Written by: Leslie Thompson RN, BSN

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The decision to transition into Aesthetic Nursing was one filled with doubt and grief for me. While many enter the field driven by a desire to enhance beauty, my interest in aesthetics was birthed during a grueling night shift in a busy downtown Baltimore ER. After five years in emergency and critical care, I was forced to confront a painful truth: the passion that once fueled me had faded. I had burnt out.

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A close friend suggested I try aesthetic nursing: “You’d be great at it, you’re such an aesthetic girl!” At the time, I took it offensively. After years in Emergency Nursing, I had worked hard to build a reputation grounded in clinical skill and judgment, not in the image I’d spent so long trying to move beyond. And yet, like a lost wanderer who craved a north star, I decided to consider this suggestion as a way out. As I write this, I have reached my one year mark as an Aesthetic Nurse. And what I’ve realized is that going into Aesthetic Nursing wasn’t a way out; it’s a way in. Here are my reflections on my one year in Aesthetic Nursing.

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The Field is actually NOT superficial– it’s complex at best.
I fought hard against the idea of going into aesthetics because I couldn’t get past its reputation for being superficial. The stereotype of aesthetic nurses as pretty girls who went to nursing school “just” to inject Botox and filler was a tough pill to swallow, especially after earning my place in a specialty like Emergency Medicine, where I felt respected for my skills. I struggled with the idea of trading life-saving interventions for cosmetic procedures. “I don’t feel like it’s real nursing,” I admitted to a mentor. But as I made the transition, I quickly realized how wrong I’d been. Aesthetic nursing required a deep understanding of anatomy, physiology, chemistry, dermatology and even physics. Despite devices being marketed for ease of use, the science behind them was complex. As someone grounded in evidence-based practice, I turned to journals and clinical literature to understand the “why” and “how” behind treatments, making it non-negotiable to base my care on credible, published research.

You’re still a Patient Advocate
One thing I loved about bedside nursing was having a voice. I could speak up, contribute to care plans, and act when my nursing instinct kicked in. Emergency Nursing taught me to tune in to my patients and advocate for what they needed in the moment. I feared Aesthetic Nursing wouldn’t offer that, that it would be all small talk and surface-level concerns. But I was wrong.

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During one of my first shifts, I mentioned to a coworker how painful laser hair removal had been for me in the past. She replied, “Ours is pain-free! No one has complained, except one Indian man. He wanted most of his body done, couldn’t tolerate the treatment and never came back.” That stuck with me. It had hurt me too. What did we have in common? Our skin color. That moment led me to research how melanin affects laser absorption, and I learned that people of color often feel more pain during treatments due to increased heat sensitivity. From there, I began advocating for more appropriate settings, realistic expectations, and client education. Because saying “the higher the power, the better” doesn’t apply to everyone, and it’s our job to know when it doesn’t.

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There are Gaps too
The lack of standardized care and clear regulations hit me hard during the transition. In the ER, I leaned on protocols and policies for safety. In aesthetics, practice varies widely by state, with no dedicated NP programs or standardized training. Nurses often have to hunt for mentors. This inconsistency creates real challenges. How does a new aesthetic nurse know if a mentor’s methods are best practice? What guides clinical decisions in novel situations? This makes it tough to define professional roles and provide high-quality care confidently. For me, navigating this gray area means constantly questioning and seeking the best evidence to protect my patients and my practice.

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The Need for Dermatology
As I submerged myself in aesthetic treatment science and data, it became evident to me that aesthetics should not be without dermatology. Everything we do in aesthetics affects one’s integumentary system. We use heat, needles, and chemicals as tools to get us to the client’s goals, tools that can greatly harm and produce irreversible effects when stewarded incorrectly. Dermatological insight is essential in deciding whether an aesthetic treatment is truly appropriate for the client or if their concerns are better addressed by a dermatology provider (physician, nurse practitioner or physician associate). A lot of times I’ve seen how clients want an easy fix, when the reality is actually seeing a dermatologist first. That is in alignment to the nursing ethical principle of beneficence, guide your clients toward the right resources that will best serve their needs and overall well-being.

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Health Inequalities Remain
I began to recognize the lack of research and device development tailored to patients with darker skin tones and diverse backgrounds in the field of aesthetics. The current technology is based on the Fitzpatrick skin type classification, which offers a limited and outdated framework that fails to capture the broad spectrum of skin tones, particularly in today’s increasingly multiracial populations. Treating darker skin with lasers demands extra caution due to a higher chance of adverse reactions. As a result, people with darker skin have to use lower laser settings, which means more treatment sessions and higher costs. In contrast, their white counterparts can usually get better results faster with fewer treatments, creating a clear inequality in both care and expense.

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After a year in aesthetic nursing, I realize it’s more than skin deep, it’s a powerful platform to advance health equity in a rapidly growing field. As aesthetics gains influence, so does our responsibility as nurses to use our knowledge and judgment to ensure care is safe, inclusive, and accessible for all. And what I now understand is that this journey is my way in, to be a part of shaping a more equitable future beyond the bedside.

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About the Author

Leslie Thompson, RN, BSN, is a nurse practitioner student and registered nurse with six years of professional experience in emergency, critical care, and aesthetics nursing. Her professional interests center on advancing health equity in dermatology, with a particular focus on positioning aesthetics as an integral component of holistic and evidence-based patient care. As a contributor to the Mahogany Dermatology Nursing | Education | Research™ platform, Thompson provides a distinctive perspective on the intersection of dermatology, equity, and clinical practice, offering insights informed by frontline experience and a commitment to innovation in nursing. She can be reached via Instagram @lesquity or LinkedIn.

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© 2025 Leslie Thompson. All rights reserved.

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