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Who's managing medspas?

Article-Who's managing medspas?

Stephen Baker, M.D., D.D.S
National report — A rare incident in which the application of lidocaine prior to laser hair removal resulted in a patient's death has raised serious questions by medical review boards and surgeons about how such a tragedy could occur — and what can be done to prevent future problems.

On Dec. 28, 2004, Shiri Berg, a 22-year-old North Carolina State University senior, suffered a seizure after applying a numbing cream of 10 percent lidocaine prior to her laser appointment. Ms. Berg fell into a coma, dying on Jan. 5. The autopsy report states that she died from an overdose of lidocaine. It also reveals that she suffered heart failure and brain damage.

While initial reports of the student's death caused confusion about how the use of the common drug led to the tragedy, the recently released autopsy report states Ms. Berg wrapped her legs in plastic after applying the drug, in hopes of avoiding the pain caused by the hair removal procedure.

Michael McGuire, M.D
Fallout from fatalities The North Carolina Pharmacy Board is investigating Triangle Compounding Pharmacy, the company that sold the compounded lidocaine to Premier Body Laser Clinics in Raleigh, N.C., where Ms. Berg was to have had the procedure. The board also is investigating Premier Body.

"We were surprised by the death (of Ms. Berg), especially since we did not know that the product was being handled in a spa setting," says Steve Hudson, director of investigations and inspections, North Carolina Pharmacy Board. "I don't think this case will impact how lidocaine is formulated, but it will enforce the process of where these products are being maintained and stored," he tells Cosmetic Surgery Times.

As a result of the evidence against it, Premier Body Clinic closed its doors Jan. 31, adding fuel to doubts about "medical spas" and the ineptitude of some in performing cosmetic procedures, such as laser hair removal and Botox injections.

Draelos, M.D., P.A
"Every procedure has a potential risk. You need to have someone who is very knowledgeable in pharmacology and is a trained medical professional to manage the patient," says Stephen Baker, M.D., D.D.S., vice chairman of the American Society of Plastic Surgeons' (ASPS) patient safety committee. "Society has become very complacent about cosmetic procedures, and, as a result, there are many who believe they can perform these procedures regardless of their lack of training. When you put potentially harmful materials in the hands of people who aren't qualified, unfortunate incidents like (Ms. Berg's death) happen."

Other cases On Jan. 25, 2002, Blanco Bolanos of Tucson applied anesthetic cream to her legs and wrapped them in cellophane several hours before a laser hair removal appointment. After suffering a seizure and living nearly two years in a coma, relying on a respirator, Ms. Bolanos died on Nov. 1, 2004.

"These incidents underline the importance of a medical spa truly being under the direction of a medical practitioner," says Michael McGuire, M.D., public education chairman for the American Society for Aesthetic Plastic Surgery (ASAPS). "So many times, procedures performed in medspas are done by unlicensed personnel who are supposedly acting under the authority of the physician, but indeed the physician doesn't know what's going on."

If a physician truly supervises a spa, then the physician needs to be there at all times to oversee the patient, contends Zoe Diana Draelos, M.D., P.A., clinical associate professor, department of dermatology, Wake Forest University, Winston-Salem, N.C.

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