| The Future of Medical Spas |
The following manuscript was presented as a Conference Session at 10 am on Sunday May 19 at The Spa & Resort Expo & Conference at the New York Hilton in New York City.
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When one considers those
types of cosmetic medical procedures that are ideal for a medical spa setting,
the following requirements are ideal. Procedures should be: 1) Incision less, 2)
Provide minimal discomfort, 3) Created little to no skin wound, and 4) Be
performed in less than 1 hour. The procedures that currently fit that model
would include those that promote anti-aging, lead to wrinkle treatment and hair
removal. There eventually may be other procedures as well.
Traditionally, medical
anti-aging and wrinkle treatments have been fairly aggressive. They have removed
the outer layer of skin, the epidermis (ablative procedures). Such procedures
include dermabrasion, deep chemical peels and carbon dioxide and Erbium:YAG
laser techniques. Such procedures, because they produce an oozing and
potentially bleeding wound, may lead to prolonged skin redness and have a risk
of infection are not ideal for spa setting.
Newer, non-ablative
procedures that do not remove the epidermis and, therefore, provide no obvious
wound are ideal in a medical spa. Such techniques lead to a wound in the second
layer of skin, the dermis, without removing the outer layer, the epidermis. The
body’s response to such a wound is to create new younger healthy collagen and
a more youthful skin appearance. The most commonly know technologies that lead
to such skin improvement include CoolTouch®, Smoothbeam®, Photorejuvenation
and Nlite®. Multiple treatments with these laser and light source machines
leads to improvement in skin toning with a reduction of mild wrinkles.
In addition to such
non-ablative approaches that improve the collagen in the skin, botulinum (Botox®)
injections that lessen wrinkles caused by years of frowning and excess muscle
tone can be lessened. Wrinkles of the forehead, frown, and crow’s feet are the
most commonly treated areas. However, upper lip, chin and neck wrinkles can be
treated as well. Finally, filler agents such as collagen injections are ideal
for deep smile lines.
The use of non-ablative
techniques, in addition to botulinum and filler agents can dramatically improve
the skin. All can be done is less than 1 hour. There is no significant visible
wound. They are all ideal for a high quality medical spa.
In addition to anti-aging
and wrinkle treatments, laser hair removal will certainly become a commonly
performed procedure in medical spas. Currently in the US, over 10 million
women spend in excess of $3.5 billion. Laser hair removal has become the
most popular worldwide cosmetic laser procedure. The number of women seeking
hair removal exceeds the number of men by 3:1. However, with the current
popularity of laser hair removal, an increasing number of men also are seeking
treatment. People are seeking a faster solution than electrology and a more
permanent alternative to waxing.
The hairs that currently
respond to laser hair removal are known as terminal hairs. These are the longer
thicker darkened hairs. They contain abundant melanin - the substance that
absorbs laser light. Blond or white hairs are not well treated at this time.
Multiple sessions are required because hair is thought to be ideally treated in
the growing cycles. Since not all hairs are in the growing cycle (anagen) at the
same time, usually 5-8 session are required to see optimal results. The
only study that has compared efficacy of laser hair removal as compared to
electrolysis has shown better results following laser treatment. Women who
sought underarm hair removal when treated with 3 sessions of laser, as compared
to 4 sessions of electrolysis, showed a 74% loss of hair from laser and a 35%
loss from electrolysis. In addition laser treatment was noted to be 60 time
faster and less painful than electrolysis.
There are many different
lasers and laser-like devices that effectively remove hair. They include ruby,
alexandrite, diode and Nd:YAG lasers as well as intense pulsed light sources.
Several manufacturers make each type of generic laser. Except for darker skin
types that are ideally treated with an Nd:YAG laser, all of the above lasers
successfully remove pigmented terminal hairs.
The successful laser user
is generally not as concerned about the laser type as she is about: 1) The
emitted pulse duration ( how long is the zap of light); 2) the fluence (how much
laser power is delivered to the skin and 3) the type of skin cooling that is
used to protect the treated skin form overheating during treatment.
The emitted pulse duration
should be longer for thicker hairs, longer for darker skin and shorter for
thinner hair. The delivered fluence should be less for darker hair, and less for
darker skin. The delivered fluence should be greater for finer lighter hair. It
should be recognized that these recommendations are generalizations and
exceptions do exist. Experience leads to the best results.
Skin cooling has become a
very important part of today’s high-powered laser hair removal devices. Newer
laser devices can deliver significant power with resultant heat formation to the
roots of hair while at the same time protecting the sensitive outer layer of the
epidermis. Most commonly either cold gel or cryogen or contact cooling are used.
All 3 types are used. Most laser users prefer cold spray cryogen or contact
sapphire or copper cooling.
Current laser users include
full time laser centers such as ours, physician offices where lasers may be
rented or the newer medical spas that may rent or own lasers. The current trend
in the medical spa environment is to provide high quality “dermatology grade
treatments” in posh skincare salons and spas. As described above, the current
cosmetic interest appears to focus on non-ablative wrinkle treatments, botulinum
and collagen injections as well as laser hair removal.
There are currently in
excess of 6500 spas in the US. In a recent survey, 5% said they intended to add
laser hair removal to their list of provided services over the next year. Laser
hair removal treatments are expected to double over the next 5 years.
Unfortunately, in the spa setting, there have been some well-publicized
complications with resultant malpractice lawsuits. Because of these problems,
state regulatory organizations as well as several medical societies are starting
to look at these trends.
The American Society for
Dermatologic Surgery recently conducted a survey of it member dermatologists.
45% of the reporting physicians had seen non-physician induced complications
from one or more of the above procedures. There has been significant recent
print, radio and television press concern about these problems. Because of the
increasing concern about non-physician performance of cosmetic procedures, both
the American Society for Dermatologic Surgery and the American Society for
Lasers in Surgery and Medicine have recently published guidelines. The
guidelines mandate that under appropriate circumstances, and in accordance
with state regulations, physicians may designate some cosmetic treatment
procedures to certified or licensed non-physician personnel. However the
physician must be on site and be immediately available. It should be noted that
some states allow non-physicians to perform these procedures, others have no
current regulations while others prohibit any person other than a procedure to
perform cosmetic laser procedures.
The medical spa movement is growing. With the increasing elegant, simple procedures now available, the time is ripe for medical spa success. However, along with the trend toward more medical spas will be increasing government and medical specialty concern. The trend is toward more regulation, not less. When planning for the development of your medical spa, all of these issues must be addressed.
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