By Alex R. Thiersch, Founder and Director of the American Med Spa Association

Determining the distinction between medical and non-medical treatments is perhaps the defining issue of the medical aesthetic industry and, in many cases, that distinction is not as clear-cut as all involved would like it to be—what's legal in one state might not be in another, for example. (AmSpa members can check their medical aesthetic legal summary to find this information.)

Medical spas, unlike most plastic surgeons' offices and traditional doctors' offices, make a lot of their money from offering non-medical treatments—such as facials, chemical peels, and aesthetician services—in addition to medical services. In fact, aesthetician services typically are among the top three treatments offered by most medical spas according to the AmSpa 2017 Medical Spa State of the Industry Survey. Many people begin their experience with a medical spa by partaking of these non-medical treatments before moving on to more invasive solutions so, needless to say, these services can be extremely valuable to a medical aesthetic business.

It is extremely important for employees of a medical spa to understand which procedures they perform are medical in nature so that they can approach them accordingly. If an aesthetician can perform a procedure by him- or herself, costs are much lower and margins are likely much higher; when you move into the medical realm, however, you must involve a physician, nurse practitioner, or physician assistant, and you must follow medical protocol and regulations. Costs go up, record-keeping requirements are far greater, patient privacy becomes an issue, and on and on.

For more information on proper medical spa procedures see AmSpa's webinars on supervision and delegation, patient-charting requirements, and much more.

Some general guidelines can help determine what is and is not a medical procedure.

Baseline Rule

The baseline rule is that anything that impacts living tissue is considered medical. Generally speaking, if you're doing something that goes beneath the outer dead layers of skin—known as the stratum corneum—you can assume that you are engaging in the practice of medicine.

Exceptions

However, there are some exceptions to this rule. In several states, laser hair removal is the subject of certifications and rules that place it at least adjacent to the medical realm, despite the fact that it does not penetrate the skin.

Additionally, microneedling, one of the trendiest procedures in the business, has been determined to be medical in nature by all the regulatory agencies that have looked at it, despite the fact that in many cases, the needles are set to a depth that does not actually penetrate the stratum corneum. Regardless, the fact that metal needles are the tools being used makes this a medical procedure in the eyes of the law in many cases.

Finally, subdermal fat-removing treatments, such as SculpSure and CoolSculpting, which don't involve any sort of conventional laser use or invasiveness, still should be considered medical, even though the matter hasn't as yet been widely investigated by state boards. There is very little doubt in my mind that as soon as an influential state board looks at them, it will determine these treatments to be medical in nature because they affect living tissue; therefore, you must observe medical protocol when performing them.