What to consider before going to a medical spa
She went to Pure Med Spa in Chicago for minor cosmetic touch-ups, a little Botox around the eyes to smooth her crow’s feet and Juvederm to plump her lips.
“It was a no-brainer for anybody who knows what they are doing,” says the Chicago Angie’s List member, who declined to be named for privacy reasons.
But she says the Pure Med experience left her bruised and disfigured for weeks. “I looked like I’d been in a head-on collision,” she says.
Jennifer Bell of Redmond, Wash., feels the same about Pure Med, only her wallet allegedly took the hit. She says she paid up front for laser hair removal, dermal fillers and chemical peels, but says she lost more than $3,000 when the company ignored her refund requests for treatments she didn’t receive.
The two women are among numerous customers who’ve written negative reviews about Pure Med on Angie’s List and other sites. At its peak, Pure Med, along with related companies, Brite Smile Brite Skin, Skin Nuvo and Lumity, operated more than 70 medical spas. Their parent company, BSML Inc., is now in bankruptcy.
However, former BSML CEO Jeffrey Nourse and COO Louise Talbot are still operating medical spas: Nourse in Canada, with at least two Pure Med locations in the Toronto area, and Talbot in Dallas and the Seattle area under the name Renew Beauty.
Nourse and Talbot are named in two civil lawsuits in California alleging personal injury caused by lasers used at now-closed Pure Med locations. The closures, often overnight, left customers holding thousands of dollars in prepaid contracts, according to online complaint boards.
Attorney Kevin Taguchi of Hayward, Calif., says he’s seen the consequences of bad cosmetic procedures, particularly secondand third-degree burns from lasers. He says he’s reached 15 confidential settlements already but can’t release the victims’ names or laser manufacturers involved and has another civil case involving a former Pure Med customer in California set for an October trial against Palomar Medical Technologies.
Taguchi, whose clients are from California, alleges Palomar sold medical lasers to Pure Med in violation of state law prohibiting the sale of medical devices to nondoctors. Attorney Tony Brazil of Los Angeles, representing Palomar, didn’t return calls from Angie’s List Magazine seeking comment. Nourse and Talbot also didn’t return our calls.
Spa injuries, finanical harm highlight industry debate
The Pure Med debacle highlights the medical and financial hazards posed by unscrupulous providers and the high price of consumers’ casual approach to non-surgical cosmetic procedures. Americans received more than 5 million Botox injections last year and more than 7 million other procedures such as laser hair removal, soft-tissue fillers, microdermabrasion and chemical peels, according to the American Society of Plastic Surgeons. Angie’s List members have gone to medical spas, day spas, dermatologists and plastic surgeons for these treatments.
By all accounts, non-surgical cosmetic procedures are generally safe when performed by properly trained and supervised providers. But the explosive growth — 123 percent in 10 years, according to the American Society of Plastic Surgeons — coupled with little state oversight, means consumers must be more cautious than ever about who they hire, warns Dr. Jeffrey Dover, a board-certifi ed dermatologist with highly rated SkinCare Physicians of Chestnut Hill, Mass., outside Boston.
“You have one face. You have to treat it wisely,” Dover says. “If you see the wrong person and they don’t know what they’re doing, you can end up with a very poor result that is often not correctable.”
Nathan Parker, owner of highly rated Zenergize Wellness Spa in Roswell, Ga., prefers to keep med spa procedures in the hands of family physician Dr. Mark Grimsley, who performs Botox, filler injections and laser hair removal when he visits a few times a week. “He works as an independent contractor,” Parker says. “There’s nobody on my staff who would be appropriate to do injections or anything like that. The doctor does it.”
5 tips for cosmetic procedures
Kristina Folsom of Silver Spring, Md., says she can attest to the high cost of bad work. About 10 years ago, she had a good experience with laser hair removal on her legs. That spa closed, so she went to Reveal Med Spa locations in White Flint and Gaithersburg, Md., both now closed, for laser work on her bikini line. Her husband, Robert Langston, also sought work on his beard.
The spa, which has a C rating on Angie’s List, advertised its laser as “painless,” but it left her with minor burns, she says: “[My] skin was peeling.” Six months, numerous treatments and $5,000 later, both she and her husband say they saw no difference. “If anything, I’d say there’s more hair now,” Folsom says.
Paul Amoruso, who owns Reveal Med Spa and continues to operate three locations in the Washington, D.C., area, says Folsom never complained to Reveal about burns and the company’s overall C rating on the List based on five reports is unfair. “We get hundreds of positive evaluations every week,” he says. “The five reviews you’ve collected is less than we get from [clients] in just 30 minutes on any given day.”
Folsom says she called a couple of times to complain. “They’d point out every single time, ‘We didn’t promise any results,’” she says, adding she’s done with med spa treatments. “Next time, I will go to my dermatologist and ask for her suggestion.”
State laws vary on when doctor is needed
Dover says that’s a good first step. State laws on who can perform minimally invasive procedures and whether a doctor needs to be present vary widely. In Michigan, a medical doctor can be off-site and delegate procedures such as Botox and dermal filler injections to anyone. In New Jersey, only medical doctors can perform minimally invasive procedures, including laser hair removal.
California requires all non-surgical cosmetic procedures to be supervised by a doctor, but does not defi ne supervision. They can delegate procedures to registered nurses and physician assistants. “Physicians need not be present in the facility when the procedures are being performed,” says Debbie Nelson, analyst with the Medical Board of California.
Pure Med’s 22 California locations were registered from November 2006 to March 2008 under the name of Dr. Anthony Joseph Ghidorzi, a California-licensed osteopathic physician. The Osteopathic Medical Board of California found that Ghidorzi did not have any ownership in Pure Med, required by state law, and thus was aiding and abetting the unlicensed practice of medicine. He was reprimanded in May 2011 and ordered to attend an ethics class, but retained his license. Ghidorzi, who now lives in Chicago, did not respond to phone calls and emails from Angie’s List Magazine.
No state laws are as strict as they should be, says Dr. Leo McCafferty, a highly rated plastic surgeon in Pittsburgh and president-elect of the American Society for Aesthetic Plastic Surgery. The ASAPS believes the supervising medical doctor should be on-site and board-certified in a skin specialty such as plastic surgery, facial plastic surgery or dermatology. “These core physicians are best qualified to do this,” McCafferty says, adding specialists know how to recognize that something is going wrong and how to correct it.
Dermal fillers, used to make skin look more full and to smooth wrinkles, for example, can block small blood vessels. “It causes that patch of skin to turn black and die,” he says. “What that would do is cause a large scar — a permanent scar.” If improperly handled, many of the procedures can cause blisters, scabs and infections, Dover says.
One of the greatest dangers is overlooked symptoms of a more serious disease such as skin cancer. Sun-induced brown spots can be lightened with a laser. “How would a non-medical person know if one of those is incipient melanoma? They wouldn’t,” Dover says. “The melanoma spreads and you can’t tell because the brown pigment has been taken out of it.”
Medical spa or doctor's office?
Dover doesn’t even like the words “medical spa.” He prefers to think of his SkinCare Physicians office outside Boston as one of the nicest doctor’s offices you’ll ever see, but still a doctor’s office: “There’s no aromatherapy. There’s no music playing. It is tastefully done but you don’t feel like you’ve gone to the spa for a day of pampering.”
Dr. Lori Brightman, a board-certified dermatologist with highly rated Laser & Skin Surgery Center in New York City, disagrees. “If a doctor chooses to have a spa to offer a more serene and tranquil environment, that’s fi ne as long as the procedure is overseen by an on-site doctor.”
Robert Logue, president of highly rated Clearstone Laser Hair Removal & Medical Spa in Houston, doesn’t believe a doctor must always supervise procedures, particularly laser hair removal. “How much time did a physician spend learning laser hair removal? Probably none,” Logue says. “Our estheticians undergo 700 to 900 hours of education.” Texas licenses laser hair removal technicians, and Logue argues that using trained estheticians keeps prices reasonable.
Dr. Alexander Cadoux, owner of highly rated Greenspring Rejuvenation Medical Spa in Tucson, Ariz., says doctors should be on-site in case any problems occur during a procedure. He urges consumers to look for experienced providers and avoid low prices, which can indicate low quality. “People tend to focus on price, but you can be penny-wise and pound foolish with these procedures, and that’s where the complications come,” says Cadoux, an emergency medicine physician with additional training and experience in cosmetic surgery.
As for payment, Parker of Zenergize advises his clients to never buy a package until they’ve had at least one procedure at that spa and are happy with results. Dover says he won’t sell packages. “I repeatedly see patients who fall into this situation,” he says. “They have prepaid for a series of treatments and part-way through they’re disappointed. They are stuck and rarely if ever get their payment back.”
Experts say it’s also important to investigate your provider. Photos can be bought and may not refl ect the doctor’s work, Dover says. “You could be a brilliant scientist and a great physician, but not be very good in this field,” he adds. “We see lips that are too full, eyebrows arched in a funny way, foreheads that are too smooth, cheeks that look like a Picasso painting toward the end of his career.”
He suggests asking: Do the before-and-after photos reflect your own work? What training and qualifications do you have? How many of these have you done? What are the risks? And may I speak with some of your patients who’ve had this procedure done? “If the doctor says ‘No’ to any of these, you walk out,” Dover says. “You vote with your feet.”