Hidden Dangers of the Med Spa Industry with Dr. Kate Dee

Summary

Fat Mascara Episode Summary: "Hidden Dangers of the Med Spa Industry with Dr. Kate Dee"

Release Date: February 7, 2025

In this enlightening episode of Fat Mascara, hosts Jennifer Sullivan and Jessica Matlin delve deep into the murky waters of the med spa industry with their expert guest, Dr. Kate Dee. Dr. Dee, a board-certified diagnostic radiologist and aesthetic medicine specialist, brings a wealth of knowledge and firsthand experience to shed light on the hidden dangers lurking within the med spa landscape.

---

1. Introduction to Dr. Kate Dee

Jennifer Sullivan kicks off the episode by introducing Dr. Kate Dee, highlighting her extensive background in diagnostic radiology and her transition into aesthetic medicine. Dr. Dee is the founder of Glo Medispa in Seattle, host of the podcast Med Spa Mayhem, and author of the book "Med Spa Mayhem: The Good, the Bad, and the Ugly Secrets of the Aesthetic Industry."

---

2. The State of the Med Spa Industry

Dr. Dee begins by outlining the alarming lack of regulation in the med spa industry. She cites recent incidents, such as the charges against the owner of JGL Aesthetics in New York City for fraud and the use of counterfeit Botox, as well as cases of illegal injections leading to severe complications.

Dr. Dee [04:30]: "There are so many med spas operating illegally, and nobody's policing that at all."

---

3. Regulatory Hurdles and Legal Loopholes

Contrary to popular belief, Dr. Dee reveals that establishing a med spa doesn't involve stringent regulatory hurdles. Unlike traditional salons that require licenses and inspections, med spas often bypass these regulations, leading to unqualified individuals performing medical procedures.

Dr. Dee [10:17]: "There aren't any extra licensing or inspections in the med spa space. It's a big loophole that's being exploited."

She further explains the complexities of state laws regarding who can practice medicine, emphasizing that while nurse practitioners can practice independently in some states, registered nurses cannot, yet many med spas ignore these distinctions.

---

4. Risks of Unregulated Med Spas

Dr. Dee highlights the significant risks posed by unregulated med spas, including the use of counterfeit products and improperly maintained equipment. She shares harrowing stories of patients suffering from infections, botulism, and other severe health issues due to these unethical practices.

Dr. Dee [14:23]: "People are making money off illegal procedures with minimal consequences, and it's putting consumers at immense risk."

---

5. Identifying Reputable Med Spas

To empower listeners, Dr. Dee provides actionable tips for identifying legitimate and safe med spas:

• Check for a Visible Medical Director: Reputable med spas prominently feature their medical director's information on their website and are accessible for consultations.

  Dr. Dee [41:51]: "Look for the medical director's name and bio on the website. You should be able to book an appointment with them."

• Verify Credentials: Use national provider indexes to verify the licenses and credentials of all practitioners.

  Dr. Dee [42:56]: "Ensure that every nurse, PA, or NP is licensed in your state and holds the appropriate credentials."

• Beware of Overly Positive Reviews: An absence of negative reviews or an unrealistic abundance of five-star ratings can indicate fake reviews.

  Dr. Dee [50:55]: "If a med spa has only five-star reviews, that's a red flag for potentially fake testimonials."

• Avoid Upfront Payments: Be cautious of med spas that require significant payments before any treatment is performed.

  Dr. Dee [53:02]: "Avoid places charging you upfront. Legitimate practices don't demand full payment before services are rendered."

---

6. Dangerous Treatments to Avoid

Dr. Dee warns against several high-risk procedures commonly offered at med spas:

• IV Therapies: The lack of medical supervision in IV bars can lead to life-threatening complications.

  Dr. Dee [24:09]: "There’s no quicker way to harm someone with an IV than improperly administered treatments."

• Fillers and Botox: Improper injections can result in severe consequences like blindness, skin necrosis, or facial deformities.

  Dr. Dee [36:03]: "Filler gone wrong can have horrible consequences, including losing the tip of your nose."

• Laser Treatments: Misuse of lasers can cause burns, hyperpigmentation, or permanent skin damage.

  Dr. Dee [38:24]: "Lasers can be turned up to a level that can really hurt someone. It’s crucial to have skilled professionals handle them."

---

7. The Need for a National Med Spa Certification

Addressing the core issue of unregulated operations, Dr. Dee discusses her initiative to establish a national nonprofit Med Spa Board. This organization aims to certify med spas that comply with legal and safety standards, much like the Certified Organic label.

Dr. Dee [62:32]: "My goal with the Med Spa Board is to certify med spas that are legally compliant, ensuring they have a legitimate medical director and use authentic products."

She envisions a consumer-facing website where individuals can verify the legitimacy of a med spa, thereby reducing the prevalence of dangerous, unregulated practices.

---

8. Concluding Insights

As the episode wraps up, Dr. Dee emphasizes the importance of consumer awareness and responsibility in choosing safe and reputable med spas. She encourages listeners to conduct thorough research, ask the right questions, and prioritize their health over enticing low prices.

Dr. Dee [65:19]: "It's common knowledge that you should verify a med spa's legitimacy, but many people aren't even aware that it's possible to walk into a place and nobody's legally overseeing the medical procedures."

---

Notable Quotes

• Dr. Dee [04:30]: "There are so many med spas operating illegally, and nobody's policing that at all."
• Dr. Dee [10:17]: "There aren't any extra licensing or inspections in the med spa space. It's a big loophole that's being exploited."
• Dr. Dee [14:23]: "People are making money off illegal procedures with minimal consequences, and it's putting consumers at immense risk."
• Dr. Dee [41:51]: "Look for the medical director's name and bio on the website. You should be able to book an appointment with them."
• Dr. Dee [50:55]: "If a med spa has only five-star reviews, that's a red flag for potentially fake testimonials."
• Dr. Dee [62:32]: "My goal with the Med Spa Board is to certify med spas that are legally compliant, ensuring they have a legitimate medical director and use authentic products."
• Dr. Dee [65:19]: "It's common knowledge that you should verify a med spa's legitimacy, but many people aren't even aware that it's possible to walk into a place and nobody's legally overseeing the medical procedures."

---

Final Thoughts

This episode serves as a crucial guide for anyone considering med spa treatments, highlighting the significant risks associated with unregulated practices. Dr. Kate Dee's expertise underscores the necessity for stricter regulations and informed consumer choices to ensure safe and effective aesthetic treatments.

For more detailed insights, listeners are encouraged to read Dr. Dee's book, "Med Spa Mayhem," and stay informed through her podcast, Med Spa Mayhem.

---

Transcript

[Sleep Number Advertiser]

They say opposites attract. That's why the Sleep Number Smart Bed is the best bed for couples. You can choose what's right for you whenever you like. You like a bed that feels firm but they want soft. Sleep Number does that. You want to sleep cooler while they want to feel warm. Sleep Number does that too. Why choose a Sleep Number Smart Bed So you can choose your ideal comfort on either side and now save 50% off on the new Sleep Number Limited edition Smart bed limited time Exclusively at a Sleep Number store near you. See store or sleepnumber.com for details. Ready to elevate your skincare Introducing Medikaite, a clinically proven dermatologist recommended British skincare brand known for age defying results. You may have heard about growth factors as the must have anti aging ingredient and that's why Medicaite is excited about their latest innovation, the Liquid Peptides Advanced MP Face Serum. This serum harnesses the power of Growth Factor Mini Protein, a cutting edge technology that mimics natural growth factors but goes deeper, delivering visible transformative results. Studies show immediate improvement in expression lines in just 10 minutes and a significant decrease in deep set wrinkles after eight weeks of use. The Liquid Peptides Advanced MP Face Serum not only reduces wrinkles but also gives a filler like effect, smoothing out your skin's appearance dramatically. Visit Medikaite US that's M E D I K and the number 8 US use code podcast20 for 20% off your purchase Today.

[ACAST Advertiser]

ACAST powers the world best podcasts.

[Jen Sullivan]

Here's a show that we recommend this.

[ACAST Advertiser]

Season on the Dream Supplies are being by nurses who run out in the middle of the night and purchase diapers but the hospital is still charging as if they still have these items. We are digging into every topic we've.

[Jen Sullivan]

Ever wanted to cover on this show. It's a spinning plate analogy.

[ACAST Advertiser]

The second that you stop spinning those plates, that crashes.

[Jen Sullivan]

So you can never stop working.

[ACAST Advertiser]

The Dream Season 4 comes at you weekly. Starting Monday, January 20, Acast helps creators launch, grow and monetize their podcasts everywhere. Acast.com.

[Jen Sullivan]

Hi everyone. Welcome to Fat Mascara. It's a podcast about beauty culture. I am Jen Sullivan, your host. I have an amazing guest today. Before we get into who Dr. D is, I want to explain why we're doing this episode. So if you listen to this podcast, you're probably aware that there's often disturbing news items about the med spa industry. For example, two weeks ago here in New York City, the owner of JGL Aesthetics was charged with fraud, smuggling and crimes related to handling of counterfeit drugs because he was purchasing counterfeit Botox, illegally injecting it into his clients, and of course, pretending that it was real. I don't know if you remember this one from our podcast. In November, a woman pretending to be a nurse in Massachusetts injected people with fake Botox there. And just last week in Philadelphia, I heard about a woman who ended up in the er. She's been to the hospital multiple times with multiple infections after a nurse who was illegally running a med spa injected her with an unknown filler. I imagine every time you see one of these headlines, you think to yourself, how does this happen? So our guest today, Dr. D. She's going to help us understand that Dr. Kate D. Runs the Glo Medispa in Seattle, Washington. She's board certified in diagnostic radiology, and she worked as a breast cancer specialist for many years before training in and transitioning to aesthetic medicine. She's also the host of her own podcast, Med Spa Mayhem, and the author of the book the Med Spa Mayhem, the Good, the Bad, and the Ugly Secrets of the Aesthetic Industry. So she's making it her mission to explain to people how med spas often operate outside the law and what you should know before you visit any of them. As you'll hear, she's also trying to work with the American Med Spa association to come up with, like, a national organization that can accredit med spas so people know which ones are operating legally. And if you're thinking that must exist already, you'd be surprised to hear that it does not. And as you'll hear Dr. D explain, some of the injectors and some of the spas may not even realize that their practices are illegal. So she's going to share her tips for finding a reputable esthetic provider, how to look up credentials of whoever is doing any sort of procedure on you, whether it's Botox or laser hair removal or derma rolling. And she's just going to get you armed with some knowledge. So you know that if you're going to a med spa, you need to check into some things before you sign any forms, before you get any treatments done. I hate that that's on the patient, always to do that. It should just be assumed that these places are safe. But as you'll hear, they're not really. So we only have an hour with Dr. D. We kind of glossed the surface of this topic. That's really complicated. But if you're interested in learning more, you should definitely get her book. Again, that's Med Spa Mayhem. The good, the bad and ugly secrets of the aesthetic industry. And I will link to that in the show notes. Okay, let's get into it. Dr. D. Welcome to Fat Mascara. Hi.

[ACAST Advertiser]

Hi. Thanks so much for having me today.

[Jen Sullivan]

So I know you're a medical doctor, but you're not a plastic surgeon, you're not a dermatologist.

[ACAST Advertiser]

No, none of those things.

[Jen Sullivan]

How did you even end up. We're going to be talking about med spas. I've already told everybody what's going on. But how did you even end up owning one?

[ACAST Advertiser]

Yeah, it's kind of a crazy story.

[Jen Sullivan]

Tell me.

[ACAST Advertiser]

So I'm a radiologist by training and I did a breast imaging fellowship and worked in breast cancer for 16 years. And so most of what I did back then was, you know, read mammograms, ultrasounds, MRIs, and did biopsies and other breast procedures all day long. And I diagnosed breast cancer every day. And one day I had two of my long term referring docs who both got their breast imaging with me, came to tell me they were retiring. And long story short, they had all their patients were still gonna come to me, but their aesthetic patients had nowhere to go. And I was like, what? What do you guys do? And they told me all about it and said how much fun it was and how great it was, and they told me it was the best part of their practice. And they were like, kate, you really should think about it because it is right up your alley. It's all doing needle procedures and talking to women all day, but you make them happy. And I had been not necessarily making everybody happy, telling them that they had breast cancer. And so anyway, long story short, they invited me to follow them around at their clinic before they closed it. They were both retiring and so I did that. And it was just incredibly fun. And it was just. It was so similar to what I already did, but just happy and positive and super interesting and a different, similar skill set, but just in a different direction. Right. And I just thought, well, let me look into it. I will take some courses and if it's fun, I'll do more. And if not, at least I got some cme. And the very first day of the first course I took was all in laser physics. And radiologists are physics geeks. We have a whole board, like, we have three sets of boards, and one of them's entirely on physics. So I was just in heaven with this stuff and it just was really fun. And so the more I did, the more I wanted to pursue it. And then, honestly, I tried to do it within my old practice. And I will never forget that board meeting. Cause I presented a whole business plan to my partners and basically they laughed at me. They were all men and they, you know, we don't think you can do this. And I was like. It was right before my birthday, like 10 years ago, and I was like, watch the. I just got angry and I was just like. Within 24 hours of that meeting, I had rented a space in my neighborhood and gotten my own malpractice insurance and hung up a shingle. I mean, basically I was like, oh, yeah, well, let's see how it goes. And it just.

[Jen Sullivan]

Nothing like a competitive streak to fire someone up to take a cha. Make a change.

[ACAST Advertiser]

Yeah, that might be a little bit about me that you really want to know. Yeah. But I just loved it. And there are actually many, many physicians who are not dermatolog or practice plastic surgeons in the space now. There's quite a turf battle. And I wrote about that in my book. That's not my favorite thing. Right. I think, why can't we all just get along? You know? And I think that anyone who dedicates their time and effort to doing something and becoming an expert in it and doing it all day, every day, they're gonna get really good at it.

[Jen Sullivan]

Yeah. But you're bringing an outsider perspective. And that, I think, is why your book makes sense from you. Because a lot of the derms or plastic surgeons that might open up their own clinical practices or med spas, you know, they've been in this world for a while and they don't. They might not see the craziness that you seem to see and that you wrote about.

[ACAST Advertiser]

Well, I actually think they totally do.

[Jen Sullivan]

They're just not telling us.

[ACAST Advertiser]

I think that. Well, I mean, you know, how many people can sit down and write a book in their spare time? I mean, most of us don't have a lot of. But I do think that they're a little too up close. And I think that it's hard for them to see the big picture, that the Plastics and the Derms actually fight each other quite a bit over turf. And then they both tend to fight non core doctors like me, but then they also have a big fight against the mid level providers and lower who are doing this without a doctor, which I. I'm also kind of on the. That really bothers me too, because, you know, in the United States, you cannot practice medicine if you're not licensed to practice medicine.

[Jen Sullivan]

Let's talk about this for people who aren't as immersed in this world as you and I are. When you started your journey to open the med spa, I think one would imagine you had a lot of regulatory hurdles to jump through. But what surprised you about the process?

[ACAST Advertiser]

Yeah, well, actually, there. There aren't any. So you might have. I imagine you've interviewed estheticians and spa owners who do non medical spa stuff. Right. You have to get licensed by the cosmetology board. Your salon probably has to have its own license, and all the people working in it do, and they come and inspect and make sure your wax is clean and your little wooden sticks have covers on them and all that. Well, in the med spa space, there's none of that. There's no extra licensing, there's no inspections. There are a lot of laws, and hospitals and doctors know about the laws and they know they have to comply. But there are so many people opening med spas that don't know about the law, don't have licensure. There are no inspections. There's none of that. And so your average med spa, there's maybe a nurse there who. Nurses can't practice medicine. Nurses can only carry out a doctor's orders. Well, there are a lot of med spas that are just owned and run by nurses now. It's not legal, but nobody's actually policing that at all. Yeah.

[Jen Sullivan]

So is there an entity that oversees the operation and safety of med spas other than like, say, getting business license for, like an insurance for the physical space? Is there?

[ACAST Advertiser]

No, there is not.

[Jen Sullivan]

There's no cosmetology board of med spas, if you will, even at the state level?

[ACAST Advertiser]

No. And all the state laws are different governing medicine. I'm actually trying to create that.

[Jen Sullivan]

And you're in Washington, right?

[ACAST Advertiser]

Yeah, but I'm trying to create a national nonprofit that's gonna certify med spas because currently, right now, all the laws are different in all the states. The one true thing, or. There are many true things. But the biggest thing is, in all 50 states, you can't practice medicine if you're not a doctor. Okay. Now, many states have laws that allow independent practice of nurse practitioners, but nurse practitioners are practicing advanced nursing. So I've learned this from my lawyer friends. This is not something I knew even before. Like, I mean, I even wrote the book before I knew this. So nurse practitioners technically can practice independently, but they're practicing advanced nursing. And in some states, if they say I'm practicing medicine, they can actually get dinged by the state. Depends on who's Paying attention. In many states, a nurse practitioner can technically own a med spa and practice in the med spa independently without a doctor. But in many states they can't. And registered nurses, which, you know, when you say a nurse, that's what that means. They can't practice independently in any state. Okay? They are not allowed to do that. But they know how to inject Botox. They know how to do many of the procedures. And so they get trained to do the procedures, let's say in a dermatology office. And they're, well, I should be able to set up my own business. And they don't necessarily know to consult a lawyer. And the lawyer will say, well, you can't do that. Right? The lawyer will say, well, you need to practice under a doctor, which means you need a medical director. Now, some of them do know this, but many of them don't.

[Jen Sullivan]

But when would that come to, like, bite them in the butt later? Only if something goes wrong, right?

[ACAST Advertiser]

Yeah, but guess what? When something goes wrong, they could lose their nurse's license. Right, but that's it. Nobody comes and arrests them. I mean, actually practicing medicine without a license is a felony. Okay, from my understanding, it's a felony in every state, but nobody's enforcing that. So like the DAs or whatever, the prosecutors, they don't take those cases there. As far as I know. I've never seen a case of a nurse practicing medicine without a license being actually charged with a crime. So if they harm somebody and send somebody to the hospital, that's possible, but I haven't seen that happen. Like, for instance, there were all these cases of botulism last year and people being sent to the hospital because nurses were ordering fake Botox off the Internet.

[Jen Sullivan]

I wanted to ask you about this because it's not just nurses, but.

[ACAST Advertiser]

Yes, well, yeah, and non medical people as well. Okay, so the one I know of in Illinois, There was like 11 different states, but the one I know of in Illinois was a nurse practitioner. Well, I don't know if she kept her license. I think she just claimed ignorance. Right. But as far as I know from that whole thing, there weren't any criminal charges anywhere. So it's not just that people are cutting that corner of ordering fake product. I mean, that's very common, that's happening all over the place. But that there really are no consequences. Like there's nobody being arrested. But there are cases where, okay, fine, the nurse lost her license, I should say her or his license. There are men in this as well. They went out and they kept Practicing anyway, and nobody's arresting them. So there was actually this nurse practitioner in Oklahoma. This was written about in a newspaper article a few months ago. I think the newspaper was called the Frontier. And there's a nurse practitioner who was actually caught importing illegal product from foreign countries and stuff. She lost her license for a period of three years. She kept practicing under a different name, a different med spa name. She was practicing under her own name. And as this got reported on, she scrubbed her name from the website. But you could tell from the Google reviews that they were thanking her like, oh, she did a great job and they named her. And so nobody arrested her for practicing medicine without a license, even though she was openly doing that for three years. And I don't know if she got her. Her license was just at the three year mark when this article came out. But what I'm saying is that in general, the consequences are so minimal. And so people are out there doing it, making money for as long as they possibly can without much of a consequence. And even if they lose a license, so they don't care and they just keep doing it and making the money and nobody arrests them. And it just seems like there's no consequence for this. Like in my book, I quote, there was a guy in Texas who wasn't even an RN and he got arrested for injecting Botox that was imported from Turkey. Because when they arrested him, the vial of Botox had Turkish on it, right? So he went to jail, there were headlines, but then he went right back out and opened his place up again when he got out of jail and nothing really happened to him. And it's like, I don't know, I mean, it just. There just aren't consequences. Right?

[Jen Sullivan]

Well, let's pretend someone is opening a med spa the way you're supposed to, which means there's a medical director on site and anything is performed with a physician's knowledge and they're the one ordering it at that point. What is the difference between a medical doctor, a physician assistant, a nurse injector? What do you even think of that term, nurse injector? What are their differences in skills? If they're doing it the way that they should be, that's legally operated.

[ACAST Advertiser]

Well, that is kind of where it should be, which is you're looking for somebody who's experienced, who's skilled, who's personable, who's listening to you, who's hearing what you're telling them as far as what your goals are, if they're really legitimate and they're Doing everything by the book, and they're getting real product and stuff. Then it's just a matter of finding a great one. Finding somebody. You jive with finding somebody who. It's like finding someone fantastic. I've got super curly hair. You know how hard it is to find somebody who can cut my hair. So for me, it's like, that's the challenge, is finding somebody who really gets me and what my needs are. Right. I would love it if everybody in the country were doing it by the book and that. That's all you were looking for, was high skill, experience, someone who's listening to you and you jive with. Unfortunately, the vast majority of places you go to, I can guarantee, are doing at least one thing, if not multiple things, kind of cutting corners.

[Jen Sullivan]

It puts it all on you, the patient, or the consumer to do the research. So we're gonna help people a little bit. I have some questions to get into that, but before we do, I have to ask, is it legal to go to a med. Let's say you go to a med spa and you never see the doctor. Cause this is the case even with. When there's the medical director who's, like, maybe an hour away, they're like, overseas, but they're not actually on site ever, which is the case. If you've never been examined by a physician, is it illegal if someone's gonna then inject something in your face?

[ACAST Advertiser]

Well, it depends on who you see. So the people who are allowed to do that initial consultation, what's oftentimes called legally as the Good faith exam. Yes. Okay. Now that came from California. California. That's what it's called. But then that's become sort of spread across the country as that's what we call that initial examination. A doctor or a nurse practitioner working under a doctor, if a state requires that, or a nurse practitioner independent, if they're in a state that allows that, or a physician's assistant working under a doctor, those people can all do the good faith exam.

[Jen Sullivan]

You did not say registered nurse.

[ACAST Advertiser]

Nurses cannot do it in any state.

[Jen Sullivan]

You did not say master esthetician. You did not say cosmetologist.

[ACAST Advertiser]

Correct? Correct. So if you go and you say, all right, look, I just want to touch up on my laser hair removal. I know I want it. I know I'm a good candidate for it. I just want to have the one thing I don't want a consultation. If they say, sure, our master esthetician can do that, or sure, our RN can do that, that's illegal. Because you are a new patient to that practice, and they've never seen you before. So it is not legal for them to go ahead and do the botox or the laser or any medical treatment.

[Jen Sullivan]

I didn't even think of the laser. Do you know how many people right now are listening to this and being like, well, I did an illegal activity? Well, they.

[ACAST Advertiser]

I can tell you, you know, I've had patients where my new patient coming to see me for the consultation is a lawyer, and they used to go to the RN or the girl, the girl down the street, and when I'm like, oh, really, girl? Like, what was her licensure? And my new. My lawyer patient doesn't know, okay? Because even the lawyers, if they're not practicing healthcare law, they don't even realize, like, oh, I'm going to this place. It looks legit. They're wearing scrubs. This is a nurse. She knows what she's doing. I like her. Even if she's been doing it for 15 years, it doesn't mean that she's doing it legally. It's not that that person's even trying to do something wrong or illegal. They just, hey, look, I've been doing this for 15 years. Why would you need to see someone else first? Well, why? Because that's what the law says. You know, the other thing we haven't touched on, which we don't necessarily need to talk about, but the other thing that's rampant, illegal, is the corporate ownership of the med spa.

[Jen Sullivan]

Say more.

[ACAST Advertiser]

So most states in this country have very strong what's called corporate practice of medicine laws, meaning if you're a corporation, you can't practice medicine and you can't employ doctors. And that is meant to protect patients from business owners dictating healthcare. Okay, so doctors are supposed to be independent practice, like, do the best for our patient. Because doctors, I can tell you now, there are scummy doctors out there. There's no question. Okay? But for the most part, we all went into medicine because we want to help people and we want people to be healthy and whatever, take care of them. So corporate practice of medicine states that a business person can't come along, hire a doctor and practice medicine through that doctor or tell the doctor what to do.

[Jen Sullivan]

That is literally how med spas work. Some of the larger franchises.

[ACAST Advertiser]

Right. Well, so again, there are legal ways to do that. They own a thing called an mso, a management services organization. An MSO can own the spa, like parts of the spa, so they can own the lease to the space. They can own equipment and computers. They can employ the front desk people. They can do all the kind of billing, hr, all the spa like stuff, business stuff. But the doctor has to own the medical practice. Okay. And the doctor actually has to get paid to do the medical procedures and then pay the MSO to manage all the spa stuff. Okay. So the lawyers have figured out a way to write these MSO contracts. Right. There's what's called an MSA or a management services agreement between the mso, the business people and the doctor. And basically the lawyers write all kinds of stuff in there so that essentially the MSO is controlling everything on paper.

[Jen Sullivan]

The paper drill says this person's doing medicine.

[ACAST Advertiser]

So the paper trail says the money goes in the right direction to the doctor and then to the mso. But essentially the doctor's relinquishing most of the control over all of that to the mso, the business people. The idea is to protect the consumer from that business doing stuff to you that is not in your best interest. Right. And so there's a reason why there's supposed to be a doctor there protecting you and your health. Right?

[Jen Sullivan]

Right.

[ACAST Advertiser]

So there are many, many med spas, however, and I'm not talking about the big chains. Cause the big chains have big lawyers who are writing this stuff for them. So they're probably dotting their I's and crossing their T's and making sure that it's legal. But there are many, many med spas across the country that are independently owned illegally. Okay? So a business person goes to Vegas and sees the IV bars there. Which by the way, is a whole other topic of why you should not go to one of those, but read.

[Jen Sullivan]

The book for the IV's chapter.

[ACAST Advertiser]

But they go, oh my God, this is so. We don't have any of these in my city. Let's open one. And they're just a business person. They're just an entrepreneur. So then they hire a nurse or a phlebotomist or whoever, or a former paramedic to put in IVs. And they might get a business license, but they don't have a medical director. They don't realize they're practicing medicine. Okay. Then eventually they maybe figure out, maybe they go to an AMSPA meeting. Someone figures out, oh, we need a medical director. So they might get a medical director, but they still might not have an mso. There are all these different medical places that look legit but are really so not. Right. Because when you think about it. Okay, I'll just go right back to why you should not get an iv. So there's no quicker way to kill someone with an IV than with an iv. And if you go to a med spa or just an IV bar and they put the wrong thing in you, it could kill you. Okay. Or make you very, very sick.

[Jen Sullivan]

Yeah.

[ACAST Advertiser]

That's why, I mean, I started my book with this bit about this woman who died in exactly that way in Texas last summer. Well, two summers ago now. But the thing is that, right, who do you want making that decision? Is it you when you don't know anything about medicine? Is it the owner of this place who doesn't know anything about medicine? Or do you want someone who really knows what kind of IV you could even tolerate much less would benefit from? You know, you need a medical person to make that decision. And the idea of an IV bar where you just order an IV up like it's a martini is so insane because.

[Jen Sullivan]

But that's because you're a doctor. You have to understand, like a real person going in probably assumes in the same way they assume every skincare product they've tried has been tested by the government before it went on the show. Like, they. It just feels like that's how it should be.

[ACAST Advertiser]

So. Right. But it's not. Yeah. And it can be quite dangerous. So, I mean, the lady who died in Texas, like this woman who didn't know what she was doing, hung potassium and killed her, like executed her. And as I've said a couple times on my podcast, that's how prisoners on death row are executed, by hanging potassium.

[Jen Sullivan]

Here in New York City, it is cold out there right now. And with dropping temperatures and lower humidity, your skin can have a really tough time retaining moisture, even if you're doing your full skincare routine. I mean, I'm doing all the serums, the moisturizers, but I still take Ritual's hyacra skin supplement. It's a clinically proven way to support skin hydration with science backed benefits like reducing wrinkles and improving skin smoothness. The hydration alone would be enough for me. But all those other benefits, why not take it every day? I have it sitting right next to my computer. Makes my life easy. Love my ritual. Haya Sarah. In fact, in a clinical study, Haya Sarah led to a 2.9 times increase in skin smoothness within 90 days as compared to placebo. And subjects reported an improvement in skin elasticity, glow and radiance in 90 days. So ritual works with world class certification bodies to validate their products, which we love. They're also female, founded and a B corp, meaning they're holding themselves accountable to not just their company's financial health, but the health of the people and our planet. That's why I love supporting this company and I love that they support Fat Mascara Start Hair to support your glow without compromising on clean science. Hair from Ritual is a clinically proven skin supplement that you can actually trust. Get 25% off of your first month for a limited [e-mail] mascara that's ritual.com mascara for 25% off your first month.

[Sleep Number Advertiser]

They say opposites attract. That's why the Sleep Number Smart Bed is the best bed for couples. You can choose what's right for you whenever you like. You like a bed that feels firm but they want soft. Sleep Number does that you want to sleep cooler while they want to feel warm. Sleep Number does that too. Why choose a Sleep Number Smart Bed so you can choose your ideal comfort on either side. And now save 50% off on the new Sleep Number Limited Edition Smart Bed limited time exclusively at a Sleep Number store near you. See store or sleepnumber.com for details. Ready to elevate your skincare? Introducing Medicaite, a clinically proven dermatologist recommended British skincare brand known for age defying results. You may have heard about growth factors as the must have anti aging ingredient and that's why Medicaite is excited about their latest innovation, the Liquid Peptides Advanced MP Face Serum. This serum harnesses the power of Growth Factor Mini protein, a cutting edge technology that mimics natural growth factors but goes deeper delivering visible transformative results. Studies show immediate improvement in expression lines in just 10 minutes and a significant decrease in deep set wrinkles after eight weeks of use. The Liquid Peptides Advanced MP Face Serum not only reduces wrinkles but also gives a filler like effect, smoothing out your skin's appearance dramatically. Visit Medikate US. That's Medik and the number 8 US use code podcast20 for 20% off your purchase today.

[Jen Sullivan]

Yeah, she overdosed this. This person.

[ACAST Advertiser]

Well okay. They get sedated first?

[Jen Sullivan]

Yeah, of course. No, it's horrible. But I think let's, let's stick for a second with the cosmetic treatments just because I think that that's what a lot of our listeners are looking for and they're not sure about this. Besides just the med spas and how they're set up and how there's a lack of regulation there. I wanted to just talk to you briefly about regulation for the machines and drugs used within these spas. So who is in charge of Making sure those treatments are safe. And I know that's different for say a drug versus a machine, but how.

[ACAST Advertiser]

Would you explain it to someone? I mean, in the spa, the medical director is responsible for that. So that's me in my spa. And if there's a medical director, hopefully that's in their job description. And then as far as government regulatory bodies, so every laser is governed by the fda. And so if it's an FDA approved or cleared laser, and those are two different things, then that laser is approved to be used on people, but only under the label that the FDA approved provides meaning. So they govern who can do it and how it can be done. And you can't sell a laser to a non doctor. So a nurse can't buy a laser. They have to have some doctor on the paperwork in order to buy it in the first place. Right?

[Jen Sullivan]

Yeah, but in your book you even said a company sent a laser to your house once when you were sampling a device.

[ACAST Advertiser]

A different device. I know. Yeah, that was super. Yeah, that was.

[Jen Sullivan]

So it's not to say the companies aren't gonna sell things to people who shouldn't be buying them.

[ACAST Advertiser]

That's how you would be able to tell that this is a dicey company. I mean, the big laser company, these are very expensive devices. So I mean, the most expensive device that I own in my SPA retails for $350,000. Okay. Most lasers are somewhere between.

[Jen Sullivan]

Wait, now I have to know which device it is.

[ACAST Advertiser]

That's mphase. That is Mphase.

[Jen Sullivan]

Mphase. MK.

[ACAST Advertiser]

Yes. And then Emsculpt Neo is 250K. And then most of the other lasers we have are between 1 and 150. Nah, 1 and 200k. They're very expensive devices. Right. And these big laser companies are not gonna sell a real laser to, you know, a non medical person in their paperwork. They need a medical director they don't need. So usually they also need the medical director to sign it. Right, so but for a nurse to order one of these lasers, they would need a medical director, at least on paper.

[Jen Sullivan]

Right, but there's all sorts of other treatments. Now, like the minute a spa opens, I see treatments and I'm like, I have never even heard of this where derma rolling. But we decided to take out the PRP and we're doing it this way. The minute the tools become available, people think up new ways to use them. Is anyone regulating these new ways?

[ACAST Advertiser]

Well, so there are laws that apply, but they're not being followed. Doctors are allowed to do anything off label if they decide it's medically appropriate. So as a physician, I could take PRP and use it for facial rejuvenation. That's legal. And people working under me, if I essentially instruct them to do that, there's. Now, there are different laws.

[Jen Sullivan]

Platelet rich plasma, this is. They extracted your blood, they centrifuge and spun it. Got the good stuff. That's prp. Go ahead.

[ACAST Advertiser]

And even Botox. So Botox is approved for injecting certain areas. If you use Botox in other areas, that's using it, quote, unquote, off label. Because the FDA did not approve that. Okay? Now, nurses are not allowed to decide to use something off label. They're just not allowed to do that. PAs can do it, NPs can do it. But as far as under what supervision? That's different in every state. So I can't speak.

[Jen Sullivan]

So if it's a nurse injector and you went to them and they gave you, quote, unquote, skin Botox, which is micro injections all over your face, not to the areas that is.

[ACAST Advertiser]

They're not. They can carry that out if a doctor prescribed it, but they can't decide to do that on their own. But that's true even of on label for nurses. Right?

[Jen Sullivan]

Right.

[ACAST Advertiser]

So it's really a little bit complicated. Right. I think that a lot of people don't even understand, even a lot of medical people don't understand the difference between on label and off label use. And as far as ensuring safety, okay. Anything that's off label, the doctor has to take a stand and say, this is appropriate and this is why. Right. That has to be our. And we have to document like, well, why we think this is appropriate. Some things are very simple. Okay. Like with a lot of things in aesthetics, let's just take Botox. Right. Allergan, the company that makes Botox, has done massive studies in order to get FDA approval for certain uses. And honestly, Botox is the only neurotoxin that's FDA approved for the three basic places where we always put it between the 11s forehead lines and crow's feet. Okay. Now one other common place is bunny lines. Those ones, right?

[Jen Sullivan]

Yeah.

[ACAST Advertiser]

Near your nose, which some people have. No neurotoxin is approved for that, but we use it all the time. It's really easy. There's like essentially no we.

[Jen Sullivan]

The physician speaking.

[ACAST Advertiser]

Yes, yeah, we. But in general, I mean, in aesthetics, it's a very easy thing to do. It doesn't take a lot of toxin. And there are essentially no I Have never seen a complication from injecting pony lines. Okay. I suppose if you did it in the wrong place, that would be a problem, but it's just not. That's off label, even though everybody does it. Same thing for using it for other areas, like for the daos down here when you've got rbf. Are we allowed to say resting bitch face on your podcast? You are, but that's off label. Now, that can have lots of complications, and you don't wanna have that done by somebody who doesn't know what they're doing.

[Jen Sullivan]

Well, this is what it comes down with. Not just off label, but with all of these procedures that if they're not done well, that's when there's trouble for the patient. I have to ask you, I'm gonna pause you for a second. Like, do you think of all of the treatments that you do at your med spas, do you think there are some that are much harder? If we're gonna go to a med spa and listen, we don't know if the medical director's on site or whatever. What would you caution people not to do if you're not sure? A little elevens with the Botox, maybe that's not so hard to mess up. Hanging an IV. Don't do that.

[ACAST Advertiser]

But what's the. I wouldn't do IV. Yeah, I would definitely not go do IVs. So the crazy thing is, the most common things are the most dangerous. So filler is hugely dangerous. Okay. Filler gone wrong can have horrible consequences. You can go blind. You can have necrosis of your skin. You could lose the tip of your nose. You could. It could be really bad. So finding somebody who's really doing it legally and knows what they're doing and also knows how to treat a complication. So when filler goes in the wrong place, we actually run little practice codes in my practice. And it should be extremely rare, and you should be able to know how to treat it. And have enough of the enzyme hyaluronidase in your fridge to be able to treat that immediately. Preferably have an ultrasound available. Preferably have a relationship with a plastic surgeon or an oculoplastic surgeon. Preferably have a relationship with someone who has hyperbaric oxygen. You could get if you need it. The worst complications that I have seen and the people I've interviewed on my podcast have been complications from filler where the person did not know how to treat the complication. Okay. And it was really bad. Okay. So that would be number one. Anything else injecting into your body. I would caution people, make sure you're going somewhere legitimate and they're ordering legitimate product because there's fake product off the Internet. And that is what we're seeing more in the headlines over the last year are people being contaminated with tainted stuff that they've gotten off of Alibaba or fake Botox that sent them to the hospital. So that would be anything that's actually being injected into you. But the other giant thing is laser hair removal. So a lot of places are using IPL devices to do laser hair removal. They're just not as efficient and also more dangerous because you can burn people with that. And so if you have darker skin, you have to be super careful. But even medium skin, and any Asian person, like, basically, if you have a skin type that has a tendency to have your. If you tend to hyperpigment, let's just say, then it can be super dangerous. You can get burns, you can get hyperpigmentation, or worse, hypopigmentation, where that little rectangle or circle becomes white.

[Jen Sullivan]

This is laser for hair loss.

[ACAST Advertiser]

Is this also laser for laser hair removal? This is. Any. Any laser can burn you, but lasers in the wrong hands can be quite dangerous. If you think about it, you can shoot down a missile from outer space with a laser. Okay, Lasers can be turned up and you can really, really hurt somebody. So think that having the right person who knows what they're doing with the laser and then also having the right laser is really important. And it's hard to know, like, if you're a consumer, it's really hard to know, like, well, what laser is that? And how do I figure that out? And so I think those are the biggest risks.

[Jen Sullivan]

Like, if you don't feel like doing homework, at least with those, do the homework. Whereas something like something that uses like a dermapen or a derma roller.

[ACAST Advertiser]

Well, derma rollers, I think are crazy. I would not. I would stay away from rollers.

[Jen Sullivan]

Why?

[ACAST Advertiser]

Well, those can't. They can't really be sterilized and they get dull. And those little needles, you can't change them out, right?

[Jen Sullivan]

Well, they're using new ones for every patient, aren't they?

[ACAST Advertiser]

Well, you'd have to. Right? But whereas a dermapen or, you know, that's a brand name, any microneedling pen will be a new sterile tip every time. But I have heard of places cutting corners by reusing tips now that can spread disease, that can spread hiv. That. I mean, I know that sounds insane, but people do It And I've actually heard that from RF microneedling as well. People reusing tips for that. Those tips are very expensive. So typically the tip for a microneedling pen is somewhere anywhere from 20 something to 60 something dollars per tip. Okay. The tips for the RF microneedling that we have is 125 per tip. And you know that's pretty pricey, Right. I can see people's wanting to reuse them, but they are not reusable. Okay. That's like reusing needles. I mean, you're gonna spread.

[Jen Sullivan]

Well, this is a red tag. If someone's getting quoted a price for like $100 introductory special for micro needling.

[ACAST Advertiser]

They'Ve gotta be cutting corners somehow because just the consumables alone. Look for me like we use a growth factor serum and of course brand new tip for every single patient. And we use really high quality numbing stuff. Like all those things cost a lot of money. But you're gonna get much better results from it, right?

[Jen Sullivan]

Yeah.

[ACAST Advertiser]

If you are reusing a tip or using the cheapest tip possible and using no growth factor serum. A lot of places do microneedling with no growth factors. And I mean you're just not gonna get as good a result from that.

[Jen Sullivan]

Are you gonna get any result if you just like injure the skin with a little needle?

[ACAST Advertiser]

Well. Cause you do have growth factors in your own blood, so you have that.

[Jen Sullivan]

So I could set off a little bit of a boost.

[ACAST Advertiser]

Is it worth it though? Like if you're gonna have that procedure, wouldn't you want the best results possible? Right. And so that's the difference between going to not just a legitimate place, but a place that's looking to maximize your results. Cause some places are looking to keep their costs as low as possible and see as many patients as possible. Right.

[Jen Sullivan]

Okay, so say we're consumer. Let's talk about the different kind of places people can go to. We're not you. I bet Dr. D can walk into any spa in this country and be like, red flag, red flag, red flag, we're walking out.

[ACAST Advertiser]

Well, you can kind of tell from the website.

[Jen Sullivan]

Okay, tell me what would people look for? What would be some red flags of this operation is probably not safe.

[ACAST Advertiser]

Right. Well, the number one thing is look for the. If you're just looking at the website.

[Jen Sullivan]

Let'S do website for you.

[ACAST Advertiser]

Look for the medical director on the website.

[Jen Sullivan]

Their name should be on there. Their name, not just a medical director.

[ACAST Advertiser]

Okay, right. Their name, their bio. And you should be able to at least get an appointment with that medical director eventually. Maybe it's not for three months. Cause they're booked out. Or maybe they only come in person every so often. Right. Okay. But if you can never, ever, ever get ahold of them, they're never there. Okay. Like for me, like, I don't see patients all that often anymore. I'm kind of way out. But, like, right now, I'm speaking to you from my home office. I live five minutes from my spa, and I'm there kind of all the time. Right. But you should be able to get an appointment with them and then also look up their license and see how does this one do that? Oh, that's so easy. And I do have links to that from, like, my book and stuff. But basically every doctor, you can look them up. There's a national provider index and you can look them up. It's very easy to do that. And maybe I'll get you a link. You can put it in your show notes.

[Jen Sullivan]

I will. So that medical director better be on that site when you look them up.

[ACAST Advertiser]

Yeah. And so you can look them up and you can see what their credential is and where they work. Like, maybe they work at a hospital 100 miles away as a anesthesiologist, let's say. Right?

[Jen Sullivan]

Yeah.

[ACAST Advertiser]

Huh. That's interesting. Well, are they ever there? You can even call the spa are they ever there.

[Jen Sullivan]

So the fact that it's 100 miles away gives you more pause than the fact that this is not an aesthetic medicine that they practice. Such as?

[ACAST Advertiser]

Well, I mean, there are plenty of anesthesiologists who are in aesthetics, and they are really great. It's not that they're in. I mean, I'm a radiologist by training. Right. But I've been doing this. I just wanted to point that out.

[Jen Sullivan]

It was like the location of them you're taking.

[ACAST Advertiser]

But like, let's say I work full time at a Hospital. I'm 100 miles away. Obviously I'm not.

[Jen Sullivan]

How could you ever be on the spot and checking the lasers, that they're up to date and giving exams, et cetera?

[ACAST Advertiser]

So. And then you look at the staff and you look at who's there. Right. They need at least a PA or a nurse practitioner or an MD that you can see to do the good faith exam. If there's none of those people on there, who's doing the good faith exam? They're not there to do it. Right.

[Jen Sullivan]

Well, nobody is, Dr. Tay. Right now.

[ACAST Advertiser]

Some places outsource that. There are companies that will do A good faith exam. They'll literally be like a 5 minute zoom call where a nurse practitioner in another state is doing your quote unquote good faith exam and making recommendations.

[Jen Sullivan]

So if you're a new patient at any clinic, you would expect that that should happen.

[ACAST Advertiser]

You have to get one.

[Jen Sullivan]

Yes, I know. There is probably 3/4 of people listening who have been to a med spa have been like, I don't think I got a good faith exam.

[ACAST Advertiser]

Well, you might not recognize it if they did it. And it was a five minute zoom call.

[Jen Sullivan]

Okay.

[ACAST Advertiser]

And you thought, oh, yeah, that was weird. You know, I met this nurse practitioner, she said, hi.

[Jen Sullivan]

Would they ask your medical history?

[ACAST Advertiser]

And they're supposed to. They're supposed to. But you know, I just, you know, there are these companies that do it that tell me that it takes five minutes. And for instance, there was an IV bar at a hotel in Vegas. I was at a conference not that long ago, and I went down there and I asked them, oh, hey, like, can I get an iv? What's that process like? And they told me that they do a 5 minute zoom call with somebody first. I'm like, okay, I get it. So they're at least crossing that T.

[Jen Sullivan]

But you want that to happen if you're a new patient?

[ACAST Advertiser]

At least that. Yeah. I mean, the goal, that person is supposed to make sure that you can medically tolerate whatever it is. Right? So let's say it's just Botox. They're gonna make sure you don't have a neurological disease, you don't have ms, you don't have some undiagnosed issue that, you know, that would mean that you can't get Botox. Right. And for an iv, then they'd be looking for heart disease, kidney disease, other things that would prevent you from being able to get an iv. They have to at least make sure they're not gonna kill you. Right.

[Jen Sullivan]

So back to this website. We wanna find the medical doctor. We wanna make sure on site, at one point it is either a pa, an np or a doctor. Yeah, or a doctor.

[ACAST Advertiser]

And then, you know, you see who the owner is. I mean, you won't be able to tell, but like, there is this one that I looked at recently where the owner was a laser tech, had no medical degree at all, and everybody in the place were RNs, and there was no medical director listed. Okay. To me, all those things are red flags, right? Like it's not owned properly. There's no even a mid level provider. There's nobody in there higher than an RN. I wouldn't touch that place with a 10 foot pole.

[Jen Sullivan]

So if I call to make an appointment and I say, oh, by the way, thanks for the appointment, by the way, who's the medical director for this facility? And. And they can't tell you. Cancel an appointment.

[ACAST Advertiser]

I didn't notice one on the website. There was another one that I called and this was cause there was a nurse practitioner who wanted to be on my podcast. And so I just looked up her website and long story short, she was in a state where nurse practitioners can't practice independently. So I was like, oh, I called the spa, I was like, oh, I see. This is. Who would I see? And who's your medical director? And when I asked that question, they said, well, we're still working on that. They knew they needed one, but they didn't have one yet. But they were up and running. I mean they were operational even without.

[Jen Sullivan]

And they knew that and they might eventually get one. We're not saying they wouldn't.

[ACAST Advertiser]

Yeah, oh, they might have one by now.

[Jen Sullivan]

But would you recommend people listening don't go anywhere until that isn't true?

[ACAST Advertiser]

Well, the thing is that, you know, if they just have it on paper and that person's never there, I mean, obviously they're not medically directing.

[Jen Sullivan]

Yeah.

[ACAST Advertiser]

So I mean, I know that that sounds ridiculous, but if you have a medical director, that should mean that they're directing the medical practice.

[Jen Sullivan]

Yeah. Besides asking about a medical director, what are some other questions you'd suggest someone ask when they're booking an appointment? Maybe they just want like laser hair removal or whatever it is.

[ACAST Advertiser]

I mean, I would ask, well, who your initial consultation would be with.

[Jen Sullivan]

Right.

[ACAST Advertiser]

And will they cater the treatment to my skin and my needs? Because a lot of places just have protocols in place and they don't actually cater anything to your skin.

[Jen Sullivan]

And you want to ask what that person's credentials are?

[ACAST Advertiser]

I imagine not just always the credentials, but then I also, once you get those, you look it up. So look up every nurse, look up every pa, every np, and just make sure they're actually licensed in your state. Because a lot of times it says something and it's not true. I mean, someone with a laser, say.

[Jen Sullivan]

The doctor comes in, they do all the check, but then they hand it off to someone who isn't a nurse or page.

[ACAST Advertiser]

Sometimes. Yeah. And so sometimes that's.

[Jen Sullivan]

I've had that happen to me. I've gone for laser hair removal.

[ACAST Advertiser]

Well, it depends on the state and what their regulations are. Like for instance, in my state, we Have a special thing called master esthetician. I think there are only six or seven states in the country that have that designation. And so estheticians can get a special degree. Doesn't take that. It takes 13 weeks to get it. And special training, and they get this designation master esthetician, and they can essentially become a laser tech. They can work under a doctor doing certain medical procedures. That is not true in most states. Most states don't allow that. But in my state, yes. And then some states have laser techs, other states do not. And some states require that laser tech person to be at least an rn. Other states do not.

[Jen Sullivan]

Do you know of any state where someone who just has a cosmetology license can wield a laser now?

[ACAST Advertiser]

I don't.

[Jen Sullivan]

Do you know how many laser hair places have just cosmetologists wielding a laser?

[ACAST Advertiser]

Yes. I don't actually know the denominator there neither.

[Jen Sullivan]

And if I wasn't being rhetorical, because I've definitely been to those places.

[ACAST Advertiser]

Yeah. I mean, some of them have gone bankrupt because they haven't been doing it properly. Right. I mean, this has been a number of years, but American Laser went bankrupt. I think it was. I'm gonna forget the other name of it. Laser Away.

[Jen Sullivan]

Was that a franchise? Sorry, I'm not familiar.

[ACAST Advertiser]

Yeah, that was a national laser hair removal. I don't know if it was a franchise or if it was just a national chain that was centrally owned that they went out of business. And actually, they were very. They were going gangbusters when I first started this 10 years ago. And 10 years ago, I did not start offering laser hair removal because every day there was some kind of Groupon or Living social, whatever it's called. And. Yeah, I mean, because it was so cheap. And I'm like, I don't know how they do that. I don't know how they do that and keep it so cheap because it's just the laser itself is so expensive. That laser was, I think, close to $200,000. And it's very finicky and hard to maintain and very expensive to run. And so I was like, I can't compete with that. So I didn't do it. And it wasn't till they went out of business and all the group pons disappeared that I was able to buy that laser. And, like, since you brought up group.

[Jen Sullivan]

Pon, I have to ask. I know we were doing red flags. We'll get back to if we missed any with Dr. Dean a second. But. But in your book, you said, do not Go anywhere that has all five star reviews on Yelp.

[ACAST Advertiser]

Well, tell everybody why there are so many fake. There are all these fake reviews also on Google and Amazon. Honestly, that should be a red flag.

[Jen Sullivan]

If it's all fives, is what you're saying.

[ACAST Advertiser]

If it's nobody, not a single four or three or two or one star review, I mean, that's impossible. So people are not.

[Jen Sullivan]

The ones that freak me out are when it's all fives and all ones. So I feel like all the fives were paid for and all the ones. Are the real reviews possible.

[ACAST Advertiser]

I mean, you know, it's possible. There's no way of avoiding one star reviews. I mean, I don't have a lot, but I mean, I had one lady who screamed at my front desk person because we require a credit card to hold an appointment. And so we charge a no show fee if you don't show up. We charge a late cancel fee if you cancel at the last second and don't have a good excuse. But anyway, this lady never came in, never booked an appointment, screamed at my front desk and went immediately on Yelp and wrote a one star review saying, how dare they require a credit card? That's ridiculous. And I was just like, my front desk person was so frazzled by this, and she saw the one star review immediately she's like, oh, my gosh, Dr. Dino, it's my fault. I'm so sorry. She just, she didn't. She refused. And I was like, look, it's fine. Because if anybody really agrees with that, they won't come. And that's okay because, like, you need a credit card to reserve a restaurant half the time and to get your lashes done half the time.

[Jen Sullivan]

Right. And a legitimate practice is gonna maybe have a one star here and there.

[ACAST Advertiser]

And that's. Yeah. I mean, it's gonna happen, right? And there's gonna be people who are, you know, but hopefully it's few and far between and most people are just happy. But, you know, the other crazy thing is a lot of people love, love, love you and they still give you a four star review. So if it's all five and not, of course, and there's no perfect.

[Jen Sullivan]

I get that.

[ACAST Advertiser]

I get that. Yeah. I mean, I was like, wow, what was she holding back for? I'm like, I don't know.

[Jen Sullivan]

But you read the review underneath the stars, so you see that it's a positive review. Yeah. But back to just. I know we're running out of time here, but the red flags. You gave us some really good ones. And we have this link now to look up the medical director and make sure it's all legit. Is there anything else? There's been so many headlines in the news lately about counterfeit Botox. Is there anything else you would tell people to look for or ask about.

[ACAST Advertiser]

When you're going to do it? Well, ahead of time, I would say, so avoid any place charging you ahead of time for a procedure. So there are places that will charge you in advance. Don't go there. Okay. There are some famous big national companies that do that. Don't do that because it's non refundable and they will basically keep your money. You've never even been there. So I would ask, like if you are having a virtual good faith exam, I would avoid that. So I would say any place that says, oh, we'll do that ahead of time by zoom or by video. Ask if you are actually seeing somebody at the spa and am I gonna see you and have my procedure done with you? Because there are companies that will have.

[Jen Sullivan]

You if you're a new patient, especially.

[ACAST Advertiser]

If you're a new patient. They're doing that to a call center in some other state and you end up prepaying and walk into the spa. You've never met a single soul there. What if you don't like them? What if you don't like your provider? What if the provider just doesn't seem right to you? Or if they don't seem like they know what they're doing? You've already paid, you've already had a consult with someone else in another state, like, just don't.

[Jen Sullivan]

I've heard so many people that, yeah, they get roped into things and all of a sudden something's happening and they feel uncomfort and they're not trusting their gut.

[ACAST Advertiser]

If it doesn't feel right, that's a big, big red flag. If they try to upsell you day one, red flag. If they try to get you to commit to something day one and say, oh, this is only available today. Giant red flag. Those are all sales techniques. That's not medicine. So, you know, if you're going to a really great place, they're going to educate you, they're going to explain how the procedure works, they're going to give you all the information and not pressure you to do a medical procedure that you may or may not want to do.

[Jen Sullivan]

Jess, I'm a person who wants to become their best. You know what's helping me right now? Masterclass. Mm, love. So here's the thing. You know how when you work in teams, sometimes someone goes rogue. You're just like, okay, how do I deal with this person? You know, who can help you from Masterclass? She helped me at least. Least Amy Poehler. Amy. Amy Poehler. The number of instructors and more than 200 instructors on masterclass these days is amazing. But I really liked this class. It's building confidence and speaking skills, but it's also how to work in teams using skills from improv. It's also funny because it's like entertainment, but I'm learning. That's what I love about Masterclass. Masterclass is the only streaming platform where you can learn and grow with more than 200 of the world's best for just $10 a month build annually. A membership with Masterclass gets you unlimited access to every instructor and you can access Masterclass on your phone. That's how I like to watch it. Computer, smart TV or even an audio mode. Now there are so many classes. I mean, I could be here all day telling you about some of my favorites. But if you want to talk about beauty, Sir John does a class create makeup looks for any moment. Jen Atkin has a class style your own hair for any occasion. And of course there are classes on lifestyle, food, your mind, your body, everything. Right now our listeners get an additional 15% off any annual [e-mail] FatMascara that's 15% [e-mail] FatMASCARA masterclass.com FatMascara.

[Sleep Number Advertiser]

They say opposites attract. That's why the Sleep number smart bed is the best bed for couples. You can choose what's right for you whenever you like. You like a bed that feels firm but they want soft. Sleep number does that. You want to sleep cooler while they want to feel warm. Sleep number does that too. Why choose a Sleep number smart bed so you can choose your ideal comfort on either side. And now save 50% off on the new Sleep number limited edition smart bed limited time exclusively at a sleep Number store near you. See store or sleepnumber.com for details. Ready to elevate your skincare Introducing Medicaite, a clinically proven dermatologist recommended British skincare brand known for age defying results. You may have heard about growth factors as the must have anti aging ingredient. And that's why Medicaite is excited about their latest innovation, the liquid Peptides advanced MP face serum. This serum harnesses the power of growth factor mini protein, a cutting edge technology that mimics natural growth factors but goes goes deeper delivering visible transformative results. Studies show immediate improvement in expression lines in just 10 minutes and a significant decrease in deep set wrinkles after eight weeks of use. The Liquid Peptides Advanced MP Face Serum not only reduces wrinkles but also gives a filler like effect, smoothing out your skin's appearance dramatically. Visit Medicaid US that's Medik and the number 8 US use code podcast20 for 20% off your purchase today.

[Jen Sullivan]

Is there a way? Okay, I'm just thinking about all of these things cost money and time on the, on your side as the provider. And this is why it costs a lot of money to get these procedures. However, they're marketed all over the place. People see their friends getting it, it makes it seem like this is no big deal and I don't need a ton of money to be able to do it. I'm gonna shop by price. Is there a price that you've seen where you're just like, oh my God, if something costs below this price, you should not be doing it like for.

[ACAST Advertiser]

Some reason, I mean, everything is like that. And so.

[Jen Sullivan]

But like for like Botox, which is probably one of the most common cosmetic.

[ACAST Advertiser]

Procedures, Botox, if you see a Groupon for Botox, don't go there. There's no way they're offering that for that price. And it's real Botox because like I've seen Botox Groupons for like eight bucks a unit. And it costs that to buy real Botox. Okay. You might get a little frequent flyer discount.

[Jen Sullivan]

How many units are in a cc?

[ACAST Advertiser]

We don't measure it by cc.

[Jen Sullivan]

What does a cc, that means? Nothing. I've never had a derm ask me about the price of a unit.

[ACAST Advertiser]

Oh, yeah. So most places sell Botox by the unit because everybody needs a different amount. So typically like for your 11s, it's usually 20 units. Sometimes a little lower, sometimes a little higher. Okay. And to buy botox, you buy one vial. It's got 100 units in it.

[Jen Sullivan]

That's what I was asking. Sorry.

[ACAST Advertiser]

Right, yeah, one vial. I mean, if you add up the cost of the Botox, which is now over 700 a vial, plus the syringe and the gauze and the alcohol and all the other stuff, it's essentially at least $8 a unit. There's no way that you can offer Botox for $8 a unit and not lose money. There's no way. Plus that's if you don't even charge if you're not paying the person to inject it. Right?

[Jen Sullivan]

Yeah. I feel like it's interesting you said that I feel like we've gotten that lesson with nail salons we learned. Like, wait, think about it. If your manicure took an hour and it cost $15, how much did the person making the manicure get? You know what I mean? So apply that same math, I'm sure, to dermatological procedures like this or cosmetic procedures.

[ACAST Advertiser]

So around here anyway, I mean, and you're not even talking about overhead, the cost of being in the space you're in, the insurance, all the things. So for, you know, different cities might be a little more or less. Right. I would imagine Botox in New York would cost a lot more money. If it's cheap and you're in an expensive city, something's going on there. Okay, there's no way that's real Botox or there's no way they're really paying for it. So, I mean, we charge right now I'm In Seattle, it's 15 a unit. That's pretty much, pretty standard in my city. There are some places that are a bunch more. There are a couple places offering it for less. But they've got to be having some cheap deal somehow, right? Yeah, but a Groupon for $10 or less is like, like it's maybe a loss leader, but that's the only way I can think of to eat that cost. It's just expensive stuff.

[Jen Sullivan]

Yeah. So price being something else, like if.

[ACAST Advertiser]

It'S too good, cheaper. Yeah. And there are other neurotoxins. So there's five FDA approved neurotoxins in the US you can get some of them for cheaper than Botox. For sure. You can get a cheaper price on any of them if you buy in bulk. And so if you're a place like mine, we're really busy. We do buy in bulk and we try to get as good a deal as possible. Right. But. But it's still not that much less. But you can buy fake Botox off the Internet for a tiny fraction of that.

[Jen Sullivan]

Does it surprise you when you hear those headlines about there was just another one last week. A guy here in New York was using counterfeit Botox. When you hear these headlines, oh, I.

[ACAST Advertiser]

Gotta surprise, I gotta find that. I was on vacation last week. I gotta go find that headline.

[Jen Sullivan]

Yeah, no, it's surprising.

[ACAST Advertiser]

It doesn't surprise me. It surprises me that it's not in the headlines more. I think it's actually happening a lot more and that it's not hitting the headlines. We're just not finding out about it. I think that it's rampant and it's not just Botox. It's all fillers. It's the other injectables.

[Jen Sullivan]

You're surprised there haven't been more problems or that we haven't heard about more problems than there are?

[ACAST Advertiser]

I think that there are actually more problems. People being harmed by fake products that are just not being reported on. So why would we find out about it?

[Jen Sullivan]

And this nonprofit, I imagine, regulatory idea that you have as we're wrapping up here, what could that look like?

[ACAST Advertiser]

Well, I'm working on that. I'm calling it just the med spa board. And mostly. Cause I got that domain. I just bought that domain. And I'm working with a couple other doctors who are really interested in this for the exact same reasons. They're seeing so many bad complications and issues with all the illegal stuff. But my goal with that would be to have. It would just be certifying med spas that they are legally compliant, that they are licensed, that they have a real medical director, that they're getting real product and that they're owned legally. And it's not gonna say this place is better than the other place. It's not gonna be ratings like, no.

[Jen Sullivan]

If you have this stamp, it's approved by the blah blah board.

[ACAST Advertiser]

Kind of like what certified organic means. When that started, nobody really knew. Does that really have a meaning? What's organic? Now everybody knows what it means. Right. And my goal would be you can at least look and say, oh, well, that one's certified. I'm going to go there and avoid the place that's not certified. And my goal is to make it easy enough for the real legit medspas to get certified. It'll be a nominal fee. They just have to submit the licensure and all the document like that. Oh, yep. We're on the up and up. And that they could get certified and that that nominal fee would somehow cover the costs of getting the people to verify all this is.

[Jen Sullivan]

It's almost like all the. Yeah. All these questions you told us to.

[ACAST Advertiser]

Ask this entity that's covered by this foreign certificate. Exactly. And I think that all the places that are operating legally would be happy to have this. Right? Yeah. Because then there would be this difference. I'll also save some time.

[Jen Sullivan]

I'm not on the phone asking the 20 questions Dr. D told me to ask.

[ACAST Advertiser]

And it's just hard to know if you don't know what is legit. It's really hard to ask the right questions. And also when people are sort of answering but working around your answer and not really Answering in a forthright way. It's easy for me to tell, but it's really hard. It's like if somebody's sort of skirting around the issue. Right. And I just think that every legitimate place or every place that's trying to be legitimate would be happy about this because they'd be like, all right, great, awesome, I'm certified. And then you'd advertise it and you'd be like, just go to a certified place. And then people would just know. Right. And let's say you wanna go get Botox for the first time. Your best friend or your daughter or your mom would be like, okay, just make sure it's certified. Oh, right, okay. And that just becomes like, make sure.

[Jen Sullivan]

You have your license.

[ACAST Advertiser]

Common knowledge or whatever it is. Yeah, just common knowledge.

[Jen Sullivan]

I think it's a great idea and.

[ACAST Advertiser]

I know there will be a lot of not legitimate places who are pissed off about it. And I'm really trying to be as even and not inflammatory as possible so that people will think it's a good thing. And I have talked to a guy who runs the American Medical Spa Association. I've talked to him about supporting that because it hasn't efforts in amspa. I don't know if you know what AMSPA is, but. Yeah. And that hasn't ever taken hold within amspa, but they support that and they are very much trying to get people to be legal. It's just. They want people. Yeah.

[Jen Sullivan]

Joining forces with them. Could.

[ACAST Advertiser]

Yeah. And then other docs across the country, there's a number of docs that I'm working with who are really interested in just.

[Jen Sullivan]

Can I put in requests as you work on this, can there then also be a consumer facing website so that we could just look up?

[ACAST Advertiser]

Yeah. Oh, that's cool.

[Jen Sullivan]

Because you even. I, when I'm working on a story in writing, depending on the state or whatever, it is so hard to find the guidelines of who can inject what and which procedures in which state.

[ACAST Advertiser]

Well, and that's hard for us to find too. You know, I mean, I just know in Washington because I've been doing this for 10 years and I.

[Jen Sullivan]

And you have lawyers that consulted you that are in this area of practice.

[ACAST Advertiser]

Meds. Medspa lawyers. And the other thing is that most healthcare attorneys don't actually know. You have to really specialize in medspa law and there's not very many of those. Well, or, you know, I actually use a law firm that is med spa law only and they're national, but they know. Yeah. And I think that it's really hard to find that information. It's also just incredibly hard to find out who owns a company, you know, and are they legit even just learning? Is it a franchise versus just a corporate chain versus individually owned? It's really hard to tell sometimes.

[Jen Sullivan]

But having this sort of accreditation would help us, the consumer, and you, the physician, see fewer complications, I imagine.

[ACAST Advertiser]

Well, let's hope. But I think also it requires, like, the consumers to know. Right. To care.

[Jen Sullivan]

I think a lot of them care. They just don't even know the right questions to ask.

[ACAST Advertiser]

Well, they don't even know that it's possible to walk into a place and nobody's actually.

[Jen Sullivan]

I know.

[ACAST Advertiser]

Cause you assume. Licensed at all in that whole place.

[Jen Sullivan]

It's the wild west out here.

[ACAST Advertiser]

Yes, it is. Basically.

[Jen Sullivan]

Before you go, Dr. D, we do this thing at the end of our podcast, the FM5. It's like a speed round just so people can get to know you better. Okay, this is the fun part. So if you're up for it, first question is, do you use the notes app on your phone?

[ACAST Advertiser]

I do.

[Jen Sullivan]

What's the last note you wrote yourself?

[ACAST Advertiser]

Oh, my God, that's so fun.

[Jen Sullivan]

I love asking people this.

[ACAST Advertiser]

You know, that's so funny, because that's hilarious. They're not in order. That's so funny. I think this'll be a lot. I think it was the dosage of my estrogen patch. There you go.

[Jen Sullivan]

Love it. Okay, I know you say in your book that you were not a makeup wearer, but there must have been a first beauty product or skincare product or hair product. You have curly hair. I know this has to be true. That you remember buying and really loving very first one.

[ACAST Advertiser]

Yeah.

[Jen Sullivan]

That you.

[ACAST Advertiser]

Oh, my God. We're gonna go back to the 80s and it would be like, mousse for my hair changed my life.

[Jen Sullivan]

Okay, do you remember which mousse?

[ACAST Advertiser]

Oh, my God. No, I don't. It was crappy mousse. Cause it. You know, when I was a kid growing up, there were no hair products that would deal with curly hair. And everybody was busy perming their hair. I know. That was ridiculous. I did not perm my hair, but there was nothing to keep the curls until mousse came out. There was 10x. If you're. You're probably too young to know. 10x was the stuff that would get you the spiky hair that we had in the 80s, but that was way, way too stiff for curly hair. But when mousse came out, Moose was.

[Jen Sullivan]

A game changer for you?

[ACAST Advertiser]

Total game changer, yes.

[Jen Sullivan]

Okay, you have a podcast. Who would be your fantasy interview subject? Could be someone dead or alive related to your work or not.

[ACAST Advertiser]

A couple people, I think, maybe if they'd be willing to talk about it. Jennifer Aniston or Courtney Cox and about their journey through what they've been through, or maybe even Meg Ryan. I don't even know what Meg Ryan's doing nowadays, but we've seen them all kind of go through, like, too much filler and then stop.

[Jen Sullivan]

Okay.

[ACAST Advertiser]

And now I'm kind of curious to know. The other person would be Linda Evangelista, who I actually have tried to reach out to, but I think she probably had to sign an NDA with Allergan when she settled the lawsuit with them. But she very famously sued them because of coolsculpting and being disfigured.

[Jen Sullivan]

And you would like to hear more.

[ACAST Advertiser]

I would love to talk to her about that.

[Jen Sullivan]

Yeah, we'd have to lift the NDA for that interview, but okay, this one's a lot easier. What's your favorite snack?

[ACAST Advertiser]

Okay, my favorite snack that I'm willing to let myself eat are just like mixed nuts from Costco. My favorite snack that I won't let myself eat is dried mango, because I love, love, love dried mango. It's so yummy. But I could easily eat my weight's worth of mango in one sitting, so I try not to do that.

[Jen Sullivan]

Okay. Very healthy of you. It's 11am on a Saturday. Let's pretend it's your day off. Well, I don't know. You probably work some Saturdays, but let's say it's 11am on your day off. What are you most likely doing?

[ACAST Advertiser]

If it's winter, I'm skiing. If it's summer, I'm biking.

[Jen Sullivan]

Love it. Okay, Dr. D, thank you so much for coming on the show. It was great learning how crazy and wild the world of Med Spa is.

[ACAST Advertiser]

Thank you so much for having me. I feel like we kind of scratched a lot of surfaces and there's so much really to talk about here, but I really am grateful.

[Jen Sullivan]

That's why people are gonna go get your book and then they'll know more. So I'll put a link to that at the show. Notes, too. Thank you so much.

[ACAST Advertiser]

We hope you enjoyed the show.

[Jen Sullivan]

It's your reviews and feedback that help us make the podcast even better. Head over to itunes to rate and review us or email your thoughts to infoatmascara.com we also want to answer your beauty questions. And hear what products you love to share a Razoon product review or to ask a beauty question. Email us at infoattmascara. If you send it as a voice memo file, we can even share your voice on the podcast. You can also do that by leaving us a voice message. Our phone number in the United States is 646-481-8182. Thanks so much for listening.

[Sleep Number Advertiser]

Ready to elevate your skincare? Introducing Medicaite, a clinically proven dermatologist recommended British skincare brand known for age defying results. You may have heard about growth factors as the must have anti aging ingredient and that's why Medikaite is excited about their latest innovation, the Liquid Peptides Advanced MP Face Serum. This serum harnesses the power of Growth Factor Mini Protein, a cutting edge technology that mimics natural growth factors but goes deeper delivering visible transformative results. Studies show immediate improvement in expression lines in just 10 minutes and a significant decrease in deep set wrinkles after eight weeks of use. The Liquid Peptides Advanced MP Face Serum not only reduces wrinkles but also gives a filler like effect, smoothing out your skin's appearance dramatically. Visit Medikaite US that's Medik and the number 8 US use code podcast20 for 20% off your purchase. Today.

[ACAST Advertiser]

ACAST powers the world's best podcasts.

[Jen Sullivan]

Here's a show that we recommend this.

[ACAST Advertiser]

Season on the Dream. Supplies are being provided by nurses who run out in the middle of the night and purchase diapers, but the hospital is still charging as if they still have these items.

[Jen Sullivan]

We are digging into every topic we've.

[ACAST Advertiser]

Ever wanted to cover on this show.

[Jen Sullivan]

It's a spinning plate analogy.

[ACAST Advertiser]

The second that you stop spinning those plates that crashes.

[Jen Sullivan]

So you can never stop working.

[ACAST Advertiser]

The Dream Season 4 comes at you weekly. Starting Monday, January 20, Acast helps creators launch, grow and monetize their podcasts everywhere. Acast. Com.