Deadly beauty: Hidden dangers of medical spas

By Melba Newsome

updated 9:40 a.m. ET July 16, 2007

In May 2001, when Terri Bowling, 42, walked into the Steliotes Dental-Medical Spa in McMurray, PA, for laser hair removal, she thought her husband had given her the perfect Mother's Day gift. "The technician wore a long white coat, had all these certificates on the wall, and said she'd been doing this for a while," recalls Bowling, who was looking forward to never having to shave her legs again. Once the procedure started, however, she began to worry.

"The pain was worse than childbirth," Bowling says. "Every time she zapped my legs, the skin would come off. I could see a purple checker pattern forming. By the time I got home, my legs were swollen to twice their size and covered with fluid-filled blisters."

The next day, an emergency room physician diagnosed Bowling with second-degree burns. Back at the spa, she discovered that the woman who had performed the procedure was a cosmetologist — and that the only doctor associated with the spa was a dentist, who'd used his license to purchase the laser.

Bowling filed a complaint with the Pennsylvania State Board of Medicine. The spa owner, Theodore Steliotes, DMD, was fined $1,000 for practicing medicine without a license, and Bowling received a small settlement from his malpractice insurance.

She was lucky compared with Shiri Berg. On December 28, 2004, the 22-year-old college student planned to head to Premier Body Laser and Skin Clinic in Raleigh, NC, for laser hair removal. At home, she covered herself with a numbing gel the clinic had sold her to prepare her skin. But as she drove to the spa, Berg had a seizure. She soon lapsed into a coma and died 8 days later.

An autopsy concluded that Berg had suffered lethal brain damage from an overdose of the numbing gel, a potent combination of lidocaine, tetracaine, and phenylephrine. Under North Carolina law, doctors are supposed to take a medical history or perform a physical exam before writing any prescriptions. Premier had no doctors on site, yet the staff routinely dispensed the gel, which is safe only on small patches of skin. The state medical board concluded that Premier's medical director, Ira David Uretzky, MD, had exhibited unprofessional conduct. His medical license was suspended for 6 months.

Birth of the medical spa
There's nothing wrong with medical spas in concept — or, in many cases, in practice. Dermatologist Bruce Katz, MD, who opened the first medical spa in 1999, says his patients had been asking for something like it for years. "A lot of our patients were telling us that they went to spas and got massages and facials but that they didn't get any lasting benefit from the treatments," says Katz, who is director of the Cosmetic Surgery & Laser Clinic at Mount Sinai Hospital in New York City, as well as medical director of Juva Skin & Laser Center. "We thought, 'Why can't we have a relaxing spa setting, but with a dermatologist doing things that really work?' "

The combination proved alluring. These hybrid facilities have become the fastest-growing segment of the $11 billion spa industry, according to the International Medical Spa Association. By 2004, there were approximately 400 medical spas, or medispas, across the country. Now there are about 2,000. The problem is that not all medispas deliver on both parts of the promise inherent in the name. Yes, you can get a facial and a pedicure at a medispa — along with a chemical peel for your crow's-feet, Botox for your wrinkles, and a laser treatment to whisk away sunspots and excess hair. The one thing you might not get is the attention of anyone with a medical license. And that can be dangerous.

"I don't think a lot of people think of themselves as patients when they walk into these places, but they should," says Michael McGuire, MD, communications chair of the American Society for Aesthetic Plastic Surgery. "It's not like going to a beauty parlor or the cosmetic counter. These are medical treatments."

They are indeed: Anything that affects the structure or function of the skin qualifies as a medical procedure, as defined by most state medical boards. That means it must be performed by a doctor or supervised by one. The catch is that states have very different rules about what supervision means. So in Louisiana, only a physician or dentist can wield a laser — while in Florida, a doctor can "supervise" the treatment from an office 75 miles away. A medispa must have a doctor as a medical director, but in many states, he or she may visit only periodically and may not be available in case of problems. Sometimes the medical director is a "ghost doctor" who never sets foot in the spa but simply leases the use of his name.

"In medispas, you can have untrained people doing procedures without proper supervision in unsafe settings," McGuire says. "I've seen some pretty god-awful-looking results."

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