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How to decide where to get your cosmetic services

By Dr. Moghissi - April 2008

You've finally decided to spend some money to look better. Maybe you noticed those crows are there even when you’re not smiling, those fine lines have turned into crevices, your pores have become enormous, your skin is splotchy, you’re tired of shaving all that hair, you’re too old for acne (for God’s sake!), or even your teenager’s acne is not responding to all the stuff you’ve bought for them. The problem is where should you go? There are spas and doctors advertising everywhere. How do you know who would give you the best results, without costing too much? Can you even afford what you’d like to have done?

My first piece of advice is to be wary of spas. There was an article in the Washington Post (page D1, 3/31/08) that I found shocking. According to the article, Reveal MedSpa had 7 locations, one full-time supervisory physician, and one physician advisor. The owner was not a physician; he appeared to be a business person. The same article also featured a dental spa where the Botox and filler injections are performed by a nurse. The problem is, basically almost anyone can open a medispa. In the Washington metropolitan area there are few regulations as to who can do what. Many will have a physician as a “medical director”, who may or may not be present when patients are being treated. There are of course many excellent medical spas owned and run by physicians, but you need to investigate who will be doing the procedures and how well trained they are.

I have heard more disturbing news. At a recent cosmetic conference a local plastic surgeon told me that at that time he was treating serious laser burns from several patients who had received treatment at a local spa for hair removal. To be fair, anyone can burn a patient. Several years ago we did burn a patient at our facility (fortunately it has only happened once!). But I am a physician, and I took care of her until she was fully healed, her final results were outstanding and the patient was really pleased. We learned from the experience and are more careful now. It does not sound like that is happening at this spa. At this same conference I met a medical person (not a physician) who wasl be run a large spa in another state. She was employed by physicians who are not involved in cosmetic medicine. She was tol receive about one week of training, and then be expected to know how to run several different lasers, and inject Botox and fillers for her first patients the next week. Would you like to be one of those patients?

There is really no residency training program for non-surgical cosmetic medicine. The closest would be some form of dermatology or plastic surgery. Most cosmetic physicians have had additional training after residency, and should be going for additional training on a regular basis. My specialty, Family Practice, has always had an emphasis in skin, and some types of surgeons (Ear Nose and Throat, Ophthalmology) have traditionally worked with aesthetics also. Any physician can be trained in cosmetic medicine. There are certainly dermatologists and plastic surgeons who are not good at non-surgical cosmetic medicine. As long as the physician is well trained, conscientious, has a good eye, and understands the basics of skin, the specialty may not be that important. It’s just more work for those of us who are not dermatologists or plastic surgeons to get there.

Now that I’ve scared you sufficiently, how do you know where to go? Do some research. Find out who is doing the procedures. My preference for injections (Botox and fillers) would be for the physician to do it, but there are some nurses or PA’s (physician assistants) who also are excellent injectors. Has the injector had much experience? For Botox, look on their site for a list of affiliated doctors. Everyone on the list has used at least 25 vials in the past year. That would usually average out to a minimum of 50-100 Botox patients in the past year. For most laser and IPL machines, it’s not always so critical who runs them. My RN (nurse) runs my machines, but I am always in the office when she does the procedure. That way if there is a complication or she is unsure about something, I am able to help immediately. It makes me nervous to think about someone running those machines without adequate backup who cannot deal with a problem when it arises.

Is the provider (and staff) getting regular training? It is common for doctors in this area to go to a weekend course to learn Botox and fillers, and then never get any further training. I go to at least one major cosmetic conference each year, several smaller (local) ones and have regular training in house along with reading many cosmetic journals each month. Techniques are constantly being refined and improved, along with the technology for devices and topical agents (creams etc). It’s a lot of work to keep up, but I feel I would be doing a disservice to my patients if I did not do this. Find out what your potential provider is doing to keep up.

There are other things to look for. When you have your initial consultation, are you comfortable with the advice you are given? Does the provider listen to your requests? Do they try to sell you more than you want or need? Do they ask you what bothers you about your looks, or do they insist on fixing things that you don’t think need to be fixed? Listen to their advice, they may have some excellent suggestions, but the ultimate decision as to what you have done should be yours.

I hope I have presented some useful advice. Remember, cosmetic services are elective, and safety is most important. You need to decide what is best for you, but try to make your decision based on good information.

Jasmine Moghissi, M.D.

Focus - Health Tips » How to decide where to get your cosmetic services

How to decide where to get your cosmetic services

By Dr. Moghissi - April 2008

You've finally decided to spend some money to look better. Maybe you noticed those crows are there even when you’re not smiling, those fine lines have turned into crevices, your pores have become enormous, your skin is splotchy, you’re tired of shaving all that hair, you’re too old for acne (for God’s sake!), or even your teenager’s acne is not responding to all the stuff you’ve bought for them. The problem is where should you go? There are spas and doctors advertising everywhere. How do you know who would give you the best results, without costing too much? Can you even afford what you’d like to have done?

My first piece of advice is to be wary of spas. There was an article in the Washington Post (page D1, 3/31/08) that I found shocking. According to the article, Reveal MedSpa had 7 locations, one full-time supervisory physician, and one physician advisor. The owner was not a physician; he appeared to be a business person. The same article also featured a dental spa where the Botox and filler injections are performed by a nurse. The problem is, basically almost anyone can open a medispa. In the Washington metropolitan area there are few regulations as to who can do what. Many will have a physician as a “medical director”, who may or may not be present when patients are being treated. There are of course many excellent medical spas owned and run by physicians, but you need to investigate who will be doing the procedures and how well trained they are.

I have heard more disturbing news. At a recent cosmetic conference a local plastic surgeon told me that at that time he was treating serious laser burns from several patients who had received treatment at a local spa for hair removal. To be fair, anyone can burn a patient. Several years ago we did burn a patient at our facility (fortunately it has only happened once!). But I am a physician, and I took care of her until she was fully healed, her final results were outstanding and the patient was really pleased. We learned from the experience and are more careful now. It does not sound like that is happening at this spa. At this same conference I met a medical person (not a physician) who wasl be run a large spa in another state. She was employed by physicians who are not involved in cosmetic medicine. She was tol receive about one week of training, and then be expected to know how to run several different lasers, and inject Botox and fillers for her first patients the next week. Would you like to be one of those patients?

There is really no residency training program for non-surgical cosmetic medicine. The closest would be some form of dermatology or plastic surgery. Most cosmetic physicians have had additional training after residency, and should be going for additional training on a regular basis. My specialty, Family Practice, has always had an emphasis in skin, and some types of surgeons (Ear Nose and Throat, Ophthalmology) have traditionally worked with aesthetics also. Any physician can be trained in cosmetic medicine. There are certainly dermatologists and plastic surgeons who are not good at non-surgical cosmetic medicine. As long as the physician is well trained, conscientious, has a good eye, and understands the basics of skin, the specialty may not be that important. It’s just more work for those of us who are not dermatologists or plastic surgeons to get there.

Now that I’ve scared you sufficiently, how do you know where to go? Do some research. Find out who is doing the procedures. My preference for injections (Botox and fillers) would be for the physician to do it, but there are some nurses or PA’s (physician assistants) who also are excellent injectors. Has the injector had much experience? For Botox, look on their site for a list of affiliated doctors. Everyone on the list has used at least 25 vials in the past year. That would usually average out to a minimum of 50-100 Botox patients in the past year. For most laser and IPL machines, it’s not always so critical who runs them. My RN (nurse) runs my machines, but I am always in the office when she does the procedure. That way if there is a complication or she is unsure about something, I am able to help immediately. It makes me nervous to think about someone running those machines without adequate backup who cannot deal with a problem when it arises.

Is the provider (and staff) getting regular training? It is common for doctors in this area to go to a weekend course to learn Botox and fillers, and then never get any further training. I go to at least one major cosmetic conference each year, several smaller (local) ones and have regular training in house along with reading many cosmetic journals each month. Techniques are constantly being refined and improved, along with the technology for devices and topical agents (creams etc). It’s a lot of work to keep up, but I feel I would be doing a disservice to my patients if I did not do this. Find out what your potential provider is doing to keep up.

There are other things to look for. When you have your initial consultation, are you comfortable with the advice you are given? Does the provider listen to your requests? Do they try to sell you more than you want or need? Do they ask you what bothers you about your looks, or do they insist on fixing things that you don’t think need to be fixed? Listen to their advice, they may have some excellent suggestions, but the ultimate decision as to what you have done should be yours.

I hope I have presented some useful advice. Remember, cosmetic services are elective, and safety is most important. You need to decide what is best for you, but try to make your decision based on good information.