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The number of medical spas (also referred to as medi-spas or medspas) has been increasing as the desire for cosmetic procedures increases.¹ A medical spa combines the atmosphere and traditional offerings of a day spa (e.g., facials, massages, manicures) with the provision of medical treatments such as injectable facial fillers (e.g., Botox), laser procedures, and even liposuction.

When cosmetic breast surgery performed by a physician who has not gone through formal plastic surgery training has an unintended result and a lawsuit results, the plaintiff and defendant will most likely seek the opinions of plastic surgeons on whether the defendant physician comported with the standard of care. As the following case study indicates, it can be difficult for plastic surgeons to support such surgery.

Lipodissolve (also referred to as injection lipolysis, mesotherapy, lipolysis, lipostabil and other terms) is not FDA approved. Informed consent is particularly important when using any type of cosmetic technology that is not FDA-approved or has not been generally accepted by the plastic surgery and dermatology communities and professional associations.

The composition of tattoos varies widely. Even when tattoo removal is done correctly, tattoo pigment may not respond predictably to laser treatment.¹ The type of laser to use, the power setting, the number of treatment sessions and other issues vary from patient to patient based on a variety of patient and tattoo characteristics. The following are some of the patient/tattoo characteristics that should be evaluated: Fitzpatrick skin type, tattoo ink colors, whether the tattoo was done by a professional or amateur, and the location and age of the tattoo. Ensuring realistic expectations through proper patient education and informed consent is a critical aspect of tattoo removal — one retrospective study showed that less than two percent of tattoos could be entirely cleared.²

“Practice drift” or “physician drift” are terms used to describe the phenomenon of physicians practicing outside their specialties. The drift to cosmetic procedures is a popular one, possibly in part because such procedures are performed on a patient self-pay basis. When insurance reimbursements don’t keep pace with overhead costs, cosmetic procedures can be viewed by providers as an effective way to increase practice revenue.¹ Also, there are plenty of customers for cosmetic procedures, and the number of patients and types of procedures keeps growing. According to the American Society for Aesthetic Plastic Surgery, patients spent more than 15 billion dollars on cosmetic procedures in 2016.²