A med spa physician supervision study in Las Vegas put a number on something owners usually discuss in generalities: when a patient has a complication, who gets told? Of 63 medical spas that answered a caller's questions, 46% said they notify a medical director or supervising physician.

The paper, by Rawaa M. Almukhtar, Alyx Rosen Aigen, Jameson Loyal and Vineet Mishra, was published in Dermatologic Surgery in October 2024 (citation and link below). We read the full text. It was funded by the American Society for Dermatologic Surgery, a physician society that also holds the article's copyright, and its conclusion says "improved regulations" of med spa procedures are needed.

How the survey worked

Almukhtar and her co-authors searched Google, Facebook and Yelp for medical spas in the Las Vegas area and found 114. Seventy-three met their criteria: a working phone number, active providers and the procedures of interest. A prospective patient then phoned each one between July and September 2023, working from a script the authors wrote, and staff responses were recorded.

Sixty-three of those spas performed injectables and were analysed. Everything below is what staff told a caller, not what an inspector or a chart review found.

What the callers were told

Nonphysicians performed the injectable treatments at 73% of the spas. The paper's first figure breaks that down by spa: a nurse was the injector at 31.7%, a physician at 27% and a nurse practitioner at 23.8%, with small shares for physician assistants and mixed teams.

An on-site physician supervised or personally performed cosmetic procedures at 38.1% of the spas.

Consultations were rarer still: a supervising physician was available for one in person at 25.4%. Then there is specialty. Among the supervising physicians identified, 21.4% were board certified in dermatology or plastic surgery. The specialty table lists 28 physicians, led by internal medicine with 10 and family medicine with nine; five were plastic surgeons and one was a dermatologist.

On complications, the paper reports that "only 46% of surveyed medical spas notify a medical director/supervising physician" when a patient has a complication or an unwanted side effect. The authors also checked websites and social media accounts and said it was unclear who performs the treatment at 62.5% of the spas.

One figure we can't report cleanly

The paper contradicts itself on after-hours contact. Its abstract says "only 39.7% of surveyed spas had a number to call after regular business hours." Its results section says 39.7% "had no number to call." The discussion repeats the abstract's version. Those are opposite findings and the text doesn't settle it, so we treat neither as the result.

There is a smaller wrinkle in the treatment mix. The paper says neuromodulator injections were performed at 83.6% of spas, dermal fillers at 78.1% and deoxycholic acid at 65.8%. By our arithmetic those percentages work out to whole numbers of spas only against the 73 contacted, not the 63 analysed. The authors don't say which base they used.

Limits

The authors name one limitation: the study covers Las Vegas only, so "nationwide conclusions are difficult to determine." They chose the city, they write, because it has one of the highest ratios of medical spas to aesthetic physicians in the country.

Other limits are ours to point out, not theirs. The paper describes a prospective patient phoning the spas and does not say whether any was called more than once. Nor does it say who at the spa answered, or whether a receptionist's account of the escalation policy matches what the spa does. And 63 is a small sample; each spa is worth about 1.6 percentage points.

For an owner

The study stops at description. What follows is our analysis, not the authors'.

Nevada's statute on fillers, NRS 629.086, lists who may inject them: physicians, physician assistants, registered nurses and advanced practice registered nurses, plus dentists and podiatric physicians with prescribed training. The section adds scope-of-practice and location conditions. So a registered nurse injecting filler in a Las Vegas spa is on the statute's list, and the 73% figure is not, on its face, evidence of anyone breaking that rule. Other states draw the lines differently. Check your own board's rules with counsel.

The 46% figure is the one that travels. It describes what a new patient hears when she asks a reasonable question on the phone. A spa may well have a sound escalation policy and a front desk that can't describe it. To a caller, and to a researcher with a script, those two spas sound the same.

That is a training gap an owner can close without changing anything clinical. The paper was funded by a physician society and ends by asking for improved regulations. Expect to see it cited when supervision comes up.

Sources