Top 10 Medi-Spa Modalities
By David Suzuki
published in Les Nouvelles Esthetiques July 2004

non-invasive and minimally invasive procedures

Maybe it’s just me, but the thought of going to a doctor or hospital makes me cringe. Most people would rather visit a less stressful place than doctors' intimidating offices. As a result, the medi-spa, which has experienced a 133 percent growth in the last five years, has become increasingly popular in our industry and among consumers who want the procedures but not the jitters of white-coat syndrome. These spas are specifically designed to place clients at ease as they specialize in minimally invasive or non-invasive cosmetic procedures.

What makes a spa "medi" is that its scope includes minimally invasive services administered by a physician like Botox, collagen and the recently FDA-approved Restylane. (These injectables are among the fastest- growing services-boasting nearly 4 million procedures in 2003.)

The synergy between non-invasive device procedures and minimally invasive injectables is, without a doubt, fantastic. The relationship between them is so strong that one would think that each was developed with the other in mind. In addition, there are no known contraindications regarding using the two categories of procedures parallel with one another. In fact, it is becoming more common than ever to combine injectables and non-invasive device procedures during one visit.

The following top-l0 list compiles the opinions of some of the nation's top plastic surgeons, medi-spa owners and traditional spa owners on today's most popular non-invasive and minimally invasive treatments. In addition, the list explains if and when they can be used in synergy in the medi-spa. All of these modalities are anti-aging, results-ori- erited and scientifically supported.

1. Microdermabrasion
The vacuum stimulation alone from microdermabrasion has been known to stimulate blood circulation and collagen production. A treatment will remove the top layer of the skin and promote new collagen and regrowth of younger-looking skin. Furrows and expression aging are eased, reducing the visual appearance of aging. Microdermabrasion is especially good for under the eyes and crow's- feet. Specialty treatments with microder mabrasion can be performed in minutes and should be prorated accordingly. Microdermabrasion not only began the revolution of device-driven, non-invasive cosmetic procedures nearly 10 years ago, it has maintained its position as the most popular non-invasive, device-driven cosmetic procedure offered today with a whopping 50 percent increase from 2000 to 2001, according to the American Society of Aesthetic Plastic Surgeons.

Average cost: $95 to $175

Performed in series: Yes, typically six treatments with a 10-day gap between services.

Stand-alone service: Yes, however, as microdermabrasion does its most substantial work from the outside in, it is important to consider combining it with microcurrent, which works from the inside out to contour and sculpt underlying tissues.

Maintenance: After a complete series, one treatment every six weeks is required for maximum upkeep.

2. Botox
Botox is a form of botulinum toxin type poison. It is injected into contracted muscle-- to cause muscle paralysis or rapid relaxation of "wrinkles in motion” It treats "expression aging;” most commonly referred to as frown lines, forehead wrinkles and crow’s feet. Usually, the skin's surface is lightly numbed with a topical anesthesia or ice prior to the injections. A localized area may consist of as many as four to six injections. The results become apparent within a few days. Botox was noted as the fastest-growing, minimally invasive, injectable cosmetic procedure of 2003 and has single-handedly brought the concept of injectables mainstream.

Average cost: $200 to $300 per area.

Performed in a series: Not applicable.

Stand-alone service: Yes, however, keep in mind that the customer in need of Botox is usually older than 35 and may need other filler injections as well as microcurrent full facial sculpting.

Maintenance: Every four to six months.

3. Microcurrent
Microcurrent is a low level of electrical current that works in harmony with the body to increase the natural levels of ATP (adenosine triphosphate--cellular energy stores). Studies at the University of Washington indicate a 48 percent increase in elastin, 14 percent increase in collagen and 37 percent increase in blood circulation in just 20 days. Additionally, microcurrent has the ability to sculpt and lift facial muscles, raise eyebrows, relax deep-set expression lines and fill crow's-feet. Microcurrent also helps products penetrate up to 70 percent more effectively, which offers instant results under the eye and crow's-feet areas, creating a smoother, firmer, wrinkle-free appearance. Microcurrent has been touted for its dramatic anti-aging benefits. Specialty treatments can usually be performed in 10 to 15 minutes and should be prorated accordingly.

Average cost: $95 to $175.

Performed in a series: Yes, typically seven to 10, 45-minute treatments, twice weekly.

Stand alone service: Yes, however, customers over 35 should also consider injectables such as Botox and/or Restylane. For those in fear of needles, you can combine microcurrent with microdermabrasion for optimum results.

Maintenance: After a complete series, one treatment every six weeks is required for maximum upkeep.

4. Collagen
Collagen is the compound that gives skin a supple, firm, full appearance. It is most commonly injected for the reduction of facial wrinkles and lip plumping. Prior to injections, the skin's surface is numbed with a topical anesthesia. A localized treatment may consist of as many as six to 12 injections. The treatment is not as quick as Botox and can also be painful for some individuals. As with all injectables, the results are seen quickly and the downtime is not more than a day. Until recently, most collagen used for injections was bovine (cow); however, it is becoming increasingly popular to consider human collagen and synthetic products such as Restylane--both of which are more expensive.

Average cost: $350 to $ 450 (bovine collagen).

Performed in a series: Not applicable

Stand-alone service: Yes it is suggested to combine this treatment with Botox. Usually, customers who partake in injectables are prime candidates for other anti-aging treatments that help stimulate the body’s natural production of collagen and elastin, such as light therapy, microdermabrasion or microcurrent.

Maintenance: Every three to six months.

5. Vacuum massage
Vacuum massage is exactly what it sounds like. It's for the treatment of cellulite. The operator's handpiece is usually equipped with rollers that help manipulate and break down the cellulite once it is aspirated into the mouth of the handpiece. The intense invigoration also helps stimulate blood circulation, lymphatic flow and natural collagen production-all of which help enhance the body's contour and greatly minimize the appearance of cellulite. Vacuum massage produces results, however, it is not for extremely overweight clients. Treatments combined with body wraps or that are supplemental to a new diet, fitness program or liposuction are most successful. Because of the sharp contrast of the invasive liposuction procedure, vacuum massage has quickly become the leading alternative and treatment of choice for the reduction of the appearance of cellulite and body contouring.

Average cost: $85 to $140.

Performed in a series: Yes, typically eight to 16 treatments, twice weekly.

Stand-alone service: Yes, however, it is an excellent treatment to combine with body wraps.

Maintenance: After a complete series, one treatment every two to four weeks is required for maximum upkeep.

6. Restylane
Although in the same "filler" category as collagen, Restylane demands its own category, as it is literally the talk of the town. Restylane is made of hyaluronic acid, a substance that already exists in the body. It is the most popular new non-collagen based product to be approved by the FDA as an alternative to collagen. Since it does not contain animal protein (these days it's formulated in a lab, even though it was initially extracted from rooster combs), it does not usually require a skin test prior to treatment. Restylane is more expensive than collagen; however, it also lasts nearly twice as long- six to 12 months.

Early statistics show an overwhelming preference and high expectation for Restylane.

Average cost: $450 to $550.

Performed in a series: Not applicable.

Stand-alone service: Yes, however, it is suggested to combine this treatment with Botox. As stated previously, customers who partake in injectables are prime candidates for other anti-aging treatments that help stimulate the body's own natural production of collagen and elastin.

Maintenance: Every six to 12 months.

7. Peels
Although the concept of a ('peel" is long- standing and traditional, the new wave of product technology is genuinely outstanding ranging from AHAs to enzyme/protein combinations. Peels are popular and are almost always combined with modality treatments. Many of the progressive systems are performed in a series with specific home care. Most peels generally are marketed at less than $100, however, it is not unusual to see specialty peels ranging upward of $500.

Average cost: $50 to $200.

Performed in a series: Specialty peels only.

Stand-alone service: Most commonly combined with microdermabrasion, microcurrent or light therapy.

Maintenance: Varies greatly depending on the system and type of peel.

8. Light therapy
Intense pulsed light (IPL) and light emitting diode (LED) therapies have been reported to increase the production of natural collagen and the level of blood circulation. The light therapy uses multiple wavelengths of light energy to create heat in the dermis, which then stimulates cellular activity to form collagen.

Specialty treatments can be incorporated in as little as 10 to 20 minutes and should be prorated accordingly. Results from light therapy are typically delayed 60 to 180 days as it takes time for collagen to form and accumulate.

Average cost: $75 to $300.

Performed in a series: Yes. Typically four to eight, 45- minute treatments, once every 10 to 20 days.

Stand-alone service: Because of the delay in results and lack of sensation, it is suggested to combine this service with something instantly gratifying such as microdermabrasion or micro current.

Maintenance: Varies, depending on modality.

9. Oxygen therapy
Oxygen therapy is another increasingly popular technology with many different applications ranging from inhaling nearly pure oxygen, blowing oxygen over the skin at close range, to "injecting" it forcefully through pressurized systems.

The fascination of oxygen therapy is relative to its continuing demand in the market place, and it has positioned itself as one of the leading add-on services in spas and salons nationwide. Similar to1ight therapy, there is not a significant sensation or immediate visual difference after a treatment is performed. With this in mind, it is advisable to always combine this treatment with other services.

Average cost: $15 to $90.

Performed in a series: Not applicable.

Stand-alone service: It should be combined with other services.

Maintenance: Not applicable.

10. Fat harvesting
Fat harvesting is just what it sounds like-harvesting fat! This process is the most invasive on our top-10 list: and requires a physician to extract the patient's fat, usually from the inner thigh or buttocks area, and transplant it via injections into the areas of concern in the facial area.

In almost all cases, harvested fat is used as an alternative to other fillers such as collagen or Restylane. Its attraction is in its lasting effect, as well as the fact that the patient is using his or her own body fat as the filler.

Average cost: $1000 to $1200 initial harvesting and injections.

Performed in a series: Not applicable.

Stand-alone service: Yes. Customers are prime candidates for other anti-aging treatments such as light therapy, microdermabrasion or microcurrent.

Maintenance: Every 12 to 16 months.

Medi-merging
The statistics of client demand are clear. Clinical evidence has shown that there exists a synergy between these top-l0 modalities. As always, the key is highly educated clinical estheticians. These top-l0 items suggest that the next big wave in esthetics will be more medi-spas and mergers with things outside our industry, such as fitness programs, dietary supplements and cosmetic dentistry. If you have not incorporated products such as lip plumpers or teeth whiteners, or if you don't have a good, reciprocal relationship with a cosmetic dentist, now is the time to consider these options. Re-evaluate your current menu. Ensure that the scope of your business has a steady focus on the bottom line. High-tech anti-aging services are not only what today's knowledgeable clients are looking for, they consistently provide the highest profit return of any skin care service.

David Suzuki, vice president of Bio- Therapeutic, Inc., has been an active member of the esthetics and beauty industry for more than 16 years.