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.”