Med Spa Industry Largely Unregulated As Use Increases

Jennifer Middleton, MD, MPH
Posted on January 15, 2024

Millions of people in the United States visit a medical spa, or “med spa,” every year. They seek a relaxing experience similar to that found in day spas (e.g., with massages, facials) but also want more powerful treatments for “acne, aging skin, hair removal, and more.” Medical aesthetics is a $15 billion per year industry in the United States, and the average med spa makes more than $121,000 a month. Few insurance companies cover the cost of treatments at a med spa, so most clients are paying for these services out of pocket. No federal statues or agency oversee med spas, leaving regulations and oversight to state medical boards already often stretched thin regarding both personnel and budgets. A growing number of people have shared stories of adverse effects, some quite serious, after a med spa visit.

The U.S. Food and Drug Administration (FDA) released a warning about so-called “fat-dissolving” treatments at med spas last month after cases of cutaneous infections, some of which resulted in sepsis, after these injections. Physicians often provide their oversight from afar and may not be on the premises for many of the procedures; estheticians instead do the bulk of the injections and treatments. Only one medication is currently approved by the FDA to decrease cutaneous fat. Kybella is approved only for decreasing fat under the chin and is supposed to be administered only by a health care professional. The desire to "melt fat" seems to be at a fever pitch in the United States right now, and several questionable products capitalizing on this desire are common offerings at med spas.

Treatments promising “fat dissolving” aren’t the only ones with risks. Chemical peels offered at many med spas can cause burns if not appropriately applied. Intravenous treatments touted to cure hangovers or boost energy can cause dangerous electrolyte imbalances. We can encourage patients who are interested in med spas to research the physician oversight at facilities, choose facilities that specialize in the treatments they are interested in, and ask for the credentials of the individual doing their treatment. The American Society for Dermatologic Surgery Association is also spearheading a coalition to increase regulatory oversight of med spas.

Finally, we can remind our patients that desires to change our body’s appearance are largely the result of internalized messaging, which is rooted in patriarchal and racist principles. Gently reminding our patients that it is normal for body composition and appearance to change with aging and that their intrinsic value is far beyond their physical appearance can provide a desperately needed antidote to incessant societal messages advertising the opposite.

The AFP By Topic on Skin Conditions includes content on treating acne, and AFP offers an editorial about “Cosmetic Procedures in Family Medicine” if you’d like to read more.