A prescription for beauty?
Medical spas offer pampering beauty services with lasting results. Is this the promised land of aesthetics or a minefield?
By Catherine Censor
I’m sitting in the doctor’s exam room, sipping spring water flavored with cucumber essence. The ceiling is trimmed with gilded moldings and my exam robe is a sumptuous terry wrap with a Frette label. No, my gynecologist hasn’t finally taken my suggestion that he “do something to set the mood.” This is Armonk’s Park Avenue Medical Spa and the only ailments treated here are those that mar the appearance.
In recent years, the worlds of medicine and beauty have overlapped. Where we once had cosmetics to hide imperfections, today we have “cosmeceuticals” to treat and prevent them. And where spas used to pamper complexions with facials, today we clamor for lasers, Botox, and injectable filler to perfect them. Remove excess hair with wax? How quaint! These days, we prefer to zap our follicles with laser beams. There are even medical treatments that claim to correct cellulite.
All of these high-tech beautifying procedures have one thing in common: legally, they have to be administered under the supervision of a medical doctor. This confluence of traditional aesthetic services with medicine has given rise to a new breed of spa: the medical spa. Offering traditional pampering with lasting results and physician-supervised safety, medical spas promise the best of all possible beauty worlds. And not surprisingly, their number is multiplying like age spots on a society doyenne.
“Medical spas are the fastest growing segment of the spa industry,” reports Bruce Katz, MD, chairman of the Medical Advisory Board of the Medical Spa Society, a not-for-profit national organization, and medical director of Manhattan’s JUVA MediSpa. “The number has doubled in the last two years”—from 200 to 400. Here in Westchester and its environs, where affluence and vanity abound, medical spas have found especially fertile ground. As Dr. Katz observes, “The fact that we can do everything in one facility is a big positive. People don’t want to go to one place to see a dermatologist and another to get a facial. If you can have it all done in one place and done to a high standard, why wouldn’t you?”
Of course, standards—or lack thereof—are what medical spa critics, and even their supporters, point to as an area of serious concern. State legislation and industry standards are either vague or nonexistent. And while most medical spas are well run, responsible facilities with adequate physician oversight, the law allows for potentially dangerous practices.
proctologists administering botox?
For one thing, you needn’t be a dermatologist or plastic surgeon to run a medical spa. All you need is an MD after your name, and you too can be administering everything from injectable wrinkle fillers, like Restylane, to acid peels. From a legal standpoint, there’s nothing to prevent your psychiatrist from moonlighting as the director of a medical spa (and how does that make you feel?). To make matters worse, the law only calls for “physician supervision” but supplies no definition of what constitutes adequate supervision.
“We take â€˜supervision’ to mean on-site,” says Dr. Katz. “But there are facilities where it’s just a physician’s name on the door—they basically just rent someone’s credentials.
What do these places do if there’s a problem and there’s no doctor around? That sets up a very dangerous situation.” In fact, recent events have shown that inadequate physician oversight can be deadly.
In January, a young North Carolina woman made an appointment for laser hair removal at a local medical spa. Although the spa’s medical director, Dr. Ira David Uretzky, an ear, nose, and throat specialist, reportedly never examined the woman or took her medical history, she was given a prescription that reportedly he had written for a potent lidocaine gel, an anesthetic cream. She was told to slather it on her legs and cover them in cellophane before coming in for the procedure. A passing motorist found the young woman having seizures in her car. She died nine days later, her death attributed to lidocaine toxicity.
Stories like these may be rare, but Dr. Katz warns they could become more common. “We’re seeing more and more spas out there where treatments are being done without adequate supervision, and that’s where people need to beware. People have been scarred by lasers. Even something as simple as an anesthetic cream can be deadly if not administered properly.”
put yourself in good hands
Safety is just one concern. When you’re paying big bucks for smoother skin, sleeker thighs, or fuzz-free extremities, you also want top-quality results. Can medical spas deliver the same quality as a doctor’s office?
Some, like David E. Bank, MD, director of the Center for Dermatology, Cosmetic & Laser Surgery in Mount Kisco, say results depend more on your choice of doctor and the training of his or her aestheticians than the treatment’s setting. “Any MD can give you Botox, but you have to have some understanding of what you’re trying to achieve. An integral part of dermatology is anatomy and training in aesthetics. Plus, dermatology journals and conferences keep us current, but non-derms probably aren’t staying current.”
Others dispute that line of thinking. Anca E. Tchelebi-Moscatello, MD, medical director of the Park Avenue Medical Spa in Armonk, is a board-certified radiation oncologist who has devoted years of study to aesthetic medicine. She thinks her medical spa can deliver superior results to those one might get in a dermatologist’s office. “My practice is completely dedicated to medical aesthetics,” she says. “I can develop a program of skincare to complement my skin rejuvenation treatments and design a diet and exercise regimen to augment my body treatments. I’ll personally determine the settings of the laser for laser hair removal. Everything that happens in my practice is under my direct supervision.”
While medical spa clients like the convenience of one-stop shopping for everything from massage to acupuncture, Dr. Katz sees other benefits as well. “We can give well coordinated care here because the patient has only one chart,” he says. Theoretically, having all your aesthetic needs met in one place results in care that’s both synergistic and streamlined.
Moreover, some medical spas offer an approach that is holistic, emphasizing healing in addition to superficial beautification. At Le Spa in New Canaan, CT, a chiropractor and acupuncture specialist perform acupuncture facials that are said to take years off. “Not only are our clients getting a younger look, they’re also getting health benefits,” says spa owner Jennifer Yates. Yates claims acupuncture facials build collagen, correct muscle sagging, help blood flow, and “balance energy.” Le Spa also boasts a resident naturopath who custom-blends herbal medicines and specializes in allergies and in Dr. Edward Bach’s “flower healing.”
In fact, some medical spas, like Le Spa, go far beyond what any mere doctor’s office could possibly offer. In this Mayo Clinic of medical spas, you can avail yourself of everything from cosmetic dentistry to plastic surgery, from permanent makeup to Reiki healing and laser skin resurfacing. There are two board-certified plastic surgeons, an acupuncturist, a naturopath, an ocular specialist, a dentist, an internist, five massage therapists, a permanent makeup artist, and a cosmetologist. “The spa services complement the medical treatments,” Yates says. “If someone is coming in for a live collagen treatment, we would follow up with our Alpine Rejuvenation Facial to reduce the resulting redness.” Medical spas of this caliber, fans say, have raised the bar in the practice of aesthetic medicine. No longer is it merely about isolated treatments, they contend. Instead, as Yates puts it, “it’s powerful integrative healing.” And it looks darned good, too.
ask the right questions
“We’re working on some kind of â€˜seal of approval’ for standards of care at medical spas,” Dr. Katz says. But at the present time, to get the quality, safety, and results you expect, you’ll need to ask some fairly pointed questions. Grilling a doctor about her relevant credentials can be a very un-spa-like experience, but it’s well worth doing.
You’d be surprised what you can learn.
In the course of researching this article, I called one well advertised Westchester medical spa to inquire about its practice. Although the person who answered the phone seemed to know quite a bit about the doctor (“He doesn’t do telephonic [sic] interviewsâ€¦No, you can’t come in.”), he refused to even name the doctor in charge. He even refused to identify himself, giving his name only as “John.” The spa’s website gives no information about medical staff but says it offers lip augmentation with collagen, Restylane, and Botox injections; laser wrinkle reduction or hair removal; sclerotherapy; and mesotherapy, a procedure that reduces body fat with multiple injections of off-label pharmaceuticals and other substances.
Obviously, a reluctance to discuss credentials should give you pause. But what else do you need to know before you sign on for beautification? The answers to the following questions, say our experts, can mean the difference between a relaxing, rejuvenating day at the spa and a very tense visit to the emergency room:
(1) Interview the medical spa’s doctor and ask, “What are your credentials and where did you receive training?” If you’re not dealing with a dermatologist or a plastic surgeon, you should see other credentials that qualify this doctor to perform or supervise your treatment. If an aesthetician will be performing your service, ask about the staff’s training as well.
(2) If you’re contemplating a medical service, ask, “How long have you been performing this treatment? Have you ever had a problem with it?”
(3) “Who performs my service?” Not all medical spa services are performed by doctors. Some procedures, like laser hair removal, can legally be done by either a physician or a supervised aesthetician. Some doctors will see laser hair removal clients before they’re treated by the aesthetician, but others will not. Incidentally, this is the case in doctors’ offices as well as medical spas.
(4) “Where is the doctor while I’m having my treatment?” If you’re having a medical-grade procedure (deep facial peel, laser treatment, etc.), the right answer is always “on site.” A doctor should be on hand to deal with an unusual side effect or unanticipated results.
a user’s guide
Medical spas are still in their infancy, and there are enormous variations from one establishment to the other. Some offer everything from straighter teeth to slimmer thighs, while some confine themselves to a few skincare options. Some medical spas are tough to distinguish from a doctor’s office, while others could be confused with a lavish boutique hotel. Here’s a quick guide to some of the more interesting offerings in Westchester and the vicinity:
Daniello Skin Care & Day Spa
145 Kisco Ave. Mount Kisco
Founded by plastic surgeon Nicholas Daniello, MD, in April 2002, this establishment claims to be the first medical spa in Westchester. In addition to traditional spa services like facials, massage, waxing, endermology (deep massage for cellulite reduction), and sunless tanning (applying DHA, the same stuff used in all bottled sunless tanners—Neutrogena, Lancome, etc.), the spa has a plastic surgeon, Michael Rosenberg, MD, who comes in to perform the medical treatments: wrinkle fillers, Botox, and collagen. The spa offers PhotoEpilation performed by a trained aesthetician. Unlike laser hair removal, this method uses a light source to damage the follicle, so a physician’s presence is unnecessary. The physical setting is pleasant, if not exactly opulent. A tinkling wall fountain, candles, and your choice of herbal teas set a relaxing tone. Special feature: the glycolic acid-based Daniello Skin Care Products, created by Dr. Daniello himself. They are sold internationally and enjoy a great reputation as effective cosmeceuticals.
Costs: Swedish massage, $80; endermology, $100 per session; PhotoEpilation starts at $80; Botox/Restylane, $400 to $600 per site; glycolic anti-aging facial, $115.
Park Avenue Medical Spa
495 Main St. Armonk
In a setting resplendent with crystal chandeliers and gilded whatnots, radiation oncologist and aesthetician Dr. Anca E. Tchelebai-Moscatello provides medical services to rejuvenate and beautify every inch of you. Medical services performed by the doctor include light to medium facial peels to remove a layer of skin and reveal smoother, younger skin; vascular laser treatment to zap broken capillaries; mesolift, an injectable facial treatment that uses a “cocktail” of drugs, vitamins, minerals, and other ingredients to rejuvenate skin; tissue fillers; FotoFacials, intense pulsed light and radio frequency that promote collagen production and diminish broken capillaries and sun damage; mesotherapy, an injectable body fat-reduction treatment used in France since the 1950s; and laser hair removal. Dr. Tchelebai-Moscatello’s husband, Augustine L. Moscatello, MD, an ear, nose, and throat specialist, and Carlo P. Honrado, MD, a plastic surgeon, are available to consult on more invasive procedures, from rhinoplasty to the new threadlift procedure, a less invasive form of facelift.
Unlike some medical spas, Park Avenue takes the “spa” component of its business quite seriously. Facialist Lorraine Hoy won a “Best of Westchester” citation, so it’s no surprise that the menu of facials includes the expected offerings and the truly unusual. Check out the the myotonology facial, which uses a microcurrent to restore facial tone, and the ultrasonic dermabrasion. Dermabrasion is exfoliation using a machine that blasts tiny crystals at skin through a little wand. It’s like having your skin sandblasted. The ultrasonic version uses ultrasound instead of crystals to do the job. Body treatments include Vela Smooth therapy, which uses infrared light and radio frequency for cellulite reduction, and stretch-mark treatments. Another body treatment is the very indulgent Moroccan Hammam Ritual; after a relaxing session in a Turkish steam bath, you’re exfoliated with Moroccan black soap and a “peau d’ange” glove. The ritual concludes with massage and a moisturizing clay body wrap.
Costs: Peels, $185; laser wrinkle reduction, $400 to $1,000; Botox, $450 per site; laser hair removal, $50 to $900.
64 Main St. New Canaan, CT
No, Dorothy, they can’t dye your eyes to match your dress, but everything else is within the realm of possibility. In this small palace furnished with art-nouveau and French antiques, you’ll find a plastic surgeon, an oculoplastic surgeon, a cosmetic dentist, a naturopathic doctor, a permanent makeup artist, an acupuncturist, an internist, a cosmetologist, two skincare specialists, a massage therapist, and a hypnotist.
If you click the heels of your Jimmy Choos together and find yourself here, you can rest easy knowing that there’s always a doctor in the house. Spa treatments complement medical procedures, so if you come in for live collagen rejuvenation treatment, you can follow up with an Alpine Rejuvenation Facial to take away the redness. If you’ve had eyelid surgery with oculoplastic surgeon Dr. James Gordon, you can get an acupuncture facial with specialist Dr. Katherine Phillips to reduce swelling. And if you’ve survived breast cancer and undergone reconstructive surgery, permanent makeup artist Angela Bramble can restore the pigment to your areola.
Le Spa lavishes money on tools, products, and staff education. The latest gadgets and costliest lasers stand at the ready to blast away your imperfections. And if you simply want a facial, you can forget “simple.” The spa’s signature facial is a live collagen treatment. Ampoules of this precious fluid are flown in fresh from Europe to freshen the skin.
Costs: Live collagen treatments start at $195; Alpine rejuvenation, $250; acupuncture facelift, $185; acupuncture for the body starts at $125.
The Spa at Split Rock
539 Danbury Rd. Wilton, CT (203) 762-5577
There’s a plastic surgery center on the premises, but Judith Stanton, the creator of Split Rock, is quick to point out that it’s a separate business in an adjacent building. While Split Rock does offer clinical treatments such as dermabrasion and facial peels, they’re not medical grade. And although the surgeons will often recommend some of their services, like lymphatic drainage massage before or after surgery (Stanton claims it speeds healing and reduces swelling from liposuction), Split Rock doesn’t dabble in the clinical stuff.
Instead of Botox, licensed acupuncturist Simone Wan offers acupuncture facials. Stanton says they’re relaxing and energizing as well as rejuvenating. And if needles don’t sound relaxing, consider their Mermaid Wassage, a massage performed on a warm, water-filled mattress that lulls you into a stress-free state of contentment. Can’t get off the table?
Don’t fret. There are accommodations available so you can savor the bliss.
Costs: Peels, $130; lymphatic drainage, $300 for a series of three, $175 for a single treatment with a facial, $125 for just the treatment; accupuncture facial, $175 for one, $878 for a series of six; Mermaid Wassage, $140.
Catherine Censor is a freelance reporter and editor based in Katonah. She was briefly the editor of Medical Spa Report, an industry trade magazine.