Derms concerned about level of medical supervision at medspas

August 1, 2007

As the number of medical spas mushrooms, so too do the dermatologic community's concerns over who's supervising medical cosmetic procedures - and even over who's performing the procedures. Less-than-stringent state regulations and an almost total lack of federal regulations are prompting dermatologists and cosmetic surgeons to lobby for change.

Key Points

Spa patients receive Botox (botulinum toxin, Allergan Medical) and Restylane (Medicis) injections, microdermabrasion and more aggressive chemical peels, ostensibly under a doctor's oversight. But such procedures are commonly administered by staffers who may be medical professionals, but most often are not dermatologists, cosmetic surgeons or plastic surgeons.

Many dermatologists question whether such sophisticated and sometimes risky procedures should be administered even by trained medical professionals who are not skin specialists, let alone by nonphysicians. There is also concern that while many states require medical supervision (there are no federal regulations specific to medical spas outside of physicians' offices), they don't necessarily require the supervisor to be on-site.

Defining 'supervision'

Joel Schlessinger, M.D., director of Skin Specialists P.C. in Omaha, Neb., says the supervision issue is a huge concern for him as a dermatologist, spa owner and president of the American Society of Cosmetic Dermatology & Aesthetic Surgery.

"While I have always been optimistic about the future of medicine and cosmetic dermatology in particular, this is an area where I have seen untold numbers of unqualified individuals start to dabble in the field over the past decade," he tells Dermatology Times. "It is especially problematic because their complications reflect on the dermatologists and core cosmetic surgeons who ethically and professionally oversee and run a spa."

To Dr. Schlessinger, medical supervision should mean being on-site and actually supervising, "not just having a name on the wall but never being there." Additionally, and more critically, it should mean "doing the procedures such as Botox and fillers yourself rather than farming them out to a nurse or nonmedical individual.

"Many spas have non-core cosmetic surgeons as their owners or supervisors, and these individuals pass themselves off as dermatologists," he says. "While they are free to do what they feel comfortable doing, it is unethical and inappropriate to claim to be a dermatologist when they clearly aren't, and don't have the educational background commensurate with this professional status.

"It seems that every day I see another medical spa opening up - usually operated by a nonmedical person who is playing doctor, sometimes with very serious consequences," he adds.

Safety concerns

Dr. Jacob can testify to that.

"There have been many dermatological patients treated incorrectly by medspas, leading to scarring," she says.

"We're concerned about patient safety foremost," Dr. Jacob says. "Improper diagnosis and treatment without a dermatologist present occurs frequently. One other issue is that, at least in Illinois, the majority of these medspas are run by physicians who are not board-certified dermatologists. In addition, the majority of these medspas do not have a physician on-site."

International Medical Spa Association (IMSA) president Eric Light takes issue with claims that medspa errors occur frequently, and disagrees with the notion that medspas should be strictly required to have medical doctors - let alone dermatologists or cosmetic/plastic surgeons - administer Botox, filler injections and laser and other medical cosmetic procedures.