Dear Doctor Column, March 31, 2008

Medical Spas and Safety

Question:

A new medical spa just opened in my local shopping center. Is it safe to get Botox or laser treatments at these places?

Answer:

Medical spas, or medi spas, are popping up across the nation. They offer a range of services from standard spa fare such as facials and waxing to Botox injections and laser skin resurfacing - procedures once more commonly performed in a doctor’s office.  

Because there are no national standards or regulations governing medical spas, the training and experience of the people performing the procedures can vary. Each state has different regulations governing rules that say who must supervise and who can perform certain medical procedures, which in spas can include chemical skin peels, injectable treatments (eg, Botox, collagen, and sclerotherapy), laser hair removal, and skin resurfacing. Different practitioners – physicians, nurses, aestheticians, and cosmetologists – are permitted to perform different procedures in different states.  

A medical spa must have a medical director who is a licensed physician, but in some states that means only that staff can consult the directing physician if something goes wrong – not that the physician is on location or even in the same state as the spa. In most states any licensed physician can serve as medical director of medi spas. Some experts feel that only plastic surgeons and dermatologists have the necessary training to supervise such procedures.  

Without proper training, cosmetic medical procedures can result in blisters, serious burns, and scars. Sometimes, botched procedures are fatal: In 2005 a college student died a few days after she applied an anesthetic gel to her legs in preparation for laser hair removal, the American Medical Association reports.  

Without regulation, consumer complaints about botched procedures are rising, says the American Society for Dermatologic Surgery. State medical boards across the nation are considering more effective regulation, but in the meantime, it’s important to be aware of safety and make informed choices.  

The American Society for Dermatologic Surgery offers this advice when considering cosmetic procedures in a spa or salon:

 Do’s

ØDo choose a location carefully. Beware of locations outside of a physician’s office, such as a spa, salon, or store-front in a shopping mall. These locations usually have no medical staff on-site or emergency care services in place should something go wrong. Also, although a medi spa may be owned or directed by a doctor, the doctor may only visit the facility occasionally. Ask if the doctor is on-site and immediately available to supervise procedures.

ØDo make sure the doctor is on site. Most cosmetic procedures should be performed by a physician who is board-certified in dermatology or another specialty with equivalent training and experience. If the physician is supervising the procedure, make sure he is on-site and immediately available to respond to any questions or problems that may occur while the procedure is being performed.

Ø Do check credentials. Putting people in scrubs and having medical charting on the walls make a facility appear professional, but it doesn’t make their staff qualified to perform a medical procedure. Ask about background and training. Is the physician a member of a medical specialty organization? This indicates a physician’s desire to keep abreast of the latest scientific data and medical information.  

ØDo discuss pain management options. Discomfort or minimal pain may be associated with some minor cosmetic treatments. Ask about your options: What are the benefits and risks associated with each option? Which option do you recommend and why?

Don’ts

ØDon’t ever go to someone’s home or a hotel room to have a cosmetic procedure performed. Cosmetic procedures are medical procedures, which should not be performed in these settings.

ØDon’t rely on price. If you are receiving a procedure that costs significantly less than usual, you can assume you are not receiving the best treatment. Price should not be the determining factor.

ØDon’t be afraid to ask questions, such as:

• What if something goes awry?
• What procedures are in place to deal with an emergency?
• What training does the staff have?
• Who will perform the procedure?
• Is this treatment right for me?
• Is this laser, device or technique appropriate for my skin type?
• Have you performed this procedure before on the same body part I’m considering? May I see your before and after photographs?
• Have you reviewed my medical history?

ØDon’t go through with a procedure if they can’t prove a trained physician is accessible. 

ØDon’t be afraid to walk away. If it doesn’t feel right, then find a more reputable location.