Medical Spas: A Physicians Perspective

By Donald Sudy

Imagine visiting a facility that allows for medical grade cosmetic procedures to restore skin health and rejuvenate the face and body, maximize health and wellness while in a serene spa-like environment. You would be visiting a Medical Spa.

International Medical Spa Association defines a medical spa as "a facility that operates under the full-time, on-site supervision of a licensed health care professional. The facility operates within the scope of practice of its staff, and offers traditional, complementary, and alternative health practices and treatments in a spa-like setting. Practitioners working within a medical spa will be governed by their appropriate licensing board, if licensure is required." It would provide a multidisciplinary approach that incorporates traditional cosmetic procedures and wellness with alternative therapies such as acupuncture, chiropractic and holistic care to maximize both health and wellness as well as beauty care. Those that adhere to the guidelines as put forth by the IMSA often have a physician on staff (preferably on site), chiropractors, massage therapists, nutritionists, and holistic practitioners.

Advancing technology allows for more dramatic non-invasive and minimal "down time" cosmetic procedures to fit patients active social and career lifestyle. This, coupled with mainstream acceptance, has led to an ever-growing consumer demand. Numerous facilities are appearing almost daily, whether attached to an already existing medical practice or as a stand alone new practice. Even some traditional hair salons and day spa’s are enlisting physicians to come by their facility periodically to perform Botox® or Restylane® injections.

With this booming demand, many investors see an opportunity to cash in on this growing market by opening medical spas ranging from "one of" to franchises. Many non-medical persons are opening up facilities ranging from laser hair removal facilities to medical spa’s, staffing them with estheticians, "laser technicians", or nurses. For a facility to purchase a laser, a physician has to be affiliated with that facility. Thus many physicians serve as Medical Director, yet have no direct clinical interaction with clients in their evaluation, treatment or follow-up.

Indeed, for some facilities the physician is not even located in the same community. Some Medical Directors have residency training in Dermatology or Plastic Surgery, while others are from different medical specialties. However, since many of these procedures and technologies are relatively new, current and ongoing postgraduate medical education and training are important.

With this rapid growth, many states medical regulations are not keeping pace with the evolving technologies, which result in loose regulatory oversight. In fact many states allow non-physicians to own and operate laser hair removal spas.

With increasing popularity and availability of these services, the incidence of injury from these "low risk" procedures is increasing. While very rarely serious injury occurs (there have been two deaths, including one in North Carolina, associated with laser hair removal and use of topical anesthetic), troublesome injuries requiring evaluation and treatment by a medical specialist are becoming more commonplace. Injuries can include scarring, pigmentation changes, and even blindness. A study on complications from laser procedures by Vic Narurkar, MD was presented this year at the American Society of Laser Medicine and Surgery. He found that 82% of all laser related complications occurred in facilities that had no direct physician supervision. 1

Training is another big issue. For example, an esthetician requires a minimum of 600 hours training before being issued a license to perform skin care and superficial peels. However, to operate a laser most states have no set training requirements. In most cases the training is done by the laser manufacture and may be only a day or two in length. While lasers are generally safe in the right hands and most persons have no contraindications, there are a few medical conditions that can lead to adverse out comes. Certain medical conditions, such as Polycystic Ovarian Syndrome, adrenal or ovarian tumors, can manifest themselves by excessive facial hair or male pattern hair growth. These could be easily missed if not appropriately screened for. Certain medications can place the laser patient at higher risk for complications. Appropriate medical screening is warranted in all new laser patients.

Another concern is what happens if someone is injured. Or, while screening a prospective laser patient, concern of an underlying medical condition arises. Can most of these facilities handle these situations? Does the staff know what to do? Is the staff astute enough to notice that a mole has some suspicious features before performing a laser treatment on it? Is there a physician on site or readily available to evaluate that mole, or treat a complication?

Medical spas provide clients aesthetic and wellness care in a serene, relaxing and pampering environment. Most patients will have no adverse outcomes or are treated without injury. However with the increasing popularity of these procedures, adverse outcomes are bound to increase. Having a physician who is actively involved in patient evaluation, treatment and follow-up is an important component to preventing injury. Establishment of a training program with ongoing education and evaluation of all practitioners is paramount. Finally, the ability to treat and refer patients who are injured or have other medical concerns is also important.

1. Complications from Laser Procedures Performed By Non-Physicians. Vic A. Narurkar, MD. Skin & Aging. Sep 2005, pg. 70-71.

Donald Sudy, MD Medical Director ReGenesis Medical Spa & Wellness Center

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