Dying to go to a Spa? Safety and licensing considerations when considering a medispa

The spa industry has grown an average of 38% in the last year alone, according to The Spa Association’s 2005 study, making it the third largest leisure industry in the United States. As spa-goers dive into their neighborhood spas and medical spa facilities some are finding that the latest in treatments are what they expected. In fact, some are emerging from laser hair removal treatments, non-ablative skin rejuvenation and other medical grade spa services with scars to show for efforts.

Spas are regulated by each state and while some states have stringent regulations that are carefully enforced, others have decades-old rules on record that have not kept up with the tremendous growth of the spa industry. The American Society for Dermatologic Surgery found that half of its 2400 members reported an increase in complications in the past year from laser procedures performed by non-medical personnel. Some states require that only doctors can do treatments such as laser hair removal and Botox injections, while others say only a doctor’s supervision is required, and the rest have no laws on the issue. In the case of permanent makeup procedures, the problem is with the tattoo ink itself. Tattoo ink is the only substance that can be injected into a person’s skin that does not have to pass any safety requirements prior to procedures. The consequences from this lack of regulation are not only hurting the spa industry’s reputation, but are imperative in safeguarding the consumer. Here are some examples that have gone wrong because of technicians doing treatments outside their scope of practice, with faulty materials or without sufficient medical attention as a part of their treatment at a spa or medical spa:

• Kim McMillin, age 40, New York: Went to a Manhattan spa for laser hair removal which was performed by a spa technician, and now has zebra-like pattern of raised scars and discolored patches on the right side of her face according to WashingtonPost.com.
• Nancy Erfan, California: Went in for a permanent makeup procedure. After the tattooing was finished her eyelids began showing many bumps and granulomas from the tattoo eyeliner, and her lips became swollen and painful. The procedure resulted in permanent swelling of the eyes and lips, according to abc7news.com.
• Virginia man, age 20: Coast Guard cadet died of allergic reaction to drugs given to him before a laser hair removal treatment according to the WashingtonPost.com.
• Shiri Berg, age 22, North Carolina: North Carolina State student died of a lidocaine overdose, a common numbing cream applied to the skin before a laser hair removal treatment. On her way to her appointment, police found her on the side of the road having seizures in her car according to WRAL.com. There is an ongoing investigation of a second female college student who died under similar circumstances as well because of this same cream.
• Terri Bowling, age 36, Pennsylvania: Deep second degree burns on legs from laser hair removal procedure performed by a spa technician according to WashingtonPost.com.
• Diane Beere, California: Eight months after first having permanent eyeliner applied, she began noticing dryness in the eyeliner, flaking, peeling, itching, and granulomas began forming around the eyes according to abc11tv.com
• Elaine Young, California: Had cheekbone silicone implants that shifted, causing uneven bumps and craters on her face according to MSNBC.com.
• Washington women, age 50: Third degree burns on face because of treatment to erase wrinkles performed by a dermatologist; a doctor who later examined the burns reported that they resembled an acid burn according to WashingtonPost.com.
• Katie O’Hara, age 27, California: Swollen foot and ankle after having a tattoo removed by a laser. If she would have waited longer for treatment of the swelling, she would have had to face foot amputation according to NewYorkTimes.com
• Eric and Bonnie Kaplan, Florida: Hospitalized and listed in critical condition after receiving what they thought were Botox injections. They were later diagnosed with Botulism, a potentially fatal illness that paralyzes muscles, eyes, limbs and respiratory tract according to CNN.com. The doctor that injected Eric and Bonnie also injected himself and his girlfriend with the toxin, and both were hospitalized with similar severe symptoms.

The Kaplan story has sparked a lot of controversy and awareness on the subject. The couple was hospitalized in November 2004, and Mr. Kaplan was just released from the hospital in early February. The doctor who performed the procedure, Bach McComb, is facing criminal charges for practicing medicine after his osteopathic license was suspended. Instead of using Botox, he diluted a powdered botulinum toxin, which is intended for animal research with saline, used for bioterrorism research and is 10 times the strength of Botox. Twelve doctors in three states are facing possible license suspension, while hundreds more are being visited by federal regulators as part of an investigation into $1.5 million worth of this unapproved Botox substitute sold and used on an unknown number of patients. 219 doctors purchased the toxin from Toxin Research International (TRI) and the FDA plans to visit each office.

These are some of the many reasons why The Spa Association (SPAA) launched its one-of-a-kind international benchmarking and licensing program Spa Secure. To become a Spa Secured facility the business must complete a pre-examination packet and pass an onsite inspection. During the onsite inspection, everything from emergency standards to the qualifications of the employees is examined. But most importantly, 50% of this onsite inspection is focused on specific health, safety and sanitation standards implemented at the business and is a step above current state regulations. During the two years the licensure is valid, Spa Secure representatives perform regional audits that mystery shop licensed facilities to ensure the spas are maintaining their high standards. Audit reports are given to each spa after a mystery inspection and they are given 30 days to make specific changes or the license is revoked. While each facility maintains the high standards set by Spa Secure they are able to use the licensure logo to let consumers know that they are in good hands and safe while visiting their spa.