Best Aesthetic Providers in District of Columbia

Three treatment levels in a 2014 Board policy

The D.C. Board of Medicine addressed cosmetic medicine in a 2014 Board policy, Policy No. 15-02 on the Practice of Aesthetic Medicine, dated November 13, 2014. It sorts treatments into three levels and says the higher two, Level II and Level III, may be performed only as part of a medical practice.

Tox (neurotoxins; FDA-approved cosmetic brands include Botox Cosmetic, Dysport, Xeomin, Jeuveau, Daxxify and Letybo) and dermal fillers are both Level III procedures under the policy. The policy says Level II and Level III procedures may be performed only by persons authorized to practice medicine under D.C. law, and only as part of a medical practice. It also says each practitioner should have the education, training and experience to perform these procedures.

One important caveat: the Board wrote that until it issues regulations, the policy is "a directive in nature and not mandatory." Treat it as the Board's stated expectations, not a binding rulebook. Before booking an injection, ask who will inject you, what license they hold and which physician oversees the practice.

What makes a med spa in the District

The 2014 policy defines a medical spa as any facility where Level II or Level III aesthetic procedures are done. It expects a medical director to be physically present at least 50 percent of the facility's weekly operating hours.

Laser and light treatments fall in the medical tiers: non-ablative lasers for hair removal and intense pulsed light (IPL) for the skin are Level II, while ablative and vaporizing lasers are Level III. Under the policy's guidance, that places laser hair removal, IPL skin treatments and ablative laser work inside a medical practice.

Basic and master estheticians

The District licenses estheticians at two levels: a basic esthetician license and a master esthetician license, issued by the Board of Barber and Cosmetology. A master esthetician applicant must provide a copy of a current basic esthetician license.

Basic esthetics covers cosmetic skin care such as cleansing, masks, manual extraction, waxing, tweezing and chemical exfoliation, and it is not for treating medical conditions. Hair removal by a basic esthetician must use methods other than electrolysis, laser or intense pulsed light.

Master-level esthetics adds body wraps, hydrotherapy, microdermabrasion, advanced extraction with a lancet, lymphatic massage and Board-approved devices. A master esthetician may do this work for non-cosmetic purposes only under the supervision of a licensed health care practitioner acting within the scope of that practitioner's license.

Board licensees may not use exfoliating products or devices that affect more than the top layer of the epidermis. "Medical esthetician" is not a license in the District or anywhere else, so ask which license a provider actually holds.

How EAG ranks providers in the District

EAG independently evaluates injectors, plastic surgeons, estheticians and laser specialists in the District of Columbia, and payment never affects placement. The rules above are general information, not legal advice, and they can change, so confirm with the relevant board. Check a physician's, PA's or nurse's license through DC Health's license verification page, and an esthetician's through the DLCP Board of Barber and Cosmetology, which links to its license search.