The rising phenomenon of spa medicine

Dr Patrick Treacy, Irish Regional Representative of the British Association of Cosmetic Doctors, discusses the developing 'medispa' industry, and highlights how initial mistakes made in the North American sector can be avoided in the UK.

Although medical day spas have been operating in the United States for at least eight years, familiarity with the concept in the UK market has yet to occur. In a recent survey of regular UK spa-goers, less than a quarter of the respondents knew the term 'medical spa' despite it being the fastest growing sector within the $13 billion spa industry. In fact, the number of medical day spas currently operating in the US has jumped by over 300 percent in the last three years, and up 50 percent from just a year ago, to around 1800. The phenomenon, according to current thinking, is largely driven by the baby boomer generation which presently comprises nearly 30 percent of the US population. Sarah Noble of the International Spa Association (ISPA) Medical Advisory Committee, Europe described the medispa industry as a  "dynamic force with the power to positively change the healthcare landscape."

The popularity of medical day spas in the UK will no doubt follow this growth trend as clients from the UK's baby boom generation, which started slightly later than in the US, with discretionary income seek to maintain their looks and search for optimal health in pleasant, relaxing environments, which without a doubt will include the cruise ship industry.

To explain, a 'medical spa' is loosely defined as a facility whose medical program is run under the strict supervision of a licensed healthcare professional. They may work full-time or visit on an 'as-needed'basis. Most medical day spas fit into one of two categories: aesthetic/cosmetic and preventive/wellness. At medical day spas with a cosmetic orientation, the primary purpose of the medical procedures is to improve appearance, with the facility employing high-tech devices, prescription medications, and, sometimes, surgical interventions. At medical day spas with a focus on wellness, the emphasis is on maintaining health, well-being, and appearance with the help of complementary and alternative medicine. Spas with the latter approach sometimes favour the term wellness centre, while spas with a cosmetic specialty more frequently incorporate the word medical into their names.

This means medical spas with an aesthetic/cosmetic orientation will utilise lasers and intense pulsed light technology (IPL) as well as Botox and Restylane injections, medical microdermabrasions, photofacials, medical peels and other medical beauty procedures. With such a portfolio of services, spas are now combining standard skincare treatments with medical procedures.

In my experience, healthcare providers in the United States were not initially involved in the early stages of the business, and many doctors were working in medical spas because they got paid right away and there was little paperwork or overheads compared with running their own business. This, unfortunately, also led to a number of doctors with little previous experience of laser treatments administering Botox. I know this because I was amongst the first doctors to provide proper aesthetic services to the US cruise ship industry and helped my colleagues there to further develop this service. The North American industry quickly learned that 'consistency of service' and 'continuation of care' where the primary requisites to provide the proper level of aesthetic care. In this regard The OnboardSpa Company has led the European industry by providing an experienced Medical Director, as well as specialised, dedicated onshore training schools for all their healthcare professionals who remain onboard for many months. This scheme was enacted in order to provide onboard clients with the aforementioned 'consistency of service' by those who work onboard their ships, a move which was initially lacking in the US model.    

Of course, medical spas at sea also continue to provide traditional spa services like facials, massages, and body treatments. Further analysis of the North American model has found that medical spas develop in one of two directions depending on the skill of the doctor in charge (who has to train the staff) and the attitude of the spa manager, who may wish to offer different ways of combining the holistic approach with conventional or complementary medical modalities. This means that some medical spas focus on aesthetics, while others offer medically supervised cosmetic procedures that can be performed without surgery or recovery time.

Accordingly, experience teaches us that the reason for the rise of the medical spa is largely the same as that of cosmetic medicine. Clients wish to maintain their features or look younger by bypassing the more radical older technologies of plastic surgery, in favour of newer, non-invasive techniques that give similar effects with minimal downtime.

However, clients and spa owners should be aware the risks, insurance and the eventual prices are higher for medical cosmetic treatments than for traditional spa services. One of the biggest problems with medical spas in the United States, originally, was the overall risk to patients receiving treatments by unskilled and under qualified medical personnel being hired by unscrupulous spa owners both trying to make a 'quick buck'.

Dr Marta Van Beek, assistant Professor of Dermatology at the University of Iowa, highlighted this fact, warning: "Clients have to be extremely careful and must not be fooled by fancy décor. In reality, you can't judge the quality of the provider by how nice looking the spa is." 

In an earlier interview, Van Beek – who also helped write a 2003 State Law placing limits on who could perform laser and other 'tissue altering' procedures such as chemical peels in medical spas – added: "Spa owners didn't often realise these lasers and pulsed light machines are potentially dangerous medical devices that can leave permanent scars".

This concern eventually led to the formation of an organisation called the International Medical Spa Association, whose aim is to strictly supervise the US industry in order to provide and maintain the highest professional standards. In doing this, they recognise the importance of bringing together the healthcare and spa industries in a way that will ensure the quality of care available to consumers, medical spa owners, licensed health professionals and other spa consultants to maintain standards and training. The bottom line is, before agreeing to any skin altering cosmetic procedure, a medispa client should consult with a properly qualified physician to weigh the risks and benefits. They should also find out who will administer the treatment at the spa, and how much training and experience he or she has had on the equipment. In terms of laser equipment, this is generally not done at sea as it sometimes involves the impracticality of numerous sessions or ablation of skin not suited to the amount of ultraviolet exposure at sea. When back on land, a client should be entitled to enquire whether the medispa laser operator has proper laser certification and, more importantly, if they have the proper insurance cover. It would seem sensible to enquire if a doctor will be present during the procedure as some smaller medical spas will no doubt have one on call, but not necessarily on site. It is also important to make sure that medical staff are always aware of your medical history and previous related allergies.

Because of the immense growth of this industry, the US Government is realising the danger posed to consumers and is currently reviewing legislation with the aim of making it mandatory to have a properly qualified cosmetic doctor on-site at all times. It was estimated that in 2006, nearly 95 percent of medical spas in the US did not have a full time medical practitioner on-site at all times, and in fact, only five states presently require a physician alone to administer laser therapy. While we consider the UK Health Care Commission has adequate regulations already in place, these are now changing as the Government already plans to deregulate the use of lasers in 'non-healthcare' treatment. These proposals were launched in March 2008 as part of the consultation relating to the Care Standards Act 2000. This has provoked an angry response from some healthcare professionals who warn that proposals to take lasers and intense pulsed light treatment out of regulation altogether would put the public at risk. It is with these thoughts that we welcome you on board confident in the realisation that The OnboardSpa Company will maintain the highest traditions of the medispa industry at sea.