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Medical spas: Don't remain silent

It seems that medical spas have become one of the "hot topics" of the day.


Dr. McDaniel
Physicians in many specialties are adding medical spas to their practices, especially dermatology and plastic surgery.

Chains of franchise-like medical spas are also beginning to multiply like the proverbial rabbits. The medical supervision – or lack thereof – is but one of many controversies of the day. Let's examine the evolution of spas in America.

Old news Spas are very old news in Europe and some other parts of the world. In France, young girls may begin as early as age 10 going to a skincare clinic. Not so in the United States.

Spas began here in some ways more as an imitation of European-type spas with ideas brought back by travelers and by estheticians who went abroad to gain the training they could not easily find domestically. Many of these therapies were based on water and natural products - not uncommonly with some element of massage and relaxation intertwined.

Esthetician training was often part teaching and part apprenticeship. Scientific research was typically conducted by the product manufacturers and formal training and credentialing was often absent. A few "destination spas" became symbols of luxury and a glimpse into the future. The integration of exercise and diet and the vision of a healthy body as well as good skin became more common.

Visionaries

What we see today is the result of years of persistent effort by various visionary leaders. Formal education, sound scientific principles and credentialing are among the fruits of their labors. Good professional societies exist as well as some excellent magazines devoted to estheticians and spas. Medical or paramedical training has become much more available and many physicians in cosmetic dermatology or related cosmetic specialties now offer services in medically supervised spas. Spas at upscale hotels, retirement communities and cruise lines are also increasing.

While glycolic acid peels were one of the first of the more "medical"-type procedures to become widely used, it was the introduction of powerful and effective medical devices that really has fueled the surge in medical spas. The popularization of light-based hair removal came on the heels of the very popular microdermabrasion therapy. More recently IPL, other lasers and new LED photomodulation therapies have become very popular, too.

With these innovations have come safety issues and credentialing and regulatory issues since some of these "medical" procedures are being performed by non-physicians. The rules currently vary from state to state, but the growth of "medical spas" has clearly outpaced the regulatory issues.

Future bright The future is very exciting, however important challenges lie ahead for serious issues related to safety, supervision, training and marketing. I hope that scientific principles, safety and sound medical doctrine will prevail – but to paraphrase an old saying: "All that needs to happen for unsafe spas to proliferate with unprofessional marketing is for the experts to remain silent." The economic forces driving sales of equipment into this new and large market as well as the perceived ability to generate fees similar to physician fees — but without having a medical license — are powerful factors that will not soon diminish.

Cosmetic surgeons, estheticians and skincare practitioners can have a powerful voice in shaping the future of medical spas so that our patients receive the best we are capable of providing. Please make your voice heard. Now is the time!

David H. McDaniel, M.D.
Eastern Virginia Medical School

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