How and why did I get into the aesthetics business? Easy answer: I turned 40. I had never heard of Botox, much less any of the other products or services I now offer in my practice. I had become interested in skin care for myself, and this interest peaked after a visit to the plastic surgeon's office for my sagging eyelids. I was told, "No, you don't need that yet; try this Retin-A product."

Shortly afterward, I came to a crossroads in my career. I saw an advertisement for aesthetics training, and off I went to learn how to perform sclerotherapy, chemical peels, microdermabrasion and dermal filler injections.

The real journey began after I completed my training and decided to open my own practice. I share with you here some of the good, the bad and the ugly. As you ponder aesthetics as a new career path, I hope this real-life experience is useful.

The Good

• This business is a cash one. You have no reimbursement or insurance headaches because cosmetic procedures are not covered under most insurance policies.
• Your patients aren't sick. Most of them are conscientious about their appearance, exercise and health status.
• You have no call duty. You do not have to provide coverage for anyone, nor does anyone have to provide coverage for you. I provide my cell phone number to my patients and receive an average of one phone call per month ? usually to answer a question about postprocedure care.
• The work is fun and satisfying. It is a pleasure to assist in the improvement of self-esteem by smoothing scars with a laser or erasing years with Botox injection. And it's particularly rewarding to reduce hair growth on a teenager's upper lip or help clear up acne.
• You choose what you will do. You can provide a few or many services.
• Malpractice risks are minimal. As long as you obtain and master appropriate training, aesthetic practice is associated with fairly low risk.
• Aesthetic services are more accepted by the general public today. Mothers bring daughters, daughters bring mothers, wives bring husbands, sisters bring sisters, friends refer each other, etc. In the past, we couldn't get people to talk about these services. Today, it's much more acceptable - and in fact a common topic of conversation.

The Bad

• When the economy is good, business is good. When it slumps, your income does as well.
• Malpractice insurance coverage is tough to obtain for nurse practitioners who provide aesthetic services - unless your state has a patient compensation fund. (Read more about this issue in Lebo S. Insuring your aesthetics practice. ADVANCE for Nurse Practitioners. 2007;15[2]:21).
• So far, no association has formed to represent NPs who specialize in aesthetics (the Association of Medical Esthetic Nurses [AMEN] is open to all levels of nurses; visit www.amen-usa.org). Meanwhile, you can join aesthetics organizations designed primarily for physicians.
• No nurse practitioner certification for aesthetics is available, but AMEN is developing one for nurses (which NPs are eligible to pursue).
• Additional training in aesthetics can be expensive, especially if you opt to provide multiple services.
• Depending on the state, it may be difficult to find a collaborating physician who is willing to provide backup for aesthetic services.
• Treatment modalities such as Botox, Restylane, Juvederm and Radiesse are expensive to keep in stock, and you must have them on hand to provide the service when a patient requests it.
• Unless you already have a patient base that can afford aesthetic services, you must develop a new clientele.
• If you opt to provide laser services, you must purchase or lease a machine. This will be your biggest expense.

The Ugly

• Some patients have unrealistic expectations about the results that can be achieved. Although you may provide thorough education in this regard, some tend not to hear what you're saying.
• Some of your NP peers may be less than supportive of your choice of specialty. Be prepared for that.
• While aesthetics is an exciting clinical focus, it is not for the faint of heart. It has taken me 5 years to get to a profitable point. Much of my financial success has to do with my collaborating physician, a well-respected female plastic surgeon.

If you choose to add aesthetic services or open your own practice, formal training is imperative to ensure that you represent our profession in the best light.

Cynthia Cobb is a women's health nurse practitioner who provides a full range of aesthetic services. She is an owner of Coccolare, a medical spa in Lafayette, La. E-mail her at cajuncobbs@aol.com.