Money Rules: Tipping Etiquette At Spas, Your Doctor’s Office, & Medi-Spas

We’ve all been there: you’re leaving the medi-spa after receiving injections, or a laser treatment, and it’s time to pay for the service. Should you add gratuity on top of the cost of the treatment? You may have de-stressed in a relaxation room prior to the treatment—was the service performed by a doctor or nurse? We all know 15-20% gratuity is standard for the spa world, but what about this gray area we call the medical spa?

According to the American Society of Plastic Surgeons (ASPS), the largest area of increase (+ 4%) from 2013 to 2014 included minimally invasive cosmetic procedures like Botox, fillers and chemical peels. Doctors are employing more aestheticians, and dermatology and plastic surgery facilities are opening up exponentially more medical spas.


We asked the pros to weigh in on the topic and interviewed four Charlotte’s Book Experts based in New York City: they supplied the dos and don’ts needed to save us from embarrassment, plus the know-how required for confidence at the checkout desk.


Jordana Mattioli, sought-after medical aesthetician with Complete Skin MD on The Upper East Side, says don’t tip in a doctor’s office. Save your tips for the spa. Mattioli doesn’t accept tips at Complete Skin MD, a dermatology practice where she performs medical facials and peels.

Dr. Melissa Doft of Doft Plastic Surgery, also on The Upper East Side agrees. “We do not encourage patients to tip,” says Doft, although some of her facial clientele insist. “If the physician, physician’s assistant or nurse practitioner is performing the procedure, no tip is necessary,” Doft points out.

Juliet Cavallaro is practice manager at Russak Dermatology Clinic located in Midtown East. She says tipping is not expected but appreciated for services performed by aestheticians, including facials or treatments that include massage. “Don’t feel pressured to tip for treatments only offered under a doctor’s license such as CoolSculpting, Ultherapy, microneedling or laser rejuvenation.” When patients feel inclined to tip, Cavallaro lets them know the clinic is not like a spa, where 20% would be expected.

Dr. Cybele Fishman, cosmetic dermatologist in Lower Manhattan, allows her aesthetician to accept tips, although it is not expected or advertised as standard practice on their spa menu. “I think tipping someone you have a relationship with is more important than the one-time visit to a random medi-spa,” she says.

All four experts concluded, tipping at the medical spa is not required or expected, especially for ablative procedures. When it comes to services performed by aestheticians, “go with your gut,” says Fishman.


It’s wise to stay ahead of the game and do some research before visiting a new medi-spa. A quick website skim will likely outline spa etiquette, among other helpful points. “When in doubt, ask the person at the front desk,” advises Mattioli. The receptionist is always a safe bet and should be able to easily fill you in on common practices within the business.

Like with any other spa or doctor visit, arrive early for your appointment as paperwork will be required. Allow yourself time to get a feel for your environment and take a breather. Come prepared with questions you may have about your skin, and don’t be afraid to ask them.


If you still feel uneasy about not tipping, there’s plenty you can do to show your appreciation and spread good karma. “It is important to do what feels right for you. I think everyone likes to feel appreciated, but there are many ways to show appreciation that do not involve a cash tip” says Doft.

“If you’re getting any treatments done at a dermatology or plastic surgery practice and feel the staff went above and beyond, referrals are the best way to show your appreciation. If you are really adamant on wanting to show further appreciation for those services, send a thank you note, some sweet treats, flowers or a bottle of wine,” says Mattioli.

Thank you cards, online reviews and referrals are some of the best ways clients can say thank you to their medi-spa staff—so take the time to write a review of your Charlotte’s Book provider.

Image: Ceci Gervaso

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  • Michelle

    Thank you for this! I went to a new office today for botox and a photo facial package for an end of the year discount. I was spending alot and it was my first time and when she rang up my total and handed me her ipad to sign it asked for a tip and infront of everyone i was including the doctor read the prompt for the tip. The minimum 15% tip was over $80. I didn’t want to be rude and didn’t know the etticit so I paid the minimum but I’m usually a 25% tipper and felt bad but this was already an expensice luxury procedure. The vetran botox-friends of mine who always paid cash were never aware of a tip and the doctor said she changed her square space credit app to include the tip option because customers asked for it. I think more people need to be aware of tipping ettiqite for these types of services.

    • Michelle – thank you so much for your comment and we are so glad you found this helpful.

    • I don’t take issue with tipping estheticians etc, but a suggested tip prompt is tacky anywhere, and especially tacky at a medical clinic. I don’t know what the rules are where you live, but I was under the impression that physicians are not techinically allowed to accept tips (in Canada). I could be wrong, but even still, it seems extraordinarily tacky to me. I also believe there should be a cap on tips for services over 100 – 200 (i.e.: 15 – 20% on first 100$ and then 1% onwards if service is exceptional). I can’t imagine someone paying a $1000 tip on top of a $5000 Fraxel treatment etc. That’s just ludicrous! I can see your doctor’s tip prompt actually backfiring as patients consider other practitioners because of the discomfort of being expected to drop 20% on top of her expensive medical procedures. She’d be better off asking pleased patients to leave a review on Google, Yelp, Rate MD, RealSelf or Social Media instead.

  • Ray Thompson

    Thanks for the clarification about tipping! I’ve often wondered what was expected or not in regards to these procedures!

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