Botox + Mani/Pedi? 3 Questions to Ask Before Stepping Into a MediSpa

22 Sep 2014 at 4:00pm

Written by Varci

MediSpaGood ‘ol Benjamin Franklin said nothing was certain except death and taxes. 225 years later, this sentiment may have changed to death and Botox. That’s to say that getting a little nip, tuck, or poke to turn back the clock sure doesn’t raise eyebrows like it used to.

How else to explain the proliferation of “medical spas” — a hybrid day spa/doctor’s office where you can rejuvenate with treatments like Botox, fillers, chemical peels, laser services, or non-surgical fat reduction in a luxury spa-like setting? Revenues of the 2,100 medical spas in the United States reached $1.94 billion in 2012, with revenues estimated to hit $3.6 billion by 2016. In the last six months alone, RealSelf saw a 160% increase in interest for various types of laser liposuction, procedures which are frequently offered at medispas like Sono Bello.

“For consumers, going to a medispa is not as intimidating as going into a doctor’s office,” says Sylvia Sylvestri, a Beverly-Hills based nurse and 20-year veteran of the aesthetic scene. “Often, you can call right up and get in. You can wake up on Saturday morning and impulsively say, ‘I want some Botox or I need a facial.’ Doctor’s offices are often closed weekends and nights.”

That said, Sylvestri and other industry experts advise a thorough investigation of a new medispa before popping in for an impulse Botox buy. Why all the caution? Well, it turns out you really need to know what’s under that white coat. Here are three questions to ask before stepping foot inside a medical spa:

1. Should You Skip Seeing a Specialist?

The exponential (and lucrative) growth of medical spas means that physicians, nurse practitioners, and physicians assistants trained in other specialties (like gynecology, primary care, or emergency medicine) are getting into the game. Because of this, you should ask exactly who’s going to be treating you before agreeing to anything invasive.

Although there isn’t anything inherently wrong (or illegal) about seeing, say, a gynecologist for cosmetic fillers or Botox, some would argue that it doesn’t make sense to see a provider who isn’t extensively trained or experienced in the area you want treated — especially when it comes to your appearance.

Dr. Mary Lupo, a New Orleans-based dermatologist, says, “There may be a rare exception to the rule that a core-trained physician with the background of years of training in dermatology, plastic surgery, facial plastic, or oculoplastic surgery is the best choice for an aesthetic procedure. But why risk it? The ‘core’ training refers to the years of background learning during residency and fellowship training. A family practice doctor spent three years learning to take care of sore throats, high blood pressure, and the like — hardly a background to give you the results you deserve. But then, I’m prejudiced as a board-certified dermatologist and proud of my residency training and certification, so the choice is ultimately [the patient’s].”

MORE: Why to Choose a Dermatologist Versus a Salon or Spa

2. Should You Trust a “Medical Spa” That’s In a Nail Salon?

Medical SpaJust because Botox, fillers, and lasers are commonly lumped into the “cosmetic” category, that doesn’t mean these procedures aren’t medical in nature.

Lasers and chemical peels have the potential to blister and burn. Botox can cause droopy eyes, a crooked smile, or uneven eyebrows if administered incorrectly. Injected into the wrong spot, fillers like Restylane can cause disfiguring lumps and bumps. And there’s always a rare but real chance of an allergic reaction or infection with an aesthetic procedure.

This is why medical spas are required by law to be under the control and jurisdiction of a medical doctor — and why you’re within your rights to ask about the background, training, certification. and credentialing of the spa director.

Seattle plastic surgeon Dr. Richard Baxter says, “The number one thing you should look for when you go to a medispa, or if you’re looking at one online, is [whether or not it’s] obvious who the medical director is and what their qualifications are. All the promotional materials regarding the medical spa should make this clear.”

The other issue you want to be certain of is the presence of qualified medical personnel onsite, says San Diego plastic surgeon, Dr. Robert Singer. “In some states, there’s a regulation that a physician has to own the medical spa, but he or she doesn’t have to be there. They can be an hour away. What happens if there’s a problem? These procedures may be minimally invasive, but they’re procedures that have real risks and potential problems. Does the staff have the mechanisms to deal with an emergency medical situation? Who is coming up with the treatment plan and determining your care?”

MORE: Is the IlluMask Worth It? Debunking At-Home Light Therapy Skincare

3. Should You Be OK With a Non-Physician Performing Your Procedure?

It’s common (and perfectly legal) to find physician’s assistants (PAs), nurse practitioners (NPs), registered nurses (RNs), and estheticians working in a medical spa alongside a physician. Each has a “scope of practice” (which varies state-to-state) allowing them to legally perform certain procedures based on their training.

For example, in California, a licensed esthetician can provide facials, remove hair (by tweezing or waxing), and provide skincare with the use of antiseptics, lotions, tonics, and creams. An esthetician is not allowed to perform Botox injections, however a registered nurse may be permitted to do so with proper physician supervision. Advanced practice providers like PAs and NPs are allowed to perform the initial exam required for Botox, while a registered nurse cannot.

The real trouble starts for consumers when medical spa employees “overstep” their scope of practice and potentially endanger patient safety. In a 2007 survey from the American Society for Dermatologic Surgery, 56% of surgeons said they had seen an increase in complications like blisters, burns, nerve damage, and scarring caused by non-physicians performing cosmetic procedures.

In fact, many states have increased penalties for the illegal practice in medical spas. Lisie Soukup, director of advocacy and public policy for ASDS, says, “It’s not just a patient safety issue; it’s a consumer fraud issue. Patients are assuming the people in white coats that are offering their treatments are appropriately trained and supervised — but unfortunately, this is frequently not the case.”

“I would ask the person injecting me what their credentials are, where they received their training, and how long they’ve been injecting to ensure that they’re capable of treating you,” says North Carolina plastic surgeon Dr. Peter Capizzi.

“Don't assume that the practitioner before you is a medical doctor,” adds healthcare attorney Michael H. Cohen. “Consumers should have a basic understanding of what ‘scope of practice’ is. Be very clear about the difference between procedures. A facial is very different than Botox.”

Have you ever received a treatment at a medispa? How was your experience? Share your story in the comments!

Photo credits: Some rights reserved by OceanView MedSpa; Courtesy of Bella MedSpa