Head and neck surgeon Michael Rassael was frustrated at how much it was costing him to get new patients for his practice, where he performs primarily cosmetic procedures. Advertising alongside other plastic surgeons in magazines and newspapers was ineffective and costly, he said, so he went another route: He opened a day spa.

Now, at Rassael's Chevy Chase location, clients can come in for something as simple as a facial or a massage while relaxing in a soothing, non-clinical atmosphere with overstuffed sofas and a plasma TV set.

If they decide that maybe it's time to have a facelift, so much the better.

"The spa draws people in -- they come in to buy the lotion for their face, the next thing they know is they want to see the doctor," Rassael said, noting that the spa has increased his business and reduced advertising costs.

Rassael is on the forefront of a new movement combining beauty and cosmetic-surgery services into one business, the medspa, offering waxing and highlights, face lifts and liposuction. The dramatic growth in less-invasive cosmetic-surgery procedures, such as furrow-erasing injections, laser hair removal and chemical peels, have turned once hush-hush treatments into an everyday extension of modern skin care. That's giving both salons and doctors a chance to cash in on each other's side of the beauty business.

Around Washington and across the country, a growing number of cosmetic surgeons, dermatologists, dentists and even general practitioners are opening spas with classic pampering services to reach a wider patient base and boost the income they have lost to managed care. Traditional beauty-oriented spas, meanwhile, are expanding to include medical procedures.

The International Medical Spa Association estimates that there are about 1,500 medical spas, about triple the number two years ago. "It's growing tremendously from both sides, from the doctor side and the layman's side," said Hannelore Leavy, executive director of the Union City, N.J., association.

Feedback Research Services of Jacksonville, Ore., which has studied the medical spa market for several years, estimates that 500 to 600 medical spas are owned and operated by doctors.

Rassael is one of several doctors working on contract with longtime Washington hair stylist Patrick Suissa at his new Suissa Medispa in Gaithersburg, where clients can stop by Starbucks next door, then come in for a manicure and a mini-face lift, a wrinkle-reducing procedure that can be performed by a doctor using a local anesthetic. Suissa said he has long known that many women having their hair or nails done in a trusted salon would welcome some advice and guidance about what else they could do to improve their looks.

"Once they're here, they're less inhibited and more comfortable about speaking with a physician," he said. If a client meets with one of the salon's doctors and decides on a more invasive surgery, the procedure would be done in the doctor's office, but the bill would still come from the spa, giving a cut of the profit to both it and the doctor.

"If I like the way they do my hair, I'm more likely to trust them if I did something like a microdermabrasion," said Linda LeClair, 48, an investigator for the Navy, while having her hair highlighted at Suissa Medispa. "If I'm trusting my face to someone, I'm not going to just anybody."

Getting a pedicure in the salon was Robyn Bennett, 28, an independent television producer, who said if she ever decided to have a medical cosmetic procedure, "this is the only place I'd come." She has already referred a friend there for Botox. "It's a lot more comfortable than some sterile doctor's office," she said. "Plus everybody knows me, so they're not going to screw up on me."

The merging of beauty and medicine is attracting big money and big names. Investment group Kidd & Co. of Greenwich, Conn., bought the famed New York beauty empire Georgette Klinger and is turning it into a chain of cosmetic medical centers. It already runs a similar facility in West Palm Beach, Fla., called the Advanced Aesthetics Institute, which is a full-service spa with a full-fledged cosmetic-surgery center.

"Once that barrier has broken, you've opened an entirely new world of thinking -- that this is not two industries, this is one. That's the Big Idea," said Richard Rakowski, a principal with Kidd & Co. and chairman and chief executive of Advanced Aesthetics Institute.

One of the first Klinger Advanced Aesthetics facilities will open next year in Chevy Chase, offering a menu of services including manicures and liposuction. The group's medical consultant for the project is Johns Hopkins Medicine, which is providing training for medical personnel, methodologies for care and advice about layout and patient flow.

"It puts under one roof all of those [services] and then has someone walk a person through, in a very personal way, all the options. For some it may be surgery, for others it may be a topical moisturizer," said Steve Libowitz, senior director of the Centers for Innovative Approaches in Healthcare at Johns Hopkins Medicine. "You walk into a place and you want to look better, and if all you have to choose from is lipstick, your options are limited."

The term "medical spa," of course, has its roots in a much different kind of business than a souped-up hair salon or softly lit cosmetic-surgery center. Spas in Europe have always based their treatments on the medical advice and guidance of doctors on staff, said Leavy of the International Medical Spa Association. Some famed spas, such as Canyon Ranch, have been operating in this country for years with medical personnel to deal with a client's inner and outer health.

And some doctors opening medspas are reaching for this holistic medicine approach, such as Grace Keenan, a primary care physician in Northern Virginia whose Nova Medical Group opened one early this year. Among its services are facials, massage, eyelash tinting, laser hair removal and Botox -- but also exercise classes and alternative therapy treatments, such as acupuncture, and an apothecary for herbal and natural remedies. The spa does not do cosmetic surgery.

"I didn't really ever have any desire to run a spa or have massage therapists or aestheticians work for me, but it's really fun because they all contribute in their way to a patient looking or feeling better and thus helping them as individuals," Keenan said.

According to the American Society for Aesthetic Plastic Surgery, the number of traditional cosmetic-surgery procedures performed has more than doubled since 1997, to just over 2 million. But nonsurgical cosmetic procedures, such as Botox and chemical peels, have increased eight-fold since 1997, to nearly 1 billion. These are not cheap services, either. Botox typically costs $600 to $800, and laser hair removal costs more than $1,000 for the multiple treatments required. A simple chemical peel might be $200 for a one-hour service.

There is enough money to be made in medical spas that it has become a popular franchising business. "There are about four or five franchise companies out there who go to the doctor and say, 'For x-y-z dollars, we'll open it up for you. You have to be there, but you don't have to worry about hiring the staff, the equipment, anything,' " said Leavy of the Medical Spa Association, which is two years old.

One of these groups, Radiance Medspa Franchise Group, bills itself as a "turn-key opportunity for physicians," with benefits such as "all cash medicine." Its Web site lists six states in which it has opened medspas and 20 with medspas in development, including five locations in Virginia.

"The market wants it, their patients want it," said Monica T. Brown, a medspa industry consultant. "Why turn away the revenue of personalized care?"

At Suissa Medispa in Gaithersburg, client Robyn Bennett talks with skin-care specialist Yulia Tsaguriya, left, and manicurist Melanie Gardner, right.

Fabienne Guichon-Lindholm of Decleor of Paris, left, works on a skin-care line with Suissa Medispa specialist Yulia Tsaguriya.

Patrick Suissa observes Thierry Axaopoulos highlighting Linda LeClair's hair.