Are Medical Spas Dangerous?

Medical spas are a booming industry, but serious questions have arisen about how safe it is to have cosmetic treatments involving injections and lasers when there may not be a doctor in the house. 

Tucked into malls and shopping centers, these facilities typically offer laser treatments to zap away unwanted hair on your legs, chemical peels, injections of Botox and Restylane (an injectable filler to smooth out facial folds), often at cut-rate prices that seem too good to be true. 

And as more and more Americans flock to these loosely-regulated spas, there’s been a surge of malpractice cases over complications of botched treatments, including burns, scars, infections and even deaths.

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So, who is wielding that laser or holding the syringe filled with Botox?

You might assume that you’ll be in the hands of a plastic surgeon or dermatologist trained to do those procedures, but the woman in the white coat at the medi-spa could well be a technician who has had little or no formal training in medical procedures that are not risk-free. 

Laws differ from state to state, but often a doctor’s presence on site is not required as long as the place is being run in his or her name. The doctor in question may not be a plastic surgeon or dermatologist. He or she could be a gynecologist, family practitioner, even a dentist. 

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Cautionary Tales

Things can and do go wrong in medical spas. Enough horror stories have come to light for the AMA to adopt a new policy calling for a formal complaint process to report injuries and an effort to draw attention to the dangers posed by spas that don’t adhere to patient safety standards. Some cases that have come to light are pretty scary:

• In preparation for laser hair removal Shiri Berg, 22, a college student in Raleigh, NC, slathered her legs with a numbing gel as instructed by a medical spa staffer. On the way to the spa, she had a seizure, then lapsed into a coma and died eight days later. The gel contained lidocaine and other potent drugs and was meant to be used only on small patches of skin. 
• In a similar case in Arizona, another woman died following a two-year coma she lapsed into after using a lower dosage of the same numbing gel before her scheduled laser hair removal.  
• In Utah, during laser treatment at a medical spa to lighten sunspots on her face, a young woman was burned so severely that she needed reconstructive surgery that couldn’t entirely erase the scars. 
• In Seattle, clients whose skin was blistered, swollen and discolored after laser treatments at a medical spa complained to the state. An investigation showed that the spa’s three technicians had no license to practice but were using lasers and dispensing prescription-strength numbing cream. 

The case led to a new state law requiring a physician be on the staff of spas that use lasers, light radiofrequency and plasma devices on the skin and that the doctor be trained in the use of lasers and train others at the facility who use lasers. 

When the Price Seems Too Good to Be True

Why go to a doctor or a clinic for a cosmetic treatment you can get at a medical spa? Part of the allure may be cost--why pay big bucks for Botox when you can get some injected into your frown lines for $99 at the medical spa at the mall? The average plastic surgeon charges $308 to inject 20 units of Botox, according to American Academy of Facial Plastic and Reconstructive Surgery’s 2011 statistics.

Consider this: Allergan, the only manufacturer of FDA-approved Botox, reportedly never discounts its wholesale price, so there could be another reason for a suspiciously good deal: An unscrupulous medi-spa could be diluting the Botox powder with more sterile water than the manufacturer calls for.

As one doctor put it, instead of cheap Botox, you could be getting expensive water. (Now you know why some of these frown-fighting treatments don’t work.) Another risky cost-cutting strategy: paying untrained, inexperienced workers rock-bottom wages, way below the pay scale of a qualified nurse practitioner. 

What You Need to Ask

If you’re considering going to a medical spa, ask these key questions before signing up for treatment. If the answers don’t feel right, walk away, rather than risk complications that may be a lot worse than a bad haircut. 

• Who is the physician in charge and what are his/her credentials? (You want a board-certified plastic surgeon or dermatologist.)
• Who will perform the procedure? (Correct answer: the doctor or a licensed nurse, physician’s assistant or nurse practitioner.)
• Will the doctor be on site during my procedure? (The answer should be yes)
• Can I see before and after pictures of patients who have had this procedure?
• Who is financially responsible if complications arise or revisions are needed?
• Is this laser, device or treatment right for my skin type?
• How do you deal with emergencies?

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