Medical Spas Offer Beauty On The Run, But Physicians Advise Choosing Carefully

By Nerissa Pacio Mercury News

Clients of Morphosis Rejuvenation Studio in San Jose can make a beauty pit stop to zap away acne, smooth pesky wrinkles and plump skinny lips -- all between shopping and grabbing a latte.

``We like to call them lunchtime treatments,'' says Linda Levenson, a nurse practitioner and founder of Morphosis at Santana Row. ``There's virtually no down time. You can get something done, put on your makeup, and go back to work. It's like running another errand.''

Medical spas such as Morphosis are a fast-emerging category in the spa industry and in aesthetic medicine, proliferating in shopping centers and strip malls in the Bay Area and across the country.

For those looking for quick, relatively affordable results without going under the knife or having to take time off, these spas, also called ``medspas'' or ``medi-spas,'' have taken non-invasive cosmetic procedures into an elegant, day spa setting.

With many offering luxury ambience, convenient retail locations with walk-in services and special discount packages, more and more people are tempted to choose a medspa over a traditional doctor's office. But despite the growing popularity of medspas, some physicians warn that there are potential safety hazards if facilities don't have the proper medical supervision.

``There's a huge demand'' for medspas, says John Buckingham, founder of the Southern California-based national medspa chain Solana MedSpas and board member for the International Medical Spa Association, ``mostly by baby boomer women in their 40s and 50s, whose kids are grown and who are now looking in the mirror saying `Oh, my God, I don't want to look like my mother.'''

``They want to be pampered, they want these procedures done in a convenient place close to other stops they are making on the weekends, and they don't want to sit next to sick people in a sterile doctor's office,'' Buckingham says. ``It's medicine -- in a spa-like, retail environment.''

Menus vary from medspa to medspa, with some offering relaxation and holistic health services such as massages, facials, nutritional counseling and acupuncture, alongside medical treatments such as Botox and laser hair removal typically performed at a dermatologist's or plastic surgeon's office.

Prices at medspas are competitive with doctor's offices for single treatment services, says Nicole Dolce, director of marketing and sales for the San Jose and San Mateo branches of Sona Medspas, a national medspa chain. Cost savings usually occur when medspas offer special discounts for bundled services, she says.

At Morphosis, for instance, prices generally range from $120 for a single 15-minute laser hair removal to $2,000 for two sessions using their new Titan Cutera machine, a device that claims to use radio frequencies to tighten the skin. Sona offers a men's spring special: spend $500 on laser back hair removal and get your neck and shoulders lasered for free.

Observers say there's a heightened demand for these procedures by a population that's time-crunched, aging and concerned about beauty.

There are about 1,500 medical spas nationwide, a figure that has tripled since 2003 and continues to grow, says Hannelore Leavy, executive director of the International Medical Spa Association.

FDA approval of Botox for treating frown lines revolutionized the specialty fields of dermatology and plastic surgery in 2002, says Vic Narurkar, founder of the Bay Area Laser Institute and president of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

The relatively simple procedure of injecting Botox meant it became the No. 1 non-surgical cosmetic procedure in the United States, with 3.2 million procedures performed on Americans in 2005, according to the American Society for Aesthetic Plastic Surgery.

``It's an effective, immediate, tried-and-true treatment that really set the bar for minimally invasive, non-surgical procedures,'' Narurkar says.

Botox's relative ease and low cost made it an ideal procedure to be offered at medspas.

There were also continuing improvements and refinement of non-surgical cosmetic procedures such as skin resurfacing that spurred more women to give them a try.

They include: wrinkle-plumping dermal fillers such as Restylane, more precise laser treatments such as Fraxel, barbed sutures inserted beneath the skin for a 30-minute mini face-lift called ThreadLift, and energy-based devices such as Thermage that claim to redistribute cellulite and tighten the skin.

``In the past, these were procedures only done by the rich or people in Hollywood,'' says Rick Noodleman, medical director of the medspa Age Defying Dermatology and co-founder of the cosmeceutical line Revercel. ``Now it's more acceptable, more affordable, and it's just another thing you do to look good -- like buying makeup.''

Despite the convenience or special discounts widely advertised by medspas, some doctors warn that clients should beware, because there is no agreement by state medical boards on how to regulate this industry.

``A lot of times these places are glitzy franchises in beautiful locations,'' Narurkar says. ``But the consumer needs to ask: `Who is doing the treatment? What is their qualification and training? Are the treatments FDA-approved?' The biggest thing the consumer needs to be aware of is safety.''

The California Medical Board states that a board-certified physician must serve as ``the majority shareholder of a business involving the practice of medicine,'' says Candis Cohen, spokeswoman for the board.

It also regulates which medical professionals can perform the procedures, Cohen says.

Only licensed physicians' assistants and registered nurses can inject Botox or use laser and light impulse treatments and they must be performed under the supervision of a physician, Cohen says. But supervision doesn't mean a physician must be present when the procedure is done -- the doctor just must be immediately available by phone in case of emergency.

The quick emergence of the medspa industry and of new technologies has created a gray area and confusion about which medical professionals can perform which procedures, says Dr. Hayes Gladstone, assistant professor of dermatology and director of dermatologic surgery at Stanford University.

``The medical board hasn't addressed this clearly,'' Gladstone says. ``As a physician, I tend to be a little more conservative. I'd want to be present at all times. These are medical procedures -- not purely cosmetic services like hair styling.''

Narurkar also warns patients to check to be sure that a medspa's medical director is a practicing physician and that his or her specialty is dermatology or plastic surgery.

``They might have a medical director who is a retired obstetrician or an anesthesiologist,'' Narurkar says. ``Now I ask you, what does this person really know about the skin?''

Doctors say do your research before booking an appointment.

At Age Defying Dermatology in Campbell, Noodleman says he is on site daily to supervise all procedures.

Morphosis has trained and licensed registered nurses and physicians' assistants performing medical services, Levenson says, and Dr. Randall Weil, a plastic surgeon, is on site every Thursday. Patients can request Weil when they book their appointment. The medspa does not employ aestheticians, who are not licensed to practice medicine.

``Most of these procedures are safe if done under proper medical design and supervision,'' Noodleman says. ``But anything that is more than a basic spa facial carries the risk of side effects and complications. Don't make the mistake of assuming that all of these places are equal and risk-free.''