Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Nonphysician Practice of Cosmetic Dermatology

A Patient and Physician Perspective of Outcomes and Adverse Events

Rossi, Anthony M., MD*; Wilson, Britney, BA, MBS*; Hibler, Brian P., MD*; Drake, Lynn A., MD

doi: 10.1097/DSS.0000000000001829
Original Article

BACKGROUND Nonphysicians are expanding practice into specialty medicine. There are limited studies on patient and physician perspectives as well as safety outcomes regarding the nonphysician practice of cosmetic procedures.

OBJECTIVE To identify the patient (consumer) and physician perspective on preferences, adverse events, and outcomes following cosmetic dermatology procedures performed by physicians and nonphysicians.

MATERIALS AND METHODS Internet-based surveys were administered to consumers of cosmetic procedures and physician members of the American Society for Dermatologic Surgery. Descriptive statistics and graphical methods were used to assess responses. Comparisons between groups were based on contingency chi-square analyses and Fisher exact tests.

RESULTS Two thousand one hundred sixteen commenced the patient survey with 401 having had a cosmetic procedure performed. Fifty adverse events were reported. A higher number of burns and discoloration occurred in the nonphysician–treated group and took place more often in a spa setting. Individuals seeing nonphysicians cited motivating factors such as level of licensure (type) of nonphysician, a referral from a friend, price, and the location of the practitioner. Improper technique by the nonphysician was cited most as a reason for the adverse event. Both groups agree that more regulation should be placed on who can perform cosmetic procedures. Recall bias associated with survey data.

CONCLUSION Patients treated by nonphysicians experienced more burns and discoloration compared with physicians, and they are encountering these nonphysicians outside a traditional medical office, which are important from a patient safety and regulatory standpoint. Motivating factors for patients seeking cosmetic procedures may also factor into the choice of provider.

KEY POINTS Both patients and physicians think more regulation should be in place on who can perform cosmetic procedures. More adverse events such as burns and discolorations occurred with patients seeing nonphysicians compared with those seeing physicians. In addition, for those seeing nonphysicians, a majority of these encounters took place in spa settings. Patient safety is of utmost concern when it comes to elective cosmetic medical procedures. More adverse events and encounters occurring outside traditional medical settings when nonphysicians performed these procedures call into question the required training and oversight needed for such procedures.

*Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York;

Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts

Address correspondence and reprint requests to: Anthony M. Rossi, MD, Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, 4th Floor, New York, NY 10022, or e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Supported by the American Society for Dermatologic Surgery—Future Leaders' Network as well as in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

The authors have indicated no significant interest with commercial supporters with regard to this study.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website