Podcast: Beware of “Bargain Botox” and Sketchy Med Spas

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Not all med spas are created equal. Dr. James Koehler and Kirstin walk through how to spot a safe, physician-run med spa versus those “too good to be true” spots.

They explain the difference between traditional spas, medical spas, and those connected to surgical practices—where you benefit from having both non-surgical and surgical options under one roof. Dr. Koehler also shares what really goes on behind the scenes, from safety regulations to who should be doing your injections.

And when it comes to bargain Botox? He’s seen what can go wrong. His advice: if the price sounds too good to be true, it probably is.

Read more about the medical spa at Eastern Shore Cosmetic Surgery

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Transcript

Announcer (00:02):
You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis.

Kirstin (00:10):
Hey, Dr. Koehler.

Dr. Koehler (00:12):
Hey, Kirstin.

Kirstin (00:13):
Today we’re going to talk about med spas and med spa safety.

Dr. Koehler (00:19):
Okay.

Kirstin (00:20):
You’ve got a med spa here.

Dr. Koehler (00:21):
Yes, we do.

Kirstin (00:22):
We love it. Who is employed in Med Spa?

Dr. Koehler (00:25):
Staff love it.

Kirstin (00:26):
Staff love it. Yes, we do love it. Who works in our med spa?

Dr. Koehler (00:30):
Brittany Cheryl?

Kirstin (00:33):
Yes. Brittany and Cheryl. Brittany is our aesthetician. Cheryl is our laser safety officer and our nurse who works all the lasers.

Dr. Koehler (00:42):
Yes.

Kirstin (00:43):
First, let’s define and differentiate between a traditional spa and a med spa. What makes it a med spa?

Dr. Koehler (00:50):
Well, I would actually like to distinguish between a traditional spa, a med spa, and a med spa that is part of a surgical practice.

Kirstin (00:59):
Oh, okay.

Dr. Koehler (01:00):
I think there are kind of some differences there.

Kirstin (01:02):
Yeah. Okay.

Dr. Koehler (01:03):
So a traditional spa is like when you go to the Grand Hotel out here, you want to get a massage. They have different types of facials that you can have done. It’s really non-invasive treatments. They’re not dangerous. They’re safe. Anybody can have them done. I mean, it’s like getting pedicures and manicures and all of that kind of stuff. It’s usually a getaway to relax. Exactly. And have a glass of wine and whatever. That’s a traditional spa. A med spa is sort of similar because there are maybe certain treatments that would cross over. We do facials. Those are things obviously like maybe somebody’s got a wedding or an event or something. They just want their skin to be, have a nice glow, whatever. Those are safe, easy procedures that you would also find in a traditional spa. But the med spa also does more advanced things that can make maybe more significant changes to your skin.

(02:05):
So things like microneedling, radio frequency microneedling, chemical peels, lasers like for photo rejuvenation, lasers for hair removal, lasers to remove tattoos. And in some med spas. Also Botox fillers, thread lifts, which I’m not a fan of, but those are the kinds of things that you find in med spas. And then what about the ones that are in doctor’s offices, surgeon’s offices? And the only reason I would say that there’s a little bit of a distinction there is that they would be the exact same as a other medi spa, except for the big difference is when you have a surgeon in that practice that’s there. I think there’s sometimes a tendency in med spas that if you don’t offer a facelift, you’re going to be offering thread lifts to all your patients. And it’s only because that’s the only tool that you have in your toolbox if you don’t do facelifts.

(03:05):
And I’m not saying that, hey, if somebody wants a minimally invasive procedure, as long as they understand what this is going to do or not do for them. And again, I’m not a fan of it, but it’s out there in my practice. If somebody’s talking about that, my staff are going to be like, they’re going to educate them on what we can do and other things that we can offer. So same thing when you have something like CoolSculpting. Okay. Well, sometimes people would come in for a cool sculpting consult and it’s like, oh, you need a tummy tuck. Like you’ve got muscle separation, you’ve got this, you’ve got loose skin. So we’re not going to just offer them CoolSculpting because we know we have something that’s probably more appropriate for them. And that’s one of the differences from just an isolated med spa versus a med spa. That’s part of a surgical practice. And also from a surgical standpoint, I have people that I maybe do a facelift on, but then I’m like, Hey, you would benefit from maintenance, and so now we can send you to, and we’re here, and if they have any issues, I’m still here so I can talk to ’em.

Kirstin (04:04):
True. So what’s required in terms of credentials for a med spa?

Dr. Koehler (04:08):
Well, the med spa has to be a physician run facility, and there needs to be a medical director or somebody who’s overseeing it all. They need to be available. There’s all sorts of other little regulations, depending on if you’re doing lasers or not. There’s some requirements there. But yeah, the physician has to be a med spa, has a physician as part of it. And in this state, the physician needs to be immediately available, so they need to be on the premises.

Kirstin (04:35):
Yep. Are there certain treatments that you say should only ever be done under a doctor’s supervision?

Dr. Koehler (04:41):
Yeah, I think we’re in the process of changing here in Alabama. It used to be only physicians could inject things like Botox and fillers, and there’s some new changes coming along there that nurse practitioners would be able to do that under certain circumstances. There’s some regulations there, but it could happen. It is happening, but under the direction of a physician. And because although rare, there can be problems and those problems will need to be managed. Like I mentioned when we talked about maybe injecting filler in noses, which I’m not a fan of, but if you inject it into an artery, if you don’t recognize that or you don’t have somebody that knows how to take care of it and handle it, I mean, that’s where the physician part comes in and that they’re there to take responsibility for that and take care of that patient. So those would be two. I mean, if an office is doing something like thread lifting and it’s an advanced practitioner or the physician themselves, those are procedural things and they’re definitely, they’re low risk, but they’re not risk free. And so having a physician there to supervise that and make sure if there are issues that they can take care of that.

Kirstin (05:51):
Have you ever had to fix something that went wrong at one of those little pop-up places?

Dr. Koehler (05:56):
I mean, we’ve seen people that have had maybe not ideally done injectables and things, and either we dissolve it or have to do minor tweaks. And we’ve had to do that in the past, but fortunately it’s not super common.

Kirstin (06:13):
A lot of people go to less trustworthy, I guess, med spas because of pricing. What would you say to someone trying to save money but still wanting a safe experience?

Dr. Koehler (06:26):
I would always seriously question when the price is ridiculously low.

Kirstin (06:31):
Too good to be true.

Dr. Koehler (06:33):
If it’s too good to be true, it probably is. And there was actually recently, this happened recently, and I’m trying to remember. I think it was in Louisiana as a matter of fact. Yeah, there were a couple issues with Botox, and I remember this actually happened in Florida, but it was probably around maybe 2004 or five. There was people selling Botox that was research grade Botox to physicians at med spas and stuff like that. And they were getting it for dirt cheap, and they injected it on people. And these people ended up with botulism, like they full on diaphragm, paralyzed, intubated in the ICU? Yes, absolutely. What they were injecting was like a million times more potent than what we would be normally using for, it’s not the FDA approved Botox. Okay. So it’s kind of like the difference between maybe you drinking one of your white claws versus drinking a hundred percent pure alcohol.

Kirstin (07:32):
Rubbing alcohol.

Dr. Koehler (07:35):
Yeah. So anyhow, the point is a similar thing recently happened with some less, and usually it’s these low price places that are doing some stuff. And again, fortunately most people are doing things on the up and up, but I don’t know when it’s too low. I always question it. I mean, there’s something there.

Kirstin (07:54):
Yeah, any cautionary tales.

Dr. Koehler (07:57):
I mean, we kind of just talked about one, but I think you want to go to a facility that looks clean, is clean when you go in there, that people act professional, that you have qualified people, nurses, whatever, nurse practitioners know who’s treating you. And I think over time, people who do good work, the word gets out. So obviously I think for these types of things, referral from friends who like I’ve had great experiences. Those are good things.

Kirstin (08:30):
Very true. We’ve got a lot of repeat customers because of the great customer service that our girls give. And Dr. Koehler.

Dr. Koehler (08:37):
Thank you.

Kirstin (08:40):
Okay. Do you have a burning question for Dr. Koehler or me? You can leave us a voicemail on our podcast website at Alabamathebeautifulpodcast.com. We’d love to hear from you. Thanks, Dr. Koehler.

Dr. Koehler (08:52):
Thanks, Kirstin.

Kirstin (08:53):
Go back to making Alabama beautiful.

Dr. Koehler (08:55):
I’m on it.

Announcer (08:57):
Got a question for Dr. Koehler? Leave us a voicemail at Alabamathebeautifulpodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the beautiful on YouTube, apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis.