In Lieu of Plastic Surgery, MediSpas Proving a Prime Draw

By Mark R. Smith, EDITOR-IN-CHIEF

Is time having its way with you as you get a little older? Are various body parts sagging a bit?
OK ... maybe more than a bit?
If you visit a plastic surgeon, know that more people are thinking twice before going under the scalpel these days, with costs ranging from $3,000 for an eyelid lift to $10,000 or more for, shall we say, more involved work.
Despite the ever-present jokes about Botox injections, numerous more affordable options are available. They can be found in what's known as a Medical Spa (often known as the MedSpa or MediSpa) - for less than $2,000.
While a growing number of plastic surgeons and medical aestheticians are offering services from a MediSpa, the average citizen needs to do a fair amount of homework before walking through their doors. Services at a given MediSpa vary - just like the educational backgrounds of the professionals administering the procedures.

Pre-Knife
The public desires those non-surgical options more than ever before, said Paul Buhrer, M.D., a plastic surgeon and partner at Plastic Surgery Specialists (PSS), an Annapolis-based firm with five area offices (including Severna Park and Crofton).
Indeed, PSS's MediSpa business is up 50% from last year. "Whether that's due to increased awareness or the sagging economy, we're not sure," he said, noting that the firm is treating more and more women who "have started taking care of their skin earlier in their lives."
While more are postponing facelifts, they want to know where they can start. That's at the MediSpa, where treatments run about $100 to $200 each every four to six weeks.
The services available at the PSS MediSpa in Annapolis include fillers like Restylane, Juvederm and Perlane, where a plastic surgeon is always on hand to tend to any of the patients' issues or questions.
Another selling point for the MediSpa is that, unlike plastic surgery, the procedures performed therein don't make the body part(s) in question appear or feel the worse for wear. "It looks like nothing more than a minor sunburn or windburn," said Buhrer, who gets the treatments every six to eight weeks.
He calls the MediSpa "a fine option" for patients who "may not be financially or emotionally ready for surgery" he said. "In my mind, this helps the patients bide some time for a few years before they come to see me for surgery."

A Bevy of Options
The director of the PSS MediSpa is Jan Sutton, a former emergency room technician at Anne Arundel Medical Center, who noted options like ReFirm, a skin tightening procedure. It involves three treatments that are separated by six weeks; total cost: $1,800.
"Some patients don't just do their faces, but their knees and arms, too," said Sutton. "It has taken off with our current and new patients. We do at least 20 to 25 ReFirm treatments weekly."
Other options at PSS include the FotoFacial, which is an IPL (intense pulse light). The treatment restores skin, removes age spots and minimizes large pores and fine wrinkles. It also lightens darkened skin.
Sutton expects business at PSS to remain brisk. "I think skin care has caught on. People are taking care of their skin more often, and it's not just women, though they comprise 85% of our business. That's definitely a big change from five years ago, because men and teenagers are taking better care of their skin, too."

Into the Act
While plastic surgeons are on hand daily at PSS, that is not a requirement of Maryland law, so MediSpas have opened in different types of places.
At Robert Andrew Medical Spa in Crofton, Director Candace Weihert pointed out that, in Maryland, a medical procedure cannot be conducted in a hair salon. That's important to note in Robert Andrew's case, as the owner has operated a well-known hair salon and day spa in the suburb for about 40 years.
It relocated to the nearby Village at Waugh Chapel several years ago; then when the MediSpa trend gained momentum, the company opened its own entry to the market in its previous location in the Crofton Station Shopping Center two years ago. A plastic surgeon is in-house twice weekly; another doctor, a podiatrist, and a physician's assistant are also on-site intermittently.
Weihart, a medical aesthetician by training, said various procedures typically start at $90, Botox (and other) injections start at about $275 per facial site and dermal fillers start at $550. All told, Robert Andrew offers nearly 20 options.
She said the Medical Spa sees about 20 to 30 patients weekly and also reports an "approximately 50%" rise in business this year.
These two examples of busy MediSpas underscore their differences, said Alan Gold, a solo practitioner and president of the American Society for Aesthetic Plastic Surgery in New York.
"I don't think that there is a single model for a MediSpa," said Gold. "They can open by hiring a new staff member, subbing the work out or adding an off-site location."
And they entail various types of procedures, he said, "that some states require be conducted by a physician and others a nurse or a technician. So the consumer needs to be educated."
Physicians in this arena also have to be cognizant of local competition, "which can come from a hair salon [depending on the state] as easily as another doctor," Gold said.
"The industry is certainly burgeoning and is a huge national operation. Some markets are very overbuilt, and just like startups in any industry, there is a high rate of failure - at least as a standalone," he said. "It's much easier to absorb the business into an existing doctor's office or a business."

Pros and Cons
As popular as the MediSpas are becoming, there are plenty of professionals in the field who would heed Gold's advice. For instance, Gary Chang, M.D., a plastic surgeon in Columbia, doesn't operate a MediSpa and doesn't plan to.
"It seems that a new MediSpa opens every month in the area and there's already a glut in the field," he said, noting his focus on surgery.
In Chang's mind, "the people who are best equipped [to operate a MediSpa] are plastic surgeons and dermatologists who have the background training in aesthetic medicine," he said. "They don't have to take courses in how to administer things like Botox, injectibles and laser treatments."
Indeed, those administering treatments in a MediSpa don't have to be trained in aesthetic medicine. They can be cardiologists or infectious disease specialists or neurologists.
Just ask Leslie Apgar, M.D., who just opened a MediSpa called Pure Vida with her partner, Paula Yates, M.D., in Maple Lawn last month. Both are OB/GYNs.
Apgar said the duo added the MediSpa because their practice, The Women's OB/GYN Group, "has 15,000 active patients and many of [the patients] were asking for these features."
They feel that the future is now for the MediSpa concept. "As surgeons, we are very comfortable working with lasers, needles and syringes," she said, "so making a move into the cosmetic surgery industry is not much of a stretch for us.
"I think there is a lot of room for growth in this market," Apgar said. "What makes us different is our luxurious spa-like environment in an up-and-coming Maple Lawn. But, as a consumer, you have to be careful who you do business with, because you might need to call someone with a problem at 3 a.m."
While the model can be different in any market, Gold agrees with Apgar that the concept of the MediSpa is "here to stay.
"And we, as plastic surgeons, know that we need to proactively incorporate cosmetic medicine into our approach," he said, "to be able to provide patients with the range of services they need."