Taking medical spas seriously
New regulations sought for some common cosmetic procedures
As less invasive cosmetic treatments such as Botox and laser hair removal have come within financial reach for an increasing number of patients, so too have concerns grown about who is performing such procedures and whether they are being done safely.
At the root of much of many of the safety worries is the fact that more of these services are now being delivered at what are known as medical spas, or medispas. The term “medical spa” usually refers to a facility that performs traditional spa treatments, such as facials and massage, but which also provides more medically oriented cosmetic procedures, including injectable fillers and skin resurfacing. In many regions of the country, those spas can be found anywhere from the local mall to a dentist’s office.
According to Eric Light, executive director of the International Medical Spa Association, a trade group based in Minnetonka, Minn., there are roughly 2,500 medical spas operating across the country. And that number is growing, Light says, adding that his association currently represents about 10% of the market.
The issue, according to many physicians who routinely perform these services, is that there is little to no oversight of these spas. In the absence of overarching federal rules for cosmetic medical procedures, decisions regarding training requirements, disclosure and physician supervision are left up to individual states, says Lawrence Green, a Rockville, Md.based dermatologist.
“Each state makes their own rules,” says Green, who also is chairman of the scope of practice committee for the American Society for Dermatologic Surgery, and an assistant professor of dermatology at George Washington University School of Medicine and Health Sciences, Washington. “In many cases, you have people who are not properly trained who are performing these procedures.”
That was the case in Maryland, too, until recently, he says. Green lobbied alongside the state’s medical society, making the case to the Maryland Board of Physicians that changes needed to be made. And in August, the state enacted some of the toughest regulations of outpatient cosmetic medical procedures in the country. The new rules define which cosmetic procedures are medical and which ones are not. Microderm abrasion, for instance, is not considered a medical procedure, while Botox—injections for treatment of facial wrinkles—and laser treatments are. The regulations also stipulate to whom a physician can delegate a procedure, and they require that personnel receive training from an accredited continuing medical education body, and not from a device manufacturer, Green says.
Finally, Maryland’s new rules include stringent rules for record-keeping, licensure and medical directors. They also require that those delegated by a physician to perform procedures, such as physician assistants or nurse practitioners, adhere to supervision and training requirements.
“We were so fortunate that the board of physicians took on this issue and decided to do something,” Green says. “I wish it could happen in other states. The bottom line is that we need to perform these procedures safely and give patients the best possible results.”
The motivation for the new rules was purely and simply to improve patient safety, says Karen Wulff, policy analyst for the Maryland Board of Physicians. “At this point, we are still trying to get the word out,” Wulff says. “When it comes to getting things done, though, regulations are the gold standard.”
And although states vary considerably in their regulations, several also have begun to
In many states, there is little or no regulatory oversight for medical spas that provide a variety of cosmetic procedures.