Explosion of medical spas prompts concerns: No legislation proposed in N.H. yet

By Rebecca Correa , Staff writer

In a unit at Elliot Hospital in Manchester, doctors can make a series of injections called Botox to eliminate wrinkles on the skin in a matter of minutes.

About five miles away at another facility, clients can get tattoos removed, liposuction and some of the same Botox procedures performed at Elliot. But this is not a hospital; rather, it’s a spa, where state board certified doctors work in the same buildings as estheticians performing facials and hair removal.

As more spas pop up nationwide – in some states even in malls – professionals warn there’s a need for legislation to ensure the facilities are properly run.

Nationwide the number of medical spas has grown from 45 in 2002 to more than 2,000 this year, according to The Medical Spa Association – and those are just the ones registered with the organization.

Smoothskin Medical Day Spa in Londonderry is one of more than a dozen spas in the state to have popped up since Botox received approval from the Food and Drug Administration four years ago.

Botox, which costs about $600 for a series of shots, is a purified protein that can be used to reduce severe head and neck pain or underarm sweating by injection. But in most spas, it’s used to eliminate wrinkles on a person’s face.

Linda Rainone, co-owner of Smoothskin, said each time liposuction or Botox is performed at her facility, it’s done by a licensed doctor with special training. But, she admits, not every spa in the country is being run by qualified professionals.

In New Hampshire, medical spas are not overseen by the state Department of Health. That means as long as a medical spa has a licensed physician, it can be open for business.

Even Hannelore Leavy, chairwoman of the national Medical Spa Association, said there are facilities in most states taking advantage of the lax state guidelines.

The organization, which formed four years ago to give some credibility to medical spas, works to ensure they are properly run and offers liability insurance, according to Leavy.

“Malpractice is very serious. We’re taking it quite serious in assuring that if they’re using the title medical spa, they better have some sort of accreditation and qualified doctors on site,” she said.

Some states, such as Florida, Georgia, Mississippi and Washington, have passed legislation. This allows the state to monitor the safety of the facilities and in some cases, assures a doctor is in charge.

Other states, such as California, New York, Indiana and Pennsylvania, are proposing it for the upcoming session.

New Hampshire state Rep. Cindy Rosenwald, D-Nashua, is the chairwoman of the Health, Human Services and Elderly Affairs Committee. She said so far, legislators haven’t discussed how safe medical spas are.

“We don’t generally tell doctors how to practice medicine. That’s what their own licensing board does,” she said. “They enforce their own professional standards and those standards evolve.”

She said legislators trust that doctors have the right education, training and credentials to perform spa procedures, if they’ve received a license.

Leavy said the association backs most state legislation, but said laws passed in Florida this year are too restrictive.

“We need to make sure the people that are administering these procedures have proper training and supervision, but there will always be a few that try to take this overboard,” she said.

In Florida, a medical spa now must be owned by a plastic surgeon and dermatologist.

In New Hampshire, spas can be owned by anyone. Doctors performing procedures can specialize in any kind of medicine, from gynecology to cardiology.

Leavy said it’s important buildings are owned and run by physicians, but she said any doctor is capable of being trained to use Botox.

Similarly, Rainone said it’s more important to ensure there’s a doctor on site than it is to have one specializing in dermatology.

“Some spas have a medical director that’s just there on paper, and you want to make sure the doctor really is present because if there’s not one overseeing the procedures, it’s going to be scary,” she said.

Some professionals worry this may be the case when medical spas pop up in malls in states such as Texas.

Rainone, a registered nurse, admits the industry is growing – just five years ago Smoothskin opened as a laser hair-removal site. Now more than a dozen medical procedures are performed there.

Thursdays are Botox days, when anywhere from two to 10 patients go to the facility for a series of injections.

The reason, according to Leavy, is that people want to look younger.

“The growth is absolutely tremendous,” Leavy said. “Everyone thinks they’ve found the fountain of youth. You walk away without wrinkles after an injection. Of course people are going to be interested.”

And while Leavy thinks medical spas will continue to pop up in malls, Rainone said she doesn’t think it will happen in New Hampshire anytime soon.

“I think that the New Hampshire consumer is a little bit more careful,” she said.


What to look for when choosing a medical spa

r Confirm a doctor will be on site during the procedure.

r Confirm the person performing the procedure is a physician.

r Ask the doctor about his/her specialty. The best trained doctors to provide Botox are those specializing in otolaryngology, plastic surgery, dermatology and ophthalmology.

r Ask how much experience a doctor has in a field, especially since Botox is a relatively new procedure.

r Have discussions with the doctor about potential risks and benefits.
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