Guiding an ‘aesthetically oriented public’ away from loosely regulated medical spas
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Key takeaways:
- 81.1% of medical spas did not have a supervising physician on-site, according to a study.
- Only 64.6% of medical spas informed patients that a physician was not on-site during their procedure.
It is 2020 and lockdown has been instated across the country, turning the world into a virtual playground. TikTok has consumed the younger demographic while adults transitioned to their pixelated Zoom offices.
More than ever before, people are staring at themselves. The result? An “aesthetically oriented public,” according to Sara Hogan, MD, FAAD, clinical assistant professor of dermatology at the George Washington University School of Medicine and Health Sciences.
“The past decade has seen an exponential increase in interest in cosmetic treatments, particularly those that are noninvasive,” Hogan told Healio. “This interest skyrocketed during the COVID-19 pandemic, as people viewed their own faces daily on video conferencing platforms like Zoom and had more disposable income secondary to shifts in spending habits during lockdowns.”
Evidence suggests that as the number of people receiving cosmetic procedures has increased, many are not having their procedures done in physicians’ offices, but instead at medical spas, according to a study conducted by Hogan and colleagues and published in Dermatologic Surgery.
This suggestion has raised alarms among dermatologists. The lack of physician involvement in medical spas may pose safety risks to patients and should be addressed by public protection measures, according to a press release from the American Society for Dermatologic Surgery.
While the American Medical Spa Association reports many states require medical spas to be owned by physicians, not all states have these regulations. Furthermore, even in medical spas that are physician-owned, there are no regulations requiring a physician to be performing or even present during cosmetic procedures.
As a result, physician involvement at medical spas is low.
In a study, Hogan and colleagues surveyed 127 medical spas in the Chicago area and revealed that most cosmetic procedures are being performed by non-physicians without patients’ knowledge.
“A supervising physician was not on-site at 81.1% of the facilities,” Hogan said. “Staff informed patients of this information at 64.6% of the medical spas, suggesting that some patients are not aware that medical spa staff are performing cosmetic procedures without the direct supervision of a medical director or supervising physician.”
Because non-physician providers lack training equivalent to physicians specializing in cosmetics, the risks for procedural complications are much higher at medical spas than physicians’ offices.
In another study published in Dermatologic Surgery, certain procedures, such as minimally invasive skin tightening, had a significantly higher complication rate of 77% at medical spas compared with 0% at physicians’ offices, whereas nonsurgical fat reduction had a complication rate of 80% at medical spas vs. 36% at physicians’ offices.
“What patients should recognize is that cosmetic procedures are still medical procedures, and carry real risks,” Hogan said. “Should a cosmetic procedural complication occur at a medical spa, a medical director or supervising physician may not readily be available for medical evaluation and management.”
Interestingly, studies show that the majority of the public is, in fact, aware of these safety risks. In a survey of 1,108 people, 91.9% of those who only received treatment from physicians’ offices in the past agreed physicians’ offices are safe, whereas 58.1% of these individuals agreed medical spas are safe.
A greater proportion of those who have only ever visited medical spas for their cosmetic procedures also considered physicians’ offices safe vs. those who considered medical spas safe (76.7% vs. 65.1%).
Although the public is aware of the dangers of medical spas, the evidence suggests that many believe the benefits offered by medical spas outweigh the risks, as these facilities are only growing in popularity.
According to the American Medical Spa Association, medical spas are a $15 billion industry in the U.S. with 7,430 spas operating in the country as of 2021, each generating an average $1,722,551 in annual revenue. As of 2022, the number of spas has increased to 8,841 with each making an average $1,982,896 in annual revenue.
“The rise in popularity of medical spas coincides with the commoditization of cosmetic procedures,” Hogan explained, adding that one of the biggest perceived benefits of medical spas is the lower price point.
According to Hogan, the difference in price can be attributed to the lower costs of paying a non-physician vs. a physician to perform procedures as well as the differences in business models between the two settings.
“Medical spas offer a less ‘medicalized’ setting than physicians’ offices,” Hogan explained. “This is because the medical spa business model focuses on volume, both in terms of patients treated and procedures performed.”
This quantity over quality approach may also explain why another appeal of medical spas is the short wait times that are often not found when making appointments at physicians’ offices.
While educating patients on the risks of receiving cosmetic procedures from medical spas may lower the rates of complications, all signs point toward the public continuing to utilize these facilities.
As a result, the American Society for Dermatologic Surgery encourages the enforcement of further regulations on medical spas as outlined in its Medical Spa Safety Act, a model legislation that works toward ensuring patient safety and proper oversight of care in medical spas.
“This model legislation calls on states to regulate medical spas and keep medical procedures under the oversight of physicians, along with requiring medical directors to have training on all procedures being performed,” the association said in the press release. “The model bill also includes additional staff education requirements, notification to the public if a physician is not on-site and options for mandatory adverse event reporting.”
In the wake of the social media and remote work era, it may seem impossible to deter patients from seeking cosmetic procedures at medical spas that do not utilize physician oversight; however, dermatologists can still stand up to these influences and continue to encourage their patients to be safe.
References:
- The 2022 Medical Spa State of the Industry Executive Summary in Context. https://americanmedspa.org/blog/the-2022-medical-spa-state-of-the-industry-executive-summary-in-context. Published Jan. 24, 2023. Accessed Nov. 11, 2023.
- Gibson J, et al. Dermatol Surg. 2023;doi:10.1097/DSS.0000000000003811.
- Safety concerns in med spas with little to no physician involvement. https://www.asds.net/skin-experts/news-room/press-releases/safety-concerns-in-med-spas-with-little-to-no-physician-involvement. Published Oct. 19, 2023. Accessed Nov. 11, 2023.
- Who Can Own a Medical Spa? https://americanmedspa.org/blog/who-can-own-a-medical-spa. Published Nov. 22, 2021. Accessed Nov. 11, 2023.
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