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New standards urged for treatment at spas

February 27, 2009 |

Legislators and doctors are pushing tougher rules for the exploding medical spa business in Massachusetts, saying some of the thousands of consumers who receive laser treatments, chemical peels, and other procedures are being put at risk by unlicensed and untrained providers.

These spas, which offer medical procedures along with traditional beauty salon services such as hair care and pedicures, would have to be licensed by the Department of Public Health, according to a proposal from a legislative task force. And laser skin procedures, including the removal of age spots and tattoos, would have to be performed by a doctor or nurse with special training.

Nonmedical practitioners – cosmetologists, electrologists, and aestheticians – would be allowed to remove body hair using a laser, but only after special training and certification.

The group said in its report that doctors and other professionals not specifically trained in dermatology have begun offering laser skin procedures, which “presents an unacceptable risk to patients.”

“An ER physician can’t just walk out of their ER and start doing Botox” injections, said Russell Aims, spokesman for the Board of Registration in Medicine, which licenses doctors and spearheaded the medical spa task force. “A hospital wouldn’t allow a dermatologist to do brain surgery.”

Because consumers pay cash for cosmetic procedures, rather than use insurance coverage, “the same standards have not been applied as in traditional medicine,” Aims said.

The number of medical spas nationwide has skyrocketed to about 2,500, compared with 500 in 2004, said Hannelore Leavy of the International Medical Spa Association. The group, based in New Jersey, does not know how many of these spas operate in Massachusetts, but task force members said there are probably several hundred, with dozens along Boston’s Newbury Street and in the Chestnut Hill section of Newton.

Regulating medical spas is complicated because they combine many different professionals under one roof, including cosmetologists, electrologists, aestheticians, nurses, and physicians. In Massachusetts, each of these professions is licensed by its own board, and each has its own standards. There are no overall regulations governing who can do certain cosmetic procedures and what type of training is required, and there is no requirement that medical spas be licensed.

Senator Joan Menard, a Democrat from Fall River who sponsored legislation based on the proposal; said she pushed for creation of the task force because she was hearing from friends and acquaintances “who were dermatologists or nurses about the growing incidence of damage to women by people who are not licensed and are using chemicals, or Botox or lasers. . . . There were people severely burned or scarred.”

The administration of Governor Deval Patrick believes that medical spas should be regulated because they perform medical procedures, although it has not taken a position on the filed legislation, said Paul Dreyer, director of healthcare safety and quality for the Department of Public Health. The agency does not have data on the frequency of problems at medical spas.  Competition among the various professional groups for cosmetic business is intense, particularly as more doctors have begun offering laser and other cosmetic treatments to satisfy their aging patients and to boost their profits while working predictable hours. Doctors’ offices would not have to be licensed as medical spas under the proposed rules.
Leavy said that only Florida has passed regulations to broadly oversee medical spas but that “all states are talking about it.” She said patient safety is not the only motivation for the push for regulation of what has become a highly lucrative business. A laser treatment to remove one age spot, for example, can cost $75 or more, and many people require more than one session.

“The dermatologists and plastic surgeons really want to corner this market,” Leavy said. “They really are the driving force, and they want to have aesthetic medicine under their wings and supervision. There are many treatments that need the supervision of a medical doctor, but also many treatments where that’s not medically necessary.”

Jeffrey Dover, a dermatologist with SkinCare Physicians in Chestnut Hill and a task force member, said that while regulating medical spas might appear to be self-serving on the part of physicians, “that’s completely false.”

He said he and his colleagues often see patients whose skin has been temporarily damaged or permanently scarred by unskilled operators. The most common problem, he said, is when operators use the wrong laser or wrong setting to remove body hair and end up removing some of the patient’s skin pigment as well, creating a spotted or zebra pattern. “There are few controls outside the doctor’s office,” he said.

In an online survey two years ago of members of the American Society for Dermatologic Surgery, more than half of the roughly 300 dermatologists nationwide who responded said they had seen between one and 10 patients in the previous year who suffered complications as a result of a skin procedure done by someone other than a dermatologist.

The proposed rules also would create a Board of Registration for Aestheticians, who now are licensed by the Board of Cosmetology. Aestheticians focus on skin care, while cosmetologists generally do hair and nails. The cosmetology board opposes this change. The task force also recommends allowing doctors to sell beauty products and other such items in their offices, a practice now banned by the Board of Registration in Medicine.

Medical spa owners in Massachusetts are split over the proposed rules.

Andrew Reudnick, president of Sleek Medical Spa, a Florida company with four locations in Massachusetts, said the regulations would “make it a much safer environment for consumers.”

But Karin Flynn, owner of Laser Spa in Newton, said that requiring spas to comply with a new set of extensive rules “would raise prices enormously” for consumers. Flynn, a licensed electrologist, performs laser treatments on hair and skin and believes she should be allowed to continue doing so. One reason for limiting laser skin procedures to doctors and nurses, task force members said, is to ensure that a medically trained professional evaluates a patient’s skin for possible cancerous spots.

Flynn said she requires customers to be checked by their dermatologist or doctor before she begins a treatment or by the plastic surgeon who works in her spa. “I’ve been doing this for 20 years, and it’s all I do,” she said. “I am not sure a doctor would give it the same attention.”

by Liz Kowalczyk


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