The Doctor Is In

What you need to know about cosmetic procedures

A decade ago, a trip to the spa might have included a pedicure, a mud mask and a massage. But lately, that list of services might include aiming a laser at your excess hair or having your wrinkles smoothed with injections.

Medical spas, or medspas, are popping up around the Twin Cities, offering less-invasive alternatives to plastic surgery. As the procedures continue to grow in popularity, mainstream spas also are adding Botox, chemical peels, and other services to their menus.

A patchwork of agencies oversee the quality of services offered at a typical medspa, and experts say consumers should educate themselves about the procedures and check the license of their provider.

"Consumers need to be proactive to ensure the services they're getting are being performed properly," says Gina Stauss Fast, executive director of the Minnesota Board of Cosmetologist Examiners. "Find out what license they hold, what they're licensed to do."

Despite the proliferation of medspas, and the addition of medical services to typical salons, purveyors say the market isn't yet saturated. Consumers, especially women—and at younger ages—are fighting the onset of wrinkles and sunspots like never before. And why not? Newer procedures no longer require weeks of recovery or general anesthesia.

"More people under the age of 30 are definitely doing it," says Elizabeth Dehn, who writes about all things beauty at and has started her own skin care line. "There's always been this desire in our culture to be perfect. If you're 22 and you think something is wrong, you might go in and think you can solve it."


At Belladerm MedSpa in Maple Grove, cushy leather chairs surround a soft rug and a wooden coffee table. A glass-block wall separates the waiting area from the reception desk, where a wall fountain welcomes customers.

Exam and consulting rooms are painted warm colors, and are adorned with artwork and floral arrangements. There are also carts with lasers, and in the cupboards, syringes for use with prescription medication.

Belladerm opened in late 2005, and managing director Robin Bernens says business has been brisk, even at the height of the economic downturn.

"I thought for sure higher-end services like Botox would fall off, but it didn't," Bernens says. "I think it's kind of like coloring your hair. Once you don't see the gray, it's harder to look at it."

Botox injections run several hundred dollars, depending on the number of injections, and last three to four months.

At Begin With Your Skin Medspa in Eagan, owner Angela Bastien offers laser treatments in a small, tastefully decorated office. Bastien, like most medspas, also sells makeup and several skin care lines.

Besides laser hair removal, she offers laser treatments for the face, including facials and photo rejuvenation, a treatment for sun damage and sunspots.

"More people are definitely seeking noninvasive options," Bastien says. "And they're starting younger."

Stephanie Rowh, 40, of Hastings started with laser hair removal at Bastien's spa three years ago, but has since had laser vein therapy and laser genesis, a type of laser facial.

"The more I did with her, the more interested I got in the other services she did," Rowh says. "I've done six treatments of laser genesis. I went to my 20th class reunion this year and I can't tell you how many people commented on how good I looked, how good my skin looked, and how young I looked."

She's offered to help pay for laser hair removal for her niece, who has inherited Rowh's bushy leg hair. Her niece is 13. "Had I known about it 20 years ago, I for sure would have done it," Rowh says. "Why make her suffer?"


Last year, U.S. residents spent more than $1 billion on Botox treatments, a 12 percent rise over 2009, according to the American Society of Plastic Surgeons.

All minimally invasive treatments— which include such things as Botox, laser hair removal, and soft tissue fillers—were up 14 percent last year over 2009.

And though the majority of minimally invasive cosmetic procedures are still performed on women ages 40 to 54, the rate among men and younger women is rising. Men now make up 9 percent of all cosmetic procedures, according to the society.

Although the number of medspas seems to be increasing, local providers don't seem worried about the competition. "In this economy, everyone is struggling," Bastien says. "But women still want to look good, look pretty. I think the pie is so big that there are enough slices for everyone."

That pie, in fact, has expanded to include more traditional spas. Lifetime Fitness has been offering Botox, chemical peels, and laser services at its LifeSpas for about a year and a half, says Judy Kozlicki, national medspa manager for Lifetime Fitness.

"It's the fastest growing business within Lifetime," Kozlicki says. "It's a huge growth pattern, and it's seen a lot of success, and we are definitely adding more." The company has added medspa services to 16 locations in 16 months.

Twin Cities salon and spa giant Spalon Montage also recently added medspa services. In August the company announced a partnership with dermatologist Douglas Gervais of Carillon Clinic. All Twin Cities locations now offer Botox and fillers administered by licensed registered nurses "within the comfort of Spalon's stunning and relaxing treatment rooms."

In Minnesota, the number of newly licensed estheticians trained to offer facials, peels, and other skin treatments, increased from 91 in 2005 to 228 in 2010, according to the Minnesota Board of Cosmetologist Examiners.


Though a relaxing spa setting might put you at ease while receiving Botox or a chemical peel, others say it's more important to use an experienced provider.

At Zel Skin and Laser Specialists in Edina, director Susan Olson says, Brian Zelickson, MD, reviews the charts of all patients. Though medspas are required to have a medical director, not all doctors are at a spa daily, or even weekly, Olson says.

"A lot of places have a medical director who comes in every two weeks to pick up his check," Olson says. "It's buyer be educated."

Though a doctor's office might feel a bit more clinical than some medspas, Olson says the level of care is what counts. She says some of her patients have learned the hard way.

Fargo model Stephanie Astrup, who often works in the Twin Cities, says she prefers a more medical setting for riskier procedures.

The 38-year-old went to a dermatology office for a laser peel. "It's your face of all things," Astrup says. "You don't want somebody messing with your face."

It's also your money. Rowh found Bastien after plunking down $4,500 at another medspa in advance, only to have the spa close its doors without notice before she could receive the services she paid for.

Bastien offered a discount on services after hearing Rowh's story. I would say don't pay up front," Rowh says.


What you should do up front is educate yourself on treatments and how they're regulated.

Estheticians are licensed by the cosmetologist examiners board. But Botox falls under a physician's individual license, and Botox and other injectable fillers are regulated by the U.S. Food and Drug Administration.

Concerned that consumers might be duped by providers trying to seem more educated than they are, the state board of cosmetologist examiners earlier this year issued a statement clarifying that the agency does not offer a license for a "medical esthetician."

The statement reads, in part: "The Board is concerned that the use of the term 'medical esthetician' may be misleading, inaccurate, and deceptive to the public and specifically those receiving services. Specifically, consumers may be misled to believe that a 'medical esthetician' has some type of advance medical training that has been licensed, registered, or sanctioned by the state of Minnesota."

Estheticians, under current state law, must undergo at least 600 hours of training. But the board is considering implementing a two-tier licensing system, Strauss says, under which more hours of training might be required for more specialized procedures like chemical peels.

Several medspas and estheticians in Minnesota have been cited for operating without proper licenses and other infractions, according to Stauss-Fast.

The FDA last year cracked down on medpas and clinics for making false or misleading claims about a procedure called lipodissolve. Injections of drugs were intended to dissolve and permanently remove pockets of fat.

But the FDA says the treatment's effectiveness had not been proven, and consumers had been reporting side effects, including scarring and skin deformation.


Doing your homework can be difficult when no one wants to admit what they've had done. Mainstream as cosmetic procedures might be, those who receive them are still not eager to talk about it, say providers and consumers alike.

Astrup, the model, says she and her colleagues don't compare notes. "It's still a hush-hush thing," she says. "The Botox and filler stuff is something people keep quiet. It is really common; I know people who probably have had it but won't talk about it."

Bernens, of Belladerm, estimates 80 percent of her clients don't tell people they've been there. "Everyone wants everyone else to believe they have excellent genetics," Bernens says.

She adds, Botox, especially, has gotten a bad rap. "It's a wonderful product," Bernens says. "The results, if done correctly, are very subtle."

Popular Procedures

Botox: Prescription medication is injected into muscles to improve the look of moderate to severe frown lines between the eyebrows for three to four months. Botox generally should be administered by a doctor or a nurse under a doctor's supervision, experts say.

Dermal Fillers: Cehmical or natural collagen is injected under the skin to plump it up, reducing the appearance of fine lines and wrinkles or enhancing lips for six to 18 months. These fillers include Restylane, Perlane, Juvederm, and Radiesse.

Liquid Face Life: A combination of injections, usually including Botox and some dermal fillers, that encompasses the entire face. Results last nine to 18 months.

Chemical Peel: A chemical solution smooths the texture of skin by removing its damaged outer layers, which helps reduce blemishes, wrinkles, and uneven skin pigmentation.

Micro-Dermabrasion: Tiny, rough grains remove the top layers of the skin to treat sun damage, age spots, acne scarring,a nd pigmentation problems. Experts recommend six reatments for full results.

Laser Hair Removal: Laser treatments use focused light that removes unwanted hair without harming the surrounding skin. The light is absorbed by the hair follicles, slowing growth of new hair. At least six treatments are required for full results.