Growing Young
Navigating a new wave of medical spas
It’s 5 p.m. on a Thursday, and I sink into a plush armchair at Skintuition Medical Spa. A soft voice from a flat-screen TV washes over me, dissolving into the hush of a fashionable waiting room. When the receptionist calls my name, I resurface from my reverie, and it hits me. I’ve finally found the fountain of youth.
I check out the glossy menu of services and discover a mouth-watering array of methods to mend my middle-age woes: Botox and fillers to erase my wrinkles, facial treatments to rejuvenate the skin, lasers to lose wayward hair, vein treatments to reclaim my legs. Who says youth is wasted on the young?
“Our medical spa gives a pampering kind of vibe,” said Kimberly Cayce, a dermatologist with DeSpain Dermatology center, who along with John DeSpain directs the Skintuition spa. “What woman doesn’t like to be pampered?” Patients like the convenience, easy access and affordability of a spa setting, and many of the services are minimally invasive but yield good results, she said. Cayce looks like the picture of health herself, and her skin is radiant. I wonder which treatments she might have received until she stands up from behind her desk and reveals that she’s expecting. (Neither the fountain of youth nor the magic of medicine can recreate that glow.)
The beauty of a medical spa like Skintuition is that DeSpain Dermatology Center, Drs. DeSpain and Cayce’s medical practice, lives here, too. Dermatology patients can choose spa treatments to complement a medical condition and vice versa. A woman who takes her child to a doctor’s appointment might decide to treat herself to a spa service, said DeSpain. “Or someone could be getting spa treatments for sun damage, and when we look more closely, we find medical issues like skin cancer.”
Cayce explains that laser hair removal and facial treatments, such as peels, are done by licensed estheticians while she and DeSpain perform Botox injections and fillers, leg vein treatments and laser surgeries. All of the treatments are administered under physician supervision. “We’re always in the office when any of these things are going on,” Cayce said. “We have a lot of teamwork here.” The entire staff implements a philosophy of treating the whole patient rather than one condition, she said.
Medical spas are the latest trend in a world where the lines between esthetics and medicine are fading faster than Joan Rivers’ crow’s-feet. Driven by patients desiring more connection with their doctors (and by aging boomers like me), these facilities blend traditional medicine with the services of a healing spa. The result is a hybrid of clinical and luxury, a holistic approach that not only treats the body but also the mind and spirit.
By seeking to create a physical, mental and emotional balance, medical spas hearken back to the way medicine was practiced in the past. The difference is that instead of an all-knowing Marcus Welby-style doctor, spas step in where the physician leaves off. In addition to aiding with recovery and prevention, some have expanded to include nutritionists, psychologists and personal trainers as part of a growing trend called integrated medicine.
According to the International Spa Association, medical spas are the fastest growing component of the U.S. spa industry. Their numbers doubled between 2002 and 2004, generating an estimated $1 billion in 2007. Services tend to be elective — deemed unnecessary by insurance or Medicare — so clients pay out of pocket, creating a revenue stream that’s free from many of the constraints of traditional medicine. In short, medical spas are good business.
“There are two models for medical spas,” said Dr. Matt Concannon, a local plastic surgeon. Some physicians expand their outpatient facilities while others choose to partner with existing day spas. “Sometimes a cosmetologist or esthetician will hire a doctor to meet requirements,” he said. And here’s where I learn that not all medical spas are created equal.
“Some spas are taking shortcuts with patient safety to make a buck,” he said, pointing to a local facility that offers procedures like liposuction with an out-of-town medical director. Even a layperson like me sees a potential red flag, especially when he explains that this particular medical spa/laser center has no emergency medical equipment — not even a crash cart. The doctor performing the surgery lives four hours away, which begs the question: Who would cover in the event of a complication? “This physician doesn’t have privileges or transfer agreements at any of the local hospitals,” Concannon said. “What if the patient has a blood clot, which is rare, but could be lethal? Itinerant surgery can get you into a lot of trouble.”
I’m reminded of high-profile cases of lipo gone wrong. A German belly dancer lost one of her buttocks in a botched procedure. The woman who wrote First Wives Club, which includes a character played by Goldie Hawn who’s obsessed with plastic surgery, died at 54 of complications from a chin sculpting procedure. Donda West, the well-educated mother of hip-hop singer Kanye West, had no inkling complications of a tummy tuck would prove deadly.
Few people would and for good reason. Fatalities from liposuction are extremely rare but highly publicized. Hard bodies and younger looking skin might be the new normal in some circles, but no one’s expecting looks to die for. In fact, though Skintuition and other spas like it don’t offer these types of procedures, this has less to do with risk than their overall mission. DeSpain explains the reason his medical spa hasn’t gotten into lipo this way: “It ought to be part of a package of lifestyle change, which goes back to our philosophy of treating the patient as a whole rather than one part.”
“In Missouri there are no laws regulating medical spas,” said Dr. Barbara Howard, a plastic surgeon in Jefferson City. “Some other states have taken that on, but Missouri has not.” Medical spas aren’t required to invest in rigorous safety standards found in hospitals, and doctors aren’t subject to peer review because there are no insurance requirements. With payment up front and the freedom to set fees, all kinds of doctors are being lured into the business. Some have little more training for liposuction than a weekend course at a hotel.
The Missouri Board for the Healing Arts, which licenses and regulates health professionals, does require medical spas providing Botox, laser hair removal and liposuction to do so under the direction of a licensed physician. However, the physician need not be on site. “The doctor is liable for procedures done there, and the doctor’s license should be somewhere present, i.e.: on the wall,” wrote the board’s Travis Ford.
How do consumers safely navigate the unchartered waters of medical spas? Cayce suggests visiting a facility and doing a little checking around before signing up for treatment. She recommends getting references from other customers, inquiring into who runs the facility and what type of equipment they use and checking board certification. Physicians should be certified in their specialty through the American Board of Medical Specialists. Most importantly, patients should make sure there’s a physician on the premises. “People, for the most part, are trusting,” said Cayce, describing how shoppers in Las Vegas can get Botox injections at a mall. Talk about a gamble.
Perhaps nothing illustrates the cavalier attitude toward cosmetic procedures better than the popular TV show Nip/Tuck. Each episode opens with: “Tell me what you don’t like about yourself.” Something tells me that the physicians, nurses and estheticians at Skintuition Spa are more likely to ask: “What do you like about yourself, and how can we make it better?”
