A Merging Of Medicine And Spas

At a free evening reception at the Vita Spa in Roslyn, Helen Proimus nibbled finger sandwiches and chatted with other guests about the pleasure of pampering themselves. The sound system lulled them with the soothing music of a typical spa: "Reflections of Nature,"� Kenny G. and "Zen: The Art of Relaxation."� When Proimus settled in a private room in the back, though, she wasn"�t receiving a typical spa service - no facial or pedicure or massage. Instead, Dr. Karina Bibicheff, an internist who runs the business, projected a digital scan of Proimus's face onto a screen, throwing into high relief every imperfection that might go unnoticed in softer light.

Then Bibicheff recommended treatments usually available in doctors"� offices: Botox injections to ease wrinkles around the eyes, filler injections to plump up the lips and laser treatments to reduce the redness of broken capillaries in the cheeks.

Proimus headed home to consider her options. But she didn"�t give much thought to the novelty of getting those procedures in a spa environment instead of a medical office. "I like the decor,"� Proimus said.

"There is a doctor here. They aren"�t doing anything so severe that I"�d have to be worried about it."� Increasingly, clients like her seem comfortable at hybrid enterprises like the Vita Spa. Known as medspas or medispas, such businesses combine standard beauty treatments with medical interventions. It all takes place under the supervision of a physician, but in the setting of a spa.

Medspas satisfy the public's growing desire to do what it takes to look younger, preferably in posh surroundings. They also fulfill the desires of doctors who want to enhance their incomes with highprofit cosmetic procedures that don"�t involve dealings with insurance companies.

The idea emerged around 2002, when there were 25 medspas nationwide, according to Hannelore Levy, executive director of the International Medical Spa Association. Now she estimates that there are more than 2,000. "The growth has been tremendous,"� she said. Singing a familiar refrain, she added: "It's the baby boomers. They don"�t want to get old."� Twelve on LI On Long Island, at least 12 medspas have opened since 2002. Their clients lounge on satin pillows in candle-lit treatment rooms painted in restful shades of beige and taupe, receiving just about any cosmetic procedure short of surgery. Although prices vary, they pay fees in the neighborhood of $800 for 10 minutes of a variety of injections, $300 for 15 minutes of laser treatments like hair removal or $175 for an hour of microdermabrasion of the skin, according to Dana Caruso, founder and president of the Long Island Nail and Skin Care Institute, a school for aestheticians that also houses a medspa in Levittown.

"The day of the major facelift is kind of over and done with,"� said Caruso. "Now it's about doing sections or areas of the face in subtle ways, so that you don"�t get that blowing-in-the-wind, 75-mileper- hour look."� Medspa operators say an outpatient setting is appropriate for these increasingly popular treatments.

And popular they are. The number of nonsurgical cosmetic procedures in the United States increased from 1.1 million in 1997 to 9.5 million last year, according to the American Society for Aesthetic Plastic Surgery, while surgical procedures merely doubled, to 1.9 million. Botox injections led the way at 3.2 million, followed by filler injections, laser hair removal, microdermabrasion and laser skin resurfacing.

Scrutinize before choosing But the businesses are prompting debate over where and how clients receive such services.

Caruso warned, "Buyer beware. You see places popping up along major thoroughfares that have signs in the windows - laser hair removal. What does that mean? Is there a doctor supervising it?"� Dr. Alan Gold, a plastic surgeon who performs outpatient procedures in his Great Neck office, said that medspas may lead patients to take procedures too lightly. "I know people who will travel 30 miles to get their hair done,"� said Gold. "But they don"�t investigate these services in the same way, because they"�re being pushed as spa services and they appear very benign."� And Gold warned patients against unrealistic expectations. Perfectly airbrushed, wrinkle-free skin is rarely possible. "Some treatments are very effective,"� he said. "But it shouldn"�t be like the emperor's new clothes, when you"�re convinced that you look better, but everyone else is laughing behind your back."� Dr. Stephen Greenberg, a Woodbury plastic surgeon who serves as the medical director of Caruso's facility, expressed reservations as well. "The business of medspas is booming because everyone wants a piece of the cosmetic pie,"� he said.

Some such facilities encourage patients to try treatments that may not be appropriate, he said. For example, Greenberg said he would not use the digital facial scan offered at the Vita Spa and others, because he views it as a marketing tool, designed to show clients at their worst and convince them that they need intervention. "The companies that make this equipment emphasize how much money doctors can make from using it,"� he said.

Hope springs eternal in beauty and in business, so physicians and investors are jumping into the medspa market. Bibicheff opened the Vita Spa two years ago. Board-certified as an internist, she spent a year working and studying for a fellowship in geriatrics. She switched to cosmetic medicine, she said, because she realized "people who like the way they look live better."� Bibicheff said she uses the digital facial scan in her medspa because she shows clients a new one after treatment, so they can see the improvement. "It's more for later,"� she said, "not to scare them in the beginning."� Helen Proimus, an actress who lives in Dix Hills, seemed to be typical of the spa's customers: Female, over 40 and worried about the effects of sun damage on her skin. "I just want to make sure I don"�t look older than 30,"� she joked.

After looking at the digital scan of her face, her humor got darker. "My God, I"�m almost suicidal,"� she said. "I"�m going to need to win Lotto."� The doctor wasn"�t specific about the cost, but it was clear it would run more than a thousand dollars.

A businessman rather than a doctor opened the Bella Mi MedSpa in Plainview in September. Charles Guerriero, the managing director, worked on Wall Street for 30 years before deciding to start a business. "I looked at many things, but the thought of owning a Carvel franchise, or one of the many franchises that are out there, didn"�t seem mentally stimulating enough to me,"� he said.

Guerriero had noticed that the stocks of laser manufacturers were doing well, thanks to the rising interest in cosmetic procedures. He linked up with a company called Solana MedSpas, which advises medspa owners and takes a percentage of their revenues. A family practitioner joined him as medical director, mostly performing injections while physician's assistants perform other tasks.

The Long Island Nail and Skin Care Institute, the school that trains licensed aestheticians, has long operated a standard day spa on the premises. Three years ago, Greenberg, who practices plastic surgery in Woodbury, started providing medical services there. A client, Juliana Carambia of Dix Hills, said she hoped they would help her fend off the effects of age.

Only 22 years old, with pale, flawless porcelain skin, she nevertheless lay back on a gold chenille throw recently for a microdermabrasion treatment. An aesthetician rubbed a wand over Carambia's face, pummeling it with tiny crystals with the goal of exfoliating and preventing fine lines.

"I"�m trying to slow down the aging process now,"� said Carambia. "Just keeping up a regimen is important."� The treatment wasn"�t painful, she added. It gave her a sensation of slight scratching, like a baby drawing its fine nails across her face. Someday, Carambia said, she might consider Botox injections.

In the next treatment room, Greenberg inserted a needle right between the eyes of Deanna Thomas, 40, of North Massapequa. The skin swelled up briefly as the Botox liquid pooled, then slowly smoothed as it dispersed. Greenberg placed additional shots in her forehead and the crow's feet area next to her eyes.

"I don"�t really care what anyone else's opinion is,"� Thomas said as the doctor worked. "I do it for me."� Greenberg mopped up a tiny trickle of blood from above an eyebrow, but Thomas smiled and said she didn"�t view the procedure as particularly medical. "If you look in the mirror and you appear younger, it makes you feel younger,"� said the patient. "That, and a new pair of shoes.

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