Be a Savvy Cosmetic Patient

As an MD who loves practicing cosmetic dermatology, I want to see my patients get the best cosmetic results that are done safely by qualified trained personnel in a safe environment.  We hold dearly to our hearts our patients’ best interests.

There have been a proliferation of spas, salons and walk-in clinics offering cosmetic procedures performed by non-physicians, and the American Surgical Dermatology Society (ASDS) has noted a significant increase in patient complications. In response to this alarming national trend, ASDS has launched a campaign warning consumers that cosmetic treatments such as those using lasers, high-tech light devices, chemical peels, soft tissue fillers, botulinum toxin and microdermabrasion techniques, are medical/surgical procedures that should be performed by a fully qualified physician or under the supervision of a physician, preferably a dermatologist or plastic surgeon.

Over the past 20+ years I have seen a large number of med-spas come and go in the Portland metropolitan area.  Many such clinics are owned and run by absent businessmen. There may be no physician ever on site, just their “technicians”. Others use “figurehead” doctors who just lend their name or come in occasionally to review charts. Some clinics advertise that they have “board certified physicians” but the training and board certification of these physicians attempting to treat your skin might have been in an unrelated field such as gynecology, family practice, emergency medicine, or naturopathic medicine.

You may see advertisements that don’t even mention the name of a doctor at all. Ask yourself why. Do physicians rotate through there so quickly that they can never keep the same name on the letterhead or website? You should be very suspicious of a salon that doesn’t even mention the name of any physician.

Now we see doctors and nurses proclaiming that they “do dermatology”.  They may have had no post graduate training at all in dermatology. They have reinvented themselves. Having an interest in something doesn’t qualify one as an expert.  Naturopathic doctors do not get the same level of training in the skin that a board-certified dermatologist does, they get days or weeks compared to our years of intense training.

The danger is that if there is a complication with any of these treatments, who is going to treat it?  In addition, there is a danger of misdiagnosis. They may have been treating a freckle that was a melanoma, or not understood why you kept blistering after your light treatments. It has been studied and documented that non-dermatologists do not approach the accuracy of dermatologists in diagnosing the 20 most common skin diseases.

There have been at least two deaths in med-spas so far because the staff were not trained to understand how much (strength and quantity) topical anesthetic is safe to use at a time.  When it comes to medical practice, winging it by untrained people is not safe for the public.

The laser companies will sell a laser to anyone who has the cash or financing. Even worse, some of the people who greet you and talk to at these spas may be professional “closers”. They are only there to make the sale, and get paid a commission. Is it really in their best interest to turn you down if you are not an appropriate candidate?

Board Certification in Dermatology requires three years of additional training in the structure and function of the skin, after completing medical school and a year of internship in internal medicine or surgery. It involves studies in dermatopathology, skin surgery, lasers and additional training in diseases of the skin, hair and nails. Only after completing the three years of residency is a physician qualified to take the board examination. Dermatology is one of the true American Board of Medical Specialties; unlike “Aesthetic Medicine”.

If a med spa doctor advertises that they have many years in practice, it doesn’t mean that that experience is exclusively in skin. Ask questions.

Large color advertisements and flashy announcements of new procedures plus self-proclaimed expertise in dermatology/aesthetic medicine, plus lots of radio and television commercials are not the same as proper training in an accredited program with Board Certification in Dermatology. If you want a “spa experience”, go to a spa and get a massage. If you want expert care and treatment of your skin please see a Board Certified Dermatologist.

In summary, find out:

  • Credentials of the doctor
  • Credentials of the assistants
  • Is the doctor typically in the clinic when the assistant is working
  • How many offices does the doctor supervise

Avoid clinics that advertise on the radio or in the newspaper heavily. Avoid doctors who say they have trademarked their own procedures. Don’t get sucked in by glitz and ads.  Photoshop is easy and you can’t trust every before and after picture you see, nor can you believe every salesperson in medical spas. Don’t believe places that promise unrealistic results like “your wrinkles and acne scars will all disappear”.

Avoid places that require full payment up front and don’t let you have your money back if you change your mind and cancel within a reasonable time. Avoid clinics that use hype and high pressure sales techniques. Avoid chain medical spas.

Trust friend’s referrals. Trust your primary care physician to refer you to someone qualified.

Do your homework.

Rev. April 2018