Cosmetic dermatology is a medical specialty focused on the health and aesthetic appearance of the skin, hair, and nails. Practitioners in this field are experts in diagnosing and treating a wide array of skin conditions, ranging from chronic diseases to concerns related to aging and sun damage. The scope of the field encompasses prescribing topical medications, oral treatments, and performing highly advanced, technology-driven interventions. The primary goal is to prioritize the overall health of the skin alongside any desired cosmetic improvements.
The Scope of Dermatologic Surgery
Cosmetic dermatologists, particularly those with specialized fellowship training, perform a variety of surgical procedures. These procedures focus on the skin and underlying fat layer, often performed in an outpatient setting using local anesthesia. A significant surgical area is the excision of benign growths and skin cancers, including moles, cysts, and basal cell or squamous cell carcinomas.
Mohs micrographic surgery is a precise technique for removing skin cancer layer by layer while preserving the maximum amount of healthy tissue. Following Mohs removal, the dermatologic surgeon frequently performs reconstructive surgery using techniques like primary closures, skin grafts, or local tissue flaps to repair the resulting wound. This reconstruction ensures both functional integrity and optimal cosmetic outcomes.
Dermatologic surgeons also perform tumescent liposuction, a technique they pioneered that uses large volumes of dilute local anesthetic to safely remove localized fat deposits for body contouring. This method allows for the removal of fat with reduced risk compared to traditional liposuction.
Furthermore, surgical techniques such as subcision are used for scar revision. This involves using a needle or cannula to break up fibrous bands tethering a scar to the underlying tissue, improving skin texture and appearance.
Minimally Invasive Cosmetic Procedures
The majority of a cosmetic dermatologist’s practice involves procedures that do not require surgical incisions, offering significant aesthetic improvement with minimal recovery time. These procedures include injectables, which are divided into neuromodulators and dermal fillers.
Neuromodulators, such as botulinum toxin type A, are injected into specific facial muscles. They function by blocking the release of the neurotransmitter acetylcholine, which temporarily weakens the muscle contraction that causes dynamic wrinkles.
Dermal fillers restore lost volume and stimulate tissue regeneration. The most common fillers use hyaluronic acid, a molecule that naturally occurs in the skin, which attracts and binds water to physically plump the treated area. Other types, known as biostimulatory fillers, utilize materials like calcium hydroxylapatite to encourage the body’s fibroblasts to produce new collagen over time.
Dermatologists also use energy-based devices, including radiofrequency and ultrasound, to tighten skin. These devices deliver controlled heat into the dermis to stimulate the production of new collagen and elastin fibers. Laser treatments are also utilized for resurfacing and pigmentation issues. Ablative lasers, like the CO2 laser, vaporize the outer layer of skin to promote significant resurfacing. Non-ablative lasers heat the underlying tissue without damaging the surface, offering less downtime for treating issues like fine lines and pigmentation.
Defining the Difference: Dermatologists vs. Plastic Surgeons
The distinction between a cosmetic dermatologist and a plastic surgeon lies primarily in the focus and depth of their specialized training. Dermatologists undergo a residency centered on the pathology, function, and treatment of the skin, hair, and nails, including both medical and surgical aspects. Their surgical procedures are typically limited to the skin and subcutaneous layer, often performed with local anesthesia.
Plastic surgeons complete a longer residency involving extensive training in general surgery, followed by specialization in the reconstruction and alteration of deeper tissue, muscle, and bone.
While both specialists may perform procedures like injectables, plastic surgeons handle large-scale, invasive surgeries that require general anesthesia and extensive tissue manipulation. Procedures typically reserved for plastic surgeons include full surgical facelifts, deep tissue body contouring (such as tummy tucks or deep-plane liposuction), breast augmentation, and complex facial bone or cartilage reconstruction like rhinoplasty.