Skip to main content
Jefferson Health

Home of Sidney Kimmel Medical College

Is a Medical Spa Right for You?

Expert advice on navigating the different facilities and practitioners when seeking non-invasive cosmetic procedures.

In the US, over 14 billion dollars was spent on aesthetic procedures in 2021 alone and demand continues to rise. To meet this demand, medical spas have multiplied across the country, outnumbering physician-based cosmetic practices in 73% of US cities. While medical spas often boast shorter wait times and affordable pricing, there is no uniform standardization for the level of training and oversight they receive, and could lead to adverse events such as burns, scarring, and pigmentary alterations. How can consumers decide the right kind of practice for their needs?

To gain insight on how you can safely navigate the aesthetic procedure market, we talked to Jefferson’s chief-resident in dermatology Alexander Valiga, MD, the lead author on a paper that explores the aesthetic procedure landscape.

What separates a medical spa from a physician-based cosmetic practice?

Medical spas are day spas that offer minimally invasive aesthetic procedures while physician-based practices are outpatient clinics offering both aesthetic procedures and professional treatment of dermatological ailments. Generally speaking, medical spas are given that name because there is a medical director at these institutions with some degree of medical training. However, that director’s experience, expertise, and day-to-day oversight of staff can vary greatly. On the other hand, all treatments at a physician-based practice are supervised or performed by an accredited doctor, most often a dermatologist or plastic surgeon, who has board-certified medical training in cosmetic procedures. Both physician-based practices and medical spas hire non-physician operators (NPOs), but the NPO designation is a broad category and the degree of training and oversight varies.

There is considerable overlap in the procedures offered at medical spas and physician-based practices since there is little government oversight controlling who can administer and monitor procedures considered minimally invasive. For example, there are no regulations stating whether cosmetic procedures must be supervised by a dermatologist or plastic surgeon or whether any physician is qualified despite not specializing in the field. The treatments offered are variable at both locations but often include injectable neuromodulators (Botox), soft tissue fillers, and various laser procedures such as resurfacing and laser hair removal.

Can you tell us a bit more about the different NPOs and what they mean in terms of expertise?

Broadly speaking, an NPO is someone working in a medical care setting who is not a doctor. It is an umbrella term that refers to a multitude of practitioners with varying degrees of training. In dermatology it is most common to see physician assistants, nurse practitioners, and aestheticians. A nurse practitioner is a registered nurse who also received a master’s in nursing. A physician assistant is someone who completed at least a bachelor’s degree and 2-year accredited physician-assistant program. Both are considered physician extenders, both are employed at both physician-led practices and medical spas, and neither require any dermatology-specific or cosmetically-focused board-certifying examination prior to entering clinical practice.

Aestheticians are typically not considered in the same category of physician extenders as NPs and PAs. Rather, they require a high school diploma or equivalent, a cosmetology certification, and a state license. They have no formal medical training like physicians, NPs, and Pas. While not the same as a board certification exam, aestheticians have a certifying exam as part of completing cosmetology school that focuses on cosmetology and the skin. Both physician-based practices and medical spas hire aestheticians as well. While it is uncommon, it is important to note that non-physician operators can also serve as medical directors of medical spas in many states while all physician-based practices are led by board-certified physicians.

Should patients avoid non-physician operators (NPOs)?

Of course not! NPOs are important members of the team in many dermatologic practices including those focused on cosmetic treatments and are commonly employed in both physician-based practices and medical spas. In the case of medical spas, aesthetic procedures are delegated to NPOs in up to 70% of cases. While this statistic alone is not a concern, the fact remains that not all NPOs have the same degree of training and on-the-job experience so it is important to do your research on the provider who will be treating you during your appointment

Despite this, many NPOs are excellent practitioners with extensive on-the-job training, so it is important to ask about your provider’s experience level. Your safety is paramount, so it is also critical to ensure there is a board-certified medical director overseeing the services you are receiving. Our study estimated that only 50% of medical spa facilities had a board-certified medical director present for on-site supervision, which can be especially important in the case of complications. In the end, the best provider for someone interested in an aesthetic procedure is highly dependent on a consumer’s values and needs.

What are the biggest dangers of medical spas? Should patients avoid them?

The biggest concern with medical spas is the variability in the level of medical experience both the director and their providers have when compared with traditional physician-based practices. Our research showed that staff at 26% of locations were unsure of the background of their medical director. That coupled with the fact that so few medical directors are present in day-to-day operations puts a greater responsibility on the NPOs who may be early in their dermatology training and, in the case of aestheticians, may lack formal medical training. Even in cases where the NPO has experience, not having an appropriately trained medical director on site may place that NPO in a situation where they are less prepared to deal with a complication such as scarring, burns, and pigmentation alterations. With that being said, many patients have had procedures performed at medical spas without complications and there are many experienced, competent providers who work in such facilities. It is important that individuals do their research to ensure the best experience.

What should patients do to find the best provider for them?

The best provider for a specific person will depend on what they deem most important. Physician-based practices tend to have longer wait times and higher prices, but in return they offer a greater degree of safety and experience. Research shows that safety and expertise are highly valued among millennials looking for aesthetic procedures, which would indicate physician-based practices are the preferred provider for a large section of the market.

When you are calling different providers or attending a consultation appointment, there are a few things patients can ask to ensure the best treatment experience and result. First, they should ask for the credentials of the medical director. Ideally, they should look for a board-certified physician, preferably with residency training in dermatology and/or plastic surgery. You can also ask if they have completed any fellowships specializing in plastic surgery or aesthetic surgery. This factor cannot be overemphasized as our research has shown that medical directors of medical spas, rather than physician-led practices, most often hold board certification in fields such as family medicine, obstetrics/gynecology, and emergency medicine. Dermatology was far-and-away the least cited background of medical directors of medical spas in our survey study.

The second question to ask is how long your medical director and NPOs have been practicing. Board-certified physicians in dermatology and plastic surgery have spent 3-6 years in residency (and potentially fellowship) being formally observed as they develop their cosmetic procedural skills. In contrast, NPOs do not participate in this type of training and instead their learning occurs “on the job” under the oversight of an experienced physician or other NPO. While there is no perfect number in terms of years of experience for an NPO, generally more experience is better. Keep in mind that physicians spend 3-6 years (or more) of training prior to practicing unsupervised so that may be a useful benchmark when evaluating the best treatment scenario for you.

Lastly, it can be helpful to ask to see before-and-after pictures of patients an NPO or physician has treated previously. Many practices post these before-and-after pictures publicly to market their services and seeing these results can help ensure the practice has experience in the procedure you are interested in and that the results match your desired outcomes. Overall, keep your safety in mind when evaluating medical spas versus traditional physician owned practices. Safety and experience of a provider often go hand-in-hand and by asking just a few clarifying questions, you can ensure a safe and successful visit to your local medical spa or physician-based cosmetic practice.

[Main photo credit:]

, ,
Research & Innovation