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Medi-Spa Ownership and Patient Safety

It is estimated by AmSpa (the American Medical Spa Association) that less than 50% of medical spas are owned and operated in a legal and safe manner. This is a frightening and inappropriate medical practice in most every state of our country. California, where I practice surgery and own a medical spa in Newport Beach, BioSpa, there are regulations requiring medical spas to be owned by physicians and treatments provided by Nurses, Nurse Practitioners and Physician Assistants according to their specific scope of practice.

Unfortunately, the Medical Board of California, apparently lacks the resources to investigate and sanction every Medical Spa that does not follow state regulations. It then falls on the consumer, in this case the patient, to do their own research to ensure they are being treated by the most experienced and licensed individual possible.

With the goal of any medical practice being that of the overall wellness and support of the patient, there should never be the ideals and finances of the practice owner ahead of the patients who deserve quality procedures.

There are some important things to remember when it comes to the ownership and management of a Medical Spa in any American State, especially in states like California and New Jersey, which have the strictest regulations. Like all medical practices, a MedSpa ( which is a medical practice) is state regulated. Some of the clearest regulations presented in California include the following:

  1. There is no such thing as a "sponsoring physician." Nurses may not, under California law, employ or contract with a physician for supervision.

  2. A nurse may not have a private practice with no actual supervision. While the laws governing nursing recognize "the existence of overlapping functions between physicians and registered nurses" and permit "additional sharing of functions within organized health care systems that provide for collaboration between physicians and registered nurses" (Business and Professions Code section 2725), nurses only may perform medical functions under "standardized procedures." The board does not believe this allows a nurse to have a private medical cosmetic practice without any physician supervision.

It is important to remember that California and New Jersey have some of the strictest laws and regulations as to who can own and run a Med Spa, as well as who can provide treatments within those spas and other medical practices.

Some examples of illegal medical practices in Med Spas include the following:

  1. In California there is no such thing as a laser technician. All lasers and energy sources used to affect the deeper layers of the skin or further must be performed by a Doctor, Physician Assistant, Nurse or Nurse Practitioner.

  2. Every patient must have a good faith exam by a Doctor, Nurse Practitioner Physician Assistant. Not even a Nurse can do the exam and definitely not an Esthetician.

  3. Many Med Spas in California have treatments like CoolSculpt, medium depth skin peels and microneedling by Estheticians. This is not legal.

  4. Although tattoos can be performed by someone licensed to perform body art and registered with their local county and regulated by the state department of health, they or a licensed Esthetician cannot use the same, or similar, device for microneedling.

  5. Many Med Spas do not have Nurses or other professionals properly trained or licensed in laser safety and/or the proper use of these energy devices.

It is important to remember that many Spas have Estheticians, Medical Assistants and LVNs who perform treatments that are not legally within their scope of practice in California. Additionally, there are Nurses at those same locations who may not be fully trained in those practices. It is important to gain complete, in-depth knowledge of the location where you are having your procedure completed in order to gain complete confidence of the medical professionals with whom you trust your end result.

BioSpa Medical Spa is owned and managed by myself, Dr. Jed Horowitz and Dr. Larry Nichter. We are both board certified plastic surgeons with over 25 years of experience. We ensure the quality of safety and care provided by all of our appropriately licensed staff. We support the idea that all other medical spas should provide the same oversight.


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