As European spas and their government-sponsored "cures" wane in popularity, Medical Spas are gaining. They are combining the best of Western medicine -non-ablative lasers and light pulse devices that rejuvenate without wounding the skin-with the best of Eastern medicine and its emphasis on relaxation, tranquility, and touch.

Dr. Aaron Barson, medical director of Surface Medical Spas in Utah, cites three factors behind the rise of the MedSpa.
      "One is the new medical technologies that show real results," says Dr. Barson. "The second is aging baby boomers, who make up more than 51 percent of the population. Boomers want to look younger but are bypassing the older technologies of plastic surgery in favor of newer, non-invasive techniques that give more natural results. The third factor is that we have the technology to perform these anti-aging procedures without surgery or recovery time."
      They all come together at the MedSpa.

MEDICAL SPAS "Any facility that presents a merger of medical practice and spa therapeutics could be called a medical spa," says Dr. Barson. "That's a pretty open definition and covers everything from traditional medical facilities like plastic surgeons who have added Botox injections to their list of procedures, to medical spas headed by a physician and staffed by nurses and estheticians, to destination health spas that have a visiting physician that gives Botox injections.

The line between day spas and medical spas is also blurry.
      "There are many different levels," says Dee DeLuca-Mattos, vice president of Avance, a skincare company based in New Jersey, and president of the newly formed Medical Spa Society. "For example, Juva MedSpa in New York City is first and foremost a medical facility, run not by spa practitioners but by doctors who treat skin and body conditions with prescribed medical solutions. So a facial at Juva uses medicinal products."
      She compares it with De Pasquale Spa in Morris Plain, New Jersey, "which is more of a wellness center that treats the skin and body with seaweed and other natural plant-based products. But there is also a cosmetic surgeon on the premises, and the staff works closely with doctors and hospitals off-premises. So De Pasquale is first and foremost a spa, but one with medical partnerships."
      One way to find out if a MedSpa jibes with your personality is to visit it beforehand, pick up some brochures, check out the clients, and ask questions of the staff.

ESTHETIC SPAS Anyone who has ever wedged a dermatology appointment into her work week will appreciate the concept behind New York-based Skinklinic and Southern California-based Complexions Rx. Storefronts that are open eight days a week and offer treatments you'd expect to find in a doctor's office. But they're delivered by nurse practitioners (registered nurses with advanced training) at slightly lower prices than doctors charge.
      These franchised face places also offer microdermabrasion, laser hair removal, facials, and glycolic peels but stop short of performing physician based treatments like Botox, skin-cancer checks or prescribing drugs like Accutane (an oral drug for severe acne), referring those cases to local doctors.

By bringing dermatology to the masses, these mall chains help the many acne sufferers who lack a regular skin doctor and aren't aware of anything stronger than Clearasil to fight blemishes. And the convenience factor is a strong lure; besides being open on weekends, some of these clinics see clients until 8:00 P.M. several days a week.

PLASTIC SURGERY SPAS Located within or adjacent to a plastic surgeon's offices, these offer pre- and post-surgery treatments like lymphatic massage (said to drain fluid from tissues before and after a face-lift, tummy tuck, or liposuction), deep chemical peels, microdermabrasion, laser hair removal, and softtissue injections.
      Most common are the plastic surgeons that add one or two pieces of technology and hire a technician working on commission to manage the non-surgical patients.
      Since the potential for improvement or harm is greater with invasive procedures, it's important to check credentials and make sure that a physician actually is in charge.
      There have been a number of cases where treatments have been performed by technicians that were supposedly under physician oversight but were in effect performing procedures on their own. Some of these cases resulted in terrible consequences for the patient and ended up, as you'd expect, in court.

DERMATOLOGY SPAS As dermatologists look for ways to supplement the reduced fees paid by HMOs, they are reaching out to the very spa personnel they scorned 20 years ago: facialists whose expensive creams did little more than moisturize.
      But with the invention of cosmeceuticals like glycolic acid and Renova that really penetrate the skin and improve its appearance, doctors are expanding their offices and hiring paramedical estheticians (facialists with advanced training) to give treatments and sell product lines formulated, not surprisingly, by the derms themselves.
      It seems to be a win-win for everyone, since patients gain access to higher-strength products distributed only through physicians and can also have blocked pores cleared with medical tools, like lancets, that only doctors or their staff can legally use.

CHECK-UP SPAS With consumers' growing interest in good health through fitness and other preventive medical strategies, diagnostic centers like Accuscan in Salt Lake City appeal to those who want a soup-to-nuts physical without having to run all over town to different specialists.
      People looking for a "manager" who can perform tests, view the results, and put it all together for them in a customized health program check into these Spas for one to three days or more, sandwiching the fun stuff (yoga classes and deep-tissue massages) in between blood tests and ultrasound scans.
      "Many of us are basically idealistic doctors who were frustrated with diagnosing diseases that could have been prevented in people who were not short on money or brains but who just didn't get screened," says Dr. Daniel Cosgrove, medical director of the Wellmax Center for Preventive Medicine in La Quinta, California.
      He's meeting the challenge of drawing people into his center on the grounds of the La Quinta Resort & Club with cosmetic dermatology treatments, "which make them look and feel more beautiful. Once we have their attention, we start talking about the less glamorous procedures like colon-cancer screenings" or bone-density testing in conjunction with a whole-body CT scan.

BUYER BEWARE "Whether you're buying a house, a purse, or a service at a medical spa, the first rule is buyer beware," says Dr. Barson. "Make sure the spa facility is reputable and that its estheticians, manicurists, and massage therapists are licensed by their state boards".
      As for the doctors at the facility, find out if they specialize in the newest non-invasive cosmetic technologies. If they are offering only one or two advanced technologies it's a sure sign that they don't specialize.
      "The new technologies require extensive training outside of surgery or dermatology," says Barson. "There is no board certification in Aesthetic Medicine. The best way to make sure you're in the best hands is to find out if your provider specializes in non-invasive cosmetic procedures or just offers it as a sideline."

BOTOX KNOW-HOW "It's important to find out if the medical spa you choose is physician-supervised," says Dr. Joshua M. Wieder, assistant clinical professor of dermatology at UCLA School of Medicine. "That way, if a question or complication arises, the physician can lend an opinion."
      As for nurses using wrinkle- fillers, he says, "For years nurse practitioners and medical assistants have injected collagen without problems." But, he adds, "Botox is much trickier to inject. It's very operator-dependent in terms of how much you put in and where you put it. I don't inject Botox in the same place on every patient, because it depends on where the muscles are pulling, and since some people's lines are asymmetrical, I may put more Botox on one side of the forehead than the other. So I wouldn't recommend having Botox injected by a nonphysician."

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