John Oliverlooked into the booming industry of med spas in the US on the latest Last Week Tonight. “You’re probably at least familiar with them,” he explained of the facilities, either because you’ve seen one pop up in your neighborhood, or you’ve been pushed by one of thousands of influencer videos about them.”
“Med spa” is a catch-all term for a facility that provides aesthetic procedures, both medical (lasers, Botox and IV drips) and non-medical (facials). In the age of Instagram, it’s a lucrative business, with an estimated 10,000 or more med spas nationwide, generating $17bn annually.
But “while many med spas are safe and staffed by actual professionals”, said Oliver, “the rapid rise of med spas has also been accompanied a rapid rise” in stories of malpractice or procedures gone awry.
That’s because “this whole industry can fall into a regulatory gray area,” as many of their procedures fall between esthetic services and traditional medical practice. “Other services definitely fall under the practice of medicine, but no one – from practitioners, to customers, to law enforcement – acts like it,” said Oliver. There are currently no federal standards for med spas, and no legal definition for what one even is. “And that has left the market wide open for bad actors,” Oliver explained, calling med spas the “wild west” of medicine.
“If an industry can grow this fast and be run this loosely, people are going to get hurt,” he added.
Oliver dissected the “perfect storm” of factors for this wild west, starting with many med spas’ franchising model, with all-cash businesses that can be opened anywhere. “It’s not exactly reassuring to hear a medical facility being pitched the same way you’d pitch a Subway sandwich shop,” he joked. “I know both technically involve getting suspicious-looking goo inside you, but through vastly different delivery systems.”
The regulatory frameworks also vary wildly by state. In New Jersey, only a doctor can perform laser hair removal, while anyone can in New York. In Texas, anyone can get certified to become an injector, and practice anywhere in the state. The laws are so behind the reality of med spas in Oklahoma that the state advises nurses to use their own professional judgment to determine what procedures they can provide based on the relevant laws. “Which feels like they’re one step away from just telling nurses to ask a Magic 8 Ball, ‘am I allowed to give this woman chin filler?’” Oliver quipped.
“What this means is from the services they sell to the people they employ to the stuff they inject into you, med spas can be far less vigorously vetted than you may assume,” he noted.
Some med spa procedures, such as facials, have scientific backing, while others – such as “ionic foot detox bath” or “ultraviolet blood irradiation” – do not. Some med spas also provide procedures like “sculptsure” via devices that are FDA “cleared”. As Oliver already covered in anepisode on medical devices, FDA cleared “doesn’t really mean shit”. FDA approval means the device is both safe and backed by “valid scientific evidence”, while cleared simply means that it can be legally marketed. “Which is barely one step above an FDA stamp declaring ‘this exists!’” Oliver joked.
“Ideally, you’d have a doctor talk you through the risks and benefits of any sort of procedure on offer,” he continued, “but that’s not possible at many med spas.” While they are required to be supervised by a medical professional with “full practice authority”, that supervision can be done remotely, sometimes from professionals located hours away.
Most of the staff in med spas are nurse practitioners, physician assistants and registered nurses. “Nothing against people who hold those jobs – they can be extremely skilled,” Oliver noted. “But their training on the procedures done in med spas can be thin at best,” as there are very few dermatology programs for non-doctors.
Oliver cited one service that claimed to allow someone to inject Botox after just a day of training, “which really does not feel like enough training to shoot a paralyzing neurotoxin into someone’s face”. Especially one that could have deadly side-effects, as was the case with one central Texas woman who had a seizure after being injected with Botox by someone with non-medical certification; the med spa’s protocol for emergencies was to call their supervising physician, a pediatrician located a three-hour drive away.
“A lot of the protections you associate with medical offices just don’t apply to med spas,” Oliver summarized. “Oversight can be incredibly lax,” as most states don’t even require that med spas register their existence.
In sum, Oliver said, med spas can cut corners both on their staffing and the contents of their injectables, and the market is rife with counterfeits. He referenced the story of one influencer who went to a med spa for B12 shots, got upsold “fat dissolving” injectables, and ended up in the hospital for four months with a necrotizing, antibiotic-resistant skin infection. Her lawsuit against the practitioner, who injected her with a substance bought off Alibaba, hit a dead end, as he was unlicensed and had no malpractice insurance nor assets. “The lack of accountability is honestly not that surprising,” said Oliver. “If you’re injured at an unlicensed med spa, there’s often little to no recourse unless law enforcement takes an interest in your case.”
And while it’s easy to judge those that seek out the procedures, Oliver noted: “it’s both reasonable to want these services and to expect the people providing them to be licensed and adequately supervised. But far too often, they just aren’t.”
What can be done? “Bare minimum, state laws and regulation should be clearly written, well publicized and enforced,” Oliver said. But “laws can only do so much when they’re ignored, and when demand is this high, and there is such a clear profit motive, there is always going to be the possibility that sketchy providers will break the rules.” He encouraged people to look up the names and credentials of any provider, get a full consultation and see the vials of any injectables before receiving them.
“And if they respond by acting defensively or won’t show them to you, get the fuck out of there,” he concluded, because “in too many places, it is far too easy to set up something that has all the appearances of medicine, but none of the protections.”