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"Our patients were the ones who encouraged us to do this," says Alice Hunt, a registered nurse with the group. "We listened to our population [the group also has offices in New Haven, Cheshire, Branford and Milford] and what their needs are." High on the list were hair removal, sclerotherapy for spider veins, skin care and massage, says Hunt, noting that clients range in age from 13 to their mid-70s. The medical staff floats between the two affiliates; for example, Hunt might assist a woman with an infertility treatment and see her later for a cosmetic procedure.
Mirroring a trend nationwide, the distinction between health, medicine and beauty is blurring across Connecticut. Dentists and physicians have become providers of services traditionally considered the bailiwick of spas or cosmetic surgery centers, and spas in turn are offering a menu of medical procedures. The marriage between science and aesthetics takes many forms, resulting in full-fledged medical and dental spas in some places and an array of kinder, gentler practices in others.
A twist on the ever-expanding spa scene, medical spas deliver clinical procedures as well as traditional spa treatments under one roof and under medical supervision. At Turquoise Medical Day Spa in Fairfield, for example, you can have a massage, temporarily fill out furrows and wrinkles with Botox, or undergo laser treatments to remove spider veins, hair or age spots.
Three years ago, there were perhaps 450 such spas nationwide; today there are closer to 1,500, with the majority near major metropolitan areas, according to Hannelore R. Leavy, founder and executive director of the 4-year-old International Medical Spa Association and 15-year-old Day Spa Association in Union City, N.J.
"People want to stay beautiful, vital and young-looking all over the United States," says Leavy. Indeed, the youth-obsessed Baby Boomer generation has both the desire for rejuvenation and the means to pay for the procedures that promise it. The continuing development of high-tech anti-aging treatments is feeding that demand, and doctors have been eager to sign on, perhaps because many services are fee-paid outside the realm of insurance.
Turquoise is run by Dr. Lawrence Fliegelman, a plastic surgeon, and Dr. Richard Levin, an otolaryngologist, who maintain a medical practice across the way. They opened the spa last fall, involving themselves in every detail down to the cosmetics (mineral-based) and skin products offered. "We not only work here but own the place, so we have a vested interest," says Fliegelman. About 30 percent of the procedures the doctors perform are clinical; they "can't be in two places at once," he says. Conventional medicine is dispensed at one address, spa medicine at the other.
As more medical spas open, you might wonder if there is room in the industry for both types. "Absolutely," says Leavy. "Spa services have become mainstream. Many people think they are a necessity."
Some in the business are less certain. Less than a block from Turquoise is the Spa at the Brick Walk, which has been servicing clients for more than a decade. Because of that, Al Dee, business manager, doesn't view Turquoise as a serious threat. As he sees it, doctors have begun competing on the pampering side because they can't earn enough on medical procedures alone. "We've been here long enough that it doesn't bother us, but it may affect others who are less established," he says.
The owner of the new Spa of Essex isn't worried, though. "My vision is more customer-service-related, a place to renew," says owner Joyce Cosenza Drew, a former nursing home administrator. "Everyone's life is so crazy. I wanted an atmosphere that is relaxing and I don't know that you can get that in a medispa-they are more sterile," says Drew, whose 10,000-square-foot spa is set to open June 1. Her vision is one of elegance, wellness and beauty from the inside out.
Spas have always had a therapeutic component, says Leavy, likening a facial to a wellness rather than a beauty treatment. "It's a matter of health maintenance," she adds. Indeed, many nonmedical spas offer wellness components such as yoga and Pilates. Tranquility Mind & Body Wellness Spa in Milford is a holistic spa offering individualized healing therapies, including Reiki. In Westport, the Energy Spa at Kismet also promotes holistic health and healing arts like Qi Gong.
"Qi Gong brings your chakras into alignment," says owner Tamson Bickford Hamrock, who learned about alternative therapies while living in Asia for seven years. "By working on crazy things like your ovaries," she says, "you can make your face come alive." Massage here is "working on the meridians," she adds.
The Spa at the Brick Walk has had doctors offer to provide Botox injections and such to its clientele, but Dee has declined. "We prefer being strictly a day spa, offering a quiet, serene ambience where people can forget their problems for an hour or two," he says. Botox is a fad, he believes, adding, "I don't think it's good to have botulism organisms injected into one's face." He also sees the high cost of Botox treatments ($400 at Turquoise) as a deterrent; his facials, which cost $85 to $125, are priced, he says, so clients can afford to come back monthly.
Others see a wide-open field for expansion, and entrepreneurs have begun looking to franchise medical (and dental) spas. In Arizona and California, medical spas are already commonplace. "Out West, people know exactly what you're talking about when you say 'medical spa.' Here, people don't know the difference between the two," says Sue Delco, spa manager at Turquoise.
While most Turquoise clients are women, men come in too, typically for laser hair removal of the lower back, massages or facials; teenagers come for facials and spray-tanning, businesswomen for facials or massages. "It's really a broad range," says Delco. "It's not all mothers at home with kids. Some couples come in together and sign up for back-to-back treatments. Some people go out for dinner, others go to a spa. For a lot of people, going to a spa is becoming a way of life."
While cosmetic procedures have been slower to catch on in the East, they are now being embraced, with a variety of new treatments available for women (and men) who want a little something but nothing as radical as plastic surgery. "A lot of research is going toward noninvasive rejuvenation techniques as alternatives to cosmetic surgery," says Hunt. "A face-lift lasts under five years and not everyone has a great outcome. The technology and the products have changed dramatically. People want to tighten and tone with no downtime."
Besides Botox, options for dealing with an aging face include collagen and Restylane, both injectable fillers; Sculptra, a treatment for HIV patients expected to win approval for mainstream use this year; and fat grafting, whereby fat deposits are moved from one area of the body to the face.
As is often the case with new technology, questions arise as to who is qualified to administer treatment. "Botox can cause some pretty severe reactions," says Wendy Furniss, branch chief in health-care systems for the state Department of Public Health. "One should have the appropriate experience and training."
Injected correctly, Botox, a protein that relaxes the muscles that create frown lines, temporarily smoothes the skin, with results lasting about four months, says Dr. Sohol Islam, a cosmetic and plastic surgeon at Advanced Cosmetic & Plastic Surgery in Ridgefield. Injected incorrectly or in the wrong place, it can cause "lid lag" (a droopy eyelid) or other cosmetic "deformities," he says. Also, infections can result if the skin isn't cleaned properly. "If something goes wrong on your face, everyone will know it," he notes. Similarly, a laser in the wrong hands can burn the skin.
For these reasons, Islam believes only board-certified plastic surgeons should perform these procedures, as they "have been trained to work with the face in three dimensions," he explains. "Rather than taking a short course on facial injectables or reading a manual, a plastic surgery residency requires six to eight years to understand the complex connection between exterior [skin] and interior systems [underlying anatomy]." And, he adds, if you need a face-lift but the technician does only cosmetic treatments, you won't get the results you're hoping for.
In Connecticut, certain laser procedures and Botox injections can be administered only by a physician, or a physician's assistant or advanced-practice registered nurse if the physician is on the premises. (Hair removal involves a lower-level laser and can be performed by RNs.) It's not enough for doctors to lend their names to a treatment center, or even to work in an affiliate office. "You can't have a PA at a spa in Norwich and the doctor at another office in Hartford," explains Furniss.
For now, the Department of Public Health has no plans to revise its statutes, which cover the scope of practice within given professions, not specific treatments. However, as medical cosmetic services grow, she expects issues may arise. "There's great interest in these treatments. The department's role is to make sure that whatever service is offered is done by capable people, so the public is protected," she says.
Concurring with the need for safety, Leavy of the International Medical Spa Association advises patrons of medical spas to bone up on licensing requirements beforehand and make sure the service provider they've chosen has the proper credentials. "It's the same as choosing a doctor. You want to know who this person is, where he or she studied and what he or she trained in, especially if we are talking about laser treatments or injections," she says.
Dental offices reflect the convergence of medicine, beauty and pampering too. Instead of white-knuckling the arm of the dentist's chair, patients at Aesthetic Smiles of Connecticut in Fairfield can relax with a paraffin treatment and chair massage during their appointment. They also receive a moist hot towel for freshening their face and hands and a bottle of water as they depart.
"We do it all," says Jeano Renzulli, office manager and dental assistant. "We're trying to make it spalike. We want to get the patient's mind off what we're doing." To that end, they also provide 3-D goggles and a movie menu with over 100 selections, and coffee in the reception area.
Cosmetic dentistry tends to be more time-consuming than conventional fill-or-pull practices, and dentists look for ways to reduce patient anxiety, says Dr. Martin Zase of Colchester, one of three dentists in the Colchester Dental Group and president of the American Academy of Cosmetic Dentistry. "It's not unusual to work on 10 or more teeth at once," he says, with single appointments sometimes stretching over an entire morning or afternoon. Premedicating patients, seating them in a heated, vibrating chair, providing sunglasses to reduce the glare from the dentist's lights, offering a choice of CDs and supplying a soft blanket-these little extras might be considered "spa dentistry," but they are really just a set of additional services added to a dental practice to foster relaxation, according to Zase.
"We are seeing that people are looking at a whole-body experience in all branches of medicine rather than just focusing on one area, and dentistry is no exception," he adds. "We've eliminated the pain. Dealing with the anxiety is now a bigger focus," says this dentist, who wears a Hawaiian shirt to work because he feels some people are frightened by clinical garb. "We wouldn't call it spa dentistry, but you're not likely to see it in an insurance-driven practice," he notes.
Cosmetic dentistry, the beauty side of the profession, is a natural outgrowth of advances in general dentistry. As fluoridation and other preventive measures have cut down on tooth decay, a greater proportion of dental work has come to involve cosmetic work, including that due to disfigurement or accident. Now, some dentists say whitening and porcelain veneers are their most requested services, and at least a few are looking to expand that aspect of their practice.
The demand is there, they say. At the Center for Esthetic Dentistry in New Haven, an all-female practice run by Dr. Nancy Summer Lerch, whitening and porcelain veneers are the most requested services. The staff provides extras such as paraffin hand wax treatments and aromatherapy for patients with lengthy appointments. Under consideration is a move to a larger location to allow for expanded cosmetic and spa services. "It's a nice concept to have Botox or massage in the same location. In the middle of a five-hour appointment, how nice would it be to have a chair massage?"asks Marianne Driscoll, office administrator.
Today, major dental advances likely fall within cosmetic dentistry. A new prewhitening agent (from GRINrx), to be introduced this month, is expected to revolutionize that process, says Dr. Zase. Comparing it to the prewash stain remover Shout, he says it is applied before whitening and reduces the time and sensitivity involved. It will mark a huge change, he predicts.
Dentists, doctors and spa managers share similar goals: to enhance comfort and self-esteem. As Alice Hunt of Madison's Shoreline Medical Aesthetics Center says, "It's about women feeling good about themselves. You've got to care about yourself if you're going to be good for someone else." Excess hair or visible veins often create embarrassment and limit clothing choices. "We treat women who have never worn V-necks because of hair between their breasts, or never worn shorts because of their veins," she says. Now at the end of the day, she often thinks, "I made someone feel good today."
