Datafrom the American Society of Plastic Surgeons indicates that minimally invasive
cosmetic procedures are on the rise. From 2000 to 2015, botulinum for cosmetic
use increased 759%, soft tissue facial filler increased 274%, laser hair
removal increased 52%, and chemical peels increased 14%. While touted to be
minimally invasive, devastating complications have been reported from these
procedures, including skin necrosis, loss of vision, and disfigurement from
scarring, infection, stroke, and even death. A literature review by Beleznay,
et al revealed 98 world-wide reported cases of blindness after filler injection
and found that the highest risk anatomical locations were the glabella and
nasal region. In another study, Park, et al reported 44 cases of permanent
vision loss occurring from obstruction at varying branches of the ophthalmic
artery and found that this complication was more frequent in patients receiving
autologous fat injections followed by hyaluronic acid.
In2004, a North Carolina college student died of neurotoxicity after improper use
of a 10% lidocaine 10% bupivacaine topical anesthetic for laser hair removal.
Safe and effective performance of these procedures is contingent upon proper
training, knowledge of the relevant anatomy and tissue physiology, appropriate
patient selection, and the ability to promptly identify and manage impending
complications.
Medicalspas combine the concept of a day spa with a medical clinic to offer a myriad
of medical and surgical aesthetic procedures. As the popularity of minimally
invasive cosmetic procedures has increased, so has the abundance of medical
spas in the United States, which grew in number from 471 in 2003 to 1,750 in
2011. While by definition a medical spa requires a physician medical director,
specific laws and regulations vary by state with many states lacking clear
rules on patient safety issues including the delegation and supervision of
procedures, adverse event reporting, and transparent marketing. A 2011 study by
Choudhry, et al contacted 50 United States state medical boards and found that
of the 31 state boards that responded, 63% allowed the medical director to
delegate procedures to non-physician providers, only 42% required physician
on-site supervision, and 13% expressly allowed off-site supervision. Even
within states with stronger regulations, medical spa transparency and adherence
to these laws remains unclear.
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