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The hidden dangers of 'medical' spas: spas have always promoted beauty and relaxation, but they now offer laser hair removal, Botox, and chemical peels. These treatments involve the use of prescription medical products, and their misuse can lead to serious health consequences for the patient.

Article Excerpt
Growth in the spa industry has been a boon to the manufacturers and distributors of devices and drugs used for cosmetic procedures; physicians who order, use, and dispense these products; and spa owners who have joined with health care providers to profit from these services. The term "medical spa," "med-spa," or "medi-spa" describes a business that offers massages and facials along with medical services such as laser hair removal, facial rejuvenation, Botox and dermal filler injections, and chemical peels.

Off-site physician supervision has become the preferred business model for medical spas. Depending on variations in state law, typically, a spa owner forms an alliance with a physician in order to obtain FDA-regulated devices and pharmaceuticals. The physician then delegates the cosmetic medical procedures to nonphysicians, such as physician assistants, registered nurses, and aestheticians.

The practice is not legal in all states, but this business model generally describes the structure of the medical spa in cases where a nonphysician performs the procedures. By minimizing the doctor's involvement and relying on technicians, the spa can offer medical services at lower prices than what clients would pay in a doctor's office.

But this affordability and convenience can be risky for consumers, who are sometimes treated not as patients but as clients in a retail environment. In the soothing atmosphere of a spa, with its ambient lighting, soft background music, and muted decor, the idea of risk may seem implausible. Spa marketing creates the impression that these procedures are risk free, a notion that is incongruous with the data being released by the medical community itself.

The FDA has reported two deaths related to the misuse of topical anesthetics in connection with laser hair removal procedures, (1) and it recently issued a Public Health Advisory statement for these medications. (2) Laser and intense pulsed light (IPL) procedures can cause permanent scarring, skin discoloration, burns, and the unintentional removal of cancerous lesions before they can be diagnosed and treated.

Temporary complications include pain, swelling, redness, discoloration, blistering, and crusting. In some patients, the treated area or the untreated skin near it may respond by growing thick, coarse hair in a process known as paradoxical hypertrichosis. (3) Botox and other injectable wrinkle removers have been reported to cause significant complications and even death. (4)

Though permanent adverse results are the exception, the number of patients seeking medical treatment for the results of procedures performed by nonphysicians has gone up. A 2007 survey conducted by the American Society for Dermatologic Surgery (ASDS) showed that 56 percent of responding physicians "indicated that there had been an increase in the number of patients they had treated as the result of complications caused by a nonphysician," 38 percent noted an increase of between 5 percent and 25 percent "in complications caused by nonphysicians in the past five years," and "many respondents ... noted that they had seen burns caused by improper use of lasers, scarring caused by chemical peels, hyperpigmentation caused by laser hair removal, and many instances of skin cancer being overlooked." (5)

Medical associations have issued advisory statements, warning patients about the risks of having low-cost cosmetic procedures performed in nonmedical settings. The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) have urged consumers to "be wary of procedures offered in nonclinical settings such as shopping malls, private homes, office parties, and group social gatherings." (6) They have recommended that skin treatments be performed by, or under the supervision of, board-certified plastic surgeons or dermatologists. (7)

Regulations to improve consumer safety in these areas have not...