Posted By Administration,
Thursday, January 3, 2019
By Patrick O’Brien, J.D., Legal Coordinator for the American Med Spa Association
Dermaplaning over the last couple of years has become one of the most popular procedures offered in medical spas. There are, however, differing opinions on who may do the procedure and whether or not it is medical in nature. Let’s take a brief look at how different states treat dermaplaning and some consideration if you plan to offer dermaplaning in your medical spa.
Before we dive into the details let’s do an overview of what is dermaplaning. Dermaplaning is a form of mechanical exfoliation. It typically involves a bladed instrument (often a #10 scalpel) used to scrape off the dead layer of skin and small hairs from a person’s face. The patient is left with more vibrant and even looking skin. In that respect it is similar to microdermabrasion treatments in that it should only remove the stratum corneum (outermost layer of skin).
Dermaplaning has the added benefit of have much lower equipment costs since it needs only a scalpel to perform as opposed to more elaborate machinery. This difference in equipment can complicate who may perform the procedure, as we will see later.
Since the procedure is intended to only effect the stratum corneum layer of the skin and not any lower it would seem that estheticians or cosmetologists would be able to perform these procedures as part of their practice of beautifying and enhancement of skin that we find in many state’s statutes. This is the case in Ohio were dermaplaning is permitted provided it only removes the cells from the top layer of skin. Dermaplaning (or using a blade) that removes skin cells below the stratum corneum is specifically listed as a prohibited act in the Ohio Board of Cosmetology rules. Tennessee likewise prohibits any type of skin removal technique that effects the living layer of facial skin. Minnesota allows their master estheticians perform treatments on the epidermal layer which is a deeper level than the stratum corneum and so they are allowed to dermaplane.
The depth of a few skin cells can seem like a very narrow margin between what is permitted or prohibited. Other states such as California have come down on the other side line and consider it a strictly medical procedure. In their rules California not only specifically lists “exfoliation below the epidermis” as an “Invasive Procedures” but also consider the removal of skin by a razor-edged tool to also be “invasive.” Illinois similarly prohibits cosmetologists and estheticians from performing dermaplaning and instead consider it a medical procedure. Likewise, South Dakota prohibits estheticians and cosmetologists from performing “invasive” procedures and specifically counts dermaplaning among them in an advisory statement. And in Montana’s administrative rules they define “dermaplane” as being performed by a physician.
Stay tuned for part 2 of “Dermaplaning: Surgery or a Close Shave?” tomorrow!
Posted By Administration,
Thursday, December 27, 2018
There were a lot of great things AmSpa put out in 2018! Here are a few blog posts, podcasts and webinars you may have missed:
Some of our Favorite Blog Posts
3 Tips for Opening a Medical Spa
In our first blog of the year, AmSpa CEO Alex Thiersch went over three tips for opening a medical spa.
There’s more to how to open a medical spa than just being an excellent medical aesthetic practitioner. Of course that is important, but there are basic business and legal compliance steps you also need to take to make sure you are successful in the long term.
In this popular #medspalaw blog post, ByrdAdatto lawyer Renee Coover, JD, defines the med spa law terms you NEED to know.
In order to protect yourself and your business from exposure to problems such as these, you should familiarize yourself with the nature of the industry and some issues that are commonly faced by medical spa owners and operators. The specific rules and regulations that govern medical spas may be a bit difficult to pin down, but ignorance is never an acceptable excuse.
Medical Spa Bad Press: Coming to Terms with Compliance
In this more recent blog post, Alex goes over compliance and bad press, and how to make sure your med spa is on the right side of the law.
The days of the medical spa industry being the “wild west” are likely coming to an end. So if your practice is not entirely compliant with your state’s medical statutes, it is certainly in your best interest to identify the ways in which it falls short and address them as soon as possible.
Episode 12: What Does the FDA Alert Regarding Feminine Rejuvenation Mean for Medical Spas?
In this podcast episode, Alex sits down with ByrdAdatto partner, Jay Reyero, JD, to discuss the FDA alert regarding vaginal rejuvenation.
Recently the US Food and Drug Administration issued a warning to several major device manufacturers about the marketing of vaginal rejuvenation devices. The notice clarified that the scope of FDA clearance on the machines only covered certain procedures, not including vaginal rejuvenation.
Jay Reyero, JD, partner at the law firm of ByrdAdatto weighs in on what this notice might mean for medical spa practices, and the steps owners and practitioners should take in light of the warning.
Episode 15: Making Money Solely On Injectables: The Smith & Popov Blueprint
In this episode, Alex interviews Danielle Smith, co-founder of Smith & Popov, to learn how she created her successful practice with only injectables.
One chair, one injector, and a successful medical spa practice. Danielle Smith of Miami's Smith & Popov talks through how she built her business model, the most important metrics she tracks, and how she stays lean, efficient, and profitable to break the myth that you can't make money on injectables.
Posted By Administration,
Wednesday, December 26, 2018
Updated: Friday, December 21, 2018
2018 was an amazing year for AmSpa, and we're so glad to have had you all with us.
The Medical Spa Show 2018
Turns out, first time is the charm! Our first annual Medical Spa Show, held at the Aria Resort & Casino in Las Vegas, was a rousing success. With over 400 attendees and 50 exhibitors, the premier conference and trade show for non-invasive aesthetics proved the need for a show for med spas, by med spas. We can’t wait to show you what we’ve made even better for MSS 2019, February 8-10, 2019, see you there!
Next! Level 2018
Held in sunny Maui, Hawaii, the 2018 Next! Level Leadership event offered education for successful medical spa and medical aesthetic professionals who need help getting to the next level in their business and careers. Topics covered included managing assets and profits; franchising; how to develop partnerships and investments; expanding your medical spa’s footprint; developing an exit strategy and so much more. Watch your inboxes for more information!
2018 Boot Camps
Wow! As fast as the medical spa industry is growing, so did our boot camps! Held in seven cities across the country, AmSpa LOVED meeting med spa professionals like you from all over the United States! This year, AmSpa Boot Camps offered two days of education on med spa law, consultations, marketing your med spa, financing, and more! Interested in attending a 2019 Boot Camp? Click here to see if we’re visiting a city near you!
And check back tomorrow, when we go over the best webinars, blogs and podcasts you may have missed!
Posted By Administration,
Thursday, December 20, 2018
By Alex R. Thiersch, CEO of the American Med Spa Association (AmSpa)
The recent medical spa related arrests in the Houston, Texas area (see here and here) have raised many questions and concerns in the Texas medical spa community. What is a licensed vocational nurse’s role in a medical spa? What are they able to do? How do I not go to jail? Fortunately, the Texas Board of Nursing (BON) provides some helpful guidance and resources on this issue that we will explore below.
Scope of practice
The Texas BON does not maintain lists of approved procedures that LVNs may perform. So don’t expect answers to specific treatment questions like, “Can an LVN inject Botox?” Instead, they provide some guidelines that an LVN may use to determine if a particular procedure is within their scope of practice. The scope of practice guidelines are available in full here. It is broken into six steps, which are:
(1)Determine if particular procedure is within the statutory definition of “vocational nursing” or if it is covered in a guidance document. Of note anything that requires an LVN to make a medical diagnosis or prescribe a treatment will never be within an LVN’s scope of practice
(2)Determine if there a valid order or protocol authorizing the procedure. LVNs do not practice independently so everything they do must be authorized by a higher level license.
(3)The procedure must be supported by medical evidence.
(4)The LVN must personally have the competency and skill to perform the procedure. This competency must be documented by and acquired from their basic, post-basic, or continuing education program.
(5)The procedure must be within the accepted “standard of care” that a similarly trained and experienced LVN would find reasonable and prudent.
(6)And finally the LVN must be willing to accept the consequences of their actions.
The LVN must be able to answer each of these six points in the affirmative for a procedure to be within their scope of practice. In order for a LVN to be able to expand their scope of practice to include new procedures they will need to acquire the competency and skill through an education program. Position Statement 15.10 highlights some limitations of this additional education. The Board believes that informal and on the job training is useful for expanding a nurse’s competency and skills. However only formal education and a higher level of license would allow a nurse to expand their scope past the statutory limits placed on vocational nursing.
LVNs do not – and cannot – practice independently. LVNs operate under the supervision of a higher medical licensee, such as an RN, APRN, physician, or physician’s assistant. Both the Board of Nursing and the Board of Medicine provide guidance on what supervision LVNs need when performing procedures outside the normal scope of vocational nursing.
The Board of Nursing provides Position Statement 15.11 on Delegated Medical Acts . The statement details that a LVN (or RN) may perform a delegated medical act when they (1) have appropriate education and are competent to perform the act (2) their education and skills are documented (3) there are written policies, procedures, or practice guidelines for the act (4) the procedure was ordered by licensed practitioner, and (5) there is appropriate medical and nursing support. The Statement however stresses that the nurse is still expected to adhere to the Standards of Nursing Practice no matter if they are performing a nursing function or a delegated medical act. And that neither RNs nor LVNs are permitted to make medical diagnoses or prescribe “therapeutic or corrective measures”.
These general rules with some additional requirements apply to laser procedures as detailed in Position Statement 15.9. To perform non-ablative laser treatments the LVN/RN must acquire education in safety and use of lasers for medical purposes and document it in their personal record. Further the procedures must have been ordered by a physician, podiatrist, dentist, or a APRN or physician assistant working in collaboration with the prior stated licensees. Since treating adverse reactions will be outside the nurse’s scope there must also be sufficient medical and nursing support. And the nurse will need to comply with any additional requirements from the Texas Dept. of Licensing and Regulation for laser hair removal, if any apply to their situation.
The Board of Medicine has adopted an administrative rule for the supervision of nonsurgical medical cosmetic procedures known as Rule §193.17 . We’ve reviewed Rule 193.17 previously here. It is written as the set of rules a physician must adhere to in providing sufficient supervision and delegation for these procedures. It stresses that it is the physician or midlevel practitioner who performs the initial examination, makes the diagnosis, and develops the treatment plan.
Although the practice of nursing (including licensed vocational nursing) does not include diagnosing or forming courses of treatment, every licensed nurse is required to apply their nursing knowledge in all practice settings in order to fulfill their responsibility to provide safe, effective nursing care to the patient. This duty is detailed in the Board of Nursing’s Position Statement 15.14. In the statement the Board stresses that protocols, policies, and supervisor orders do not surmount the nurse’s duty to act in the best interests of the patient and provide safe and effective nursing care. According to Position Statement 15.15 this duty applies whether the nurse is performing traditional nursing functions or functioning in a different role.
Licensed Vocational Nurses can be useful and valuable members of a medical spa team. But the LVN license does not have the same scope and authority of midlevel licensees such and physician’s assistants or advanced practice registered nurses. It is critical that the limitations of their license be considered when directing them to perform any delegated medical procedures in the spa. Above you can see that there are numerous considerations for performing any type of procedure, the major points being neither LVNs nor RNs are permitted to make medical diagnoses or prescribe courses of treatment. Additionally, RNs and LVNs must have documented training, education, and written protocols in whatever task they are going to perform and at all times are responsible for providing effective nursing care. The Texas Board of Nursing provides many other FAQs on nursing practice and Position Statements that may prove helpful in developing protocols and supervision arrangements for LVNs in Texas medical spas.
Posted By Administration,
Wednesday, December 19, 2018
By Terri Ross, Founder of Terri Ross Consulting
The front office is often a patient’s first glimpse into the workings of a practice or medical spa, and if a patient has a positive experience with your front office staff, it sets the stage for a positive experience overall. As with any business, effective communication in the medical aesthetic office or medical spa is key. The first interaction you have with potential patients is often a phone call. Front desk staff should be trained on how to begin and execute a productive and engaging phone call. In their interactions with patients, front office staff should strive to be enthusiastic, knowledgeable and engaging.
7 Steps to a Positive First Impression:
1. Be Enthusiastic, Engaging, Confident.
A positive attitude is infectious and an important element of success in any business. Convey a positive attitude; speak and articulate information with confidence and engage the patient in dialogue to ensure you have gathered all of the facts about them and what they are requesting. This will set you apart significantly from others practices that invest in training their staff.
2. Listen first.
Listen to prospective patients—assess their needs and desires before pitching a service or treatment. Strive to make a genuine connection with each patient. You want to “land the patient.” See TSIA’s explanation of the LAER (Land-Adopt-Renew-Expand) model here. The LAER Model that I teach stands for Listen, Acknowledge, Explore, Respond. Most often, people tend to Listen and Respond without really understanding patient needs. Explore more details, show empathy and acknowledge that you fully understand what the patient is telling you.
3. Ask Questions.
Your ability to connect, ask questions, and engage with potential patients is critical. The medical aesthetics space is very competitive, and consumers are far more educated and have numerous resources to explore. They also have many choices. So your ability to articulate with conviction by credentialing the business, the medical providers, and knowing the products and treatments you offer over the competition is paramount to a prospective patient wanting to schedule with you instead of another office.
4. Never say “no!"
If a patient asks if you offer Ulthera and you don’t, never say “no” or you’ve lost them. Instead, say: “May I ask who is calling? Hi [patient name], so you are interested in skin-tightening is that correct?” In order to start this conversation, you must know your technology and your competition, and be able to effectively convince them why what you offer is equally as good, if not better, than another option. More importantly, your knowledge and skill-set will make them want to schedule with you. If that doesn’t work, ask if you can follow up with them.
5. Respond to patient needs in a timely fashion.
If a patient calls or e mails with a question or need, make a point to respond immediately, within 1 to 3 hours or 24 hours at the very latest. There are several different types of patient inquiries and one of them is NEW LEADS. This is critical, because they are shopping around, but haven’t yet decided on your practice. Current patients are the ones that know you, trust you, and already have a relationship with you. However, communications with current patients are equally as important as this helps to establish patient retention. If a patient asks a question you don’t immediately know the answer to, respond that you are searching for the answer and will get back to them as soon as possible. This lets them know that they are important.
6. Be the expert.
It is essential for your front office team to know every product and service offered in your office. They need to do their homework. They need to know every treatment: what it does, what it’s used for, and how it can be incorporated into a personalized treatment plan. By knowing the services and how they compare to your competitors, the patient is engaged and it makes them feel they have landed at the right office or medical spa.
7. Go beyond what is expected.
In attitude, knowledge, and service, go beyond the patient’s general expectations. Make sure the patient has a positive experience from start to finish. Are you the Four Seasons or the Marriott
Posted By Administration,
Tuesday, December 18, 2018
Sponsored Content: CareCredit
The holiday season is upon us and your clients will want to end the year on a positive note by treating themselves to aesthetics services to help ensure they look and feel their best. Take advantage of this period by offering specials and promotions that tie to the holiday season. Follow these simple tips and experience success throughout the season and beyond, well into the New Year.
1.Offer the most popular treatments of the season:
First, monitor trending treatments and maintenance procedures to best serve your clients and help them achieve the healthy, well-rested and refreshed looks they desire. Capitalize on popular wash and wear treatments, which can be done in a lunch hour or before and after work. Head-to-toe skincare and minimally invasive body refinement services are also hot through December, ensuring clients look their best as they head from one holiday party to the next.
2.Introduce new treatments that provided added value: The holiday season is a great time to launch new treatments and therapies designed provide multiple benefits. Facial treatments, for example, can grouped together as exclusive “add-on’s” to offer greater value and benefits. Promote these offerings via social media and e-blasts so your clients are in the know. With new treatments that address more of their concerns, your clients will be more likely to book extended versions of each treatment during their next visit.
3.Give your clients the gift of a dedicated payment option with promotional financing options: While many of your clients may want to take advantage of seasonal treatments, they may not have a strategy in place for how to pay for their aesthetic services. Help them by offering a payment option like the CareCredit credit card. With promotional financing options* including no interest if paid in full within 6, 12, 18 or 24 months** your clients can purchase and enjoy all the treatments and promotions the season has to offer without dipping into their holiday gift giving budgets.
CareCredit works with more than 210,000 provider and retail locations across a broad range of specialties including medical care, beauty, dental, optometry, hearing and veterinary services. With CareCredit’s 11 million cardholders, spa and med spa businesses can get connected to a new client base, while providing optimal service for current clients.
Visit carecredit.com/beauty now to learn more and enroll so you too can offer your clients CareCredit as a preferred payment option.
*Subject to approval. Minimum payments required.
**No interest will be charged on the promotional purchase if you pay the promotional purchase amount in full within the 6, 12, 18, or 24-month promotional period. If you do not, interest will be charged on the promotional purchase from the purchase date. If your purchase qualifies for a 24-month promotional offer, fixed monthly payments are required equal to 4.1667% of initial promotional purchase amount until promotion is paid in full. The fixed monthly payment will be rounded up to the next highest whole dollar and may be higher than the minimum payment that would be required if the purchase was a non-promotional purchase. For all other promotional offers, the regular minimum monthly payment terms of the account will apply. Regular account terms apply to non-promotional purchases and, after promotion ends, to promotional balance, except the fixed monthly payment will apply until the promotion is paid in full. For new accounts, Purchase APR (interest rate) is 26.99%. Minimum Interest Charge is $2. Existing cardholders should see their credit card agreements for their applicable terms. Subject to credit approval.
Posted By Administration,
Friday, December 14, 2018
The American Med Spa Association (AmSpa) is working hard to put the finishing touches on planning for The Medical Spa Show, the premier trade show for non-invasive medical aesthetics, which will take place February 8 - 10, 2019, at the Aria Resort and Casino in Las Vegas. AmSpa has developed a very strong agenda that offers real insight into cutting-edge treatments, including microblading, new techniques in fillers and Botox, platelet-rich plasma (PRP), stem cells, and more.
It is very important to note that The Medical Spa Show’s room block at the Aria is very close to being full, so if you are planning to attend and wish to take advantage of the special rate we are offering in conjunction with the resort, you need to register for the conference and reserve your room very soon. The room block will sell out, and we want to make sure everybody who wants to stay at the Aria gets the chance. Click here to register for the conference; upon registration, you will receive information about the room block.
Also, the expo hall is completely sold out. It has sold much quicker than we ever could have anticipated. The Medical Spa Show is welcoming an incredible array of exhibitors from all different verticals in the industry, from injectables to lasers to digital marketing, and everything in between. Learn about all the latest trends and opportunities available to the medical aesthetics industry on our show floor. Check out the list of exhibitors here.
Thank you to everybody who already has registered to attend. The entire AmSpa team is very excited to present the best show in the country for medical spas. We can’t wait to see everybody there!
Posted By Administration,
Thursday, December 13, 2018
Updated: Friday, December 14, 2018
Take a tour through Windermere Dental & Medical Spa, located in sunny Orlando, Florida.
Maegen Kennedy, PA-C, shares the success of her medical spa and highly regarded microblading training in this member spotlight feature.
Windermere Dental & Medical Spa is a popular destination for not only injectables and microblading, but also general and cosmetic dentistry.
Maegen attended the Orlando AmSpa Boot Camp in November 2018 to speak on the social media panel. She will also be teaching an all-day microblading training session at The Medical Spa Show on February 7, 2019, at the Aria Resort & Casino. For more information on training, click here.
To visit Windermere Dental & Medical Spa’s website, click here.
Posted By Administration,
Tuesday, December 11, 2018
By Alex R. Thiersch, CEO of the American Med Spa Association (AmSpa)
Aquagold Fine Touch is a channeling device offered for sale by Aquavit Pharmaceuticals that has become extremely popular in the medical aesthetics industry. It delivers micro-droplets of a variety of drugs—typically including Botox and other toxins, as well as fillers—into the skin. What’s more, its manufacturer claims the treatments it provides are pain-free.
Unlike a typical Botox treatment, in which the drug is directly injected and paralyzes the muscle, an Aquagold Fine Touch treatment is essentially microneedling. It delivers tiny amounts of the drug with which it is loaded over a wide area—much wider than a Botox treatment can manage. It is suitable for sensitive areas where Botox is impractical or impossible, such as the neck, and because the doses are much smaller than typical toxin treatments, it tends to result in skin that looks more natural and vibrant. Patients who wish to avoid the “frozen” look that Botox and other toxins often produce are embracing this technology.
As is typically the case when such a product emerges, we at AmSpa are getting a ton of questions about who can actually perform Aquagold Fine Touch procedures. The treatment appears to be very straightforward—a provider simply applies the device to the skin like a stamp. Its simplicity raises an obvious question: Can an esthetician or licensed vocational nurse (LVN) perform this procedure?
It’s good that we’re getting these questions because it shows that medical spa owners and operators care about remaining compliant, but because technology moves faster than the law, it’s sometimes difficult to determine what the answers are when new technology emerges. However, we can use what we know about similar treatments and technologies to determine the most prudent course of action until government agencies make their rulings.
Simply put, the Aquagold Fine Touch is essentially a microneedling device, so a lot of the issues we’ve addressed in recent years regarding microneedling are likely also going to apply to it. Every state that has looked into microneedling has found it to be a medical treatment, so a good-faith exam must be performed before the procedure, and if a doctor is not administering the treatment him- or herself, it must be properly delegated.
Unfortunately for practices that would like to use unlicensed practitioners to perform Aquagold Fine Touch procedures, this takes them out of the scopes of practice for estheticians and LVNs. In addition, the fact that Botox and fillers are being administered raises the question of whether or not this represents an injection and, therefore, if it can be administered only by a registered nurse or, in some cases, a nurse practitioner, physician assistant or physician.
The only conclusion we can draw with any sort of certainty is that Aquagold Fine Touch will be regulated in much the same way as microneedling, both in terms of medical board rulings and FDA approval, which has become a bit of a sticking point for microneedling products recently. Additionally, mixing different drugs together, as many doctors do with the Aquagold Fine Touch device, may represent a violation of pharmaceutical regulations, as many IV bars are finding out. Does a practice need to be registered as a pharmacy and have pharmaceutical oversight? Can nurses do it? Can LPNs? Who is qualified, capable and allowed to do this under the law?
Unfortunately, I don’t have all these answers at the moment, but I am going to find out, so stay tuned to AmSpa for more about Aquagold Fine Touch treatments. Thus far, it has been very safe and very well received, but the industry needs to have a firmer grasp on the regulatory issues surrounding it.
Posted By Administration,
Monday, December 10, 2018
By Michael S. Byrd, JD, Partner, ByrdAdatto
Unless you’ve been living under a rock, you may have noticed the increasing number of medical spas and aesthetic practices popping up in areas across the country. Similarly, the variety of non-invasive cosmetic procedures are continuing to attract ― and now contract ― bodies into its facilities.
Using high-intensity focused electromagnetic energy, or HIFU, Emsculpt is the newest non-invasive aesthetic procedure in the body contouring market. It induces supramaximal muscle contractions to burn fat and strengthen abdomen and buttocks muscles in weeks instead of the months it would take to get the same or similar results in the gym, or with the alternative butt-lift.
Emsculpt, and similar non-invasive procedures, are commonly referred to as “cosmetic” procedures which may suggest that the procedures are different from other medical treatments; but as names can mean almost nothing, so do many states that broadly define what constitutes the practice of medicine and medical treatments. In other words, states couldn’t care less about the attractive name of your business ― if it operates like a medical facility, employs like a medical facility and treats physical conditions like a medical facility, then it’s a medical facility.
Emsculpt, as is the consistent case with Coolsculpting and SculpSure, will be considered the practice of medicine and constitute a medical treatment in most states. Although the law and enforcement of the law lag behind advances in technology, the various states generally look to see what happens to the body with the treatment. For example, Coolsculpting causes changes in the body to eliminate fat; Microneedling stimulates collagen production. Both of these treatments are routinely considered the practice of medicine.
If Emsculpt is indeed the practice of medicine, this can legally impact who can own a business that provides Emsculpt. Virginia and California are two examples of states that broadly define the practice of medicine and that would characterize Emsculpt the practice of medicine; however, Virginia allows anyone to own a business that practices medicine, while California’s ownership laws are more restrictive. These state specific nuances are just as important when determining who can and cannot perform the procedure.
Compliance is not stagnate; rather it is a moving target that changes as the laws, technology, and providers change. For more information and state law guidance on Emsculpt or other aesthetic procedures, please contact ByrdAdatto. AmSpa members receive a complimentary 15-20 minute annual compliance consultation call.
Michael S. Byrd , JD, is a partner with the law firm of ByrdAdatto. With his background as both a litigator and transactional attorney, Michael brings a comprehensive perspective to business and health care issues. He has been named to Texas Rising Stars and Texas Super Lawyers, published by Thompson Reuters, for multiple years (2009-2016) and recognized as a Best Lawyer in Dallas by D Magazine (2013, 2016).