The teaching of aesthetic surgery is an integral component in the training of a plastic and reconstructive surgeon yet one which has come under increasing pressure with recent changes in the health care industry. In an effort to respond to these pressures, an independent Aesthetic Service at the chief resident level was implemented at the Baylor College of Medicine Division of Plastic Surgery to transition impending graduates from a position of largely assisting attending surgeons to a position of independently managing aesthetic patients. In contrast to a previous plastic surgery clinic, the Aesthetic Service was relocated from the clinics to the main faculty office and empowered with privileges and responsibilities accorded a junior faculty position. The service is highly profitable. Success of the Aesthetic Service is attributed to several factors including patient reassurance that the service is a direct component of the Division; patients are cared for in a manner comparable to private practice patients; practice in a location with an aesthetically established infrastructure, including waiting area, examination rooms, minor procedure and laser facilities, and support staff; and recruitment of a dedicated registered nurse. The success of the service has ensured a supply of cosmetic patients for continued resident education.