EPISODE 7: Us Vs Them

Confused about whether to see a dermatologist or an esthetician for your skin concerns? In this episode, we talk about the conversation that has been quietly happening in the skincare world for years: dermatologists vs estheticians. The truth is, it should never have been us vs them. Both professions serve very different yet very important roles in skin health, and when they work together, clients get the best results.

We discuss what each profession is trained to do, what they do well, where things sometimes go wrong, and how the industry is changing. We talk about when you should see an esthetician versus when you should see a dermatologist, especially when it comes to acne, skin conditions, prescriptions, and long-term skin health.

We get into real conversations about common treatments and medications like spironolactone, antibiotics for acne, tretinoin, and Kenalog injections, including the side effects we sometimes see and what clients are often not told before starting these treatments. We also talk about different skin conditions, how dermatologists typically treat it, and how estheticians approach it differently.

We explain why estheticians are often better for routine skin care, maintenance, barrier repair, and acne management, while dermatologists are essential for diagnosing skin diseases, skin cancers, rashes, abnormal skin conditions, and prescription medications. The best providers refer back and forth and work together, not against each other.

This episode is an honest, respectful conversation about the skincare industry, what is working, what is not working, and where we believe the future of skin health is going.

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Transcript

SPEAKER_01 0:13

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SPEAKER_00 0:54

Seriously. Okay. Are we is this working? Okay. We're not gonna lie, you guys, we it takes us about 30 minutes to get this audio set up every time. Hopefully, we'll set it up somewhere we won't have to take it down. Or one time we'll take a video so we can remember how the fuck we're supposed to do it. But, anyways, we got it. We're here.

SPEAKER_01 1:21

We're here. This will be an interesting one today. We were a little nervous to bring you this one, but because we are very open to everyone in the industry and all specialties and different licensings and all those things, and we support all areas.

SPEAKER_00 1:37

Absolutely. Collaboration, not competition.

SPEAKER_01 1:40

100%.

SPEAKER_00 1:40

But so we want to be completely honest and truthful today. Um, we want to talk about the good, the bad, the where we see the future and where it could be better, where there's room for improvement. And, you know, it's okay, why are we so nervous?

SPEAKER_01 1:55

I know. I think this is one that we see a lot every day with our clients, and we are very good about um watching what we say and how we respond to certain recommendations from other providers because we're very respectful of other providers in the industry. We are so respectful. And we think that there's room for everyone and that there's a specialty that can work for someone that might not work for others. Yes. And so it's very important to never make the client feel like they're doing anything wrong and that they should see whoever they feel is treating them in the best way for their special needs.

SPEAKER_00 2:27

And I think that like when somebody is putting somebody else down to make themselves look better is also not the the vibe or the look that we try to go for all.

SPEAKER_01 2:36

And this has become a theme in our in our industry, and that means all skin, not just aestheticians. And I don't like it. It's not nice.

SPEAKER_00 2:44

Yeah. So, okay, we've already rambled for that was a good minute and a half of you don't know you guys have no idea what we're about to talk about. But we want to talk about the dermatological field and aestheticians and aesthetic field and skin care, skin health, and where we see the future of it, how we feel it's working right now or not what's not working, and kind of want to go into that because we were talking about this earlier where we don't understand when it became like this us versus them kind of scenario, like when it's like North versus South or freaking Democrats and Republicans, Montague's and Capulets. Like why is there why is there a fight? There shouldn't be a fight. Like we're all trying to achieve the same thing, which is making our patients happy. So we want to talk about this because there's a certain place in time for somebody to go to a dermatologist, and also there's a certain time and place for someone to come into an ascetician for their skin.

SPEAKER_01 3:36

And you should be seeing both.

SPEAKER_00 3:37

Every year you should be going for a skin check, if not every six months, especially if you're like have a pre like a you know, predisposed history or whatever to skin cancer. You need to be going and getting a mole check from a dermatologist. Absolutely.

SPEAKER_01 3:49

But there are some things that I feel like clients are very confused on when to go see which provider and for what. And a lot of times I'll have clients say, Oh, I'm gonna go to my derm for this. And I'm like, but derms don't treat that. Like one of those things being acne. If you have basic acne and you're having breakouts here and there, hormonal, blackheads, whiteheads, whatever type of acne, cystic, anything like that, the first step should always be to see an esthetician. You should be getting your skin balanced and under control first. And then if you are having a hard time hitting a wall and things are not working or they're getting worse, then every esthetician should be telling you you need to go see a dermatologist.

SPEAKER_00 4:29

Absolutely. And so let's talk about like dermatologists. Okay. So they are MDs, they've gone to medical school, they've done the rotations. There is a place for them, absolutely. And we're not negating that whatsoever. They are amazing, like we talked about skin cancer, identifying that. They are there to diagnose and to also to help treat. That is what they're supposed to be doing, skin health. So they can biopsy, they can identify lesions and rashes and see, you know, what might necessarily be on a prescription medication. Totally.

SPEAKER_01 4:58

And I would say a good way to think about this is like a psychiatrist and a therapist. A dermatologist is your psychiatrist, you're going to them for their your prescription, and then you're going to your therapist to actually help you long term to manage the factors causing the issues. Like I think that is caused by the main issue. And I think that that is the main differentiation. Like you're going to go to get your prescription as needed, but you're going to long term be building a relationship with your therapist, like a skin therapist, in the same manner for them to help you have a well-rounded approach to your what you're dealing with.

SPEAKER_00 5:33

I think that's a really amazing way to put it because that's not negating what derms do. No, germs are essential. They are essential. And I think it's also not putting us down or making us better in our field. So I I do love that that we are the therapist and the derms are the psychiatrist, which makes total sense because one has an MD and the other one doesn't. But, you know, in our practice, there have been times, many times, where we've referred people to derms because we feel like, you know what, you've been coming in and this actually doesn't seem to be looking right. So, like you were telling me about one of your clients, Gabby, the other day, that you actually had referred to a derm because what was going on?

SPEAKER_01 6:08

Yeah, she has autoimmune issues already, and she was developing these pustulars in a specific area of her face that to me did not seem like a normal acne breakout. And we talked about it in length, and she did get better after treatments from LED, from the treatment I did, from the cleaning and all those things, but it was still flaring up again. And I told her and instructed her that this was time that she needed to go see someone. And this was a client I had been seeing for years, and we knew her skin very well. She was clear, she was beautiful, her skin was on a great track. And then something started erupting that was abnormal and out of her norm. And I knew that this was not a normal situation or allergic reaction. This was something deeper, and she needed to go to see a derm to discuss it and further address it. And I'm glad I did, and it helped her. And we've been working in conjunction together with the derm to still keep her skin strong and balanced while she is on prescriptions. Uh, that she was developed, which happens in your 30s or late 20s, uh papustular rosacea around her nose. And that's normal. There are different types of rosaceas that you can develop later in life. You're not necessarily born with it, or there's other factors that affect that. And so I love this term, and I was very impressed with his analysis and his recommendations of prescriptions given to her because they were very effective and not over the top. And he was very clear about the usage and using it in conjunction with her aesthetician. And I think that that's amazing and that's the way it should be working. Collaboration, 100%.

SPEAKER_00 7:32

And like for me, I've had some clients where, you know, I I went on Accutane three times. I was I was a failed Accutane user, but there have been, you know, right now that I'm thinking about I have two clients right now, one who ended up going on Accutane because it just the amount of comodones and posturals she was getting and not being able to get on top of it and the financial burden and the emotional and physical pain that she was going through. Accutane just seemed like the best fit for her. And I do hope that it works for her and like stays long term. Because some people, like my brother, went on Accutane and it worked for him. He's never had to go on it again. Does he have dry skin now? Yes, but he's never really had any breakouts ever again. So there are times when I feel like the dermatologist, in regards to acne, can be beneficial, but there have been many times, and again, I'm not trying to talk shit, but but I am going to a little bit, where we have clients that come in, and people have been referred to us because, like, oh my god, this person helped my acne. You gotta go see her, right? And like one of the stories that just keeps popping in my head is like this one girl who literally looked like a deer in headlight. She came in with a bag full of stuff. It was a benzyl peroxide cleanser. She had a clindomycin, uh, like topical, and which is an antibiotic, and then she was also put on doxycycline, oral antibiotics, and then in addition, some like salicylic something, and then also a tretinoin, too. There was no regimen, there was no instructions, there was nothing. It was just this is what you need to use for your acne. And for us, skin health is so important, and balanced skin is like literally the number one goal before we do anything. And so just to give you six different actives, that's not solving the problem. And so she here she went to the derm, you know, it was cheap because like her copay was like 25 bucks, and then she paid $2 for the tritino, and the other thing was 14 cents, whatever. But then her face was like dry and she said it hurt to smile because she was so cracked, right? But there was no mention of uh gentle cleansing, there was no mention of moisturizing, there was no mention of SPF. There was literally not one regimen written out for her, and that's the problem that I feel like we're constantly seeing is that there's no follow-up and follow-through in the dermatological field when it comes to acne. And I'm not saying that as a blanketed statement. I'm sure there are other derms that do, you know, write a regimen for people. But for us, you need to clean out the skin. Using a product is not going to like clear your skin out. You need extractions, you need hydration, you need treatment. It's a balance between the two things, between what you're using and what you're doing.

SPEAKER_01 9:55

And I recognize derms are extremely overloaded at this point. It's become a big theme. Most of my clients can't get derm appointments, which is very frustrating to me. It takes them months and months and months to get in to have skin checks on certain things, but that's where, even more so, there needs to be more collaboration. They need to be working alongside a skin professional to help the clients further address their concerns and their routines and their regular lifestyle choices along with the prescriptions given.

SPEAKER_00 10:20

Well, like, let's talk about some of the things that I'm gonna be, let's whatever, let's just do it, okay? What bothers us? My first one is spiral lactone. Like I just, you guys, every single person who is coming on spiral lactone, one doesn't know what it is. So spirinolactone is a potassium-sparing diuretic, which you know, you want to go into it a little bit?

SPEAKER_01 10:39

Yeah, sure. So I've seen many clients on spiron lactone, and it is basically a what? Nothing.

SPEAKER_00 10:46

Spirinolactone, spiral lactone, tomato, tomato.

SPEAKER_01 10:49

Uh-huh. Yeah, spiron lactone. It's an oral medication. It blocks the androgen hormones, which is basically testosterone. And in people with PCOS and other hormonal issues, you usually have more of that testosterone, which causes more oil production and more inflammation. So it can be a very helpful tool, especially when you're dealing with things like PCOS and things that are a little bit more out of control with your hormones. With your hormones. But I think that it is definitely a band-aid and people are never explained what this can do long term and being on it for si for many, many years is not always the answer.

SPEAKER_00 11:20

Or, you know, like what is the plan? Am I going to be on it for six months? Is it three years? Is it indefinite?

SPEAKER_01 11:26

I've had clients on it for years and years and years, and I've told them, well, I don't think you even need it anymore. You were on it at a very young age, and now you're in your 40s, and you probably don't have as much oil production as you had back then either, and your hormones might be in a whole nother different state. You should have probably checked that out a while ago to make sure that you maybe you can wean off or lower your dosage or start to move on because you don't need it as much.

SPEAKER_00 11:47

I honestly found the opposite. So I I remember I had a coworker where I used to work who she was in her 40s, she was put on spirinal lactone, she had like really crazy pustules around her mouth, whatever. She was put on spirinol lactone. She had been on it for like, let's say six, seven years. And she was like, you know what? I feel like this is kind of weird. I've been on it for so long. Like, let me get off of it. She gets off of it and laid her face just explodes. Like crazy. And you know what? She was trying. We were trying to just do the extractions, trying to clean her out. And she just was like, I'm 45. Like, I like this is no one wants to kiss me. Like, I have white heads all over my mouth, her chin, like where she was breaking out when she was in her 20s. She's like, I can't. So she is still on spirinal lactone now. And and the thing is that when I have somebody who comes in who has been on spirinal lactone for like two plus years, you titrate slowly. Like we go off, you don't just stop it immediately, which is like number one, what happened. But again, there was no instruction from the provider that, like, hey, we're gonna put you on this potassium-sparing diuretic that is going to work on your male hormones that are not gonna create the oil, like what Gabby was talking about, or as much oil. So, like, it is gonna work on the hormonal acne that's going on, but you might be on it for life. And are you okay with that? Because then, in my opinion, why is no one checking anyone's potassium? Like, this is a potassium-sparing diuretic. This is this was used for like heart and kidney medication. That's what the original medication was created for, which is fine. Other medications then have like multi-purpose for it, right? But it's a band-aid, and that is the problem that we're seeing in in everything, basically, with like being put on birth control for your acne, or like, you know, like being given antibiotics.

SPEAKER_01 13:22

And this is my band aid is first of all, I love this rain. It's so amazing. I don't know if you guys can hear it, but it's wonderful. My other thing is so, yes, they need to be checking the medications or cross-referencing, and a lot of doctors are not, and a lot of doctors are not prescribing all the medications you're on. So they don't know that maybe you've been now put on an anti-anxiety medication. I had a client that this was something that I felt I shouldn't be part of, but she's telling me about her horrible anxiety and she's been on spiral and lactone at a high dosage for a while, and that her now she's like, Yeah, I'm I'm getting onto, I'm trying new medications, I'm having a hard time with these different ones that are putting me on anti-anxiety medication because my anxiety is so high. And I'm like, wait, I was like, but you you realize that anxiety is a very normal side effect of taking high doses of spiral and lactone. And she was like, No, I didn't know that. I said, Well, I would definitely address that before you start trying anti-anxiety medications. And why is your doctor not addressing this? And I think something people don't understand, the pharmacist's whole job is to stop the doctors from over and under prescribing the wrong medications because doctors don't always keep track of all the medications you're on it with different providers. Right. The pharmacist does. The pharmacist's job is to watch those things, and so it's kind of an interesting thing that that's their whole job. And that's why they're a little bit more in control and a little like difficult sometimes when it comes to medications, because they often are stopping doctors from misprescribing things or putting the decimal in the wrong place.

SPEAKER_00 14:43

I'm gonna be honest. I don't like when I go to CVS, I barely see the pharmacist. I'm picking up the medication and that's it.

SPEAKER_01 14:49

My pharmacist is on my ass. Oh, really? Yeah. So their whole job is to make sure you don't die or that you are not misprescribed. So glad you have a good one. So it but it's just to go to show that this is a very normal thing for doctors to over, under, and misprescribe because they're not they're busy and they're not keeping track of everything and things slip through the cracks. And so you need to be your own advocate. And this is something I see, and I felt weird. I was like, as your esthetician, I'm telling you this, but I don't feel like it's my place. You they should have gone over this with you. Yeah. That your high rate of anxiety could be due to this medication. It might, you might need to just reduce this medication instead of adding another.

SPEAKER_00 15:22

Yes. So this is something another medication that's going to cause another problem down the line. 100%. So I think that's something we're very frustrated on. And you know what? It is your place to say something because good for you for knowing that that like one of the main causes of high doses of spiral lactone is uh anxiety. So that's why you're amazing. So good job.

SPEAKER_01 15:39

It's just we learn over time as we see more and more cases like this, that this is a very common thing. It's just, I mean, what was the other case? It was when they were putting them on, oh, like oral antibiotics and making their acne worse because now their gut microbiome is getting destroyed, causing them to have other acne issues.

SPEAKER_00 15:55

Or like people with perioral dermatitis. I I can't tell you how many people have come in with perioral dermatitis that I've helped that have been on six months of doxycycline. I don't give a fuck if it's a low dose. You should not be on an antibiotic that long. And then not even being told, oh, hey, maybe you should be taking a probiotic to counter this or a prebiotic. Like, let's let's discuss like what's going on internally. What's going on with perioral dermatitis? What are you using? Is it the is it the toothpaste? Is it the cold weather? Are you taking extremely hot showers? There's so many things as skin experts. I feel like that we can ask to help with like changing our habits before being put on a medication. And ultimately, sometimes you do need that medication, and that's fine, but like long-term antibiotic usage is just it's never the answer, in my opinion. Same with like antibiotics, like you were talking about for acne. We know, we know, we know it's it doesn't work.

SPEAKER_01 16:44

Acne is not caused by bacteria like that. No, acne is it a follicular issue and a clogging issue, and it is something to be addressed with yes, retinols, exfoliation, proper exfoliation. When we say that, we don't mean scrubs. Yes, but we're exfoliating and doing three different six different types of exfoliation. Yeah, so it has absolutely nothing to do with bacteria, and I want you to repeat that in your head, repeat that in your car. Acne has nothing to do with bacteria. Exactly.

SPEAKER_00 17:09

So and we see it. Like, I mean, someone was put on a benzyl and clindomyosin topical.

SPEAKER_01 17:15

Clindomyosin is an antibiotic, benzyl peroxide is is not the same thing.

SPEAKER_00 17:20

But what is that doing, you know? And going back to my story with the client that had like the deer in the head light kind of look, we don't solve acne. And I mean, when I had acne and I was going to the dermatologist as a teenager, and then as like in my 20s, you think you need to dry it out. There's like this common misconception of like, I need to dry the shit out of my face. That way, like I won't have these postules, and like the white heads will go down, and then hopefully like everything will kind of clear. But like the truth is, the more drying things you do, because you clearly have like a higher testosterone going on, so you are a little bit more oilier, your body is gonna be pumping more oil to overcompensate for the dryness that we have now created with those prescription medications. So we want balance. And that is the problem when we see people coming in with prescriptions for their acne because we just don't really feel like it helps. I'm not gonna lie. There are some times when someone comes in on a tritinoin, like they've just got it from their derm, they picked it up from the pharmacy, and it does help. I'm not gonna lie, like it does help. But then I have this problem with the formulation of the compounded tritinoin. One of the first ingredients in it is an extremely poor clogging ingredient, which then we can go into the whole conversation of like what is a pore clogging and what is not, and some people don't believe that scale. But isopropomeritate is like extremely pore clogging and it's like the third ingredient in tretinoin. So you have all these people that are using it and their skin freaks out, and then we tell it say it's like, oh, it's the purging phase, da da da. But one, are they being told to go to an estation to help with like clearing out their skin while they're in that air quote purging phase? Or is this product creating more of a problem for them? And that is what's causing the acne to get worse right now. It's not gonna be like get worse before it gets better kind of thing. This is like a, I think this is actually creating more of a problem. That's my opinion.

SPEAKER_01 18:56

And rot no cacin and retinols are inherently inflammatory, and so it really depends. It's a case-by-case basis. So that's why she's saying some people come in and it's working for them, and then some people come in and it's absolutely not the right answer. It is way too strong, way too aggressive, way too direct for them. They need a more buffered approach. And so some people, you maybe using TRET twice a week and then filling in the other nights with retinol is a better option for you. There's so many different ways to use a vitamin A. That's why just giving a prescription for retino into someone is not the answer. And is I wouldn't put that on my face. And I would definitely strip my skin, it would become imbalance. I would get other types of acne breakouts because of it. And I know that because I've done it, but I wouldn't do it again.

SPEAKER_00 19:36

Oh, we've we've all been, I mean, like I, me personally, I was prescribed doxy. I was prescribed glindomycin, retin A, all the things for my acne, benzyl peroxide, salicylic. Like, oh my god, I remember one derm put me on this like crazy scrub that like you would never use on somebody that was like But it's because they're not spending the time to get the acne out.

SPEAKER_01 19:56

They're like, oh, just scrub it off because they're not gonna remove it from you because a derm is not gonna do a facial on you and renewable acne. I'm sorry. They don't have the time. And that's like they have time, exactly. So we're we have the time. So like let's bridge this gap, guys. Like, this is the job. Go to your psychiatrist, your dermatologist for your prescriptions, go to your aesthetician and your therapist for your long-term benefits. Like it's just like a nutritionist or someone helping you through. Like you need that guidance, and our whole job is to understand these things and to explain it to you.

SPEAKER_00 20:23

But then again, my problem is the shortcuts. And we live in this like immediacy world where like we we rely on Amazon to deliver things to us within like 24 hours and we want results like like that. We want we want quick results. And I believe me, we're all there. We get it. We're impatient. We are an impatient generation, like we have no, we have no patience.

SPEAKER_01 20:43

Look, if you wake up with a huge ass cyst on your face and you're getting married tomorrow, fine. I'm not gonna be mad at you if you go and get a kenalog shot in that I'm not a fan. I do not recommend it nine out of 10 times. That's probably one of the only situations I would ever be like, fine, go do it. But be careful because most of the time you need to treat it and get it removed safely and quickly and easily, and then help it heal and move on so that you never have to deal with it again. But if you're gonna get a kenalog shot in your face or a cortisone shot, which they offer so freely, you need to think twice because that is going to degrade collagen, break down that area. You're not clearing the breakout. So you are going to continue to break out in that area, you're going to have scarring in that area under the surface, and you probably will get pitting.

SPEAKER_00 21:25

So, and so I used to work at a med spa, and that's one of the things that they offered was kenalog. So, kenelog, like she said, is a cortisone. So, what cortisone does is an anti-inflammatory to help to decrease the inflammation from a pimple. Okay. So, what she's saying is like you have prom, you have your wedding, and like it's day of large pimple or the night before, whatever. Fine, you can inject it. But this is not the treatment for every single time you have a white head to inject it because there have been so many pictures that you've seen where the person now has an indent in their skin because they injected too much kenalog, too much cortisone into that pore. And now that pore no longer has the Structure that it needs to stand erect, and now it's a divot, okay? So now you have to wait. Hopefully it gets better with microneedling, with lasers, with peels, but sometimes it doesn't, honestly. Like there was one study I went to a conference and it showed like this huge divot in this woman's forehead. It was, it was horrible. Like I felt so bad for her. But that's because no one warns you of the possible side effect of getting an indent from the cortisone injections. Kenelog is amazing for keloids, like for people that like have an overgrowth of skin cells that cause scarring. Like there are clinical applications for a kenelog injection. Having a pimple or having a breakout is not one of them, in our opinion.

SPEAKER_01 22:36

And I think it's really important to remember that when you are having a breakout like that, it's inflamed on the surface. That is your body trying to fight it. That is the end stage of the pimple. If you don't want a pimple, you need to be doing the right things from the get-go for the most part to maintain your skin health so that you don't get to that point. But that is the end point. Once you do a kenalog shot like that, you're stopping the healing process of your skin and you're basically avoiding it. So that's always going to create a bad outcome in the end. So sure, you might stop that in its process right at the moment. So maybe it looks a little bit better that day. But then you're going to have long-term. I have clients who have sparring from that that they constantly are breaking out in the same spot. And it's going to take probably years for us to break it down, get it cleared out, get it to heal properly fully, so she can stop or he can stop breaking out in that spot. Right. So is it worth it? Not in my opinion. I think there's a lot of other things you can do.

SPEAKER_00 23:27

Yeah. Again, we are not, we are not bashing dermatologists.

SPEAKER_01 23:31

We just want a little more education behind it. Absolutely.

SPEAKER_00 23:34

Like I had a client literally last night who had a milia. Okay. So milia, they take like five to seven years to grow. It's not a pimple, it's a clogged oil gland. It usually comes from using too occlusive of a product or some trauma. And so she had two milia. One on her forehead popped out super easy, no problem. And then one on her chin. She was like, Oh my God, this has been bothering me. My derm has been trying to get it and she can't get it. And I'm like, what do you mean? What did she try to do? She's like, well, she tried to squeeze it and nothing happened. And then she took uh a cautery and tried to burn it off, and then it was still there the next day. You guys, you do not want to burn these things because all your I can't even tell you. I have gone into these, so sebaceous hyperplasia, which is called like a seed milia. I have gone into these ones before where you're taking them out and they're little pearls basically made into like a donut shape. Someone who went to a derm who literally zapped them all, and I've seen other nurses also talk about how they zapp them. What it does is it melts it like so it becomes like a tar-like substance in that it's not a pore, but in that area. And then I have to go in and literally like taffy, pull it out.

SPEAKER_01 24:36

It's basically an overactive oil gland that comes from sun damage most of the time.

SPEAKER_00 24:40

Or it can be genetically.

SPEAKER_01 24:41

Or genetically, if you're extremely oily, people usually have more of it.

SPEAKER_00 24:44

And so it just you burning it, zapping it is not removing it. Again, that is a quick fix. And I think that maybe that's what we're we're not the quick fixers. Like we're here for the long term. We're we're in it for for basically till we die. So those quick fixes are not the answer. And so that is why we wanted to make this podcast today, just kind of discussing like derms versus aestheticians, and like how do we talk about it? Well, we don't want to be rude, we want to be insulting, we want there to be enough for there's enough room at the table for everybody. So why don't we just ask Chat GPT?

SPEAKER_01 25:17

The demonic basically chat GPT for everything, sure. Okay, let's go. Well, just because this is not coming from us, this is what our AI will say. And let's see. Why would I go see a dermatologist versus an aesthetician? Cool. So, okay, I'm nervous. It says dermatologists, they're medical doctors who can diagnose and treat skin diseases, accurate, can prescribe oral and topical medications, absolutely check, perform medical procedures such as biopsies and mole checks. Check, check, and lasers. Cool. And necessary for serious skin conditions like rashes, infections, and unexplained lesions. Cool. Absolutely.

SPEAKER_00 25:56

I 100% agree. You know what, chat? I agree. All right.

SPEAKER_01 25:59

Aestheticians focus on skin health, correction, and cosmetic improvement. They specialize in hands-on treatments, extractions, chemical peels, hydration therapy, and acne management programs.

SPEAKER_02 26:11

Okay.

SPEAKER_01 26:12

Help clients stay consistent with routines and results, offer long-term skin coaching, lifelong guidance, and curated product routines, perfect for maintenance, prevention, and non-medical skin correction.

SPEAKER_00 26:24

Love that. I think that like we didn't even need this podcast. We just needed to open that up. There you go, guys. Bye. But so the point is there's enough room for us all at the table. We want to collaborate. We want the best for our patients. And because we've made it our business to like, we follow up, we check in. You've come to me four days later, I'm texting you. I want to see how do we care? We care. And we're not saying that derms don't care.

SPEAKER_01 26:50

They don't have time to care the way that we do. We make it our job.

SPEAKER_00 26:53

And that is the problem in, I mean, we won't go into that, but like in the medical field, like that is what's happening in medicine is that there's no time for true patient care. And it's not anybody's fault except for insurance's fault, honestly. But that's a whole other topic that we won't get into because that has nothing to do with acne. But there are so many products out there that they get reps that trying to tell them like that.

SPEAKER_01 27:16

We didn't even go there. That's a whole thing.

SPEAKER_00 27:19

I mean, like my derm said that Cera V was good. Yes.

SPEAKER_01 27:23

They are given samples for free for these brands. Is it? Because they are owned by yes, pharmaceutical brands. So there's always a reason that they're recommending those things, and it's not because they're using it in their home. I guarantee you of that. We do not get paid to sell the products we sell. We do not sell products that do not work. The products that we sell are our toolbox. Yeah. And we use them because we know how they work and how they're going to play with other things and how they're going to benefit you. And if they didn't work or caused issues, we would absolutely not have them on our shelves. So that's another reason. Like that is a huge, huge part of our job is to vet products and make sure that they do what they're supposed to do.

SPEAKER_00 28:01

We we are just in a place where we're not doctors and we know that, and that's okay. We didn't go to medical school, that's fine. I'm not trying to be a doctor, but we're not trying to dismiss the knowledge that we've gained over the 13 plus years of dealing with skin in knowing, you know, skin ailments and how to treat them as well. We're not diagnosing, we're not prescribing, but we're creating regimens for you. And we're there for you. We're we're holding your hand along the way. And especially with acne, okay? Like it is a very emotionally traumatizing situation. It's it's a it's a mental health thing, honestly. You know, it's it's debilitating. I remember when I had horrible acne, like I wanted to wear like a veil, like I thought it could be in fashion, like putting one of those things like over your hat, you know what I mean? Like it was horrible. You don't want to be seen. And I I get it. And Gabby, you get it. We've been there before. So it's like having that compassion and empathy and like having been there before, it it makes us understand you better. And so when you do want to go to a derm because you just want that quick fix, we're not gonna stop you because you gotta do what you gotta do. But at the end of the day, we know you're gonna be back. They always are, they always come back. Um, okay. I feel like this was a little serious. Sorry guys, this wasn't as funny as before. But these are just kind of some of the topics that we wanted to discuss because we wanna be polite, we wanna be correct, we wanna be PC, we wanna do all the right things, and we wanna, we don't want to tear other people down because that's not doing anything.

SPEAKER_01 29:29

But we've seen a lot of derms out there tearing other providers down, and I think that's where this all came from is there's there's not a competition, there's room for everyone, and we need to be working together.

SPEAKER_00 29:41

Yeah. My my thought process is that like I think that derms are doing these treatments like prescribing benzoyl peroxide because they think that's or like adaptogent or not adaptants, uh uh like epiduo or whatever like those things are, right? I think they're doing that because that is what they've been told is the gold standard. Of course. And then what's happening is these people are not coming back for follow-up, so they don't know that it's not working. Yeah. So I kind of like, I'm not even blaming them. I just think that like they're just reading it in a textbook, they're seeing that like this is what we're supposed to be doing, and then people are getting disappointed because they're not getting the results, and then they end up going to an esthetician or some skin specialist.

SPEAKER_01 30:15

Yeah, so it that's the only reason I wish they would speak up a little more about what's in their field of expertise and what's not, so that people were not so sorely disappointed. Or this is my thing is I I feel like people are really getting this misconception of their skin and being like, oh, I'm sensitive because my germ gave me these things and I'm really sensitive. And it's like, no, they gave you aggressive stuff, and so anyone would feel sensitive using them, but you're not sensitive, you're using the wrong things for your skin type, or you're not supporting your barrier along with these things. And so that's where I feel like it upsets me because I have clients coming in constantly, like, I have rosacea. I said, Where? I know they saw a little tiny thread because you ran up the stairs on your way to your appointment and now you're flushed and they said you had rosacea. Like, are you kidding me? I know. I said, No, you don't have rosacea. Like, they have no time, they are busy, they are getting you in and out and giving you what they think is proper for your caseload, but they're not going further than that. And so that's where I have the problem where clients are coming in on prescription medications because they're like, Oh, I'm diagnosed with rosacea. I'm diagnosed with perioral dermatitis. They think it's something special. It's not. I'm sorry, it's not special. You're being mistreated, and that's where the misconception comes in. And I wish they would just stay in their lane and not give these confusing endpoints to people or conclusions.

SPEAKER_00 31:32

Like, I have rosacea now.

SPEAKER_01 31:34

Right. The end point of this whole conversation is like we refer to derms when we see things that are outside of our scope. And I wish derms would refer to us when there are things that are that they don't have time to handle.

SPEAKER_00 31:46

Yeah.

SPEAKER_01 31:46

I mean, because not everything's not it's it's in their scope. Sure. If they want to spend all day and fucking talk to you about your health and stuff, fine, but they're not going to. And so it's like, I feel like that's kind of the end point.

SPEAKER_00 31:58

Yeah. I think the problem with this podcast right now, or this episode, excuse me, the podcast has nothing wrong with it. This is an episode. I'm a people pleaser. So it's hard to I don't want to put anybody down, but I also want to point out, like, okay, so the client that I had that went on Accutane, you know how doctors say, like, don't get facials, don't do anything for like three to six months after you get off of Accutane. So she didn't listen, and she was still coming to me actually probably like every two, three weeks, because and she was afraid she's like, Oh my god, the commodones are going down, they're going away, like you need to get them out. Because she could feel them starting to like suck back in. So she was coming in, and I'm able to get them out. They actually were coming out pretty well. So that way of incorporating Accutane plus the extractions, I felt like we're setting ourselves up and herself for success. Yeah. So I again, it's just like there needs to be a collaboration, there needs to be a different perspective on aestheticians. And don't get me wrong, there are other aestheticians that like they do like the holistic y, like the facial massage and like the make you feel good, you know? And I think you and I, the way that we approach skincare, it's we don't make you feel good in the in that moment, but like we make you feel good at the end. Like, you know what I mean? With our with our goals and our treatments and what we've created. Like while you're sitting here, we're torturing you. But like at the end of it, you're gonna be so thankful and you're so grateful, and you're like, oh my god, I never knew I could have skin like this. Like, how many times have people said that to you, right? Like, you've changed my life. Like, literally, you've changed my life. Skin fairy, skin therapist, whatever. So we just want there to be again, room for all of us at the table to then be able to perform and do our job without any type of judgment from any other profession, right? Yeah, a hundred percent. Okay.

SPEAKER_01 33:42

There it's very easy for a dermatologist to say, I'm gonna give you tretino, and it's to address this and this, and then you need to go see an esthetician to work this into the proper routine for you. Yeah, that's all. I mean, I think it's not fucking hard. I think that sounds great. That sounds exact that's exactly what the dialogue should be. That's all the dialogue should be. Because why would a derm, someone who is skin focused, want anything other than success for you and healthy skin?

SPEAKER_00 34:06

No, you're right. So again, we're all here for the same thing. We want to make our patients happy. That's the outcome.

SPEAKER_01 34:11

So yeah. So if you have a germ that's just giving you a bunch of stuff prescriptions and then sending you out the door, go see a professional first and hold on to the prescriptions and they'll tell you. Because sometimes I'll tell you, go fill this and don't fill this. Yeah. I mean, I will do my best to utilize within your budget anything I can get my hands on if it's going to help you. So see an aesthetician first. Think of them as a therapist or someone who's guiding you on this path, and then use the dermatologist in between.

SPEAKER_00 34:38

Absolutely. I love that. All right. Thank you. So on today's episode of Four Decisions, we hope one person learned something because we're depressed now. Yeah. Anyways, okay, tune in next time because we promise we'll it'll be way more fun next time.

SPEAKER_01 34:52

We're not gonna, I'm not gonna do another one of these for a whole year.

SPEAKER_00 35:06

We really want to hear from you guys. So after you listen to the episode today, let us know your comments, questions, concerns. We want to keep this in open dialogue.

SPEAKER_01 35:14

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SPEAKER_00 35:22

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