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 spas 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 spas, 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
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