Med-spa trade groups recommend, and some states require, that facilities be supervised by a physician. But in some facilities the doctor on the letterhead is absent while nurses or even non- medical staff perform cosmetic procedures. And when a doctor is present, he could just as easily be a pediatrician as a dermatologist. “So many doctors are disenchanted with the current medical system,” Goldman says. “They think that they can make a quick buck in the med-spa arena.” But do you really want a podiatrist injecting paralyzing toxins into the muscles of your face? Amy Newburger, M.D., a dermatologist at St. Luke’s-Roosevelt Hospital Center in New York City, says it’s important to find a doctor with “a real understanding of the anatomy, structure, and function of skin, particularly facial skin.”
What you can do Make sure the supervising physician is on-site and specializes in either dermatology or plastic surgery.
The FDA is currently reviewing the safety of Botox and other related drugs after some reports of respiratory failures and deaths. The most serious of these cases involve unapproved uses of the drugs in children (for severe muscle spasms, for example), but there have also been cases involving adults who probably got the shots for FDA-approved cosmetic purposes. And odds are there are unreported cases too. “The process for reporting adverse events is so time-consuming and cumbersome,” says Newburger, who has participated on several FDA-approval panels. “It’s no wonder that just 1 to 10 percent of adverse reactions are ever turned in.” Botox, Botox Cosmetic, and Myobloc have low doses of botulinum toxin, a powerful natural poison that relaxes overactive muscles. Doctors have long known that in people who have pre-existing neuromuscular disorders, the shots, in large doses, can trigger effects far from the injection site, including difficulty swallowing and breathing. New reports suggest that those effects may occur in others too. More common problems that can happen with Botox, especially in the hands of an inexperienced person, include drooping eyelids, a flattened lower lip, a sagging mouth, or even a speech impediment, Newburger says.
What you can do Consider the potential risks of Botox, and have it injected only by a physician with plenty of experience. “I’m telling my patients about new findings,” says Macrene Alexiades-Armenakas, M.D., “and particularly discouraging my younger patients--those in their 20s and 30s--from using it, as any theoretical side effects would likely worsen the longer the drug is used.”
Injectables with hyaluronic acid, such as Juvéderm Ultra, Perlane, or Restylane, and collagen-based injectables like CosmoDerm and Zyderm, last several months and are generally safe. A recent study suggests that at least one form of hyaluronic acid may even spur collagen production, which can further improve skin’s appearance. Semipermanent fillers, which can last up to two years, are another story. The tiny particles that give them staying power can irritate the skin, migrate, or break, causing swelling, bumps, and scarring. And FDA approval can be based on small, short-term studies. An example is ArteFill, the longest-lasting of these fillers, which the agency approved based largely on one clinical trial of 251 subjects followed after treatment for no more than a year. The panel wasn’t allowed to consider many reports of complications caused by a previous version of the product used in Europe. Some experts have also raised concerns about the long-term aesthetic outcome and potential side effects of the filler, which one critic calls “injectable Plexiglas.”
And while ArteFill is approved only for nasolabial folds, the creases that extend from either side of the nose to the corners of the mouth, some doctors could inject it elsewhere, such as around the lips, which might cause scarring and other complications. This type of off-label use is legal, but it’s not always a good idea.
Newburger, a member of the FDA panel that approved the filler Sculptra for facial wasting in HIV-positive patients, was disturbed when she heard physicians representing the manufacturer endorse the product as a general-purpose wrinkle filler. “I felt betrayed, quite frankly,” she says . “We fast-tracked the approval of this product on a compassionate basis, assuming that it would be controlled and dispensed only to a certain population.” The safety of the drug in people with normal immune systems is unknown.
What you can do Newburger recommends avoiding semipermanent fillers until more safety testing is done. “In this case, the latest is not necessarily the greatest,” she says. “A product should be used by a lot of other people for a long time before you should consider it safe enough for yourself.”
Brown skin is more prone to scarring, loss of pigment, and dark marks. And brown skin isn’t necessarily dark. “You may not realize it, but if you have Asian, Hispanic, Mediterranean, African-American, Native American, or Middle Eastern ancestry, among others, you likely have brown skin,” says Susan Taylor, M.D., director of the Skin of Color Center at St. Luke’s-Roosevelt Hospital Center in New York City. One way to tell if you have such skin is if things such as light burns tend to leave dark marks.
What you can do Ask if the practitioner has the experience and equipment to meet your special needs. New color-blind machines (long-pulsed Nd:YAG or diode lasers) lessen the risk of burns. Taylor recommends patch tests before full treatments.
For one thing, they might be done with older equipment. “With some of the older machines, it may take 10 treatments instead of three to achieve near-permanent hair removal,” Goldman says. “Or they may not be able to safely handle dark skin or light hair.” Many people walk in thinking that there is one laser machine that does everything, he adds. Truth is, each type of procedure--removing hair, treating sun-damaged skin, or zapping spider veins--requires special equipment and training. Goldman’s office has 32 laser machines, three just for hair removal. Using the wrong machine or the wrong setting can cause severe burns and scarring.
What you can do Shop by quality, not price, and find a doctor with specific laser expertise who can tell you the pros and cons of each machine. “Think about it--who do you want pointing a powerful laser at you?” asks Alexiades-Armenakas says. “You don’t want it to be someone who’s just taken a weekend class.”
Treatments can smooth skin, but that’s not a good thing if they camouflage telltale lesions. “Laser treatments could hide a melanoma,” Goldman says. “By the time the lesion becomes apparent, the cancer may have spread.”
What you can do Ask a doctor to check your skin before it’s zapped, peeled, or plumped, particularly if you have moles. “Patients should always be seen by a supervising physician to discuss treatment options before undergoing any cosmetic procedures,” says Richard D’Amico, M.D., president of the American Society of Plastic Surgeons and an assistant clinical professor of surgery at the Mt. Sinai School of Medicine in New York City.
One example of a heavily advertised procedure that may not have been adequately tested is mesotherapy, also called lipolysis, which involves injections--often of non-FDA-approved drugs--that supposedly dissolve fat.
What you can do Wait for results of lipolysis clinical trials. And before getting any cosmetic treatment, ask if it’s FDA-approved. “If not,” D’Amico says, “that’s a big red light.” Even then, don’t agree to a treatment until you know what it’s approved for and under what conditions. And if your doctor is using the drug for an unapproved purpose, ask why, and what experience he or she has in using it for that purpose. You can find out more about approved uses, side effects, and potential warnings by searching for the drug or procedure at the FDA’s Web site.
In 2006, the FDA issued an advisory after two young women died from complications related to an anesthetic cream they used on their legs before laser hair removal. In addition to death, numbing creams can bring on irregular heartbeats, slowed breathing, seizures, and coma if used incorrectly. Anesthetic cream is widely used but can cause problems if you use too much, apply it to irritated skin, leave it on too long, or if you overheat the treated area by wrapping it or exercising, for example. Another serious risk: creams used by med spas that have not been approved by the FDA but instead are custom-made in a pharmacy. Some of these creams may be more potent than FDA-approved products.
What you can do Request an FDA-approved cream. And ask to have a medical professional apply it. Or at least have one supervise you while you’re applying it.
