America—and a good deal of the rest of the world—is in love with spas. The idea that it’s desirable to allow ourselves to feel and look good, and to spend money to make that happen, has emerged victorious over decades—make that centuries—of self-deprivation engendered by the Puritan Ethic, the Victorian period, the Great Depression, and other social, economic, and religious influences.

All sorts of businesses are reinventing themselves as spas: Just check out your local health club, hair salon, or luxury hotel. All of them offer facials, manicures, pedicures, massages, peels . . . the list is growing all the time. You simply can’t go anywhere without getting pampered.

And of course, you, the aesthetic plastic surgeon or dermatologist, may well be offering the same services. It’s only natural. You’re in the business of making people look (and therefore, feel) better, and who has more ways to do that than you?

On The Web
See “Is a Doctor Needed in the House?” by Cheryl Whitman in the October 2006 PSP. Go to and click on “Archives.”

Nobody. That’s why there are now about 1,500 medical spas operating in the United States, according to Beautiful Forever Medical Spa Consulting, located in New Jersey and Florida. Of course, not all of them are owned or operated by plastic surgeons or dermatologists; many other physicians, such as general practitioners and obstetricians/gynecologists, who do not ordinarily practice aesthetic medicine, also have opened spas.

Any physician who operates a medical spa has to do it right, especially in terms of protecting patient safety. To this end, last month the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) jointly issued a “patient safety advisory” on selecting medical spas and procedures they provide.

The second paragraph of the advisory contains a disquieting passage: “For those providing treatments outside of the medical office, there are no national standards for medi-spas, no recognized definition of what constitutes a medi-spa, and no oversight organizations that provide the information you need to make an informed, safe choice.”

The advisory goes on to give several pages of excellent advice on how to choose facilities, practitioners, and procedures; and provides questions patients should ask themselves and spa personnel before deciding to obtain medical-spa services.

But the ASPS and ASAPS, at least in this document, don’t address the important issues they raise in that second paragraph. However, to their credit, in October 2006 they jointly issued guiding principles on the supervision of nonphysician personnel in medical spas. But who indeed should be promulgating definitions, setting standards, and overseeing medical-spa operations?

Now, we do know that some state medical boards have gotten into the business of determining how medical spas should be run, especially in terms of physician presence and supervision (left). But does it make sense for there to be different rules for each state? As we’ve seen many times in the course of American history, this just penalizes the ethical practitioners in the stricter states and drives the sleazier ones to open up shop in the states with few or no regulations.

Shouldn’t one or more of the national associations—ASPS, ASAPS, American Board of Plastic Surgery, or even the American Medical Association itself—step up to the plate and at least set definitions and standards (not just guidelines) for medical spas? Even better, maybe the time is ripe to create a physician-run board that would oversee and certify medical spas. Such a board would consist of representatives from all medical disciplines that are involved with spas, and would serve to ensure patient safety while protecting the interests of those who run medically sound operations.

Of course, there may be other ways of accomplishing these goals. Please send PSP your suggestions as to how medical spas should be governed, and we will publish them online as well as in next month’s issue.