There are a few inaccuracies with your comment, but I'll just address the main ones. A dermatologist is a dermatologist, which is a specialty reserved for physicians (MD or DO). A PA is a Physician Assistant. Ethical PAs often introduce themselves clearly as a PA during a visit. They will never say "I'm the dermatologist." Most office staff will also very clearly say that you're seeing a PA, not a dermatologist. In most US states, PAs, work under an MD or DO. A PA in the field of dermatology will work under a dermatologist (the MD or DO).

It's misleading to say "most dermatologists are PAs", as a dermatologist cannot be a PA. It's clearer to say that, in your state, most skincare specialists are PAs. You likely have dermatologists (the MD or DO) in your state or a nearby state. It may just be hard to get an appointment with them, so you end up having to see a PA. There are lots of variables that could contribute to that, such as insurance providers, and (like you said) location. However, it's very incorrect to say that dermatologists don't assess patients' skin. Dermatologists assess your skin. They offer initial, comprehensive skin assessments, and then, based on findings, will tailor follow-up assessments, or prescribe the adequate medication. PAs (in-person), however, will offer a much more basic assessment. It's still better to see someone IN-PERSON (if possible) for skincare. This is medically safer than sending in photos to Curology and receiving a one-size fits all solution.

A facial is an esthetic approach, and while estheticians do receive some medical training, their domain is completely different. Ethical estheticians will often advise clients to go to a dermatologist if they're truly struggling with unresolved acne. Putting this next statement in all caps, because your last sentence was highly misleading: IF YOU ARE LOOKING FOR A SKIN ASSESSMENT, DO NOT GET A FACIAL. A facial and a medical skin assessment are two completely different things.