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How to choose a good medical spa

January 21, 2007
The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery recently came out with some useful guidelines about how to select a good medical spa. It seems, at least in Los Angeles, that you can't swing a cat (not that I would advocate swinging cats around - its just an expression) without hitting a medical spa, medi-spa, or other place that offers aesthetic procedures. These are some useful questions that can help weed out the legitimate ones from the fly-by-night, make a quick buck shysters.
Here goes - with a bit of editing for clarity:

About the facility:

Is the Medi-spa located within a physician's office?

While problems are infrequent, physician's offices generally have medical personnel available if a problem develops.

Is the Medi-spa located outside of a doctor's office in, for example, a mall or salon?

If so, ask the name of the physician responsible for oversight and when they are available for consultation or questions before having any injectable, deep peel or laser treatment. Also ask about the training of any other medical personnel. This is vital to protect your health and insure an optimal outcome. These are generally safe procedures with minimal recovery, but do have real risks. If they hem and haw, or if they do not give you a straight answer - run away.

About medical supervision and personnel training:

Does the medi-spa have a physician who can help in determining your goals, provide a treatment plan and direct your care?

What are the credentials of the physician supervising the treatments in the medi-spa?

Injectables (such as Botox, Restylane, Radiesse and Juvederm), skin treatments (such as Fraxel laser, intense pulsed light photofacials, and Thermage) and deep peels should be under the supervision of physicians with significant aesthetic training. The specialty of the physician should be at least related to aesthetic medicine (dermatology, facial plastic surgery, plastic surgery, otolaryngology). A one week course for an internal medicine doctor is not sufficient training. Ask to see the doctor's credentials. Doctors in other specialties, designating themselves as "cosmetic medicine physicians" may lack the comprehensive training that is needed for administering drugs and treatments to the deeper levels of the skin and lack the experience necessary to achieve optimal aesthetic results or to manage potential complications. Just as you wouldn't see an allergist if you were having a baby, it's in your best interest to see a physician who specializes in plastic surgery and dermatologic care when seeking cosmetic medical procedures.

Who is performing the injection?

Depending on the State you're in, injections and deep peels may be performed by a nurse, physician's assistant or nurse practitioner. However, never allow a non-medical, unlicensed person to perform a medical procedure and be sure that the procedure is supervised by a properly trained physician. Your health and safety depend on it.

About efficacy and risk of procedures and realistic expectations:

How effective are facial injectables and what is the right product for me?

Injectables are generally very safe and effective treatments. There are a wide range of products on the market that are FDA approved and provide good outcomes. However, be sure to ask your provider the following questions:

Is the product FDA approved? Is it approved for this use?

If your provider is reluctant or does not directly answer this question, don't proceed with the treatment. Don't be afraid to ask to see the manufacturer's label for any injectable product.

Can a medication, filler, or a device be used for a purpose different from which the FDA originally approved it?

In the United States, FDA regulations do not prohibit physicians from prescribing approved medications, fillers and devices for other than their original intended indications.

Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgment.

If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, to fully inform the patient that it is being used "off-label" and to maintain records of the product's use and effects.

Will injections last and prevent the need for a facelift in the future?

In most cases injectables are temporary solutions and will not give the long-lasting outcome of a surgical procedure.

Have you been fully informed of the possible benefits and side effects of the proposed treatment and have you been apprised of possible options?

Have all of your questions been answered and are you are fully aware of the risk and rewards of the procedure?

All medical procedures, whether they are injections or surgery carry some risk. If you are not fully informed of all risks and requirements for after care, find another provider.

These procedures should never be performed in someone's home, hotel room, or at a party. This is not only unethical and legally risky for the injector but unsafe and potentially dangerous for you.

About taking control of your own treatment options:

What do I expect from my medical procedure?

Discuss your expectations with your provider. If you are promised unqualified, 100 percent success it is probably best not to proceed.

If it sounds too good to be true, it probably is!

Am I taking the procedure seriously?

Surgical deep peels and injectables like Juvederm, Restylane and Botox are not the same as getting facials or other superficial beauty regimens. Make sure you have done your homework on the treatment you seek and be aware that these are medical procedures.

Am I basing my decision on the best treatment option and not on price?

Medical care of any kind is not a commodity. Be sure you have based your decision on the credentials and experience of the practitioner, not on price.

Have you asked to see before and after pictures?

They can be very helpful in determining with your provider the right treatment for you.

What if I'm unhappy with the result?

A qualified practitioner can provide you with appropriate revisional or after-care. Make sure you ask this question before the injection or treatment.

Have you been told who holds financial responsibility for any revisions or if complications arise?

You don't want any surprises later

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