Beauty treatment

Aesthetician Afi Rowghani applies a mud mask as part of Nina Irigaray’s facial at Spa MD in La Jolla. (Allen J. Schaben / LAT)

Krista DAVIS is a 34-year-old self-confessed medical spa addict.

Every few weeks, she indulges herself at her favorite medical spa, Sherman Oaks-based Blue. On a typical day, she runs up a tab of $980 as she moves from manicure to pedicure, to underarm and leg laser hair removal, to Botox and to microdermabrasion, in which mineral crystals are used to sandblast the skin.

It's not cheap, but the Porter Ranch woman, a former aesthetician who now sells skin-care products, feels she gets more bang for her buck at Blue Medical Beauty Spa than she would at a traditional spa, because pampering and "aggressive" medically based beauty treatments are offered under one roof.

And it's under a roof that is far more appealing than an old-fashioned, green-walled doctor's office. Davis loves Blue's futuristic décor, including the big flat-screen televisions, the well-cushioned chairs, the sheepskin rugs and the lush, dark-blue velour curtains. Says Davis, "People don't want to go into a cold setting. They want more inviting settings."

Consumers such as Davis have turned medical spas into the hottest segment of the $11.1-billion-a-year spa industry. "The spa and the medical world are combining in a new entity," says Eric Light, president of the International Medical Spa Assn. Dermatologists, plastic surgeons and other medical professionals, including dentists and gynecologists, are either opening their own spas or signing on as consultants at existing ones.

But consumer advocates and others worry that regulation of medical spas has not kept up with the industry's growth. The U.S. Food and Drug Administration oversees the safety of the machines and skin-care products used at medical day spas. But it is up to each state to figure out which practitioners can administer the treatments safely.

That job falls mostly to state skin-care and medical licensing boards. But because of explosive growth in the medical spa industry and rapidly changing treatments, those boards cannot regulate medical spas effectively, says industry marketing analyst Nancy Griffin. "As a consumer, you can't count on your state boards to protect you."

Griffin recommends that consumers be in buyer-beware mode when they go to medical spas, because even treatments that are touted as being state of the art can damage the body if performed incorrectly.

Medical beauty treatments can also be pricier than the services at your regular old-fashioned spa. But proponents stress that the prescription-strength products and treatments offered at medical spas are more effective than the body and skin care available at a traditional spa.

Charlie Sheridan, director of the Institute in Marina Del Rey, a medical spa that offers everything from "lipstick to liposuction," says that because the facility's medical director is a plastic surgeon, it can offer pharmaceutical-grade "cosmeceuticals." These prescription products, says Sheridan, are more effective than the skin products available over the counter.

In addition, the Institute offers treatments such as Botox injections; photo facials that use intense light to combat a variety of imperfections, including large pores and age spots; and a face-lift that uses radio frequency energy. Sheridan stresses that these treatments cannot replace surgery, but that "with advanced medical technology, it is quite amazing what can be done. With injectable fillers, peel products and lasers, we can offer amazing improvement."

Manhattan's Juva MediSpa also touts its "physician-formulated spa treatments" that "far surpass the normal spa techniques." For $135, it offers a 70-minute anti-aging "medical facial" that includes "clinically proven 5-FU [5-fluorouracil, an anti-cancer drug used topically] to remove sun-damaged cells." Says dermatologist Bruce Katz, founder of Juva: "We use medicine in our facials and our body treatments. We put antioxidants into our spa oils."

No matter how "medical" beauty treatments are, insurance companies won't pay for them, which makes for a highly motivated clientele. They're "people who are serious about getting their skin into the most ideal physical and aesthetic condition," says Sheridan. "You have a client population of serious buyers, so to speak."

Cash-based medical spas also provide freedom for doctors who say they are tired of being second-guessed and under-reimbursed by insurance companies. A want ad that appeared recently on the message board of eSTART.com sought "entrepreneurially minded" doctors to work or own a medical spa in New Jersey and New York. The listing, posted by Mobius Development Group, which sells medical spa franchises and consulting services to doctors, stresses "no more hassles with insurance companies."

Dermatologist Mitchel Goldman says chucking the insurance companies he "hates" has enabled him to practice more patient-friendly medicine.

At Goldman's 15,000-square-foot Spa MD in La Jolla, there are soothing waterfalls designed using feng shui and bamboo floors, but there is no waiting room with "20 stupid chairs," as he puts it. Instead, Spa MD features a concierge who directs patients to four nicely upholstered chairs in an area called a reception room. "No one waits. I give people time."

When Goldman was accepting insurance, he packed in 40 to 50 patients a day. "It was like working in a mill." Now, says Goldman, he sees 15 to 20 patients a day. "I'm not going on volume anymore. I'm going on quality."

Doctors can avoid insurance companies at medical spas, but they cannot avoid pricey malpractice insurance coverage. With five full-time and three part-time physicians, 18 nurses, one physician's assistant and one nurse practitioner, Goldman, for example, pays $250,000 a year in malpractice insurance.

That's not surprising, given that there have been a number of lawsuits against spas that employ physicians.