The aesthetic industry has expanded dramatically over the last decade. Treatments that were once limited to dermatology and plastic surgery offices are now available in nearly every city, shopping center, and social media feed. While this accessibility has made aesthetic care more mainstream than ever before, it has also created a new challenge for patients: understanding how to distinguish thoughtful, medically driven care from an increasingly crowded med spa marketplace.
At Aesthetic Solutions, this is a conversation our physicians think about often. Across different generations of training and experience, all three dermatologists share a common belief: aesthetic medicine is still medicine, and provider selection matters more than ever.
From Medical Offices to Mainstream Culture – Dr. Sue Ellen Cox
Dr. Sue Ellen Cox has watched the evolution of aesthetic medicine unfold firsthand over the course of her career. When she began practicing, Botox was not even an available treatment, and aesthetic procedures were still considered highly medicalized and relatively uncommon outside dermatology and plastic surgery offices.
“As injectable treatments began to gain approval, they were performed exclusively in medical offices by core four physicians,” she explains. “At the time, aesthetic procedures were still somewhat taboo, and for early adopters, each option was very much considered a medical procedure.”
Today, the landscape looks very different. Aesthetic treatments have become more accessible, socially accepted, and widely discussed than ever before. That shift has brought meaningful advances to the field, including more sophisticated injection techniques, improved energy-based devices, and a broader range of treatment options that allow for more natural, individualized outcomes.
But according to Dr. Cox, rapid growth has also introduced new challenges.
“The challenge is that growth has outpaced standardization,” she says. “Not all providers have the same depth of medical training or aesthetic experience, and patients often have difficulty distinguishing between them based on appearance or marketing alone.”
Why Training Still Matters – Dr. Lisa Ishii
For Dr. Lisa Ishii, one of the most important distinctions patients should understand is the difference between simply performing aesthetic procedures and practicing cosmetic dermatology.
“We practice cosmetic dermatology at Aesthetic Solutions, not simply aesthetics,” she says. “We are looking at the skin holistically as experts, not simply looking at the skin as a vessel for injectables or lasers.”
That broader medical foundation often extends far beyond cosmetic concerns alone. Over the course of routine aesthetic consultations, Dr. Ishii has diagnosed skin cancers, autoimmune conditions, infections, and even serious systemic illness.
Her point is not that cosmetic visits should feel intimidating or overly medicalized, but rather that expertise in skin health matters, particularly in a field where training pathways can vary dramatically.
Training requirements in aesthetic medicine can vary significantly from state to state, particularly as the industry has expanded so rapidly. While some pathways require relatively limited formal aesthetic training, others involve years of additional specialization focused on skin health, facial anatomy, injectables, lasers, and complication management.
At Aesthetic Solutions, all three dermatologists chose to pursue fellowship training in cosmetic dermatology, an additional year of highly specialized education completed after dermatology residency.
“It’s a responsibility not taken lightly,” she says. “Certainly not something that was decided over a weekend course.”
The Social Media Effect – Dr. Payvand Kamrani
Dr. Payvand Kamrani entered aesthetic medicine in at era shaped heavily by social media, online education, and rapidly evolving beauty trends. From her perspective, that visibility has both improved access to information and complicated how patients approach treatment decisions.
“The upside is huge,” she says. “Patients now come to the office really well informed, and the stigma around aesthetic treatment has faded.”
Many patients arrive having already researched treatments privately online, often with a solid baseline understanding of what they are considering. But social media can also blur the line between education, advertising, and trend-driven decision making.
“Trends, by definition, are not long term,” Dr. Kamrani explains. “They come and go, and our goal is never to chase that revolving door.”
The challenge, she says, is that demand for a specific treatment can sometimes form before anyone has stopped to ask whether it is actually appropriate for that patient’s anatomy, goals, or long-term outcomes.
That philosophy also shapes how she thinks about natural results, an area she believes is widely misunderstood in public conversations around aesthetics.
“One of the most common misconceptions is the fear that aesthetic treatments are always obvious,” she says. “But in reality, that is the opposite of what we are aiming for. The goal is for the work to be undetectable.”
What Patients Should Actually Look For
In a market saturated with med spas, branding, and social media marketing, patients are often left trying to determine what meaningfully separates one provider from another.
One of the clearest indicators is often the consultation itself. A thoughtful provider evaluates the face comprehensively, taking into account anatomy, balance, long-term aging patterns, and overall goals rather than focusing on a single isolated concern or trending treatment.
Patients should also feel comfortable asking direct questions about who is performing the treatment, what their medical training includes, how complications are managed, and whether emergency protocols or reversal agents are available if needed. The depth and pace of the consultation can also be revealing. Individualized evaluations tend to involve more discussion, examination, and education, while higher-volume settings may feel more transactional or treatment-driven.
Perhaps most importantly, a qualified provider should be comfortable saying no when a treatment is not in a patient’s best interest. In aesthetic medicine, restraint and judgment are often just as important as technical skill.
The Bottom Line
The rapid growth of med spas has made aesthetic treatments more accessible than ever before. But as the industry continues to expand, patients are also being asked to navigate a landscape with enormous variation in training, philosophy, and medical oversight.
While products, technologies, and trends will continue to evolve, one principle remains unchanged: aesthetic medicine is still medicine. Choosing a qualified, thoughtful, and appropriately trained provider remains one of the most important decisions a patient can make.
For thoughtful, expert care in the Raleigh, Durham, Chapel Hill area, contact our team to start your journey.
