Why one appointment can be both medical and cosmetic

Dermatology sits in an unusual position. In most specialties, the reason you came and the way the visit is handled are the same question. Here they are two questions, and a single appointment can contain both kinds of answer.

It is worth understanding before you arrive, because it affects what to bring, what to ask, and what you will be asked at the desk.

The two kinds of visit

Medical dermatology is the diagnosis and treatment of a condition. A changing mole, a rash, acne, psoriasis, eczema, hair loss, a suspicious lesion, hyperhidrosis, a skin cancer. The whole of our conditions list is this category. These visits run like any other specialist appointment: you have a complaint, it is examined, it is diagnosed, it is treated, and it is billed to your insurance in the ordinary way.

Cosmetic dermatology addresses something that is not a medical problem — a line, a loss of volume, texture, laxity, the colour of a scar that has healed perfectly well. There is nothing wrong, and the aim is a change in appearance. This category is paid out of pocket, as it is everywhere, and it is the one our payment plans exist for.

Where the line actually falls

Not where most people expect, and not always where it intuitively should.

Acne is medical. The scarring left behind by acne is usually cosmetic. A mole that has changed is medical; the same mole removed because you dislike how it looks on your shoulder is cosmetic. Excess sweating is medical. Rosacea is medical, and the persistent redness it leaves behind frequently is not.

Which means the same word can describe either. "I want this treated" said about a scar, a mole or a patch of redness does not tell us which conversation we are having, and the honest answer is sometimes that it is both — the condition is medical, and one of the things you would like addressed afterwards is not.

Why you get asked at the desk

Because the two are documented and handled separately, and because the question is far better asked at the start than discovered at the end.

A visit can legitimately contain both. You can come in about a rash, have it diagnosed and treated, and ask about something cosmetic in the same appointment — that is routine and nobody minds. What is not possible is folding the second into the first, and the point of asking early is so that you know which part of the visit is which before anything is done, rather than being told afterwards.

If you came for one and want to ask about the other, say so. It is a normal request and the answer is almost always yes.

What to bring

For a medical visit: your insurance card, a photo ID, a list of your current medications and supplements, the name of your primary care doctor, and anything previously prescribed for the problem. If there are records or pathology from somewhere else, those too — a prior biopsy result changes decisions.

For a cosmetic visit: a clear sense of what bothers you, which is more useful than a procedure name. "This line, when I am not moving my face" leads to a better plan than "I think I want filler", because the first describes the problem and the second has already guessed the answer. Photographs of yourself from a few years ago are genuinely helpful.

For either: a realistic account of what you have already tried. It saves a visit.

Two practical notes

A cosmetic consultation is a real appointment. It takes time, it involves an examination, and it ends with a plan. Practices handle them in different ways and it is a fair thing to ask about when you book.

Insurance is between you and your plan. What any particular plan covers for any particular diagnosis is specific to that plan, and the only reliable answer comes from them. What we can do is tell you clearly which category a given treatment falls into, which is the part people most often cannot find out until it is too late to matter.

The full set of what to bring, how to pay, and how to reach us is on the patient resources page.