Face Value
Loosely regulated, the medical spa business in Florida is growing fast, selling everything from $350 Botox injections to $2,000 laser hair removal treatments.
 By Amy Keller
Growth Projections
> In 2005 , light-based treatments, including laser hair removal and tattoo removals, generated $8.5 billion for practitioners and $707 million for manufacturers. By 2010, laser-based treatments will earn practitioners an estimated $15.2 billion and manufacturers $1.1 billion.
> Botox injections generated $2.4 billion in procedure fees in 2005. Treatment revenue will grow to $4.6 billion by 2010, earning suppliers an estimated $878 million.
> Approximately 3 million dermal filler procedures were performed last year, earning practitioners $1.3 billion and suppliers $442 million. By 2010, an estimated 9 million treatments will generate $3.5 billion for doctors and $1.3 billion for suppliers.
Two and a half years ago, Brian Sidella was contemplating a career change when he tuned into an episode of Fox's extreme makeover show "The Swan."
An executive in the telecommunications industry at the time, Sidella was struck by the ravenous public appetite for cosmetic self-improvement that the show revealed. He thought of Florida's rapidly growing population of aging Baby Boomers and their desire to stay youthful-looking - and wondered what sort of business opportunities it might create for him.
Online research introduced him to medical spas. Medi-spas, med spas or medical spas, as they are called, originated in California as facilities offering doctor-supervised cosmetic procedures, such as laser hair removal and Botox injections, to those with enough vanity and disposable income. Typically located in malls and shopping centers, the sites are more convenient and usually far more luxurious than the average doctor's office. "Within weeks of pulling down the information, I decided that I wanted to be in this industry," Sidella recalls.
Today, Sidella's Forever Young MedSpa in the Fort Lauderdale suburb of Cooper City is part of a $10-billion industry that is growing between 50% and 100% each year. Startup costs average around $750,000, but the typical med spa is a cash cow, generating about $10 million in revenue over just five years, industry experts say. Typical prices in Sidella's establishment: $350 for a "one-zone" wrinkle-removing Botox treatment, $1,700 for a package of five photo-facial treatments to minimize sun damage, and $2,000 for laser hair removal from a woman's legs or a man's back.
Florida 's demographics have made the state the second-biggest medical spa market in the country after California . Solana Medspas CEO and co-founder John Buckingham has helped investors, including Sidella, set up eight franchises around the state and predicts he'll have another 100 locations statewide within the next five to seven years. The affluent Baby Boomers flocking here in droves aren't content to let nature take its course as they age, Buckingham says: "Boomer women don't want to look like their mothers. They've worked hard. They're at the top of their game. They don't want to age gracefully."
What's also made the Sunshine State attractive for med spa operators is a permissive legal and regulatory climate. For one, Florida is among only a handful of states that does not have a corporate practice of medicine law. Typically, those measures prohibit corporations and other non-medical entities from employing doctors - in order to keep physicians out of situations in which they might have to put a company's economic interests ahead of a patient's needs.
In Florida , the lack of such statutes means that corporations and investors are free to invest in medical practices. Physicians own and operate some medical spas, but many are owned and run by businesspeople with no medical training who hire a physician to serve as the "medical director" of their spa.
The law requires physicians to supervise and control the actual medical practices. But lax regulations have helped spa operators find creative ways to offer both medical and non-medical procedures under one roof. And the loose regulations mean that the nature of the supervision varies greatly.
Physicians themselves may not be required, for example, to perform the procedures administered at the spa - or even to be on-site while the spa is operating. Certified electrologists can't conduct laser hair removal unless a physician is on the premises. But physician assistants and advanced registered nurse practitioners may perform laser hair removal and give various injections under the physician's "indirect supervision" - meaning the doctor must be reachable by phone but doesn't have to be on premises. Supervising physicians are required to post a schedule of their regular office hours and the hours they're not on-site.
Another issue is the types of doctors who serve as medical directors. Many medical spas prefer to contract the services of a plastic surgeon or dermatologist, since the specialties seem to fit the cosmetic services the spas offer. Any physician may perform most cosmetic procedures, however, and a host of doctors, ranging from emergency room physicians to gynecologists to pediatricians, has jumped at the chance to supplement the income from his or her regular practice by affiliating with a med spa. That is about to change. But it's unclear whether the change will make the spa treatments any better or any safer - or whether it will just hand over the lucrative med spa procedures to a smaller group of physicians.
Medspa Opportunity:
Brian Sidella (with wife Diana Santa Maria) got the idea to start Forever Young MedSpa in Cooper City after watching an episode of Fox's extreme makeover show "The Swan." In the show, no longer on the air, women received a cosmetic-procedure transformation and then competed to win cash and other prizes.
Control Issues
In May, Gov. Jeb Bush signed a law, House Bill 699, that limits the number of "satellite" offices a plastic surgeon or dermatologist may operate to one. (Physicians already operating two are grandfathered in and will be allowed to operate two until 2011.) The law, which took effect July 1, requires that the offices must be located within 25 miles of the physician's primary practice and that all satellite offices must be within 75 miles of each other.
More significant for the med spa industry, the law also states that only dermatologists or plastic surgeons may serve as medical directors of med spas. Some in the med spa industry say the change is a blatant move by plastic surgeons and dermatologists to corner the market on the lucrative med spa procedures, particularly Botox - and kick other physicians off the gravy train. After all, they point out, other types of physicians may still perform Botox injections, medical microdermabrasion, chemical peels and laser treatments in their primary offices - but House Bill 699 means they can no longer perform them at a med spa.
"It's a push by the dermatologists and plastic surgeons to control the industry in the guise of safety," says Eric Light, president of the International Medical Spa Association, which sent 200,000 e-mails unsuccessfully urging Bush to veto the bill.
Industry groups also complained that one of the legislation's co-sponsors, Rep. Eleanor Sobel (D-Broward), is married to Hollywood dermatologist Stuart Sobel and operates a skin care products company. She should have recused herself from the debate on the issue, the groups say. Sobel did not respond to requests for comment.
Florida state Rep. Joe Negron (R-Stuart), the original sponsor of the legislation, says he never intended to regulate the medical spa industry when he introduced the bill. That effect, he says, was merely one of several unintended consequences of legislation meant to enhance patient safety. "When I filed the bill, I had no interest in regulation of the medical spa industry, didn't know anything about the medical spa industry, and this is not a medical spa bill," Negron says.
Negron says he was worried that doctors, and dermatologists in particular, were juggling more offices than they could supervise and taking on more patients than they were capable of handling. Negron says one local dermatologist showed him files of patients who had been referred to dermatologists for treatment but never even saw one. Instead, they'd been treated solely by physician assistants and often never even realized it.
"There was a Tampa doctor talking about opening a satellite office in Tallahassee ," says Negron. "There are doctors with five, six, and - particularly in the dermatology arena - up to seven satellite offices. Could they actually supervise that many offices, and were they actually seeing patients?"
After the bill passed, Negron says he changed his mind after fully understanding the effect of the legislation on med spas but stopped short of asking Bush to veto the bill. He believes "that's something I think the Legislature next year should take a look at." A lawyer with Akerman Senterfitt, Negron dismissed suggestions that his firm's work on behalf of the Boston-based laser technology manufacturer Palomar had anything to do with his change of heart, saying that he has always kept his legislative work separate from his professional life.
Palomar, one of the largest makers of aesthetic laser equipment used for hair removal, tattoo removals and other cosmetic purposes, hired Akerman to help defeat Negron's legislation two days after the Florida House passed it.
Haphazard Approach
Dr. Steven Rosenberg, a West Palm Beach dermatologist and chairman of the Florida Society of Dermatology's legislative committee, says the impact on medical spas was just "one small component" of a bill intended to give the board of medicine the responsibility to determine the appropriate levels of supervision for certain "physician extenders" like nurse practitioners and physician assistants - a hotbutton issue that had been on the Florida Medical Association's radar for six years.
Nevertheless, Rosenberg believes any move to regulate the industry is probably a good idea. "Who knows what kind of sterile procedures they're providing, what kind of care they have for an emergency situation. The reality is medical spas didn't exist when most rules and regulations were developed, and now they sort of fall through the cracks," he says.
Sidella believes enforcement of existing regulations is haphazard. He says a new employee told him that a competing med spa was using aestheticians to perform Botox injections, in violation of Florida statute. When he called to report the incident to the Department of Health, he "got frustrated. They didn't want to hear it. They didn't even seem to know what a med spa was."
Moreover, members of the med spa industry argue, the Legislature could have taken more effective steps than limiting the field to plastic surgeons and board-certified dermatologists. For instance, if lawmakers were concerned about burns from laser hair removal, they might have required all physicians in the medical spa industry to be trained in intense pulsedlight technology and other types of aesthetic laser-procedures. Dr. Sharon McQuillan, who trains other physicians how to inject Botox and operate laser equipment at her Ageless Aesthetic Institute in Sarasota, says that discriminating against the type of doctors who can operate a med spa is counterproductive. "We have trained many anesthesiologists who are wonderful with a needle. If they can put a catheter in a baby's vein, they're pretty good at doing Botox," she says.
Dr. Steve Cimerberg, a family practitioner and licensed osteopath who runs the Advanced Medical Spa in Plantation , won't feel any repercussions from the new law because his spa is his primary practice, but the physician clients he teaches to use laser equipment might. Why limit med spas to just plastic surgeons and dermatologists, he asks, when "there are physicians from other specialties that are trained just as well or better."
McQuillan says that while H.B. 699 may prevent some chains from putting unsupervised personnel in "potentially harmful" situations, it didn't ensure that all med spas will deliver consistent and safe treatments. As a result, she is spearheading an effort to develop practice standards for the industry. McQuillan says she is working with the American Academy of Family Practitioners, the American Academy of Osteopathic Physicians, the American Academy of Ophthalmologists and a number of other organizations to establish a set of "best practices" for the light-based treatments and fillers, as well as competency requirements for practitioners that the state board of medicine could implement. "We want to standardize the way these procedures are offered, so practitioners can practice effectively."
For now, says Solana Medspas cofounder Buckingham, the only ones hurting financially in the medical spa industry are the gynecologists, family practitioners and others who will soon be shut out of the Botox gold mine. "I can't believe the doctors were caught napping in your state," he says.
Labor Intensive
When Andy Rudnick, owner of Sleek MedSpa in the Boca Raton Town Center Mall, moved his headquarters from Boston to Boca Raton last year, the biggest headache he encountered was in labor costs. "We have to pay $35 to $55 an hour to the same person who in Boston we'll pay $20," says Rudnick. The reason? While Florida offers generally lax regulation of med spas, the state is slightly pickier about who may operate the equipment used in laser hair removal. In Florida , only physicians, nurse practitioners, physician assistants and certified medical electrologists may perform laser hair removal. In Massachusetts , RNs can perform the technique.
Rudnick, who ran a chain of weightloss centers before getting into the med spa industry, says that finding qualified help is also so difficult that he plans to launch his own " MedSpa University ," where he can "breed" future employees. If all goes well, he plans to open another Sleek location in Aventura Mall in the first quarter of 2007. He hopes to have 12 locations from Coral Gables to Palm Beach .
Rudnick says that so far he hasn't been adversely affected by H.B. 699, but that's only because of the way his business is structured. The plastic surgeon affiliated with Sleek MedSpa independently owns and runs a medical corporation. Sleek, in turn, serves as a retail company that has a service agreement with that physician's medical corporation. He says the regulations won't pose any threat to his expansion plans. "We only work with plastic surgeons, and they benefit from this. If we have to have 12 plastic surgeons, so be it."
Shopping for Bargain Filler
An exchange on Medical Spas Online's "physician-to-physician" message board reflects the unregulated aspect of the industry when it comes to the source of the raw materials used in one kind of procedure.
In one conversation, a Florida medical spa owner calling herself "aestheticRN" asks other med spa operators whether they'd had any luck buying the cosmetic filler Restylane overseas. "I recently spoke to some folks who purchase their Restylane from Bulgaria for almost half the price as it is in the U.S. They say it's the same as we use here, same packaging, etc. I know Botox can only be purchased from Allergan but what about Restylane? Anyone else import it?"
User "MD" responds a couple of months later to report buying Restylane from a distributor in Colombia at a third the cost and "never had any problems with it."
The Food and Drug Administration cautions against buying medical products abroad, noting that they may not meet U.S. requirements. Medicis Aesthetics, based in Arizona , holds all marketing rights to Restylane sales in the U.S. and says it has had a problem with counterfeits from abroad. The company includes a hologram on the product's packaging to ensure authenticity.
Mishaps
Walk into a local medical spa, and you may be swept away by the scent of aromatherapy and the promise of youthful rejuvenation. But medical experts warn that a spate of incidents around the country should alert consumers to the potential dangers they face when undergoing any cosmetic procedure.
Selen Adak, a 24-year-old Palm Beach County woman, suffered 300 second- and third-degree burns on her leg from a laser hair removal treatment performed by a technician at the American Laser Centers in Boca Raton , according to her attorney, David Zappitell. In a lawsuit, Adak says she was receiving the final treatment in a package of six laser hair treatments in October 2005 when she felt pain and alerted the technician working on her. When Adak got up from the treatment table, she says her leg was bright red and swollen and later developed a dark brown checkerboard pattern. Zappitell says the technician provided Adak with ice. The plastic surgeon affiliated with the center was not on-site at the time of the incident and later refused to examine her, he says. Today, Adak is too uncomfortable with her appearance because of the pigmentation damage to wear shorts or short skirts, Zappitell says.
Florida Trend found that nine doctors affiliated with medical spas around the state have settled more than $2.1 million in malpractice claims. In several cases, physicians were sued for burning patients with lasers.
The American Society for Dermatologic Surgery reports that its members have noted a 45% increase in the number of patients requesting treatment for complications such as burns, splotching and irreversible pigmentation and scars from laser hair removal, chemical peels, microdermabrasion and other cosmetic procedures performed by cosmetologists, aestheticians and others without adequate training or supervision.
Dr. Steven Rosenberg, a Palm Beach dermatologist and member of the Florida Society of Dermatology, blames such problems on loose regulation. "As it turns out, we're now finding there were big problems with the medical spas. They're not licensed under any category. There is no official department that regulates medical spas," says Rosenberg . "So much is going on without adequate supervision or real experience."
In 2003, a Department of Health inspection of a Pensacola medical spa called Body Indulgence revealed that an unsupervised medical assistant had been performing laser hair removal for more than a year, often with no supervision. It's illegal in Florida for anyone other than physicians, physician assistants, nurse practitioners or boardcertified electrologists to perform laser hair removal. As punishment for breaking the law, the spa's supervising doctor, Michael Rush, was fined $1,500 and made to complete 10 hours of community service.
Other than requiring a physician to be on staff at a medical spa, Florida has no guidelines specifically aimed at medical spas, and several medical spa owners interviewed by Florida Trend seemed unsure of exactly which procedures could be done by which employees and with what level of supervision. The businesses' operating rules are essentially determined by what sort of activities are being conducted at any specific site.
While cosmetologists, facial specialists or full specialists can perform microdermabrasions, for example, Botox injections are more highly regulated. Generally, the state conducts no inspections of medical spas unless a complaint is filed against the facility.
Dr. Steve Cimerberg, who transformed his medical practice into the Advanced Medical Spa in Plantation in 1999, says patients should not be shy about investigating doctors. That means asking about training, asking to see before and after pictures of people they've treated, asking who will perform the procedure and where the doctor will be in case of emergency. "Certainly, the number of places these services are offered has proliferated, and in order to get the best outcome, the consumer needs to make sure they go to the best practitioner of this kind of treatment," Cimerberg says.
Still, knowing whether physicians have mastered their craft is easier said than done. When it comes to laser hair removal, "there's no board certification for this type of training," Cimerberg admits. "This type of training is the type of training where a physician would seek out lecturebased and hands-on training and sometimes individual training in learning how to do the procedures."
ANTI-AGING
Posted on Tue, Dec. 12, 2006
Technology launches the face of the future Johnson & Johnson is introducing a cutting-edge technology in skin care at a Cooper City med spa that pores over your every pore.
BY BRIDGET CAREY
bcarey@MiamiHerald.com
When the TruVu Digital Imaging System takes your picture, it doesn't just capture your natural glow. It reveals every clogged pore, wrinkle and childhood sunburn. Forever Young Med Spa in Cooper City is the only place in Florida where Johnson & Johnson is launching the TruVu system, a highly advanced technology in skin care for analyzing facial skin features.
The machine -- marketed under the slogan ''See more. Know more.'' -- takes digital photos under four different types of light to detect skin conditions that cannot be seen with the naked eye.
''You're going to see sun damage you've had as a child,'' said Brian K. Sidella, president of Forever Young Med Spa. ``It's going to show you the freckles, the spots that will be coming through your skin over the next five to seven to 10 years.''
A CLOSER LOOK
It's not all about showing the effects of sun damage below the skin's surface. Clients rest their heads in the orb-shaped machine, and four flashes later, a monitor displays extremely magnified, high-resolution images of fine lines, irritation, redness, bacterial activity, clogged pores and pigmentation. Forever Young has worked with Johnson & Johnson for about a month to test the device, which is especially designed for use at medical spas, or med spas for short -- makeover havens overseen by licensed physicians. It is being tested at four other locations around the country: San Diego, Las Vegas, New York and Raleigh, N.C. Creighton said Johnson & Johnson plans on running the test for about another six weeks and will officially market the machine to med spas in 2007 at a cost of between $16,000 and $20,000. It will be marketed through spa conventions, trade magazines and direct mailings. 'In the past we would just take a mirror and say, `Oh, I see a lot of UV damage on your face,' '' said Katie Cheng, Johnson & Johnson Group product director. ``But here you can take a picture, and it doesn't lie. The pictures show you exactly where it is and can pinpoint areas of concern.''
Once the photos are taken, the client and the med spa aesthetician can use the software to analyze the severity of problem areas on a scale of one to 10 and discuss treatment options. The client gets a printout of their photos with a list of recommended treatments and products. The information is protected using the client's fingerprint scan; the machine can store up to 67,000 client images. The entire process takes about 15 minutes.
READY FOR MARKET
The technology has been in development for the past 10 years, but up until this point it has only been used by Johnson & Johnson in product testing. ''As time went on -- and certainly as the interest in skin in the last five years has exploded -- we looked for ways we could potentially commercialize this,'' said R. Scott Creighton, a vice president at Johnson & Johnson. Creighton said the growing interest in skin care is attributed to the growing number of people in the baby boomer generation who are not willing to give into aging. Concurrently, there have been advances in skin research ''and for the first time we're able to deliver results,'' he said.
Using the TruVu is free for Sidella's clients during the testing period. It will remain free for clients who purchase another spa service, otherwise it will cost about $95. Sidella added that he has noticed a growing number of clients in the corporate world who are moving into their 40s and 50s and ``have this driving, burning desire to look younger and not be bypassed for promotion.''
Creighton said he and his team chose Forever Young over other Florida med spas because the spa previously used a less advanced machine from a competitor. Also, with the spa's experience with using some of the latest spa technology, they would be helpful with suggestions during the test period. The software compares more than 50,000 images to a client's image to determine how severe a skin condition is according to its ranking system. The machine Forever Young previously used compared a client's image to 3,500 images.
''The big difference is image crispness and the detail that you can see,'' Sidella said. "I haven't been able to achieve that with any other machine.''
Medical spas are a growing trend in South Florida
Market ripe for spas who promise clients they will feel and look younger
December 2005
The Miami Herald reports on the growth of medical spas in South Florida. They are taking non-surgical procedures traditionally performed in the office of a dermatologist or plastic surgeon and moving them into malls and shopping centers with a more customer-friendly approach.
MediSpas are already the fastest-growing segment of the spa industry, with revenues expected to exceed $1 billion by the end of 2006, according to Eric Light, president of the International Medical Spa Association in Union City, N.J. And South Florida is turning into a prime battleground for that growth. Several of the national companies already have locations in Boca Raton and this month others will open in Coral Gables, Cooper City and South Miami. Coming soon are sites in South Beach, Aventura, Fort Lauderdale and Weston.
"Florida is going to be our biggest market behind California," said John Buckingham, chief executive of Solana MedSpas, which has 16 open locations. "The demographics are all there. You have people who are wealthy, sun-burned and aging baby boomers." Right now the development of the MediSpa business is dominated by several national companies, including Solana, Radiance, Sleek and Sona medspas. They typically recruit local entrepreneurs or doctors to open as franchises or licensed operators. "There hasn't been a brand front-runner in the category," said Heather Rose, president and chief operating officer of Sona, with 36 locations. "Ultimately you will see consolidation in the space so that there will be one or two dominant brands. That brand recognition is really essential."
The Medispa concept appeals to consumers because it removes the clinical atmosphere often found in the doctor's office and replaces it with the luxury trappings of a spa. MediSpas also offer the convenience of evening and weekend hours, plus the assurance that appointments run close to on schedule. Since medical insurance doesn't cover these types of cosmetic procedures anyhow, the idea is to make sure customers get better customer service. “We're going to offer Ritz Carlton service," said Brian Sidella, owner of Forever Young Medspa opening this month in Cooper City. "You're a client, not a patient. You have rights to be seen immediately. It's not like a doctor's office where you're waiting for someone behind a glass window to give you the time of day."
Press Release - September 2005
Date: September 8, 2005
Contact: Andrea Pinsonneault, Marketing Director
Phone: (954) 442-5957
For: Immediate Release
Fountain of Youth Springs to Cooper City (Cooper City, Florida) -- Forever Young Medspa today announced the Grand Opening of its state-of-the-art medical spa providing the safest, most effective non-surgical aesthetic procedures on the market today. “After 16 months of preparation and the careful selection of our highly qualified medical staff, I am pleased to announce that we are now open for business” said Brian K. Sidella, President and CEO of Forever Young MedSpa. “On September 29th, we will be hosting a celebratory reception with tours of our facility to introduce patrons to the innovative services being offered to reverse the signs of aging and improve the condition and appearance of their skin,” he added. All Forever Young cosmetic procedures and treatments are performed by certified medical practitioners under the supervision of Blane T. Shatkin, M.D. (http://www.bshatkin.com) , a talented and experienced Board Certified Plastic Surgeon with offices located at 1604 Town Center Blvd. in Weston. Dr. Shatkin will serve as Medical Director for the spa in addition to maintaining his current practice which specializes in body sculpting and contouring, natural breast enhancement, and facial rejuvenation. Dr. Shatkin will be an outstanding resource for Forever Young patrons who wish to take their aesthetic enhancement procedures to the next level.
Performing many of the aesthetic procedures is Christopher Powell, MPAS, PA-C a Board Certified Physician Assistant who brings 15 years of medical experience and a passion for cosmetic dermatology to the team. Christopher has treated countless patients in all areas of general Dermatology. His professional, yet caring manner puts patients at ease while his clinical expertise and technical skills bring added value to all Forever Young patrons. Forever Young MedSpa is located in the Stirling Town Center at 8723 Stirling Road, Suite C-7, in Cooper City, Florida. Services include the most popular “lunchtime” cosmetic procedures like Botox®, Restylane, Hylaform, MicroDermabrasion, chemical peels; live stem cell rejuvenating facials, plus some of the newest FDA approved technologies to be introduced to the MedSpa industry. These include, VelaSmooth™ by Syneron, the only proven, non-invasive treatment for the reduction of unsightly cellulite. In FDA trials, patients enjoyed a visible reduction in cellulite with an average loss of 2-3 inches from hips, abdomen, love handles and thighs. Forever Young MedSpa will also to carry the most powerful light-based aesthetic system on the market today, the Palomar StarLux™ Pulsed Light and Laser System. While it possesses the newest innovations in power, safety, comfort and efficacy, what really distinguishes the StarLux™ from all other IPL laser systems is its versatility. Available with a variety of treatment specific hand-pieces, the Starlux can be used for a full spectrum of aesthetic treatments including: Permanent Hair Reduction, Acne, Pigmented Lesions and Rejuvelux™ Photofacial Skin Rejuvenation. What’s more, within the year Palomar will be introducing an InfraRed hand piece that will facilitate skin tightening treatments and a new Fraxel hand-piece for facial rejuvenation.
|
