January 30, 2007

"We have lots of walk-in business," says William Nelson, medical director of Skinovative Laser Center. In fact, some people have used Westcor gift cards received as Christmas presents for skin treatments.

But eager customers don't get a beauty fix right away, not only because the clinic requires a consultation before treatment, but also because it's usually booked.

Medical spas - especially those in shopping malls - have bridged the gap between the doctor's office and the cosmetics counter. There are more than 2,000 medical spas in the country, and though they accounted for 3 percent of all spas in 2004, that grew to 7 percent in 2006, according to the International Spa Association.

Nelson says people seek out mall spas because they are more convenient and luxurious than a doctor's office.

And although some of the clinic's business is walk-in, most people know what they want and have done research before they arrive, Nelson says.

"People are not coming in here ignorant," he says. "They'll ask about specific types of lasers and what kind of training we've had."

Asking questions is the best way to get a good outcome at a medical spa, according to the American Society for Dermatologic Surgery. There's no uniform regulation of medical spas, and states vary widely in requirements for training and supervision. In Arizona, medical spas are not required to be licensed by the state Department of Health Services. Laser technicians are required to have 40 hours of training, and a physician is not required on-site but must be reachable by phone.

"People assume there is some minimum standard of training. They see people in white coats," says Ranelle Hirsch, a dermatologic surgeon in Boston and chairwoman of the ASDA committee that's working on the regulation issue.

"The challenge of this is, what if something goes wrong?" Hirsch says. "That's where the training (of a physician) comes in."

The society is trying to ensure that all technicians are supervised by a physician on-site.

"If they don't have the training, they're not aware that something is going wrong. The expertise is being able to look at the skin and see that something is going awry," Hirsch says.

Nelson, a naturopathic physician, says the most popular procedure at Skinovative is laser hair removal, followed by BOTOX® injections to smooth wrinkles, and then tattoo removals. But the various laser treatments to rejuvenate skin are also becoming popular. That follows nationwide trends as well, which means that most of the problems that crop up are with laser hair removal and other laser procedures - either operators using the wrong laser or using the correct laser the wrong way.