How Spa Dermatology Has Evolved for the Better & Worse

Dr. Keller:
Welcome to DermConsult on ReachMD. I’m Dr. Mattew Keller and joining me today to discuss spa dermatology is Dr. Joel Schlessinger, the President of Lovely Skin, a dermatologist owned and operated beauty website, and a board-certified Dermatologist and Cosmetic Surgeon. Dr. Schlessinger, thanks for being here today.

Dr. Schlessinger:
It’s great to be here with you. Thank you.

Dr. Keller:
So Dr. Schlessinger, for our listeners who are unfamiliar with spa practices, can you share some of the benefits of spa dermatology?

Dr. Schlessinger:
Now keep in mind spa dermatology is something that has morphed over the last twenty to thirty years from a very early form where there was maybe an esthetician who worked in the practice and may have come in as a temporary contract employee to where many dermatologists, including myself, have separate arms of their practices where there are spas and multiple estheticians. And basically it’s a completely separate business that has its own focus.

Dr Keller:
Have you heard any ethical concerns about patients turning to spa dermatology to solve skin concerns? If so, what are your thoughts on this?

Dr. Schlessinger:
So ethically speaking, I think that there are a lot of areas where the line is now being challenged and potentially crossed. So from the standpoint of a medical practice and dermatology practice, I think that we started out back in the ancient days, like my first foray into having an esthetician or a spa within the practice was I believe 1995, 1996, and there really weren’t many estheticians that were working alongside dermatologists. There is an organization or several organizations where the spa individuals had sub-units that were med spas or medical spa-oriented areas. But what’s happened in the past twenty to thirty years has been an explosion in spas and many of them are run by, people who are not dermatologic in nature and yet they still proclaim to be dermatologists or dermatology-oriented spas. So we’ve gone from a situation honestly where there has been oversight in the true med spa arena to where a med spa can mean anything, ranging from an owner  who happens to be hanging around to a national owner, to somewhere that there is no ‘med’ in the med spa, ie: there is no MD that is even remotely related to the med spa and it’s just a bunch of people who claim that they’re medical in orientation.

Dr. Keller:
Do you find that there is a lot of crossover with spa dermatology and general dermatology or do you feel that the practices have grown apart?

Dr. Schlessinger:
I think that there’s so many ways that care is delivered that it’s almost impossible to say what you’re getting and what the spa is delivering without thoroughly vetting what is the ownership of the spa, who are the estheticians or healthcare professionals that are in it.

So, for example, you can have a spa that is alongside a dermatologist and speaking as a board-certified dermatologist, I feel like that’s honestly the best way to do it because I think that there’s some collaboration. So I work hand-in-hand with the estheticians who are in my employ to run the spa and I make sure that if there is a complication, which we all know that there can be complications of any well-done procedure and if there is a complication, I want to be there for it.

Now in the general spas that you see, many of the estheticians or whatever they claim to be as healthcare professionals are administering some fairly complex treatments. And these may range from Botox all the way to complicated lasers that are potentially rife with side effects.

In our spa, I do all the treatments that are potentially related to complications. So I do all the Botox, fillers laser procedures, it’s rare that we get to a procedure that has an undue risk that I don’t have a hand in it, so that we can follow it carefully if there are any complications.

Dr. Keller:
For those just tuning in, you’re listening to DermConsult on ReachMD. I’m Dr. Matthew Keller, and today I’m speaking with Dr. Joel Schlessinger as he shares his insight on spa dermatology. Dr. Schlessinger, a few months ago our host, Dr. Greenberg spoke with practicing dermatologist, Dr. Evan Rieder, on his experience with patients interested in cosmetic surgery during the COVID-19 pandemic. He actually saw an increase in interest throughout the pandemic. Did you experience something similar in your practice?

Dr. Schlessinger:
Absolutely. I think that there was a dramatic increase in people who wanted to access dermatology and dermatology-related procedures because frankly it was a great time for downtime. And so we saw people who had treatments like liposuction, kybella, which is a fat melter for under the chin, people who had fillers for the first time because they had been afraid of bruising and wanted to have a mask if they did bruise. We have definitely seen an uptick in people who wanted to do these procedures.

Now keep in mind there were a lot of people who during the pandemic did not get their procedures done for three, four, five months while their state or localities were on lockdown and then there was a mad rush to get these procedures done because there’s nothing worse than your Botox disappearing and your wrinkles reappearing and just seeing the signs of aging while you’re on a Zoom call, especially. I mean, there’s nothing more humbling than seeing yourself for 60 minutes in a row and, oh my gosh, that wrinkle does not play well.

Dr. Keller:
What do you find drives patients to explore spa dermatology options? And, would you say you see more of? Female or male patients?

Dr. Schlessinger:
There’s always been this, I’ll call it a myth, that male patients want to access spa treatments. I think that there are a select group of treatments that male patients access and that’s it. In general, our spa is frequented by about 90 percent females, maybe higher than 90 percent females. Now we obviously see many men for cosmetic procedures. But, in general, the men are incredibly time sensitive in their devotion to getting in and out and they don’t always have as much love of procedures that have downtime because they won’t be wearing makeup, in general. And so it’s a little bit different emphasis.

So having said that, we do see men who come in for facials, certainly for Botox, fillers, liposuction, other things. Now most of those are not spa, necessarily treatments. There are a lot of guys who come in for treatments of their skin, however, and generally speaking, there’s an emphasis on get in, get out. But then again, this is all changing and we’re seeing a more healthy interest on the part of men to take care of themselves, take care of their skin and that’s great.

Dr Keller:
Before we come to a close, Dr. Schlessinger, I want to open up the floor to you. Are there any takeaways you’d like to leave with our dermatologists?

Dr. Schlessinger:
There are a lot of dermatologists who have resisted the concept of putting a spa into their practice because they didn’t feel comfortable with sharing their patients with an esthetician or sharing their procedures with another professional. And honestly, I think  that’s the biggest mistake they’re making because what that leads to is a vacuum and that vacuum has clearly been taken over by spas that are either a corporate-run entity that is absolutely, purely profit-driven and has very little emphasis on quality control or the I call it the “mom and pop” spa that is owned by a person who is in absentia and maybe their significant other, maybe there’s a physician somewhere involved there, but in general it’s a low-level physician who has very little interest or experience in the spa industry who is running a spa with the major emphasis on profit or just running it because they have nothing else better to do and they’ve decided that this is their ticket to riches. It’s extraordinarily disturbing to see this because as a dermatologist, we see their complications and some of them are very significant. Some of them are gravely concerning. We’ve been involved in situations where laser hair removal done in the wrong situation has led to permanent scarring on individuals. We routinely see people who are, mistreated in fat removal procedures, whether it’s by fat removal devices that are completely and absolutely not indicated for what they came in for. So, for example, a person who might have a BMI of 30-plus who’s being told that this minor fat removal procedure like a non-invasive fat removal procedure is appropriate for them. And that couldn’t be further from the truth.

So what we see is unfortunately the dark side of this. And I feel that dermatologists and other cosmetic physicians, esthetic physicians who integrate these spas into their own practice have more skin in the game. They have  hopefully more ethics than the people that we see out there a corporation who sets their people out there every month and says, “You’re gonna have to make your numbers by getting this many people in for this or that procedure,” rather than organically saying, you know, “If a person comes in and they need this then we treat them and do what is ethically appropriate and responsible.”

So we have a very difficult and evolving situation where the med spa industry has become so monetized by venture capital money and by other people in it that a person that walks in the door is looked at as a dollar sign rather than a patient. And that’s not what we want by any stretch of the imagination. We want to have the situation coming back to a medical, ethically derived practice that is providing care based on what is needed, not what the monetary needs for that day or that month are.

Dr. Keller:
Well that’s a great way to end our discussion on spa dermatology. I want to thank Dr. Joel Schlessinger for being on the program. Dr. Schlessinger, it was great speaking with you today.

Dr. Schlessinger:
I appreciate it.

Dr. Keller:
For ReachMD, I’m Dr. Matthew Keller. To access this episode and others from DermConsult, visit ReachMD.com/DermConsult, where you can Be Part of the Knowledge. Thanks for listening.