The Magic of A Cosmetic Dermatologic Surgery Fellowship

The Road to Fellowship, Paved

The moment I first walked into the dermatology clinic as a medical student at UC Irvine, I knew I wanted to become a dermatologist. It was as though I had stepped into a dream world – a place where patients truly loved their doctors because they helped them achieve results that were tangible to them and the world around them. I witnessed giants in the world of cosmetic dermatology perform what I believed at the time to be magic. With a zap of a laser, browns and reds faded from sight, leaving the surrounding skin unaffected; even the darkest port-wine stain lightened with consecutive treatments. Fractionated resurfacing lasers removed signs of sun damage, leaving behind rejuvenated skin. Injectables transformed aged, hollowed faces into more youthful versions from the past. The patients were happy. The dermatologists were happy. I was happy.

The magic continued into my dermatology residency. Trained by some of the most brilliant minds and trailblazers in dermatopathology and complex, medical, pediatric, and surgical dermatology, I learned to provide the highest quality of dermatologic care. Yet, I could not help but feel disempowered. I was capable of clearing acne but unarmed with devices to manage complications such as scarring. I treated papulopustular rosacea but was forced to refer for laser treatment of the erythematotelangiectatic component. I was proficient in skin cancer surgery yet incapable of managing most post-surgical scars. I treated countless patients with pseudofolliculitis barbae and hidradenitis suppurativa in the absence of devices for laser hair removal. These are just a few of many examples that opened my eyes to the possibility of fellowship.

Owning My Specialty

Dermatologists are, and have always been, at the forefront of innovation in cosmetics.¹ Procedures such as hair transplantation, tumescent liposuction, neurotoxin for facial rhytids, soft tissue augmentation, and lasers and energy-based devices were all developed by dermatologists.² Yet, cosmetic dermatology comprises the smallest subset of most dermatology resident curricula.² As society experiences an unprecedented rise in cosmetic procedures,³ patients will continue to ask their dermatologists for these treatments, and many will find it difficult to accept the artificial division between medical and cosmetic dermatology.

Dermatologists must acquire the skillset to meet patients’ needs, or someone else will. In the current state, dermatologists are being stripped of their specialty, and many would argue that we are giving it away. Medical spas have warped the landscape of cosmetics,⁴ and untrained practitioners offering risky procedures have resulted in an increase in complications.^5,6 As a young dermatologist entering this space, I aspired to meet the growing cosmetic needs of my patients, becoming a dermatologist who can treat the skin holistically.

My decision to apply for an American Society of Dermatologic Surgery (ASDS)-accredited Cosmetic Dermatologic Surgery Fellowship was born from my desire to own my specialty as a general, surgical, and cosmetic dermatologist. This decision was fortified by my love for research and interest in innovation in aesthetics. When attending conferences and meeting experts in the field, I found myself at home in the cosmetic dermatology community and began to reimagine my career as an expert and key opinion leader. I was excited with the prospects of interfacing with industry partners to develop and study emerging lasers, energy-based devices, injectables, and body contouring techniques. Driven by patient’s desires for more effective, less invasive treatments with minimal downtime, developments in cosmetics have and will continue to astonish – and I wanted to be part of the magic.

A Day in the Life of a Laser and Cosmetics Fellow

As the current Laser and Cosmetic Dermatologic Surgery Fellow at SkinCare Physicians, I am fortunate to train under the leading authorities and pioneers in the field of cosmetic dermatology, Drs. Kenneth Arndt, Jeffrey Dover, Michael Kaminer, Thomas Rohrer, Karen Kim, Brooke Sikora, Laura Morton, and Prasanthi Kandula. I see more than 200 cosmetic patients in a week who receive a combination of soft tissue augmentation, neurotoxin, sclerotherapy, vascular or pigmented laser, laser resurfacing, body contouring, radiofrequency devices and other energy-based devices. I conduct cosmetic consultations and learn to choose and counsel patients on the appropriate treatments to adequately address their cosmetic concerns. Unique to my fellowship, I spend one half day per week training in Mohs Micrographic Surgery. After hours, my co-fellow and I perform patient injections under supervision, and we meet with industry representatives for in-services on new devices or injectables. We also hold a monthly journal club to discuss the latest publications in cosmetic and surgical dermatology with our mentors.

Another unique training experience at SkinCare Physicians has been learning the intersection between the practice and business of dermatology – an important skill not taught in residency. Board-certified dermatologists are groomed to successfully identify and manage more than 3,000 skin conditions, yet basic business acumen remains an afterthought. After residency, dermatologists are left to learn the nuances of navigating the inherent difficulties of thriving in a real-world practice. Since its inception in 2000, SkinCare Physicians has grown to be a national premiere practice for general dermatology, surgical dermatology, and laser and cosmetic surgery, and the pillars of its success are evident to patients and staff alike. From cultivating a friendly work environment, to handling complicated patient encounters, to device or product investment, fellowship has afforded me the opportunity to learn firsthand the principles of managing or working in a successful cosmetic dermatology practice.

Another highlight of my fellowship has been my role as a sub-investigator for clinical trials conducted at SkinCare Physicians. Experiencing site initiation visits, treating research patients, performing study assessments, and learning about new investigational treatments have been exciting additions to my training. New technologies will continue to enter the arena of aesthetic dermatology; understanding the process of device and product research, development, and approval is crucial expert knowledge.

Who Should Consider Laser and Cosmetic Fellowship?

Fellowship training in laser and cosmetic dermatology is a prerequisite for early-career dermatologists seeking to become true experts, key opinion leaders, and innovators in the field. Yet, the magic of fellowship training extends beyond expertise.⁷ Fellowship provides an invaluable network of esteemed dermatologists who serve as lifelong mentors and friends. It builds the confidence, aptitude, and empathy required to delicately treat patients’ cosmetic concerns.7 Importantly, it provides the tools to flourish as a leader in the everchanging landscape of aesthetics and spread the magic to patients or, just maybe, to an unsuspecting medical student.

1. Bangash HK, Eisen DB, Armstrong AW, Nelson AA, et al. Who are the pioneers? A critical analysis of innovation and expertise in cutaneous noninvasive and minimally invasive cosmetic and surgical procedures. Dermatol Surg. 2016;42:335–51.

2. Waldman A, Sobanko JF Alam M. Practice and educational gaps in cosmetic dermatologic surgery. Dermatol Clin. 2016;34(3):341-346.

3. American Society for Dermatologic Surgery. Survey on dermatologic procedures: Report of 2019 procedures. https://www.asds.net/portals/0/PDF/procedures-survey-results-presentation- 2019.pdf. Accessed November 13, 2022.

4. Valiga A, Albornoz CA, Chitsazzadeh V, et al. Medical spa facilities and nonphysician operators in aesthetics. Clin Dermatol. 2022;40(3):239-243.

5. Jalian HR, Jalian CA, Avram MM. Common causes of injury and legal action in laser surgery. JAMA Dermatol. 2013;149(2):188-93.

6. Wang JV, Albornoz CA, Goldbach H, Mesinkovska N, et al. Experiences with medical spas and associated complications: a survey of aesthetic practitioners. Dermatol Surg. 2020;46: 1543–8.

7. Saedi N, Dover JS, Arndt K, Kaminer M, Rohrer TE, Poon E, Alam M. Why do a fellowship in advanced dermatologic surgery? Derm Surg. 2018;44(6):899-902.