The Med Spa 911: Tips for When It’s Time to Pull in Your Physician


Estheticians who work in a medical spa are usually doing more aggressive procedures than those who don’t. Depending upon in which state you practice and your state board, these might include aggressive laser procedures, certain injections (i.e., kenalog, lidocaine), strong chemical peels etc. It is very important to have a clear understanding of what circumstances necessitate involving your medical director or physician.

Sooner Than Later

My No. 1 rule for the estheticians who work in my medical spa is to get me if they have any concerns or questions. I would much rather have them involve me too quickly than too slowly. For example, my staff is permitted to inject lidocaine into tattoos before performing laser tattoo removal.

"As a medical director, I would much rather the esthetician involve me too quickly than too slowly."

Most of them feel very comfortable with this, but some don’t want to inject into the neck area or the face. I would rather they let me do the injections than to do something they don’t feel confident and competent. 

Meeting Client Expectations

If a patient is not getting expected results from a series of treatments, the medical director should be involved. If there is little change in a client’s skin after a series of IPL treatments, I want to know. There may be a medication that I can prescribe that can augment the laser’s activity, or in reviewing the patient’s medical history and current meds, I might find something that is inhibiting their results.  

Sometimes, in reviewing the treatments the patient has received, I can make suggestions regarding the laser settings that the esthetician may not have thought about. 

Combating Side Effects

Your medical director should also become involved when any significant side effects occur. If any patient develops blisters, burns, hypopigmentation or hyperpigmentation after a procedure, the medical director needs to be made aware.

"Follow-up by the medical director can help the patient to feel more confident in his or her treatment and more assured that he or she is being taken good care of."

His or her involvement and awareness should always be documented in the patient’s chart. Follow-up by the medical director can help the patient to feel more confident in his or her treatment and more assured that he or she is being taken good care of.

Spotting Something Suspicious

My estheticians are trained to look for suspicious lesions on the face, neck and chest of any patient that they are treating and to come get me if they see anything that concerns them. Even though we are not a dermatology clinic, I feel it is best practice to do this for our patients.  If I agree that the lesion looks suspicious, I refer the patient to a dermatologist for a follow-up. 

If you work with a medical director and aren’t sure when they want to be involved, this is an important conversation to have from the beginning. Guidelines should be well defined and communicated, both in order to provide excellent care and for your professional liability protection. 

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