Washingtonians Tuck Into Medical Spas

"In this society, it's important to look good," Kelly Vergot said as she sat in the busy waiting room of the Dental Spa one recent Friday morning. As she spoke, New Age music played softly over the din of dental assistants answering calls and helping walk-ins at a reception counter nearby.

But Vergot was not there to get her teeth cleaned nor whitened. Instead, the 42-year-old was waiting for an 11 a.m. appointment to smooth away some of the wrinkles on her forehead with a shot of Botox.

The Dental Spa in Lake Ridge is no ordinary dental office. The walls are not painted a clinical white, but rather a soft, earthy hue. And as Vergot sat in the waiting room that Friday morning, a large, flat-screen television streamed promotional videos of women with shiny faces and broad smiles. The videos extolled Botox's benefits.

The Prince William County spa is one of a growing number of medical spas, in retail centers or shopping malls, that offer cosmetic treatments such as injections of Botox or Restylane, chemical peels and laser treatments. The number of medical spas has grown to about 2,500, up from only about 35 in 2002, when Botox was approved by the Food and Drug Administration, according to the International Medical Spa Association in New Jersey.

Doctors, nurses and entrepreneurs have rushed into the industry in recent years because patients overwhelmingly pay for the pricey treatments out of pocket, eliminating third-party insurance companies.

Cosmetic procedures such as Botox injections have gained in popularity as shows such as "Nip/Tuck" and "Extreme Makeover" have helped make the drug part of the national lexicon. But the growth of these spas has also concerned some in the medical community because the industry remains largely unregulated.

"Each state has its own different set of regulations as to who can inject what," said Foad Nahai, president of the American Society for Aesthetic Plastic Surgery. "It is up to the patient to be their own advocate."

There are no laws specifically governing the conduct of medical spas in Virginia, Maryland or the District. Instead, each jurisdiction regulates particular procedures such as Botox injections, though there is no uniformity in the rules.

In Virginia, for example, only licensed medical professionals such as nurses and doctors can give injections of Botox and Restylane. In the District, anyone can give an injection, as long as the procedure is supervised by a doctor -- but the level of supervision is not clearly defined. Maryland issued a declaratory ruling in 2002, deeming that a diagnosis by a physician must be performed before any laser or similar treatment. Regulators say the ruling also applies to Botox injections.

Medical spas vary in type and size. Some are part of national chains; others are extensions of doctors' offices.

Eliot F. Battle, Jr., a cosmetic dermatologist and laser surgeon, founded his Cultura Cosmetic Dermatology and Laser Center in the District in 2002 after completing a three-year laser fellowship at Harvard Medical School.

Battle describes his practice, in the Chevy Chase Pavilion across from a Neiman Marcus and a Saks Fifth Avenue in Northwest Washington, as an "integrated" approach to skin care merging dermatology, laser surgery, plastic surgery and spa therapy.