Incorporating Medi into Spas

Part One: the bad and the ugly

Many spas have considered incorporating or have already incorporated medical spa treatments into their existing menu of services. The lure of all the potential benefits have outshone the reality of the risks and liabilities. It is imperative, however, to closely examine the drawbacks of becoming involved in medical spa treatments.

In this first part of a two-part series, we will examine the incorporation of laser treatments which are now in widespread use throughout spas and salons. In the second part, we will evaluate the incorporation of injectable treatments such as botox and dermal filler treatments. Keep in mind that other skin treatments such as chemical peels, microdermabrasion, and cosmeceuticals can also create short- and long-term complications, especially pigmentation issues.

What are the risks of laser treatments?

The risks of laser treatments are not trivial and cannot be overlooked. Unfortunately, one of the most common complications is burns from laser hair removal (performed with either a laser or IPL machine) which can lead to serious problems. Temporary problems include prolonged discomfort or pain, swelling, redness, blisters, infection, and discolouration. Permanent problems can include scarring, or hyper or hypo-pigmentation (darker or lighter discolouration of the skin).

Lasers or IPL are often used to treat other skin conditions such as sun spots, pigmentation, redness, rosacea, or spider veins. Photofacials or photorejuvenation carry additional risks. If a suspicious skin lesion is not recognized, a potentially harmful medical condition, such as skin cancer, can be left undiagnosed. Also, laser vein treatments can cause even more serious complications such as vascular impairment leading to poor circulation in the foot, wounds, infections, ulcers, burns, scarring, etc.

Why do complications occur

Most complications with lasers occur due to inaccurate skin typing, choosing the wrong laser, inappropriately treating tanned skin, not screening for contraindications (such as use of certain medications), and laser malfunction.

Most complications are preventable with adequate training. Unfortunately, laser companies usually provide only a brief training on how to use the laser but much more in-depth training is required. A thorough knowledge of laser physics and skin physiology, typing, and reactions are crucial to prevent complications. For example, too often there is a misconception that an IPL machine can be used at low settings with all skin types and is not as dangerous as a laser. In general, this is not true, especially with darker skinned or tanned clients.

Purchasing appropriate lasers and ensuring regular servicing and maintenance of the laser is also very important in preventing laser problems. Lasers and IPL machines can vary tremendously in their safety and efficacy. Negligence, ignorance and substandard technologies are therefore common contributing factors leading to laser burns and resultant lawsuits.

What are the costs involved with lasers?

Lasers are not only expensive to purchase, they are also expensive to maintain. A good IPL or laser can cost approximately $50,000 to $150,000 each. There are cheaper lasers available but often the quality and safety features are not optimal. There are often consumable costs as well. Warranty cost is around $5,000 to $15,000 per laser, per year. Keep in mind that usually several pieces of equipment are required. Don’t be fooled into thinking one laser can do it all.

A high volume of laser treatments is required to off-set the high costs involved. You may therefore need to add advertising or promotional costs to the overall price tag. Also add in extra insurance coverage, staff wages, air-cooling system and/or extra ventilation, and space allocation.

What are the rules and regulations of laser treatments?

In Canada, it seems that anyone can own and/or operate a laser. Lasers are in many malls, spas, and salons throughout the country. Many people have already been harmed by laser injury. It is predictable that further damage will ensue since many unqualified individuals are now buying and operating lasers indiscriminately. It seems past time that rules and regulations on laser use should be implemented.

What about liability of laser treatments?

Liability is a huge issue and one that a spa should consider before getting involved with medical treatments. It can take only one lawsuit to find out the financial implications of conducting high-risk laser treatments. Training and competence of the technician, following established policies and procedures set out by the spa or clinic director, along with safety and appropriateness of the equipment are paramount factors in liability claims. Check with your insurance provider to make sure you have adequate coverage before you incorporate any medical treatments.

What are other considerations?

Competition in the medical spa industry is now huge, especially in large urban centres. Can spas not specialized in medical treatments compete with the many medical clinics available which are run and operated by the top cosmetic physicians in the city? These medical clinics typically have the highest quality staff and equipment as well as a wide diversity of treatments.

Also consider, if you bring in lasers into your existing spa, will you be hiring new staff to conduct these treatments or will your existing aestheticians be operating these high-tech machines? Who will be training them and how will they be trained? Who will be supervising them? What happens if complications occur? If you do not have the best laser technicians or lasers, you will not be providing the best service to your clients. Note too that although your original spa services may maintain their top quality, the reputation of your spa may suffer if your new services do not meet or exceed industry standards.

In summary, risk, liability, cost, and long-term implications should be assessed prior to incorporating medical aesthetic treatments into a spa. Consider that a good alternate may be to set up a referral system with a local physician with whom you trust. Or develop a good working relationship with someone with laser expertise so that you may ask for guidance if needed. Educating yourself is the best starting point in any new endeavour.

Next Issue Part 2: Incorporating injectables such as botox and dermal filler treatments into your spa



Dr. Diane Wong, MD, is a cosmetic physician, and owner and founder of Glow Medi Spa in Toronto. Her focus is on non-surgical cosmetic treatments and enhancements such as cosmetic injections, lasers, and skin treatments.

by Dr. Diane Wong | Spring 2014