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Spa Worldwide Guide 2003

Deciphering the Medi-Spa

At last count, there were 162 medical spas in the United States—and just about as many definitions. From shopping-mall clinics that hawk Botox and collagen to health resorts
that offer check-ups for wealthy executives, they're all calling themselves medi-spas, shunning the cold white tile of the doctor's office for warmly decorated suites with original artwork on the walls. Trolling for already healthy clients who want to live longer and look good doing it, medi-spas want YOUand your cash, check, or credit card, since very few of these treatments are reimbursed by health insurers.
Why you would prefer a medi-spa to your regular dermatologist, internist, or plastic surgeon is a good
question-with, it turns out, a few good answers.
Here's how to decipher this phenomenon and find out if it's consumer-friendly-or just a con....

BY LAURIE DRAKE

As European medical spas and their government-sponsored "cures" wane in popularity, American medi-spas are gaining. According to the International Spa Association (ISPA), medi-spas have had the highest growth rate--133 percent--of any type of spa in the last five years. they are combining the best of Western medicine--non-ablative lasers that rejuvenate without wounding the skin and diagnostic procedures like bone-density screening and ultrasound scans of your organs--with the best of Eastern medicine and its emphasis on relaxation, tranquility, and touch. Dr. Robert Keller, medical director of the Pebble Beach Skin Institute in California, cites four factors behind the rise of the medi-spa. "One is the alternative-medicine movement, which took root because its languages is understandable to lay people and encourages them to take charge of their own health," says Keller. "The second is the fact that we have the physical structure os spas in place, which is where people go to get touched, whether that means having a massage, facial, or body treatment of some kind. The third factor is aging baby boomers, who make up more than 51 percent of the population and will, in five years, see the largest transference of wealth in the history of the world as their parents pass away.

Boomers want to look younger but, as former hippies, also want a sense of 'high touch,' and they can pay for it. The fourth factor is that we have the technology to perform these anti-aging procedures outside of a hospital setting." They all come together at the medi-spa.

MEDICAL SPAS "Any facility that presents a merger of medical practice and spa therapeutics is a medical spa," says Dr. Pamela Peeke, medical advisor to ISPA and assistant professor of medicine at the University of Meryland School of Medicine in Baltimore. "That's a pretty open definition and covers everything from traditional medical facilities like the Cooper Institute in Dallas, which has added a spa, to places like the Soho Day Spa in New York City, headed by a physician and staffed by acupuncturists and estheticians, to destination health spas like Canyon Ranch in Arizona and Massachusetts. Other destination spas may bring in physicians to lecture and maybe do a little testing, but I wouldn't count them as medical spas." 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 Medi-Spa 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 Pasquala is first and foremost a spa, but one with medical partnerships." One way to find out if a medi-spa
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

"Clients can come in after work, have dinner at the mall, then have their collagen."

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. Accessibility is a big draw: If you wake up on a Sunday morning with a zit that threatens to erupt, you can have it flattened with a cortisone injection that same day. Ditto if you need your frown lines erased with muscle-paralyzing Botox or your lip line plumped with wrinkle-filling collagen. These franchised face places also offer microdermabrasion, laser hair removal, facials, and glycolic peels and dispense drugs like tetracycline and Retin-A for acne, Renova for wrinkles, and Lustra to lighten brown spots. But the nurse practitioners stop short of performing full-body skin cancer checks or prescribing drugs like Accutane (an oral drug for severe acne), refering those cases to local doctors.
Some critics say that collagen and Botox injections are so technician-dependent they should be farmed out to doctors as well. But Robin Kittrelle, director of Nurse Practitioner Services for Complexions Rx, says that's an example of old-line thinking, similar to the fact that "back in the 1930s, nurses never took blood pressure-that was considered a physician-only job. "Times have changed, she says. "What's important is that the collagen or (5) Botox provider be linked with a supervising physician, and that the provider does a lot of the procedures. Our nurse practitioners go through an extensive, comprehensive training with our physicians and demonstrate competence before they work in our centers, which we consider to be an extension of our medical director's office," Kittrelle notes. And, as at Skinklinic in Manhattan, a board-certified M.D. is on call 24 hours a day. "We do a narrow band of treatments--collagen, Botox, peels, and lasers," continues Kittrelle, "but we do a lot of them, with remarkable results and an excellent safety record."

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, these clinics see clients until 8:00 P.M. four days a week, "so they can come in after work, have dinner at the mall, then have their collagen." says Kittrelle. For more information about www.Skinklinic.com; for Complexions Rx, call (619) 683-2820 in San Diego or (858) 642-9100 in Mission Viejo, or visit www.complexionsrx.com.

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 soft tissue injections. Some medi-spas feature an oxygen rich hyperbaric chamber to speed the healing of skin after an invasive procedure, as at MeSuá Dermocosmetic Spa in Miami, owned by Dr. Jorge Suárez-Menéndez. "I have dermatologists on board with me so that we can cover the whole nine yards, from plastic surgery to lasers and chemical peels, Botox, nutrition consultations, and even exercise consultations," says Suárez-Menéndez.

Since the potential for improvement or harm is greater with invasive procedures, it's important to check credentials and make sure that a dermatologist or plastic surgeon is in charge. "Just because a doctor is there doesn't mean it's a medi-spa--general practitioners and gynecologists are also jumping on the bandwagon, but what do they know about (7) anti-aging procedures?" says Suárez-Menéndez. He also cites the recent case of a California dentist who performed a blepharoplasty (eyelid lift) on a patient, which ended up, as you'd expect, in court. Among the well-regarded plastic-surgery medi-spas are MeSuá Dermocosmetic Spa in Miami ( 877-77-Mesuá, www.Mesuá.com ), SK Sanctuary, owned by plastic surgeon Dr. Stephen M. Krant, in La Jolla, California (858/459-2400), and plastic surgeon Dr. Norman Leaf's day spa in Beverly Hills, California (310/276-5558, www.leafskincare.com ).

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 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.
Among those with excellent reputations are the Ageless Center for Rejuvenation near Seattle, owned by dermatologist Dr. Barbara J. Schell, which offers laser removal of wrinkles, brown spots, unwanted hair, or broken blood vessels as well as Botox, collagen, chemical peels, and massage (206/467-1000, www.agelessinseattle.com ); and the Skin and Spa Center in NYC owned by dermatologist Dr. Howard Sobel, who formulated the DDF line of skincare products, where everything from facials and seaweed wraps to laser resurfacing and liposuction is available (212/288-0060, www.drsobel.com ).
The granddaddy of the genre is Murad Spa in El Segundo, California, owned by Dr. Howard Murad, who opened a skincare salon in 1986 after developing glycolic acid products for home use (310/726-0470, www.murad.com ).

Scalp treatments with medical-grade essential oils to cure flakiness and moisturize dry, damaged hair are offered along with massage, waxing, bronzing, and nine different facials at the Ava & Philip B. spa, which is attached to the Laser Institute for Dermatology and European Skin Care, owned by dermatologist Dr. Ava Shamban, in Santa Monica, California (310/264-2421).

CHECK-UP SPAS With consumers' growing interest in good health through fitness and other preventive medical strategies, these diagnostic centers 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 medi-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 (10) 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. Among the 20 services at Wellmax are test that record the levels of artery-clogging plaque, cholesterol, homocystein (implicated in heart disease), and fasting insulin, along with exercise stress testing and Positron Emission Tomography (PET) scans of your body's chemistry, which can detect early stage cancers. In addition to Wellmax (800/621-5263, www.wellmax.com ) other well-respected check-up spas are Canyon Ranch Medical Center in Lenox, Massachusetts, and Tucson, Arizona (800/742-9000, www.canyonranch.com ); Destinations Health at the Ojai Valley Inn & Spa in Ojai, California (800/709-7019, www.ojairesort.com); and Cooper Wellness Program in Dallas, Texas (972/386-4777, www.cooperaerobics.com ).

BUYER BEWARE "Whether your buying a house, a purse, or a service at a medical spa, the first rule is buyer beware," says Peeke. "Make sure the spa facility is reputable and that its facialists, manicurists, and massage therapists are licensed by their state boards," with the proof visibly posted. As for the doctors at the facility, find out if they are board-certified in the specialty you've come to them for: dermatology, plastic surgery, or internal medicine. "If you don't see that paper up on the wall, ask to see it," says Peeke. Among the other questions she would ask: "How many of these procedures have you done? Over what period of time? Are you on faculty at a university?" A yes to this last question is a good sign that the doctor is plugged into a credible, academic environment. "Con-tinuity of care is important, too--a true medical practice will have 24-hour call to deal with emergencies." For example, if you get Botox at a day spa and find yourself with a droopy eye at 9:00 P.M., long after it's closed, who you gonna call? "A medical doctor is always reachable by phone to soothe you and say your fine, we'll try something in the morning."

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 more tricky 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."

- Cutting-Edge Treatments at Medi-Spas -

Gene Tests: "Since your genes play a big role in how predisposed you are to heart disease, lung cancer, and other processes of oxidative stress, we're checking more than 40 genes so that you can see the cards you've been dealt," says Dr. Cosgrove of Wellmax. If he finds a weakness in a gene, he can reduce your risk factors by suggesting changes to your diet and lifestyle. The good news: Genes only need to be checked once in a lifetime.

IPL Laser Treatment: This wrinkle reduction procedure is non-invasive and does not require general or local anesthesia. It works by heating the tissue under the skin with intensive, pulsed light waves to stimulate new collagen growth from cells that have pooped out, either from aging or sun damage. The collagen-building boost from a single treatment may not appear for at least 60 days. Find it at the Pebble Beach Skin Institute (831/622-6480, www.pbskininstitute.com) or at a location listed at www.wrinklereduction.com.

Rosacea Therapy: Its redness and bumps are often misdiagnosed as acne, but rosacea requires very different drugs so as not to inflame already sensitive skin. Complexions Rx's new Rosacea Therapy includes prescription topical solutions and calming masks to reduce redness.