By Alejandro Lazo
Washington Post Staff Writer
Monday, March 31, 2008
"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.
Battle keeps on staff a full-time plastic surgeon, two dermatologists, five nurses, three skin-care specialists known as estheticians and a physician's assistant. He believes that cosmetic procedures should be performed under the careful supervision of a medical doctor.
"There is a difference between the Hippocratic oath of a doctor which is 'do no harm' and that of a business, which is 'make money,' " Battle said.
Paul Amoruso, chief executive of the Reveal MedSpa, is not a doctor, and his company, based in Tysons Corner, operates seven spas throughout the Washington area under the Reveal banner. He keeps a supervisory doctor on his staff full-time and said he employs a second doctor as an adviser. While neither can be on site at all times, Amoruso said he has developed procedures to insure safety.
"I would challenge you to find a physician's office that has the same approach to quality as us," Amoruso said. "I think there is absolutely a way to do this very safely in a medspa environment."
The Dental Spa, next to an H&R Block in the Dillingham Square shopping center west of Woodbridge, is the creation of Marvette Thomas, a dentist and native of Montgomery, Ala.
Thomas offers family and cosmetic dentistry through her practice, as well as aromatherapy, a relaxation lounge, massaging chairs and warm hand towels scented with rosemary water.
Last year, the Dental Spa began offering Botox and Restylane injections as well as wrinkle erasers known as dermal fillers after patients began asking about the treatments. A nurse, Diane O'Neill, performs the procedures on Friday afternoons. The spa has two medical directors that serve in advisory roles.
Coming to the Dental Spa was a matter of convenience and comfort for Vergot, a nurse at Inova Fairfax Hospital, who works there with O'Neill.
Vergot had begun to notice wrinkles, and she was determined not to sit idly by.
"I don't want to look old," Vergot said.
A few minutes after 11 a.m. that Friday, O'Neill led Vergot into one of the Dental Spa's treatment rooms, where Vergot reclined on a bed.
After a discussion about allergies, O'Neill made six dots with an eyebrow pencil in the shape of a "V" on Vergot's forehead.
"What does it feel like when it starts to have its effects?" Vergot asked.
"You can't do the same amount of muscle actions that you were able to do before," O'Neill answered.
O'Neill put a gloved hand over Vergot's forehead, steadying the long needle, and then began administering the treatment.
"You are a brave girl, Kelly," O'Neill said as she injected her.
"Can I get a sticker when I am done?" Vergot said jokingly.
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