Over the last three and half-decade of my life, I have seen the changes in dermatology and marked paradigm shift towards procedural dermatology and cosmetic dermatology. Dermatosurgery clinics started in 1996, and lasers were procured in 2009, setting the tone for laser and cosmetic dermatology at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. Cosmetic dermatology (aesthetic medicine/medical aesthetics) has now been recognized as a sub-specialty of dermatology. Dermatologists have supremacy over other aesthetic practitioners as they also treat visible as well as stigmatizing skin disorders. In the last two decades in India, more and more women are taking up dermatology to pursue aesthetic practice. Women in dermatology have started their association, the Women’s Dermatologic Society, and their journal, International Journal of Women’s Dermatology (IJWD). Skin lightening products are overwhelmingly used by women and are one of the world’s largest markets. Nowadays, aesthetic surgical procedures are done with a motive to earn profits. Cosmetology has gained tremendous interest in the world, especially in the United States of America. Much of its recognition is due to scientific research in the development of imaging techniques, drug therapy, and other nonsurgical methods lessening downtime for the patients. The focus in dermatology is shifting gradually from diseased skin to desired skin which people prefer. Hence, the journal CosmoDerma, gives cosmetology its due place. Moreover, there is an increase in the anti-ageing population in this world who don’t want their face wrinkles and aging skin changes. In the absence of world wars in recent times and the increasing longevity of man, the cosmetic industry/aesthetic industry is surging ahead despite the COVID 19 pandemic. Accreditation system to regulate the practice of cosmetology practice needed to be put in place in all countries. Many of these cosmetology practitioners are inadequately equipped to perform cosmetology procedures. There is a need for structured training and accreditation for cosmetic dermatology, aesthetic surgery, dermatosurgery, use of lasers, and hair transplantation.