The Past, Present and Future of Medical Aesthetics, Part I

Posted By Madilyn Moeller, Tuesday, May 21, 2024

QP Past Present Future- medical professionals wearing gloves, handling syringes

By Michael Meyer

For some, it’s difficult to remember a time when medical aesthetics wasn’t a part of our lives. In reality, however, it is an industry that has come of age relatively recently. Sure, there have been treatments that we now recognize as part of medical aesthetics that have been performed since ancient times, but it hasn’t been until recently that it’s all come together as the industry that we know now. What are the steps we’ve taken to get here, and how can we make sure that medical aesthetics continues to grow and thrive? Here is a look at the past, present and future of medical aesthetics.


Medical aesthetics is inextricably linked to plastic surgery, and, famously, surgeons have been practicing plastic surgery since ancient times. Records of procedures we can recognize as plastic surgery have been found from ancient Egypt, and ancient Indian doctors are known to have performed surgeries that are recognizable as rhinoplasties. Doctors in ancient China and Rome also performed surgical procedures that were designed to improve the appearance of their patients.

As time progressed, surgical techniques like these were refined and made their way around the world. Additionally, non-invasive procedures were created—even some that we recognize today as key parts of the modern medical aesthetics industry. For example, in Victorian times, aesthetics patients were receiving filler treatments, although instead of hyaluronic acid and other substances that are found in modern fillers, injectors at the time used materials such as paraffin. If you’ve seen what happens to paraffin near an open flame, you can imagine why we no longer use paraffin as a filler.

In the 20th century, reconstructive plastic surgery became a more visible part of everyday life, as modern warfare found new ways to harm soldiers, and many of those soldiers had to return home to continue their lives in much different states than they were in previously. In the 1970s, doctors began using lasers for medical purposes, and cosmetic plastic surgery became a sensation in the 1980s and 1990s. However, it was a seemingly benign U.S. Food and Drug Administration (FDA) approval in 2002 that truly marked the beginning of medical aesthetics as an industry, setting the stage for the explosion of the multi-billion-dollar business we know today.

Early days

Allergan’s botulinum toxin formulation was initially approved by the FDA for treatment of strabismus (misalignment of the eyes), blepharospasm (uncontrollable eyelid twitching) and hemifacial spasm; it was subsequently rebranded as “Botox.” Around this same time, several doctors were experimenting with it as a cosmetic treatment, treating fine lines and wrinkles in multiple areas of patients’ faces. Of course, in the next decade, Botox would grow in popularity as more doctors conducted research and provided off-label treatments to patients, and finally, in 2002, the FDA approved Botox for cosmetic use. This marked a turning point in medical aesthetics as we know it.

“I started working with a plastic surgeon about 24 years ago, and he built one of the first ambulatory surgery centers that had a medical spa attached to it,” says Georgia Cirese, RN, CANS, owner of Georgous Aesthetic Bar in Kansas City, Missouri. “Once Botox got FDA approved in 2002, we kind of self-taught ourselves.”

The injectors of the time weren’t starting from zero with Botox—they had experience with injecting fillers, but the world of fillers was much different than the one we know today. The approval of Restylane in 2004 helped progress the industry even further.

“The fillers back then were bovine collagen,” Cirese says. “We had to skin test everybody. So, when Restylane hit the market, being a hyaluronic acid filler, that was revolutionary in the sense that we didn’t have to skin test anymore. It lasted six to nine months. Aesthetic medicine was very young, and I still today say aesthetic medicine is pretty young because it’s growing very fast, and there are so many other options today—so many neuromodulators, dermal fillers, lasers, skin care options. It’s a vast array of products and procedures.”

These and other non-surgical aesthetics treatments became immensely popular in the early 2000s, which was great for the people providing them, but demand soon outstripped supply, and the need to effectively train more providers soon became undeniable.

“I started working at Dr. Steven Dayan’s practice in 2006, and I was just hired to run his medical spa,” says Terri Wojak, LE, owner of Aesthetics Exposed Education. “The first week there, I was talking with Dr. Dayan about how there’s no education for estheticians who want to work in the medical field. I was like, I’ve been trying to do that. And he’s like, ‘Well, why don’t you put something together?’ And I go, ‘Okay.’ Rolled my eyes. I just got hired to run your medical spa, and I’m going to put together an education course? Right. And then the next week he’s like, ‘Are you working on that course?’ I’m like, ‘Seriously?’ And then I was like, ‘Oh, why not?’ So, I started researching how to do it, and I put together my first 10-hour class, and then it kept growing from there.”

In addition to having a lack of training options, the young industry also faced a knowledge gap when it came to legal compliance, and practitioners’ and entrepreneurs’ livelihoods depended on filling that gap as quickly as possible.

“I started my own law firm, and one of the first clients who walked in the door was this nurse who owned a medical spa in the southern suburbs of Chicago and was killing it, making several million dollars a year,” said Alex Thiersch, JD, founder and CEO of the American Med Spa Association (AmSpa). “The medical spa was being investigated by the state of Illinois for unauthorized practice of medicine, improper ownership—all the things that we always talk about. Right. She was desperate for help because she realized that her license was on the line.”

Thiersch’s client’s story was extremely common in the early days of the medical aesthetics industry as we know it, but medical spa professionals simply didn’t know what laws they needed to follow.

“She had partnered with this physician who was her medical director,” Thiersch says. “She opened this medical spa and was doing all these treatments—laser treatments, injectables, what have you. And she had no idea that the doctor needed to be on site and needed to be seeing new patients. She said all the other people in the industry that she knew were doing it the exact same way. She was very confused and upset and didn’t understand what was going on. That was literally the first time I had heard of a medical spa, and I really knew nothing about health care regulatory law or anything at this point. So, I had to bring in another attorney who had represented people before the state boards, and with her help and with the help of this nurse, I just was introduced to the industry, the treatments, the finances, and the ups and downs of medical aesthetics.”

Stay tuned for Part II!

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