In September 2009, a 37-year-old Florida woman suffered seizures and died while undergoing a minimally invasive liposuction procedure to remove fat from her abdomen and thighs. She was given lidocaine and propofol, a sedation-inducing drug believed to have contributed to the 2009 death of singer Michael Jackson. The alarming incident has caused lawmakers to question whether tighter regulations are necessary on who should be allowed to perform certain procedures. While the procedures medical spas offer are generally safe, the market has exploded in recent years and additional regulations may be needed. Here, Brian Hurley, who runs Illumination MedSpa in Irmo, South Carolina, explains his position on medical spa regulation.
The regulation of medical spas varies widely from state to state. Many medical spas are owned by business entrepreneurs who hire a medical director. Whether the medical director has to be physically present for most procedures to be performed varies depending on the state. However, the trend is toward physicians being required to be on-site for many cosmetic procedures, especially ones that use lasers, such as Lipotherme. In some states, certain procedures can be performed by a non-physician, including injectables such as Botox and dermal fillers (Juvederm, Restylane), as well as laser and radio frequency procedures.
In South Carolina, a physician has to be onsite for a laser procedure to be performed, as well as for procedures that involve injectables such as Botox and dermal fillers (Juvederm, Restylane). This is not the case in North Carolina as of now. There, a physician just has to make himself available within a reasonable span of time should a problem occur.
I am in favor of tighter regulation of the ownership of medical spas. However, I do not think that medical spas should only be operated by plastic surgeons or dermatologists. Although it is not ideal from a business perspective for a physician to always be onsite, I believe that a physician should be either onsite, or at the very least be available within minutes should a problem arise.
In the aforementioned Florida case, in which the woman died during liposuction, the physicians were using general anesthesia, although it was a minimally invasive procedure. Procedures such as Vaser and Lipotherme are usually done with wide awake, tumescent anesthesia. However, there are physicians — usually plastic surgeons — who use general anesthesia for such procedures. The potential problem with that is that the patient cannot give the physician feedback when he is under general anesthesia. When local anesthesia is used, the patient can tell the physician when he is in pain, and the physician can redirect the cannula.
The information in the article is not intended to substitute for the medical expertise and advice of your healthcare provider. We encourage you to discuss any decisions about treatment or care with an appropriate healthcare provider.
