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Ignorance is not bliss


Dermatologists are increasingly challenged to keep their patients informed of the risks involved in receiving skin and cosmetic treatments from nondermatologists or nonphysicians. Patients need to know that care at medspas may be uniquely different than what they can expect from a board-certified dermatologist. A list of questions from the American Society of Dermatologic Surgery can help guide patients on what to ask and expect.

Key Points

National report - With cosmetic dermatology procedures increasingly offered by nondermatologists and even nonphysicians, dermatologists are finding themselves challenged to keep patients informed of the risks involved in receiving skin treatments outside the realm of dermatology.

Whether or not a physician is on staff, day spas and spas calling themselves "medspas" can do a convincing job of creating the impression of indeed providing a medical setting. But despite the white coats and sometimes even bolder misrepresentations of medical care, customers should know that the care at such centers is uniquely different from that provided by dermatologists, says Helen Torok, M.D., medical director of Trillium Creek Dermatology & Surgery in Medina, Ohio.

No substitute

Dr. Torok also informs patients that even the products they receive likely won't be the same.

"The products are not medical grade. They'll have a lower percentage of alpha hydroxy acids (and) antioxidants, and the quality of ingredients is not there, so it's not going to offer the same results as what would be available at the dermatologist's office."

Marketing materials at medspas may contribute to the impression that lasers and other devices can be quick and simple procedures, but patients may not understand the depth of knowledge needed to administer such treatments, says Ranella Hirsch, M.D., a cosmetic dermatologist based in Cambridge, Mass., and spokeswoman for the American Society of Dermatologic Surgery.

"The challenge is so much more than simply turning a laser on and putting it on your skin," she tells Dermatology Times.

"There needs to be understanding on how the skin reacts with a particular laser or injectable, because there are subtle signs that someone without a trained eye doesn't have the knowledge to watch for. The biggest key to safety is to have a specialist who has the skill and training to catch complications before they happen and the knowledge to manage them expertly if they do."

"I wouldn't want a dermatologist managing a diabetes patient," Dr. Hirsch adds. "Similarly, an internist is not going to be the best bet for the aesthetic management of your face."

Patient safety tips

Safety, of course, is the most important issue, whether consumers go to a nonmedical spa or a medspa with nonphysicians or nondermatologists in charge.

In response to growing questions and concerns from patients about the spas, the American Society for Dermatologic Surgery has posted a useful guide, the "Do's and Don'ts When Considering Cosmetic Procedures in a Spa or Salon," to which dermatologists can refer patients. Tips include:


• Do choose a location carefully. Beware of locations outside of a physician's office, such as a spa, salon or storefront in a shopping mall.

• Do make sure the doctor is on site. Most cosmetic procedures should be performed by a physician who is board-certified in dermatology or another specialty with equivalent training and experience.

• Do check credentials. Putting people in scrubs and having medical charting on the walls make a facility appear professional, but it doesn't make the staff qualified to perform medical procedures.

• Do discuss pain management options. Discomfort or minimal pain may be associated with some minor cosmetic treatments. Ask about your options.

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