• Botulinum toxin and fillers are products that require medical qualifications and knowledge of how to deal with complications.
• Before each procedure, the patient has the right to ask who performs it and what preparation they have for it.

Find out more about the specialist

Piotr Rak, MD, PhD, is an oncological surgeon at Wyspa Medycyny Przyjaznej in Gdańsk. He deals with surgical procedures and procedures in the field of aesthetic medicine. This text was created from observations of the office - not from the desire to set boundaries for anyone, but from the need to answer patients' questions why we do not perform certain procedures differently.

Meet Dr. n. med. Piotr Raka

Let's start with what a cosmetologist does better than a doctor

I write this as the first sentence of the chapter on purpose, because the discussion about competences too often starts with what someone is not allowed to do. Meanwhile, the honest starting point is different: a cosmetologist has competences that a doctor does not have.

A cosmetologist has completed studies entirely devoted to the skin - its structure, physiology, care, active ingredients, selection of preparations, treatment techniques. This is knowledge that the medical curriculum does not cover to this extent because it serves other purposes. The surgeon learns to operate and not treat acne-prone skin for six months.

There is also something that cannot be made up for with a course: time and regularity of contact with the patient. A beautician sees the same skin every few weeks, observes the reaction to the preparations, detects irritations, and corrects home care. The doctor in the treatment room just doesn't do it.

The effect of most aesthetic medicine treatments depends largely on what happens between treatments - skin preparation, sun protection, and proper post-treatment care. This is the domain of a cosmetologist and it is a real, measurable value, not a courtesy.

Where is the border - and why there?

Our position is based on four questions. If the answer to any of them is "yes", the procedure is performed by a doctor.

1. Does a diagnosis need to be made before the procedure? If removal of a lesion requires a prior assessment of what the lesion is, that is a medical decision.
2. Does the treatment use a medicinal product? Botulinum toxin is a prescription drug. Its qualification and application are the responsibility of the doctor.
3. Does the treatment deeply disrupt tissue continuity? Lipotransfer, liposuction and thread lifting are surgical procedures, not cosmetic - with the risk of bleeding, infection and damage to structures.
4. Is medical intervention needed in the event of a complication? This question is the most important and I return to it below.

Note that none of these questions are about who is "better." They are all about what you need to be able to do when something goes wrong — and this is a completely different criterion than the efficiency of performing the procedure itself.

Procedures that, in our opinion, must be performed by a doctor

Laser removal of skin lesions

For me, this is the most important point on the whole list and at the same time the one where I see the most damage. The problem is not how to use the laser - that can be learned. The problem is decision whether this lesion can be removed with a laser at all.

The laser destroys tissue. After the procedure, there is no material left that can be sent for histopathological examination. If the removed lesion was an early form of skin cancer, the diagnosis is lost forever - and the patient leaves convinced that the problem has been solved. It is reported again after months or years, when the lesion grows back, and then the scope of the necessary procedure is much greater.

Therefore, our rule is clear: a pigmented lesion or a lesion of unknown nature is not removed by tissue-destructive methods. First, an assessment, if necessary, dermatoscopy, and if there is any doubt, excision with histopathological examination. The laser has its place, but with changes whose nature has been previously determined.

Botulinum toxin

Botulinum toxin is a medicinal product subject to prescription. The qualification includes an interview regarding neuromuscular diseases, medications taken, pregnancy and feeding, previous reactions and a realistic assessment of expectations. It's a medical interview.

The second thing is complications. Drooping eyelids or eyebrows, asymmetry, weakness of muscles other than those intended - these are transient situations that require recognition, explanation to the patient and management. The person administering the preparation must be able to recognize what has happened and know what to expect.

Lipotransfer

Own fat tissue transplantation is a two-stage procedure: fat collection, preparation and administration. It includes anesthesia, disruption of tissue continuity in two areas and work in conditions requiring sterility. This is a surgical procedure in the full sense of the word.

We write more about the procedure itself here: lipotransfer - fat tissue transplantation.

Thread lifting

The introduction of threads requires knowledge of the facial anatomy and the course of vessels and nerves. Possible complications include unevenness, skin depressions, thread displacement, pain, inflammation or the need to remove the material. The treatment in such situations is procedural.

Liposuction

There is basically nothing to discuss here. Liposuction is a surgical procedure - with anesthesia, qualification, assessment of the general condition, preparation and postoperative care. Calling it an "aesthetic procedure" does not change its nature.

Fillers based on hyaluronic acid

I'm adding them to the list, even though they weren't on the original list, because from the point of view of complications they belong to the same category. The most serious of them are vascular complications - injection of material into a vessel or its compression, leading to skin ischemia and, in rare cases, ocular complications.

This is a situation in which it is not the hour that counts, but the minutes. The person performing the procedure must recognize the symptoms, have access to a preparation that dissolves hyaluronic acid and be able to use it. This is the fourth premise from the previous chapter in its purest form.

Treatments that should be performed by a cosmetologist

This list is not a list of "the rest". These are treatments in which a cosmetologist has a real advantage over a doctor, and I believe that they should belong to him.

• Superficial peelings - selecting the preparation, concentration and frequency to suit the skin type is a cosmetologist's daily practice.
• Care and moisturizing treatments - an area where knowledge of active ingredients and their interactions is important.
• Manual and mechanical cleaning - technique, patience and experience that cannot be replaced by a device.
• Epilation - with the correct selection of parameters for the skin phototype.
• Microdermabrasion and exfoliation treatments - superficial.
• Home care - the most underestimated element of the entire process.
• Preparation of the skin before a medical procedure and care after it - directly affecting the final effect.

The last point deserves elaboration, because in practice it determines the result. Skin that is well prepared before the treatment heals differently, and consistent photoprotection after exfoliation or laser treatments actually reduces the risk of post-inflammatory discoloration. A patient who has someone to discuss it with and who monitors it achieves better results than a patient left with a leaflet.

Mesotherapy - a topic I do not intend to simplify

Needle mesotherapy is a controversial topic in the industry and it would be unfair to pretend otherwise. Supporters of wider access point out that some preparations are non-pharmacological and the injection technique is easy to master. Supporters of the narrower approach emphasize that we are talking about breaking the continuity of the skin and introducing substances into the tissues - with the risk of infection, allergic reactions and local complications.

Both sides have arguments and this will not be decided by a blog. We adopted our own solution, resulting from the same logic as the rest of this text: on the Island of Friendly Medicine, mesotherapy is performed by a doctor or nurse.

The role of the nurse is important here and it is worth naming it clearly. A nurse is an independent medical profession, prepared to perform injections, work in sterile conditions, recognize adverse reactions and act in the event of their occurrence. This is not a "doctor's backup version" - these are separate competencies that are fully sufficient for this particular procedure.

Cosmetologists who have gone further

There is a phenomenon that is worth noting because it changes the image of the entire discussion. Many cosmetologists also took up nursing studies - and thus expanded the scope of their qualifications to include the competences of the medical profession.

This is a decision that is difficult to overestimate. It means several years of study, state exams, internships and full professional responsibility - undertaken by people who already had a profession and could stay in it. The result is a specialist who combines two things that rarely go together: thorough knowledge of skin and care with formal medical competence.

From my perspective, this is the right way and such people are very valuable in teams. It also shows that the boundary I am writing about in this text does not run between people or between professions - runs between competences. And competences can be acquired.

Division of treatments - summary

The scope of treatments actually available in the clinic and the people performing them should be confirmed during registration.

When you need to seek help immediately after the procedure

Regardless of who performed the procedure, the following symptoms require urgent contact - preferably with a doctor, and in case of severe symptoms, with emergency help:

• strong, increasing pain disproportionate to the procedure,
• pallor, bruising or marbled appearance of the skin in the area where the filler was administered,
• any visual disturbances,
• rapidly increasing swelling, especially affecting the lips, tongue or throat,
• shortness of breath, itching all over the body, hives, dizziness,
• fever, chills, spreading redness and discharge of pus,
• drooping eyelid or distinct asymmetry after administration of botulinum toxin,
• a lesion that grows back after removal or does not heal.

The last point is special - it does not require a rush on the scale of hours, but it should not be ignored. A lesion that grows back after removal requires evaluation and most often excision with histopathological examination.

The most common myths

• "A doctor is always better than a cosmetologist." No. A cosmetologist has an advantage when it comes to care, selection of products and skin care.
• "A cosmetologist is a skin doctor." No. It is a separate profession, with different education and different competences.
• “Since the procedure is performed in a beauty salon, it is simple.” The place of execution says nothing about the risk.
• "Removing a mole with a laser is more convenient." Yes - and that's why it can be dangerous. There is no material left for testing.
• "Botox is just an injection." This is a medicinal product that requires qualifications and knowledge of how to deal with complications.
• "Fillers are completely reversible." Preparations based on hyaluronic acid can be dissolved, but this requires quick recognition of the complication and access to the appropriate preparation.
• "Course certificate is enough." The course teaches how to perform the procedure. It doesn't teach you what to do if something goes wrong.
• "It's a money dispute." There is one criterion: what you need to be able to do in the event of a complication.

You don't know which treatment is right?

Start with a consultation. We will determine whether you need a medical procedure, care by a cosmetologist, or both in the appropriate order.

What does it look like on the Friendly Medicine Island in Gdańsk

Treatments requiring medical qualifications are performed by our doctors - this includes laser removal of skin lesions, botulinum toxin, fillers, lipotransfer, thread lifting and surgical procedures. Mesotherapy is performed by a doctor or nurse. Care treatments, superficial peels and skin preparation are in the hands of the cosmetologist.

This division is not a hierarchy. It is the answer to the question of who is best prepared for a specific task - and who will cope when something goes differently than planned. The current scope of treatments, availability of dates and prices should be confirmed during registration.

Aesthetic medicine Lipotransfer Price list

What to ask before the procedure?

• Who will perform the procedure and what is their preparation for it?
• Is a medical qualification required before the procedure?
• What are the contraindications in my case?
• What complications are possible and how often do they occur?
• What happens if a complication occurs - who will manage me and how?
• Is there a preparation that dissolves hyaluronic acid available at the facility?
• Will the removed lesion be sent for histopathological examination?
• How to prepare the skin before the treatment?
• What does post-treatment care look like and who will conduct it?
• How many treatments will be needed and at what intervals?
• What effect can I realistically expect?
• When should I go for a check-up?

FAQ - doctor or cosmetologist

What is the difference between a cosmetologist and an aesthetic medicine doctor?

These are two separate professions with different education. A cosmetologist has thorough knowledge of skin, care and preparations. The doctor makes diagnoses, qualifies for medical procedures and conducts treatment in the event of complications.

Can a cosmetologist remove skin lesions with a laser?

We don't think so. The problem is not the operation of the device, but the decision whether a given lesion can be removed using a tissue-destructive method. This assessment is up to the doctor.

Why aren't moles removed with a laser?

Because after the procedure there is no material left for histopathological examination. If the lesion was an early form of skin cancer, the diagnosis is lost and the patient considers the problem solved.

Who should administer botulinum toxin?

Doctor. It is a medicinal product subject to prescription, the administration of which is preceded by a medical qualification, and possible complications require diagnosis and management.

Who performs mesotherapy?

This is a controversial topic in the industry. At the Island of Friendly Medicine, mesotherapy is performed by a doctor or nurse - because it is an injection that interrupts the continuity of the skin.

Can a nurse perform aesthetic treatments?

A nurse is an independent medical profession, prepared to perform injections and work in aseptic conditions. He performs mesotherapy with us. The scope of tasks depends on the qualifications and organization of the facility.

Can a cosmetologist become a nurse?

Yes, and many cosmetologists did just that - they completed nursing studies and expanded the scope of their qualifications to include the competences of the medical profession. It is a valuable combination of skin knowledge and formal medical preparation.

What treatments are better performed by a cosmetologist?

Superficial peelings, care treatments, cleansing, epilation and care before and after medical treatment. In these areas, a cosmetologist has an advantage over a doctor.

Are fillers safe?

Each treatment requires qualification and discussion of possible contraindications. The most serious complications are vascular in nature and require diagnosis within minutes and access to a preparation that dissolves hyaluronic acid.

Is the course certificate sufficient to perform the procedure?

The course teaches performance techniques. It does not replace the education needed to qualify the patient and deal with a complication - and this is the criterion we follow.

Can a doctor and a cosmetologist work together?

Not only can they - they should. The effect of a medical procedure largely depends on the preparation of the skin and post-treatment care, i.e. on the area in which the cosmetologist is competent.

What to ask when making an appointment?

Who performs it, what preparation they have, what are the possible complications and what will happen if they occur. The patient has the right to know the answers to these questions before the procedure.

Sources

• Wyspa Medycyny Przyjaznej, lipotransfer: https://www.wyspamedycynyPrzyjaznej.pl/pl/lipotransfer-blog
• DermNet, Botulinum toxin: https://dermnetnz.org/topics/botulinum-toxin
• DermNet, Dermal fillers: https://dermnetnz.org/topics/dermal-fillers
• DermNet, Chemical peels: https://dermnetnz.org/topics/chemical-peel
• DermNet, Laser treatment: https://dermnetnz.org/topics/laser-treatment
• DermNet, Skin surgery: https://dermnetnz.org/topics/skin-surgery
• DermNet, Melanoma: https://dermnetnz.org/topics/melanoma
• NHS, Cosmetic procedures: https://www.nhs.uk/conditions/cosmetic-procedures/
• NHS, Botox (cosmetic): https://www.nhs.uk/conditions/cosmetic-procedures/botox-injections/
• NHS, Dermal fillers: https://www.nhs.uk/conditions/cosmetic-procedures/dermal-fillers/
• NHS, Liposuction: https://www.nhs.uk/conditions/cosmetic-procedures/liposuction/
• British Association of Dermatologists, patient information: https://www.bad.org.uk/patient-information-leaflets/