But, in some medical spas in California and elsewhere, doctor involvement is low. In Beverly Hills, for example, some prominent medical spas are owned by a businesswoman or man who pays a physician for use of his or her medical license. The doctor is not involved, Dr. Rivkin tells Cosmetic Surgery Times.
"As long as you have places that are run with business being the first priority and the physician having a very marginal role, corners are going to get cut and quality of patient care will be sacrificed," he says.
"Medical boards are sometimes aware of what is happening at medspas in their state and sometimes they don't even know what to do," says Hannelore Leavy, founder and executive director of the International Medical Spa Association in Union City, N.J.
Here's a look at the regulations in three states: California, North Carolina and Florida.
A physician must be the majority shareholder owner of any medical spa and is responsible for the healthcare providers who work for him or her, says Candis Cohen, information officer of the Medical Board of California. For many procedures, the state only allows physicians, physician's assistants, registered nurses and vocational nurses to do them under the direct supervision of a physician.
"This doesn't mean the physician has to be standing there," Ms. Cohen explains. "They don't have to be on site, but they do have to be immediately reachable."
"It's an issue of ownership," he explains. "I am responsible for everything that happens, no matter what."
Physicians, registered nurses or licensed vocational nurses can do Botox (Allergan) injections. Only physicians, physician's assistants and registered nurses can perform procedures with lasers or intense pulsed light devices. Licensed vocational nurses, cosmetologists, electrologists or estheticians are legally prohibited from doing so.
No regular inspection
The medical board does not inspect medical spas unless there is a specific public protection reason to do so.
"We would need some information that either a physician is doing something he or she shouldn't, or an unlicensed individual is practicing medicine," Ms. Cohen says.
The board has not received any complaints about unlicensed personnel performing medical services in medical spas. Within the past year, they received fewer than 10 patient harm complaints involving medspas that they are currently investigating.