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NEWSLETTER
Summer 2008
What is Wrong With Medi-Spas Today?
What I am about to say is not anything very new or surprising but probably most Americans are not really aware of these issues. No physician I know would recommend a family member go to a medic-spa today and I will tell you why. The number of bad outcomes that have been reported over the years coming from "medical procedures" in medic-spas is astounding. The American medic-spa phenomenon has been a "Frankenstein" problem for many years but it has been very difficult, if not impossible, to stop for a number of reasons.
Let me give you a little history. Starting in the 1950's dermatologists began developing newer and better ways to improve a person's appearance. These pioneering physicians developed dermabrasion, chemical peeling, and sclerotherapy for leg veins, hair transplantation and other techniques. Some dermatologist's added surgical techniques such as eyelid surgery, scar repair, face lifting and liposuction to their repertoire and the American Society for Dermatologic Surgery was born.
For over 30 years, we dermatologic surgeons have been inventing and perfecting these and many other procedures. As a rule, all our work is peer reviewed by many other physicians and scrutinized constantly for any problems and improvements. Training is taken very seriously and all our skin care physician surgeons undergo rigorous initial training as well as lifelong continued training. Most of the development and training in the US , if not worldwide, in the use of Botox, collagen and other fillers, chemical peeling, laser skin procedures of all types, and leg vein treatments have come out of our dermatologic surgeons' work.
We helped start the premier cosmetic surgery society, the AACS, many years ago so that surgeons from many fields could learn, practice and teach these cosmetic procedures all over the world. While our leaders worked very hard to keep up the standards of all of our surgeons, there were many dermatologists that were not interested in the serious surgical procedures. They were content with the rapidly enlarging fields of cosmetic filler materials, Botox, microdermabrasion, chemical peeling and laser skin procedures (hair removal, tattoo removal, scar and wrinkle removal, etc.).
In the late 1990's there was a move to combine the dermatologist's expertise in skin care, skin rejuvenation and now the newer techniques mentioned above. Adding elements of the aesthetician's facials, the "medi-spa"was born. Our patients were asking for all these services from us and were starting to go to traditional aestheticians or spas for their skin care recommendations. Many of us started offering a menu of cosmetic skin care services, not usually covered by insurance, in part of our dermatology offices. A few dermatologist entrepreneurs opened large facilities across the country. Articles about their "successes" led others to investigate incorporating these services into their offices as well. Dermatology residency programs were forced to add these procedures into their training programs in order to not appear to be outdated.
For awhile all seemed to be going well. Media attention blossomed and we all received glowing reports for our methods which keep people looking younger and healthier. Then, a few plastic surgeons noticed our success and began hiring some of our trained nurses to run a similar "spa" in their offices, mostly as a method to feed potential surgical cases into the traditionally lucrative part of their practices. The vast majority of these plastic surgeons had no training or interest in skin care and skin problems and totally relied on partially trained nurses to diagnose and treat these patients. Other physicians from every field of medicine, disillusioned by plummeting insurance reimbursements in their own practices, started opening similar medi-spas after a weekend seminar from a laser company, microdermabrasion company or a cosmeceutical product company. The traditional "spa" world also took notice and added a Medi-Spa section to their conventions. These became so popular that they soon out drew the regular spa arena. There are now hundreds of companies pitching their machines, medi-spa consulting services and a myriad of products to sell to non skin care physicians, nurses, physician assistants, aestheticians, and just plain businessmen/women who saw the potential to make money from our country's fascination with these procedures. They could see easy money to be made (or so they thought). Soon you had thousands of medi-spas opening all over the country offering medical type services along with traditional spa services. The consumer had no idea that most of them had no one on staff with appropriate training. Perhaps the new business owners themselves were not fully aware of their own lack of knowledge.
Soon, we started seeing hundreds of patients in our offices with terrible outcomes from services in these medi-spas. As these spas are generally not regulated or even certified for the services they offer, all these disgruntled patients could do was to ask one of their local dermatologists to help fix the problems (scars, infections, loss of pigmentation, etc.). When the full extent of the abuses going on in these unregulated medical type facilities became widely known to us, our surgical society tried to collect these cases to report to the government. Knowing that it would seem a bit self serving to report these problems, our leaders still felt we had the duty to help protect future patients from going to such facilities. It has been a few years since this problem became obvious and the media has reported on it, but I still do not see much regulation or even investigation being done by our government as to who is buying and using all these skin lasers and equipment and which advertisements are legal and appropriate. The spa shows in Vegas and elsewhere are still packed with thousands of salespeople and participants.
One interesting development I noticed lately was in a letter I received in the mail offering to sell me any one of 3 southern Californian medi-spas. I have long suspected that many of these enterprises were not going to last long, even if they were in the right area, offered the right services and had a good business model. Sooner or later the customer would realize that they are not being treated by reliable medical professionals and that there are safer and more effective alternative locations to get these services. I removed the whole concept of medi-spa from my promotional materials so as to distance myself from these other facilities years ago. Most of my colleagues have done the same. The dermatologist's office is the only place to go for these cosmetic services and we need to let our patients know it.
Return to Summer 2008 Newsletter
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