Everything You Need To Know Before Going To A Medical Spa

Photographed by Megan Madden.
If you're a betting person, you'd be wise to put your money on medical spas. In 2016, the industry was estimated to be worth $3.6 billion and expected to grow by 18% yearly as the demand for cosmetic surgery and minimally-invasive procedures steadily rises year-over-year. But where there is rapid expansion and big bucks, there are opportunists waiting to take advantage — and chances are you've read enough stories of lipo and fillers gone very, very wrong to know that med spas don't have the cleanest reputation.
But as more and more renowned plastic and dermatological surgeons open their own med spas, often directly next door to their practices, in an effort to give patients greater accessibility to cosmetic treatments, the tide may be turning. We talked to celebrity cosmetic dermatologist Paul Frank, MD, of PFRANKMD Skin Salon, and plastic surgeon and Botched star Paul Nassif, MD, of the recently opened Nassif MD Medical Spa and Nassif MD Skincare, about the red flags to look for and the questions to ask before getting any procedure.
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Whether you're buying shoes, property, or a vaginal rejuvenation package, the old adage applies: If the price seems too good to be true, it probably is. But searching for a deal on a haircut is one thing; dirt-cheap injections are a whole other level of risky.

Dr. Frank warns that you should always steer clear of buying treatments from third party websites that offer cheaper prices. "The financial arrangement of [sites like] Groupon is such that they discount procedures so cheap, essentially the doctor is doing it for free. Now why would the doctor do it for free? Because they don’t have experience or patients," he says. "Their expectation is that they’ll get on Groupon and do a bunch of cases for free in the hope that patients come back or they tell their friends. It shows lack of experience and lack of professional conduct."

Instead, look for discounts being offered within a practice. Both Dr. Frank and Dr. Nassif say it's standard for medical spas and doctors' offices to advertise seasonal specials, like 10% off laser removal or 2-for-1 CoolSculpting treatments. "You don't have to be wary of those kinds of deals and discounts — everyone, including me, will do a special," says Dr. Nassif, who adds that if you're going to purchase from discount sites, it's safer to stick to spa services like a Hydrafacial versus more invasive procedures.

"It's important to realize you're not purchasing a syringe of Botox or a syringe of Restylane — you're purchasing the skill and professionalism of the person who's administering it," reminds Dr. Frank. "People call up and price-shop all the time and we generally tell them a range, but you're paying for the doctor's service. Doctors are doing a discredit to themselves if they stick to a true syringe model."

The pull of the quick fix is strong, but it's worth waiting until you can afford services from a reputable, board-certified pro rather than rolling the dice with your face and body.
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Asking the average customer to be familiar with the differences between an MD, DO, RN, PA, NP, and aesthetician is asking a lot — and shady medical spas prey on this confusion. It's crucial to remember that even though the word "spa" invokes images of cucumber water and nature soundtracks, legally and liability-wise, you're in a doctor's office.

"First and foremost, you need to know that there is a doctor who oversees, owns, and runs the place. Ideally, you want a physician who has a board certification in some sort of cosmetic medical specialty, so plastic surgery or dermatology," says Dr. Frank. "A third of my practice is liposuction and a third of those patients come to me because they’ve had poor results from things like CoolSculpting. The problem is, at the majority of places that do these non-invasive fat removal treatments, the patients aren’t evaluated by doctors first, so you have unlicensed aestheticians treating people [who aren't the right candidates]," he says. This is because the financial incentive is high for untrained professionals who do it for a commission that would be illegal for nurses to receive.

If the doctor in charge of the medical spa is a dentist, anesthesiologist, or in any field that doesn't directly relate to the treatments on the menu, it's a pretty clear sign that you should look elsewhere. "A lot of doctors and OB/GYNs are trying to get certified in fillers because it's an opportunity for them to make more money, and I don't agree with that," says Dr. Nassif. "Only professionals related to the plastic surgery field should be doing these things."
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Medical spas have a wide variety of treatments available, from lasers to fat-freezing to lip plumping, and each requires certain credentials to administer. The confusing thing, says Dr. Frank, is knowing which is a medical procedure and which is an aesthetician procedure.

"Hair removal and facials aren't medical in natural and can be safely and legally delegated to aestheticians, but the laws vary from state to state for cosmetic procedures," says Dr. Frank. Registered nurses can, in some cases, do injections, but more commonly, you'll be seeing a nurse practitioner or physician's assistant who works under the dermatologist or plastic surgeon.

A good rule of thumb for determining if your procedure is medical or aesthetic? The presence of a consent form. "With medical procedures, even though most now have less downtime, you will always be required to sign a consent form in case you get a burn or scar or something of that sort," says Dr. Frank.
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No matter the treatment, you're always entitled to a thorough consultation (at no charge) that addresses all your questions and puts you at ease. If you feel rushed or pressured into adding on more services, consider whether this is a professional you want to entrust with your face.

If the consultation is being done by an RN without the presence of a doctor, that's a red flag. According to Dr. Nassif, a doctor has to be in the room if an RN is doing the evaluation, but only has to review the charts after if it's a NP or PA. Of course, you can always request to see the doctor that oversees the practice, but know that you will be paying more for services in that case.

Want to really do your due diligence? Ask to see the facility's OSHA certificate (it should be visible to patients in the waiting room), which Dr. Frank says is a stamp of approval of the cleanliness and sterility of the practice, and the certificates from injectable manufacturers like Galderma and Allergan that say the nurse or PA has been trained in them.
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Though Dr. Frank says he personally insists on taking before-and-after photos, he acknowledges that most medical spas don't do them. It's not a dealbreaker if they're not offered, but it is to your benefit.

"In my practice, if a patient refuses medical photography, they check the box with the understanding that I cannot give them the best results because I don’t have before and afters to compare and that this may prevent me from offering any free touch-up or adjustment, which I would more typically do," says Dr. Frank.
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Both doctors agree that Yelp reviews should be taken with a grain of salt. Of course, you should steer clear if they're all one-star reviews, but don't get freaked out if there are a few negative reviews scattered among a bunch of positive ones — that's to be expected. "If you have an upset patient for whatever reason, they're going to give you one star. If someone called my office and had to wait for six months, they're going to be negative, so don't give it that much weight," he says.

You should also be wary of places that have all good reviews, says Dr. Frank. "Like doctors, friendship, and food, you can't please all the people all the time — it just doesn’t exist. I have good reviews on mine, but I have tons of people write that I'm a rip-off and too expensive," he says. Let Yelp be one part of your research, but not the be-all end-all. If you need reassurance before deciding on a doctor, Dr. Frank says it's not uncommon for people to ask to speak to some of his patients first.
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First things first, make sure you are, in fact, sitting in a chair in a medical spa. You've likely heard of Botox parties where the Champagne is flowing and the women are lining up for their turn, but Dr. Nassif says, "You don't want to do that. Injections have to be done in a medical facility and no one should be drinking any type of alcohol if they're having a procedure."

If you're getting injections, Dr. Nassif says you should watch the nurse or doctor open a fresh box, pull the product out of a sealed container, and see that it's FDA-approved hyaluronic acid [in the case of dermal fillers].

Now, the rules when it comes to sharing injectables, because we know you've wondered: Can my friend and I split the cost of a vial so none goes to waste? If it's Botox, yes. As long as you use a sterile syringe to draw up liquid from the bottle (and never, ever share needles, obviously), the stuff left in the bottle won't be contaminated. That's not the case when it comes to fillers, where the risk of contamination is high. "Little particles from the other person can get up in the syringe and cause a massive reaction," says Dr. Nassif. "You never want to share fillers."
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You may not require a follow-up phone call or appointment after your med spa procedure, but the most important thing is that you're given the opportunity for it. "Before you leave, you have to make sure you were given the means to contact someone should there be a problem," says Dr. Frank. "After every procedure in my skin salon and practice, you're given an instruction sheet with a direct line to my nurse's station that says 'do not hesitate to call this number.'" There should be a reciprocal ability to interact, he says, because at the end of the day, a medical spa is nothing more than an extension of a doctor's office.
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