ENCosmetology in Germany works differently from what advertising suggests: what matters is not the devices but who may work on the skin and who is responsible. Some procedures are reserved by law for doctors; others require certified training.
This page covers the field, who runs the appointment, which treatments are medical and what comes with them: an assessment, a written record and a follow-up date. For a skin disease rather than appearance, see dermatology in Germany.
Who runs a cosmetic appointment
A cosmetic appointment in Germany is run by a doctor, usually a dermatologist and sometimes a plastic surgeon; there is no separate medical specialty of cosmetology. The beautician (Kosmetiker/in) is a state-recognised but non-medical occupation: skin care, not injections. Some injections may also be given by a Heilpraktiker, licensed by the state to practise healing without being a doctor.
Every procedure therefore starts with a conversation about indications, contraindications, medication and allergies. German civil law (section 630e BGB) requires the doctor to explain risks and chances of success orally, in good time and understandably; consent is usually signed and the treatment recorded, so that if anything goes wrong, the notes show what was injected where.
At a first appointment the doctor examines the skin under good light, sometimes checks moles with a dermatoscope, asks what the person wants and says honestly what is achievable; he is not obliged to perform a procedure he considers medically unjustified.
Injectable treatments
Injectable treatments include botulinum toxin, hyaluronic acid fillers, mesotherapy and injections of plasma from the patient’s own blood. Botulinum toxin is a prescription-only medicine prescribed only by doctors or dentists, so a doctor injects it. Fillers are medical devices sold without prescription; doctors and Heilpraktiker may inject them, beauticians may not, because courts treat filler injections as practising healing, which needs a licence.
A session involves marking, numbing with cream or cold, fine injections and observation afterwards; swelling, bruising and tightness are normal at first. Call the doctor at once if pain increases, skin turns white or bluish, or vision changes: filler may have blocked a vessel. The Federal Institute for Drugs and Medical Devices (BfArM) warns in its guidance on filler risks that this can cause complete loss of vision.
An honest doctor does not promise a permanent result: botulinum toxin wears off and hyaluronic acid is absorbed. Nor will he promise perfect symmetry or that an injection can replace surgery, which is what removes excess skin; see plastic surgery in Germany.
Device-based treatments
Device-based treatments include laser resurfacing for uneven texture, fine lines and acne scars; vascular and pigment lasers and IPL (intense pulsed light) for visible vessels and pigment spots; and radiofrequency and ultrasound, which heat tissue under the skin to firm it, with varying effect.
Device treatments have a medical side: wrong settings or unsuitable skin can cause burns, lasting colour changes and scars, more often on darker or tanned skin. So the doctor assesses the phototype (how skin reacts to sun) and discusses sun protection first. Since 31 December 2020 the NiSV regulation has reserved for trained doctors resurfacing that removes skin and other skin-breaking procedures, treatment of vessels and pigment spots, tattoo removal, fat reduction and targeted thermal coagulation of tissue by ultrasound; other procedures require certified competence.
A course means several sessions at intervals, an interim review and before-and-after photos under identical lighting. The result is judged only after several weeks, once the skin has healed; if it disappoints, the settings or method change at the follow-up, or the doctor says the device has nothing more to offer.
When cosmetology becomes treatment
Some reasons for coming are dermatology, not aesthetics: acne and its scars, rosacea, scars after surgery or burns, marked hair loss, changed moles. Diagnosis then comes first, and the procedure follows from it.
Germany keeps the two tracks apart because this decides who looks after the patient and which documents are issued: a dermatologist manages a skin disease with a diagnosis, treatment and a report, while an aesthetic procedure has its own consent and invoice.
Timing and what to ask in advance
Short procedures such as injections are often done on the day of the appointment if the patient has had time to decide calmly. Laser courses need repeat visits, and resurfaced skin must heal before a flight or sun exposure, so plan for this.
Before booking, ask who will see you and their specialty, which product or device is used, what the invoice covers and when the follow-up is. For costs, see cosmetology prices in Germany, the botox price in Germany and the CO2 laser resurfacing cost in Germany.
Frequently asked questions
Who may inject botox and fillers in Germany?
A doctor injects botulinum toxin: it is a prescription-only medicine prescribed only by doctors or dentists. Hyaluronic acid fillers are sold without prescription as medical devices; the law allows doctors and Heilpraktiker, but not beauticians, to inject them. BfArM recommends leaving such treatments to qualified medical staff.
Can a non-doctor perform laser treatments?
Yes, but not all of them. Under the NiSV regulation, resurfacing that removes skin, treatment of vessels and pigment spots, tattoo removal and other skin-breaking procedures are for doctors only. Laser or IPL hair removal may be done by a non-doctor who has passed the prescribed training; ask to see the certificate.
Why don’t German clinics show before-and-after photos?
Because the German law on healthcare advertising (HWG) bans before-and-after comparisons in ads for aesthetic operations without medical necessity, and the Federal Court of Justice has ruled that this covers hyaluronic acid injections that reshape the nose or chin. Photos for the medical record are documentation, not advertising.
What documents do patients receive after a procedure?
Patients receive copies of everything they signed, such as the consent form. The doctor records what was done, including the product or device and the area treated. By law patients may inspect their file and request a copy; the first copy is free.
How AlenMed arranges a cosmetology appointment in Germany
AlenMed finds a doctor, usually a dermatologist or plastic surgeon, and a date, obtains a written estimate before the trip and helps with the visa invitation. An interpreter attends the consultation so that nothing is signed unread.
How many days to allow for recovery depends on the procedure, and the doctor will tell you. We help you obtain the report and aftercare instructions in a language you read and pass any later questions on to the doctor.
This material is for information only and is not an offer; the indication and method are decided by a doctor in person.