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Over the past 10 to 15 years, there has been a boom in the phenomenon commonly known as "medspas" - an outgrowth of the purely Aesthetic day spa, combining herbal wraps and massages with medical or near-medical therapies, such as microdermabrasion and chemical peels, and progressing into lasers, fillers and Botox treatments.
The extent of the services that can be offered by medspas can be limited by state regulation, but with physicians signing on as medical directors, even if they are infrequently on site, medspas can operate in many areas.
Many medical directors are members of specialties not traditionally considered to have an aesthetic base, such as family practice, emergency room medicine and orthopedics. They are, however, offering procedures that have become staples of the practices of many cosmetic surgeons, dermatologists and plastic surgeons.
Some dermatologists say they do feel the presence of medspas in their community. Practicing in the Hawaiian Islands, Gregory Herbich, M.D., knows he is competing with the medspa.
"The most common cosmetic procedures in Hawaii are hair removal and tattoo removal. So far, the medspas aren't removing tattoos, but they are doing laser hair removal.
"When I first bought lasers, only physicians were using them, and I was about the only game in town doing laser hair removal. Now, even though the number of people having the procedure done has increased, my numbers have actually decreased. I would attribute that to the medspas.
The cost of competition
"To compete, I've ended up lowering prices, and that's helped. My prices are actually less than the medspas' now, so patients get a good deal here.
"The biggest reason I think people are still going to the medspa is that the medspas advertise. I don't choose to compete in the advertising, but I do in price," Dr. Herbich tells Dermatology Times.
In Arcadia, Calif., Shirley Y. Chi, M.D., says the impact of medspa competition is even more blatant in her practice.
"I tell them they're doing that at their own risk - that the medspa employees don't understand the appropriate skin treatment for various skin types, and, of course, they don't have board-certified dermatologists.
"We actually get a fair number of people coming back from the medspa, because they've gotten burned - literally. The spa actually refers their patients to me when complications occur," Dr. Chi says.
Cheryl L. Eberting, M.D., runs a small solo practice in Alpine, Utah, and thinks she might see more competition from the medspas if she were practicing full-time.
"My practice is under 2 years old, and I have two small children, so I don't run a full practice. Perhaps if I had a full-time office, or did strictly cosmetic dermatology, medspas could definitely be a problem.
"I don't cut prices to compete, because I've got medical dermatology patients coming out of my ears," Dr. Eberting says.