Mall medical spas cater to need for speed

DaLisa Velte of Mesa, Ariz., receives a skin-tightening laser treatment on Jan. 22, 2007, from William Nelson at Skinovative Laser Center in Chandler, Ariz. The medical spa is located in a shopping mall. (Gannett News Service, Michael Chow/The Arizona Republic)

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A trip to the mall used to mean shopping and maybe a bite to eat. Now, a mall customer can stop to have some minor surgery or a laser treatment at a medical spa. "We have lots of walk-in business," says William Nelson, medical director of Skinovative Laser Center at a fashion center mall in Chandler, Ariz.

Eager customers don't get a beauty fix right away, not only because the clinic requires a consultation before treatment, but also because it's usually booked.

Medical spas - especially those in shopping malls - have bridged the gap between the doctor's office and the cosmetics counter. There are more than 2,000 medical spas in the country, and though they accounted for 3 percent of all spas in 2004, that grew to 7 percent in 2006, according to the International Spa Association.

Ease of use is key

Nelson says people seek out mall spas because they are more convenient and luxurious than a doctor's office.

Although some of the clinic's business is walk-in, most people know what they want and have done research before they arrive, Nelson says.

"People are not coming in here ignorant," he says. "They'll ask about specific types of lasers and what kind of training we've had."

Asking questions is the best way to get a good outcome at a medical spa, according to the American Society for Dermatologic Surgery. There's no uniform regulation of medical spas, and states vary widely in requirements for training and supervision.

"People assume there is some minimum standard of training. They see people in white coats," says Ranella Hirsch, a dermatologic surgeon in Boston and chairwoman of the ASDS committee that's working on the regulation issue.

"The challenge of this is, what if something goes wrong?" Hirsch says. "That's where the training (of a physician) comes in."

The society is trying to ensure all technicians are supervised by a physician on the site.

Hair removal is No. 1

Nelson, a naturopathic physician, says the most popular procedure at Skinovative is laser hair removal, followed by Botox injections to smooth wrinkles, and then tattoo removals. But the various laser treatments to rejuvenate skin are also becoming popular. That follows nationwide trends as well, which means that most of the problems that crop up are with laser hair removal and other laser procedures - either operators using the wrong laser or using the correct laser the wrong way.

"It's especially risky for people of color - Latino or African-American, or people with tan skin," Hirsch says.

Lasers target melanin, the pigment that gives the skin its color, so the procedure must be more precise for people with darker skin. If the laser is not used correctly, the skin can have blistering, scarring and pigmentation abnormalities. Hirsch says these can be permanent problems.

"I had a patient who has a checkerboard pattern of scarring on his back," she says.

Nelson says he often will not use laser treatments on a darker-skinned patient, instead treating with Cosmelan, an intensive topical face cream.

He says laser technology is continually changing, with the goal not only of improving results and safety, but also of reducing the "downtime" after treatments. Laser skin treatments often leave customers sore, with a sunburned feeling for several days. One newer treatment is the Pixel laser, which is pain free and promises that patients can return to work right after treatment.

DaLisa Velte, 48, of Mesa, Ariz., recently had her second Pixel laser treatment at Skinovative in Phoenix, and she says the discomfort afterward was minimal, with mild tenderness for about 24 hours. She plans to have three more treatments in the next few months.

"I had lines around my mouth from talking and smiling, just the lines you get from life," she says. "I want that to be tightened up so it's not so obvious. I wanted a healthy look."

TIPS FOR BEST MEDICAL SPA RESULTS

Here are some tips for getting good results at a medical spa:

* Keep your expectations realistic.

* Find out about staff training and how many procedures the staff members have performed.

* Ask if there is a physician on-site in case something goes wrong.

* Make sure you discuss your medical history before any procedure, particularly whether you have hypertension, diabetes, herpes or take blood thinners.

* Discuss how painful the procedure will be and how much recovery time you will need.

* Ask whether the laser is appropriate for your skin type and color.

* If you are fearful of a reaction or result, ask whether you can have a patch test on a small area of skin.

* If you experience intense pain or unexpected side effects, call your doctor immediately. Don't wait.

Sources: American Society for Laser Medicine and Surgery, American Society for Dermatologic Surgery