Informed decisions

Kim Harty thought a few laser treatments would be a fast fix for a brown sunspot on her face. So did the nurse who suggested it. But after four sessions at a medical day spa and no improvement, she was told to see a specialist. “I thought, ‘This is really expensive for not doing anything,’” Harty said. Colorado Springs dermatologist Dr. Nathan Trookman quickly realized why.

The spot was melanoma — the most serious form of skin cancer — and it should never have been zapped with a laser. Recognized and treated early, melanoma can often be cured. Left to spread, it can become one of the most difficult cancers to beat. Melanoma is the most fatal skin cancer, according to the Skin Cancer Foundation.

“It was in the beginning stages where it hadn’t spread, but it was fairly deep,” said Harty, 47. “Here I am thinking this lady (who referred Harty for treatment) is an R.N. Isn’t there some kind of accountability there?”

Medical day spas, which blend spa luxury with cutting-edge skin care, have made it easy for anyone with disposable income to reverse time, remove unwanted hair and smooth skin.

The promise of a sizable income has tempted many otherwise-uninterested doctors into the industry, which exploded to more than 3,000 “medspas” nationwide from about 50 in 2002, according to the International Medical Spa Association.

Though complications are possible during any medical procedure, some dermatologists believe a disproportionate number of problems stem from poorly run medspas.

“There is a misperception of regulation, certification and quality that is not reality in medical day spas that don’t have a physician on-site,” said Dr. Joel Cohen, a dermatologist with practices in Lone Tree and Englewood.

Medspa standards vary by state and practice. The Colorado State Board of Medical Examiners recently decided to examine Rule 800, which outlines appropriate delegation and supervision in medical clinics, after Cohen raised concerns earlier this year with medspa regulations. The board decided Thursday to postpone action until the rules committee discussed proposed changes. At the earliest, the board will revisit Rule 800 in February.

Colorado medspas must be backed by a licensed physician, who acts as medical director of the business.

Overall the physician takes responsibility for the clinic, and duties include writing prescriptions, delegating medical procedures to other qualified staff members, and reviewing medical records.

The doctor must be available on-site within 30 minutes in an emergency.

Cohen thinks these regulations can allow for “ghost medical directors” — doctors that back a spa but hardly ever enter it.

Cohen said he sees a couple of new patients a month who come to him after complications performed at a medspa.

Trookman expressed similar concerns with medspa regulation, and questions some doctors’ interest in the industry.

A medspa can make upwards of several hundred thousand dollars a year, Trookman said, and any licensed doctor can jump on as medical director.

“People are ditching their speciality,” Trookman said.

“They’re not as well trained, but they’re doing weekend courses and they’re learning.”

He suggests clients seek out offices run by core aesthetics specialists — dermatologists, plastic surgeons, oculofacial plastic surgeons and otolaryngologists (ear, nose and throat doctors) — who have three to five years of training in anatomy, aesthetic-related procedures and treatment of complications.

“I think these are medical procedures,” said Trookman, who is co-medical director of the Rocky Mountain Laser Center, a Colorado Springs clinic that performs medspa procedures.

“The medical procedures are becoming so easy for the operator that we’re overlooking what can go wrong.”

However, most medspas aren’t run by core aesthetics specialists, and some doctors argue intensive training isn’t necessary to successfully run a medspa.

Skin Deep Colorado, a medspa and laser clinic on North Academy Boulevard run by four OB-GYNs, opened in April.

The doctors said they took hours of certification classes on lasers and injectables before opening the spa, and have continued to focus on their education.

The spa, which is adjacent to their practices, always has a doctor on-site or moments away, and all complications are treated by a doctor.

Dr. Diane Ryan, one of the medical directors, said bridging the gap between her specialty and medical aesthetics required her to hone skills she already possessed.

“We are used to doing invasive procedures,” Ryan said. “Things like injections and the dermal fillers take skills that we already have.”

OB-GYNs regularly address and evaluate their patients’ skin, she said, and refer patients to specialists when necessary — standards the doctors carry into their medspa and laser clinic.

“If we have a doubt, we will always have that patient evaluated by a dermatologist before we treat,” she said.

“We will never treat a lesion that’s suspicious.”

Dr. Lisa Jenks, medical director of Genesis MedSpa on East Cheyenne Mountain Boulevard, said she started taking certification classes more than a year before opening her medspa in August.

Previously, she worked in an emergency room.

“I’m an M.D., which obviously shows I’m hard working and intelligent and highly trainable,” she said.

“Can I go back and become certified in these procedures after putting chest tubes in people? Yes, I can do this.”

But the doctor’s specialty often is inconsequential if he or she isn’t performing the procedures.

According to Rule 800, “a license to practice medicine is not required for the rendering of services, other than the prescribing of drugs, by persons qualified by experience, education or training.”

Many medspa procedures are performed by staff members — physician’s assistants and aestheticians.

Each office follows its own standards; some doctors insist on performing procedures, such as injecting Botox or Juvéderm, while others train members of the staff to do it.

According to Rule 800, any medical procedure a doctor can legally perform in a medical clinic can be delegated to a qualified staff member. There are no standardized tests to determine qualification. The doctor must prove the chosen staff member has the appropriate amount of education, training or experience to perform a given procedure.

Patrice Quintero, 35, recently visited Genesis MedSpa — her first medical day spa experience. Like many women, Quintero was curious about what the industry could offer but unsure what to ask or expect.

“As far as I knew, it was kind of the next step to beauty school,” said Quintero of Colorado Springs.

“I didn’t even know you had to be medically certified.”

She admits she was initially skeptical of their product pushing, but said she relaxed as the consultation continued.

“Once we got into the conversation, I thought it was very comfortable,” she said. “(Jenks) told me her entire history and why she decided to get into it.

“This woman wasn’t somebody who was just a hairstylist yesterday and today is shooting all kinds of weird things into my face.”

Most medspas offer free consultations for this reason — for clients to have their skin analyzed and their questions answered. The professional’s knowledge should be obvious, said Dr. Trudy Skiles, co-medical director of Skin Deep Colorado.

“I think once you start talking to somebody who has experience, it’s going to become evident,” Skiles said.

“If you aren’t asked a lot of specific questions about your skin type, then there’s a chance that you’re going to be undertreated or overtreated,” which could make skin more susceptible to burn or blister.

CONTACT THE WRITER: 636-0152 or melissa.cassutt@gazette.com

COMPARING PROCEDURES & PRICES

Here are three local medspas and the cost of a few procedures they offer:

Rocky Mountain Laser Center: Directed by Drs. Nathan Trookman and Michael Turner; call 471-8560.

Genesis MedSpa: Directed by Dr. Lisa Jenks; call 579-6890 or visit genesis-medspa.com.

Skin Deep Colorado: Directed by Drs. Diane Ryan, Brent Shelton, Trudy Skiles and Andrea Lerch; call 597-1885 or visit skindeepcolorado.com.

LASER HAIR REDUCTION

Rocky Mountain Laser Center:

$200-$500/treatment; five treatments or more necessary.

Genesis MedSpa: $80-$500/ treatment; packages of five treatments available for a discount.

Skin Deep: $125-$600; six treatments necessary, prices reduced with multiple treatments. Packages available.

PHOTOFACIAL (or Intense Pulse Light facial)

Rocky Mountain Laser Center: $400-$500/ treatment; five treatments typical.

Genesis MedSpa: $350-$650 /treatment; packages of four available.

Skin Deep: $400/treatment; reduced price packages of four, five or six available.

BOTOX

Rocky Mountain Laser Center: $200-$600/ area; price reduced with multiple treatments

Genesis MedSpa: $12 per unit; about 20 units necessary for initial treatment of frown lines between eyes, fewer units needed with multiple treatments

Skin Deep: $12.50 per unit; about 20 units necessary for initial treatment of frown lines between eyes; fewer units needed with multiple treatments

WHAT TO ASK BEFORE GETTING TREATMENT

Physicians interviewed for this article suggest clients consider these questions before committing to a medspa procedure.

1. Is a free consultation available?

You should not have to pay to discuss the results you want, how they can be achieved and how much they will cost.

2. Is a doctor on-site at all times?

If a doctor is not on-site, find out how far away he or she is. Ask to meet the physician.

3. Who performs the procedures? How much training have they had?

Ask to see degrees and certificates. Ask about training seminars — who taught them, how many hours were spent on each procedure — and how many patients the person has performed the procedure on (the more, the better).

4. What are the risks and who treats complications? How are follow-up appointments scheduled?

5. Are there before/after pictures of your patients?

Be sure to ask whether the pictures are corporate photographs, which aren’t a good indicator of the results from a specific staff.

6. Is this treatment FDA approved? Is it FDA approved for this use?

Federal Drug Administration approval certifies that a drug or substance tested safe and effective for a specific treatment. However, it is not illegal or uncommon for FDA-approved drugs to be used “off label.” Botox Cosmetic, for example, is only FDA approved to treat worry lines between the eyebrows; however, it’s commonly used in other areas of the face.

7. Does the staff work on commission or accept tips?

Some doctors believe commissions put pressure on the staff to sell more procedures and products, and take the focus away from the client.

8. Has the spa had any complaints filed against it?

Medspas are a business, so the Better Business Bureau logs any complaints made against the spa in the past 36 months. Go to bbbsc.org. You can also gather information about a medical company or a physician (such as whether a physician is licensed or whether any action has been taken against the doctor) by checking the state Automated Licensure Information System Online at https://www.doradls.state.co.us/alison.php.