Medi-spas offer services usually done by dermatologists

Michaela Walker says she would never go to anyone but a board-certified dermatologist to get her regular Botox injections “because I’ve seen Priscilla Presley.”

VENTURA, Calif. — Michaela Walker says she would never go to anyone but a board-certified dermatologist to get her regular Botox injections “because I’ve seen Priscilla Presley.”

But there is an increasing number of “medi-spas” springing up across the U.S. under the supervision of physicians who are not dermatologists, offering cosmetic procedures such as Botox, fillers and laser resurfacing. They are called medi-spas because a physician performs or supervises the procedures or is on the premises.

Dr. Peter Karlsberg, Walker’s dermatologist in Ventura, Calif., said many of the supervising physicians at medi-spas are not dermatologists or plastic surgeons. Some are not physicians but are nurses or nurse practitioners.

Karlsberg is among the dermatologists who say they are seeing more patients who ask them to fix problems caused by a skin procedure performed by a non-physician or a physician without dermatology or plastic surgery certification.

A 2007 survey of 290 members of the American Society for Dermatologic Surgery showed that 56 per cent reported an increase over the past two years in the number of patients they had treated as the result of complications caused by a non-physician.

Even more of the dermatologists surveyed — 59 percent — reported seeing an increase in the number of patients with complications due to a physician who was not a dermatologist.

“Botox fillers or lasers seem simple or safe, but there is always the potential for complication,” said Dr. Andrew Kaufman, who is board-certified in dermatology and internal medicine. “There is always risk.”

Of the dermatologists surveyed, 91.8 per cent saw at least one patient over the last year who had skin cancer either overlooked or misdiagnosed by a doctor who was not a dermatologist.

The president of the International Medical Spa Association, Allan Share, said these reports from professional dermatologic associations are self-serving. “A lot of dermatologic societies lean heavily toward protecting their own business,” Share said. “They want to do it (procedures) themselves because they can charge a boatload more money.”

Share said it’s tough to say how many medical spas exist, because the definition has not been standardized.

“You might have a spa where a doctor comes in twice a week and gives Botox, and they call themselves a medi-spa,” he said.

Share said the nation probably has about 1,800 true medi-spas, where a doctor is on the premises at all times.

Dr. Antoine Hanna in Oxnard, Calif., is an OB/GYN who opened La Nouvelle Medical Spa eight years ago. Because most clients seeking cosmetic procedures are women, it seemed like a natural fit for an OB/GYN, Hanna said.

“It was consumer demand,” Hanna said. “I thought an OB/GYN would be really well-positioned because of the clientele and the trust you’ve built with your patient. . . . They figure, ‘He’s seen my bikini line before.’”

He said he has been studying these skin procedures for eight years, attending seminars, and participating in hands-on workshops.

Business is going so well, he’s begun doing a minimally invasive form of breast augmentation in which he uses liposuction to take fat from one area of the body and inject it into the breast. Hanna also plans to hire a nurse to do some of the skin procedures.

Karlsberg believes there’s no substitute for board certification in dermatology or plastic surgery. He has seen the mistakes that can occur if someone not familiar with facial anatomy accidentally injects a muscle or nerve.

“It can result in someone not having an eyelid that opens,” Karlsberg said.