How to get started in Aesthetics - My story and advice

Burnt out at bedside and thinking of making the switch to aesthetics? Its more complex than you think and aesthetics isnt for everyone, but can be very rewarding in the long run.

Experience & Employment Contracts

Most aesthetic practices prefer candidates with prior experience; however, some will hire without experience in exchange for a training or employment contract. This is common, as training a new aesthetic nurse is a significant financial investment for employers. Hands-on training courses typically range from $2,000–$5,000, and even with over a decade in aesthetics, I personally invest $10,000–$15,000 annually in continuing education, conferences, and professional development. Aesthetic medicine evolves rapidly, and ongoing education is essential to remain current and safe in practice.

Non-compete clauses are not enforceable in California, though this varies by state. A non-compete typically restricts employment within a certain geographic radius for a specified time after leaving a position. While many non-competes do not hold up in court, it is critical to verify state laws and have all contracts reviewed by a labor attorney prior to signing.

Many nurses experience “sticker shock” when transitioning from hospital-based nursing to aesthetics. Unlike hospitals, aesthetic practices often require clinicians to personally invest in training and professional growth.

Certification

Most hands-on injectable courses issue a certificate of completion, which is often misrepresented as “certification.” Currently, the only recognized aesthetic nursing certification is the Certified Aesthetic Nurse Specialist (CANS) credential, awarded by the Plastic Surgical Nursing Board.

To qualify for CANS, nurses must meet experience requirements (a minimum of two years in aesthetics), pass a comprehensive examination, and fulfill additional criteria. I successfully passed the CANS exam in 2022. At present, there are approximately 600 CANS-certified nurses in the United States. More information is available at ispan.org, and I provide a detailed breakdown of the process on my YouTube channel. Learn more about the CANS certification here: https://youtu.be/AyeApbbneyg?si=Vt2IFLzjzCViLtYL

Read my blog post on the CANS certification here

Where to Apply

Apply broadly and consistently. Recommended job platforms include:

• Jobsnob.net

• Indeed

• LinkedIn

• Titan Aesthetic Recruiting

• medicalspamds.com

  
  

Follow up on applications when possible. In addition, seek out practices with strong reputations—especially those frequented by friends or family—and prioritize offices with positive patient reviews and established credibility. If you are getting interviews but no offers, focus on your interviewing skills.

Compensation Expectations

Many nurses transitioning from hospital roles should anticipate a temporary reduction in pay. In California, entry-level aesthetic RN wages typically range from $30–$35 per hour and NPs $60-$80 per hour depending on location. Mastery of skills, building a loyal clientele, and achieving income parity with hospital nursing can take 2–3 years.

Some nurses leave aesthetics due to lower initial compensation and fewer benefits and ultimately return to hospital settings. Aesthetic nursing should be viewed as a long-term investment, not a short-term financial gain. For context, I left a six-figure home health position with excellent benefits to work in dermatology at $32 per hour plus commission, with limited paid time off.

Aesthetics as a “Side Gig”

While many nurses pursue aesthetics part-time, I personally believe that framing this specialty as a “side gig” diminishes the complexity and responsibility of the work. Aesthetic nursing requires significant financial and time investment, including training, skill development, and patient retention.

Treating aesthetics as a secondary role often delays clinical competency, slows client-building, and extends the timeline for professional growth. While this approach may work for some, it is important to understand that long-term success typically requires full commitment.

Opening Your Own Practice

Due to the competitive nature of aesthetic hiring, some nurses and physician associates open independent practices without prior experience. This path is extremely challenging and carries significant risk. New owners should strongly consider partnering with or hiring an experienced aesthetic clinician (RN, NP, or PA) rather than attempting to become fully independent immediately.

Collaboration, mentorship, and in-person clinical support are essential. Attempting to operate independently without adequate experience often leads to poor patient outcomes, lack of client retention, and damage to professional reputation.

I currently mentor nurses practicing independently without on-site medical directors or adequate support. For those interested in my mentorship program, please contact Info@nursemarisa.com.

Benefits

Comprehensive benefits in aesthetic practices are inconsistent and usually practice dependent. Most private practices and medspas do not offer benefits comparable to hospital systems unless they are large, well-established, and financially able to do so.

Commission Structures

Commission models vary by practice and are becoming less common due to fee-splitting regulations, which differ by state. Clinicians should always verify applicable laws within their jurisdiction.

Good Faith Exams

In many states, registered nurses may perform injectables and laser treatments under physician or advanced practitioner supervision. However, RNs cannot diagnose or prescribe. Therefore, patients must receive a medical clearance—commonly referred to as a good faith exam—from an NP, PA, MD, or DO prior to treatment.

The good faith exam includes a review of medical history, contraindications, and risk assessment, resulting in a diagnosis and treatment plan that serves as medical orders for the RN. These exams are typically required annually. Telemedicine-based good faith exams are available through third-party services and may be appropriate when the supervising practitioner is unavailable; however, they should not replace consistent medical oversight.

Medspa Management

Most clinicians are not formally trained in business management, and many practices suffer from poor operations and high turnover as a result. An ideal practice employs a dedicated practice manager to oversee daily operations, allowing clinicians to focus on patient care. My current practice follows this model, which significantly improves workflow and job satisfaction.

Selecting a Quality Injectable Training Program

When evaluating injectable training courses, consider the following:

• Verify the trainer has extensive aesthetic experience, not just medical credentials

• Verify the trainer has at LEAST 5 years injection experience

• Confirm hands-on training with live models (not observation only)

• Ask how many models you will personally inject

• Inquire about post-training support and follow-up

• For filler courses, ensure training includes hyaluronidase use and complication management

• Confirm that complications and emergency protocols are thoroughly addressed

For more information on the different types of trainings read more here

Interview Questions to Ask

• Is the physician or advanced practitioner on-site?

• Who performs good faith exams for RNs?

• How many patients will I see per day? May I review the schedule?

• Is training provided or reimbursed?

• Are employment contracts required, and are there penalties for early termination?

• Are benefits and a 401(k) offered?

• Are there yearly reviews, oppurtunities for growth and raises?

• Who manages daily operations and administration?

• What is your social media policy? Am I able to build a social media page with before and afters?

Shadowing & Due Diligence

Before accepting a position, request a working interview or shadow day to observe workflow, culture, and safety practices. Additionally, verify the medical license of the physician or owner through your state licensing board to ensure it is active and in good standing.

Final Advice

Be open to entry-level opportunities, as aesthetic positions are competitive. However, never ignore red flags or accept roles that place your license or patients at risk. Early positions may serve as stepping stones, but ethical practice and patient safety must always remain the priority.

My Aesthetic Nursing Background

2009- I graduated from nursing school with a two-year Associate Degree in Nursing (ADN). Although my long-term goal was to obtain a bachelor’s degree, life progressed quickly. Despite this, I built a successful career in aesthetic nursing with an ADN. Upon graduation, I initially aspired to work as an emergency room nurse; however, due to the economic downturn in 2009, many hospitals suspended new graduate programs. As a result, hospital positions were extremely limited for new nurses.

Like many of my classmates who struggled to secure hospital roles, I began my nursing career in home health. I accepted my first position just weeks after learning I was pregnant with my first child. While I appreciated the flexibility and independence home health offered, I quickly realized it was not the right long-term fit for me.

Shortly after obtaining my nursing license, I visited a medical spa for a facial and observed a registered nurse working in the aesthetic setting. This experience sparked my immediate interest, as I had never considered that RNs could practice in medical spas. I began asking questions, applied to that same spa, and—despite not being hired initially—continued applying to aesthetic positions for nearly a year. Eventually, under new ownership, I was hired by that original spa with no prior aesthetic experience and began seeing patients within my first week.

2012- began my first official medspa role, performing laser hair removal, intense pulsed light (IPL), Thermage skin tightening, and B12 injections. It was a high-volume laser-focused practice with minimal training, and I was pressured to treat patients immediately. At the time, I was unaware of the potential risks to patients and my nursing license due to inadequate training. I witnessed patients presenting with burns and poor outcomes, which was alarming and served as a pivotal learning experience.

This role taught me the importance of advocating for both patient safety and my professional license. Due to limited employer-provided training, I invested in my own education by purchasing textbooks and independently studying. I was also fortunate to shadow a nurse practitioner at another location, which further supported my learning.

A few months into this role, I took out a personal loan to attend the National Laser Institute in Scottsdale, Arizona, where I completed a two-day Botox and dermal filler training. The hands-on experience with live models significantly increased my confidence, allowing me to begin injecting patients immediately upon return.

Despite the valuable clinical experience, the practice itself was poorly managed, with frequent scheduling errors, staffing issues, and no physician on-site. “Good faith exams” were conducted improperly by photographing patients rather than completing legally required face-to-face or telemedicine evaluations by an advanced practitioner. Recognizing the legal and ethical risks, and after learning of California Board of Nursing undercover investigations related to improper medical oversight, I began actively seeking positions in dermatology or plastic surgery practices with appropriate physician supervision.

2013–2015- After relocating to a new city, I took a temporary break from aesthetics and returned to home health while pursuing opportunities in dermatology or plastic surgery.

2015- I was hired part-time at a dermatology office while continuing part-time home health work. Unfortunately, the practice did not have sufficient patient volume to provide a consistent schedule.

2017–2020- I was hired full-time as a Cosmetic Registered Nurse at a large dermatology practice with a strong emphasis on aesthetics. This marked a major turning point in my career, allowing me to leave home health permanently. The practice employed five advanced practitioners, over 50 staff members, and operated out of a 10,000-square-foot facility.

The organization invested heavily in staff education, providing ongoing in-office trainings and covering attendance at major conferences, including the Vegas Cosmetic Surgery and Aesthetic Dermatology Conference annually. My scope of practice included injectables, laser treatments, skin tightening procedures, and assisting in the operating room with skin cancer surgeries, lipoma excisions, and cyst removals. I also treated patients with vitiligo and psoriasis using laser therapy.

While the clinical experience was exceptional, the high-volume environment, poor management, and frequent staff turnover led to burnout. I was often pressured to see patients every 15 minutes, and some advanced practitioners declined to perform required good faith exams, creating a high-anxiety and legally risky work environment. I ultimately left this position during the COVID-19 pandemic.

2021–Present- I currently work three days per week in an established aesthetic practice, primarily performing injectables, as well as laser treatments and microneedling. In addition, I hold a per diem position with Lumenis, where I train clinicians on newly purchased laser devices.

Outside of clinical work, I dedicate time to laser and injection trainings, consulting for medical spas, mentoring aesthetic nurses, presenting at aesthetic conferences and developing online educational programs. I currently offer a microneedling course, filler dissolving course, and a beginner neurotoxin course and advanced lower face neuromodulator course through my website. I am also a co-founder of Skin of Color Aesthetics, an online educational platform dedicated to training aesthetic clinicians in the safe and effective treatment of skin of color and ethnic skin types. skinofcoloraesthetics.net

GOOD LUCK WITH YOUR ADVENTURE!!

CONTACT ME FOR MORE INFORMATION AT INFO@NURSEMARISA.COM