Skin Anarchy Podcast

Episode: The Truth About Med Spa Safety Standards with Tom Terranova of QUAD A

Host: Dr. Ekta
Guest: Tom Terranova, CEO of QUAD A
Date: March 19, 2026

Overview

This episode explores the critical and often-overlooked topic of safety standards in med spas and non-surgical aesthetics. Host Dr. Ekta welcomes Tom Terranova, CEO of QUAD A (formerly the American Association for Accreditation of Ambulatory Surgery Facilities), to illuminate how safety, accreditation, and patient advocacy intersect in the booming and poorly regulated world of non-surgical aesthetic medicine. Tom shares the mission behind QUAD A, the new global med spa initiative, and gives actionable advice for both patients and providers.

Key Discussion Points & Insights

1. The Origins and Mission of QUAD A

[01:42–06:37]

• QUAD A began in 1980 as a third-party accreditation organization for outpatient surgery, ensuring patients moving out of hospitals into private offices weren’t compromising on safety.
• It has expanded to include diverse specialties and now operates in 23 countries, aiming for a global safety standard.
• Their impartial evaluations and accreditations are recognized at state, federal (CMS), and international levels.
• Quote:
  • "We’re not really trying to…harm the industry in any way. We’re trying to balance what’s protecting patients with what’s allowing physicians to move from the hospital operating room into the outpatient setting." (Tom, 05:11)
• Recent focus: expanding into med spas and non-surgical aesthetic and wellness facilities.

2. The Problem: Lack of Uniform Standards in Med Spas

[08:07–11:57]

• The market is rapidly growing, alluring patients with the promise of less-invasive procedures—but there are virtually no uniform safety standards.
• Patients wrongly assume med spas are held to the same scrutiny as hospitals.
• Many states lack strong oversight even for office-based surgeries; for med spas, comprehensive protocols are rare or nonexistent.
• QUAD A launched a rigorous, peer-driven assessment program specifically for med spas on March 12, 2026.
• Quote:
  • "You have patients who expect a certain level of safety anytime it’s healthcare, but you also have a service that is less and less associated with healthcare and more with beauty… We're blurring that line." (Tom, 09:21)

3. Defining and Assessing Safety: QUAD A’s Four-Tier Risk Stratification

[12:23–19:50]

• Procedures are classified into four colors by risk: Green (low), Yellow (moderate), Orange (moderate-high), Red (surgical, not for med spas).
• Critical focus: training and credentials of those performing procedures; currently varies wildly state-to-state.
• Even basic requirements like licensing are inconsistent.
• It's not just about procedural skill—recognizing and responding to adverse events (e.g., swelling, necrosis, rare blindness) is vital.
• Operational factors: sterile practices, emergency protocols, and proper storage of drugs/products are evaluated.
• Quote:
  • "There’s no uniformity in legislation on who can provide these services or even what services we’re talking about... So our program had to stratify the risk and set scaffolding for safety." (Tom, 13:29)

4. Adverse Events, Underreporting & Global Challenges

[19:50–25:36]

• Many adverse effects go unnoticed or unreported, both by practitioners and patients.
• QUAD A funded independent research showing underreporting in the UK, revealing illegal or unsafe practices are more common than admitted.
• Even minor swelling post-procedure can be a significant adverse event if unrecognized.
• QUAD A warns strongly against "injectables parties" or similar unregulated environments.
• Quote:
  • "Any agent, any drug product—whenever you’re interacting with the body, there is a known, expected rate of adverse event." (Tom, 21:31)
  • "Bad idea. Any patient listening out there who's like, I'm gonna do a margarita party where we all get injectables—don't do it." (Tom, 23:22)

5. Team Structure, Accountability, and Medical Directorship

[26:27–34:47]

• Proper emergency response requires a team—not just a skilled injector.
• Many med spas have absentee medical directors, in name only, which is both unethical and risky.
• QUAD A’s program insists medical directors be actively involved in oversight, protocol training, and emergency planning.
• Quote:
  • "There is no purpose in being a medical director that gets a salary just to not show up… One, it’s unethical, and two, you’re opening yourself to a lawsuit or malpractice." (Tom, 32:07)

6. Rethinking “Low Risk”—A Call for Reasonable Standards

[34:47–39:41]

• The misconception: Med spas are "no risk," when in fact they’re "low risk" but never risk-free.
• The goal: Sensible, scalable standards that protect patients without unnecessarily constraining practitioners.
• Quote:
  • "Low risk is not no risk… Clearly, it is less invasive… but it doesn’t mean there’s no risk." (Tom, 34:47)
  • "A minor procedure is a procedure on someone else." (Tom, 37:54)

7. Value for Top-Tier Providers and Consumer Empowerment

[39:41–45:08]

• Accreditation validates best practitioners and gives others a roadmap for improvement.
• The market is expanding (estimated only 10% saturated); patients struggle to distinguish reputable providers from unsafe ones.
• Accreditation should become as important a differentiator as price or social media presence.
• Recommendation: Patients should always ask about and verify facility accreditation.
• Quote:
  • "In a crowded market where patients have no clue who to pick because they can't tell the difference... What we need to do is say, 'I am the luxury brand. That's why you pay 5% more for me—because that 5% is your safety net.'" (Tom, 42:18)

8. Improve Transparency and Documentation

[45:08–46:33]

• Advocates for multilingual documentation and transparency, especially when serving diverse communities.
• QUAD A offers visible indicators (certificates, digital seals) of accreditation for public reassurance.

9. How Patients Can Identify and Use QUAD A Accreditation

[46:33–50:40]

• Patients should look for the QUAD A seal in physical clinics, on digital platforms, and can (soon) use the online directory.
• True accreditation requires on-site inspection—not just paperwork or self-assessment.
• Patients should always ask, “Are you QUAD A accredited?”

10. The Government’s Role and QUAD A’s Relationship with Regulators

[51:32–57:48]

• U.S. regulation is fragmented; about half of states strongly mandate office surgery accreditation and fewer address med spas.
• State Departments of Health typically only oversee large institutions, not private practices; boards of medicine/nursing oversee individuals.
• QUAD A often partners with states (e.g., New York) and international regulators (e.g., Dubai) to supplement limited government oversight.
• Quote:
  • "States can do what they do best—complaints, adverse events, four-cause investigations—and coordinate with us for boots-on-the-ground inspection." (Tom, 56:10)

11. Empowering the “Middle” Practitioners and Patient Advocacy

[57:48–62:00]

• Most providers aren’t willfully unsafe, but lack comprehensive education or resources.
• Accreditation upgrades “C students” to “A students” in clinic safety.
• Patients have a responsibility to educate themselves and ask for transparency.
• Quote:
  • "Some percentage of folks are at the top tier, some are up to no good – but a lot in the middle don’t know what they don’t know… that’s where this stuff really makes a difference." (Tom, 59:49)

Memorable Quotes & Moments

• On Patient Empowerment:
  • "Ask, 'Are you QUAD A accredited?' If not, leave. Say, 'I'm not coming back until you are.' Vote with your wallet." (Tom, 49:50)
• On Market Dangers:
  • "We’re at 10% saturation… Wait five years, it’s going to be a really crowded market. Without some differentiation, patients have only Instagram and price." (Tom, 42:10)
• Practical Analogy for Accreditation:
  • "I look at accreditation the same way I look at a driver’s test: We’re looking for the ability to demonstrate compliance, not surveillance every second. It’s about setting every spa up for sustained success." (Tom, 18:36)
• On Adverse Events:
  • "Not to scare anyone, but you do have to recognize that even these 'less-invasive' techniques disrupt tissue, disrupt normal physiology—you have to recognize the signs." (Ekta, 20:09)

Actionable Takeaways & Recommendations

• Patients:

  • Look for the QUAD A seal or digital certificate; use the (forthcoming) online directory.
  • Always ask for proof of accreditation and don’t be afraid to leave non-accredited practices.
  • Speak up and advocate for your own safety.
  • Avoid “injectables parties” and other unregulated settings.

• Providers:

  • Seek robust, transparent accreditation such as QUAD A (especially as consumer scrutiny increases).
  • Ensure active, present medical directorship and regular protocol/review practices.
  • Adopt a culture of continual improvement, not just regulatory minimums.

Important Timestamps

• Intro to QUAD A and Accreditation Philosophy: 01:42–06:37
• Med Spa Regulatory Gaps/Launch of QUAD A Med Spa Initiative: 08:07–11:57
• How QUAD A Stratifies Risks: 12:23–19:50
• Adverse Events & Underreporting: 19:50–25:36
• Medical Directorship and Team Training: 26:27–34:47
• Governments, Boards, and QUAD A Partnerships: 51:32–57:48
• Action Steps for Patients & Providers: 46:33–50:40, 57:48–62:00

Conclusion

This episode serves as a wake-up call for anyone considering aesthetic procedures: don’t treat med spas like salons. Accreditation exists to protect you — demand it. QUAD A’s initiative is reshaping a booming industry, making sure that as the demand for non-surgical beauty grows, safety won't be sacrificed for style or price.

Resources:

• www.quada.org
• Check show notes for social media and direct links to QUAD A’s standards and directory.

Follow @skincareanarchy and @quad_a_now for updates and provider highlights.

“The market will only get more crowded—you need accreditation to stand out and for patients to truly be safe.”