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Are Medspas The Walmarts of Esthetic Medicine?

Are Medspas The Walmarts of Esthetic Medicine?

Are Medspas The Walmarts of Esthetic Medicine?

When Should You Choose an Esthetic Physician Practice Instead of a Medspa?

Americans spent more than $14 billion on esthetic services in 2021,1 and Florida is currently home to 2,924 medical spas (also known as medspas).2 Medspas provide simple cosmetic medical treatments, and their number has exploded with the increasing demand for non-surgical esthetic treatments. The number of medspas has multiplied so fast that they now outnumber physician-based esthetic practices in 73% of US cities.3 However, most people aren’t aware of the differences between medspas and esthetic physician practices. In contrast to medspas, esthetic medical practices are staffed by at least one physician who directly provides treatments, nurse practitioners and/or physician assistants with advanced esthetic training and privileges, and aestheticians who can provide medical-level skincare.

So, when should someone choose a physician-based esthetic practice over a medspa?

According to Cynthia Elliott, MD, an esthetic physician and physician trainer who owns Skinspirations and ExpertEsthetics in Clearwater, FL, “Medspas are like Walmart. People are happy to shop at Walmart for the basics, but for higher quality purchases, they go elsewhere.”

Here are three reasons why a physician-based office may be the better choice for receiving esthetic medical treatments.


Unlike doctors’ offices or hospitals that are required to follow strict national and state-specific rules for medical professional qualifications, the regulations for medspas are left up to individual states. For example, in New Jersey, laser hair removal can only be done by a physician,4 while in New York, cosmetologists may perform the procedure.5

Medspas are required to have a physician medical director who is responsible for overseeing the medical aspects of the business, but in most states, the directors don’t ever have to physically step foot on the premises. In many medspas, none of the treatments are performed by a physician.

Even though many esthetic medical treatments are touted as “minimally invasive,” some can have severe complications. Blindness, strokes, and even deaths have been recorded when wrinkle-filling substances were accidentally injected into arteries.6 Burns from lasers can cause scarring and severe infections, which are a possibility with any treatment that penetrates the skin.

Some severe complications can be avoided with quick action, but treatment providers with less training than a physician may not have the knowledge or resources to manage problems in time to prevent permanent damage.

For cosmetic treatments that don’t penetrate the skin, like basic facials or massages, a medspa may be the perfect choice, but the more potential complications associated with a procedure, the more important it is for people to choose a physician for the treatment or at least have one present and available. A dermatologist is the safest choice for anyone with an underlying skin condition.

Quality of Results

If someone is interested in a pampering facial or a Botox “lip flip” where the worst possible outcome is no results, choosing a medspa for the treatment is a reasonable option. At the other extreme, the results of treatments like laser skin resurfacing or a “liquid facelift” are operator-dependent. Physicians with extensive experience are comfortable with choosing aggressive laser settings or even combining different devices or treatments to achieve the best possible results, whereas medspa employees are more likely to follow a conservative protocol and use a “cookie cutter” approach with a single device or treatment.

Better Treatment Options Potentially Available

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Sometimes, the best esthetic treatment options aren’t available in a medspa. For example, dermal filler treatments are usually available in a medspa, but a patient who would benefit more from a fat transfer won’t be given the choice. Likewise, medspas may only recommend non-invasive fat reduction treatments to a patient who’d get better results with liposuction.

Because esthetic lasers and devices are extremely expensive, it’s not uncommon for a medspa to only own one or two and promote them to treat concerns for which a different device would have been safer and/or more effective. For example, laser hair removal on dark skin using a laser made for light skin can cause blistering and permanent scarring.

Dr. Elliott advises anyone seeking more than simple esthetic treatments or skincare to go to a physician-based practice, even if it’s more expensive. She adds, “Would you go to a facility for heart surgery because they had a special? Your face deserves the best and safest results possible, so it’s up to you to do your homework.”

Skinspirations, owned and operated by Dr. Elliott, is an aesthetic and regenerative medical practice that provides advanced treatments with esthetic injectables, lasers and other devices, body contouring, and regenerative therapies for musculoskeletal problems and aesthetic concerns. Dr. Elliott has been practicing aesthetic medicine exclusively for 18 years and, prior to that, was a board-certified emergency physician for 15 years. She is also a nationally known trainer who teaches other doctors esthetic injectable and laser techniques. Skinspirations’ midlevel providers and other doctors have all been with the practice for at least seven years, and her aestheticians for at least 12 years, so they’re a very experienced, well-oiled team.

Visit Skinspirations on YouTube.

Cynthia Elliott, M.D., is the owner of Skinspirations, an esthetic and regenerative medical practice that also provides hands-on training to new esthetic clinicians. Located in Clearwater, Florida, Dr. Elliott is valued for her medical expertise and her training on the national level for the makers of Botox® Cosmetic and Juvéderm and internationally for Cutera Lasers. Her patients seek her expertise, knowing that she and her long-tenured staff have trained many professionals in the Tampa Bay area. Skinspirations has performed over 88,000 cosmetic medical treatments since 2005 and is known for the most effective aesthetic and regenerative medical treatments available, providing the quality results that other practitioners are still trying to learn. 


  1. Society, The Aesthetic. “The Aesthetic Society Releases Annual Statistics Revealing Significant Increases in Face, Breast and Body in 2021.” PR Newswire: Press Release Distribution, Targeting, Monitoring and Marketing, 11 Apr. 2022,
  2. “Number of Medical Spas in Florida: SmartScrapers.” SmartScraper, Accessed 8 Sept. 2023.
  3. Wang JV;Albornoz CA;Noell C;Friedman PM;Zachary CB;Saedi N; “Skewed Distribution of Medical Spas and Aesthetic Physician Practices: A Cross-Sectional Market Analysis.” Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.], U.S. National Library of Medicine,,unequal%20distribution%20of%20medical%20spas. Accessed 8 Sept. 2023.
  4. WestlakeDermatology. “Understanding Cosmetic Laser Treatment Safety Laws.” Westlake Dermatology & Cosmetic Surgery®, 12 Feb. 2020,,to%20licensed%20or%20unlicensed%20persons.%E2%80%9D.
  5. New York State Constitution – Department of State, Accessed 8 Sept. 2023.
  6. Sito, Giuseppe, et al. “Vascular Complications after Facial Filler Injection: A Literature Review and Meta-Analysis.” The Journal of Clinical and Aesthetic Dermatology, U.S. National Library of Medicine, June 2019,