Times Staff Writer

YOU take care of the kids, the lawn, your mother-in-law. Pay the bills, help with laundry, get the car smogged. After a workday that would stagger Paul Bunyan, you fight the traffic, fix dinner, make sure homework gets done, kiss your spouse good night -- and fall into bed.

And that’s just Monday.

No wonder, then, that when you, the caretaker, actually get a vacation, you want to be taken care of.

Spas, an $11.1-billion industry, promise to do that for you. But are you getting your money’s worth when you sign up to be steamed, wrapped, pummeled and pampered with Baltic black mud, nightingale droppings and caviar? Even without the high-end therapies, the stress reduction can be pricey. Your day of delight can range from $50 or so to an hours-long splurge for hundreds.


Prices aren’t the only things that vary at the 12,000 spas in the U.S. There is no single watchdog agency overseeing spas, and regulation and licensing of practitioners are inconsistent from state to state and county to county.

Furthermore, it’s unlikely that the consumer knows the qualifications of the person giving a treatment. What, for example, is the difference between a massage therapist and a massage practitioner? What constitutes a medical spa, and how do you know whether the treatment will harm or help you?

Armed with the right questions and a willingness to ask them, consumers can benefit from a spa experience.

They may not find the fountain of youth, but they may have at least stumbled on the fountain of feeling better.

As travelers know, any hotel resort worth its sea salt now has a spa.

“It’s no longer acceptable to have a spot in the basement with one or two treadmills,” said Lynne Walker McNees, president of the Lexington, Ky.-based International Spa Assn.

Hotels and cruise ships have been busily adding spas since the late 1990s. Even the Connaught, the upper-class London hotel that prides itself on tradition, will turn part of a building next door into a spa as part of a $100-million renovation.

Closer to home, on Nov. 14 Caesars Palace will open Qua, a 50,000-square-foot spa with 51 treatment rooms, including a crystal-art room offering customized Swarovski body art.

More pampering

THERE are destination spas and day spas (see accompanying stories beginning on Page 1), club spas and mineral-springs spas, airport spas and spas catering to teens and tweens.

Along with pedicures, manicures, facials and massages, they offer reflexology, cellulite treatments, exfoliation scrubs and aromatherapy. And no longer is a massage just a massage, a facial just a facial. Variations include moonlight massages for two and rubdowns with diamond-infused oils.

Medical spas are claiming an increasing part of the market, offering services such as Botox, laser hair removal, acupuncture and teeth whitening.

The most popular spa treatment remains the massage, whether it is deep tissue, hot stone or another variation.

But how do clients know whether their masseuse has been fully trained?

For the most part, they don’t.

The state of California has no set requirements for the practice of massage, said Beverly May, government relations co-chair of the California chapter, American Massage Therapy Assn. Areas that are urban and more populous usually have local ordinances; requirements range from 70 to 1,000 hours of education in an accredited school.

Professionals such as cosmetologists are state-licensed, but massage therapists are not. Typically, local jurisdictions that regulate massage (including several cities in Orange and L.A. counties) require a massage permit besides a business license. Some require that therapists pass a test.

“In California,” May said, “there is no way for the client to know what a person means when they say they are certified, licensed, therapist, practitioner, master, body worker or anything else.

“In Redwood City [where she practices], 70 hours makes a massage technician or therapist, and in next-door Foster City, [it’s] 500 hours and an accredited national certification exam.”

A bill by state Sen. Liz Figueroa (D-Fremont) would have shifted regulation of massage therapy to a new private nonprofit agency funded by licensing fees and created two tiers -- massage practitioners (500 hours of training) and massage therapists (250 hours).

The bill, which failed in the Assembly in August, “would have been a start toward standardizing the titles,” May said. “Now, anything goes.”

Spa goers also need to be concerned with the cleanliness of facilities. In California, that is one job of the Board of Barbering and Cosmetology.

But the board, which conducts surprise on-site inspections, has only 18 inspectors for 38,000 cosmetology establishments -- or one inspector for every 2,111 establishments, said spokesman Kevin Flanagan.

Sanitation inspections are crucial.

Between 2000 and 2005, three outbreaks of bacterial infections affected about 300 clients of Northern California nail salons. Clients suffered skin lesions linked to improper cleaning and disinfection of whirlpool pedicure foot spas.

The culprit: mycobacterium, a hard-to-treat bug that thrives in water. The Centers for Disease Control and Prevention in Atlanta then tested whirlpool foot spas in 18 salons in four counties, including Orange, and found mycobacteria in 98%. “Potentially pathogenic mycobacteria are widespread in these foot spas across California,” it found, and the outbreaks should be a wake-up call.

The Board of Barbering and Cosmetology subsequently increased fines for foot-spa violations to $500 per chair, with a maximum $5,000 in fines per inspection, and set more stringent foot-spa cleaning procedures. In September, Gov. Arnold Schwarzenegger signed into law emergency legislation by Assemblyman Leland Yee (D-San Francisco) authorizing the board to place a licensee in violation on probation for a year, without a hearing, and to require the licensee to take remedial training in health and safety procedures.

For some, going to a health spa promises both pleasure and the hope of enhancing one’s looks. The number of medical spas has tripled in the last two years, and by some estimates, there are as many as 1,600 nationwide.

Such spas are under considerable scrutiny from the medical profession.

Dermatologists cite dangers of scarring, burning and disfigurement from laser and Botox treatments by non-physicians. Some spa operators oppose stricter regulation, saying dermatologists are simply protecting their turf.

So how safe are these treatments? The Food and Drug Administration oversees products and machines, but individual states determine who may give treatments and how much training is required for practitioners.

Dr. David Goldberg, of the Rolling Meadows, Ill.-based American Society for Dermatologic Surgery, said that few states properly regulate medical spas and that “there are states where pretty much anybody can do anything.” Goldberg, who is in private practice, is a faculty member at New York’s Mt. Sinai School of Medicine and a law professor at Fordham University, expects that, as medical spas proliferate, so will malpractice suits.

In California, the state medical board makes clear who may do what:

* Laser or intense-pulse-light treatments to remove hair, tattoos or spider veins may be given by physicians or by physician assistants and registered nurses under a doctor’s supervision. They may not be given by cosmetologists, electrologists or aestheticians.

* Botox injections may be given by physicians or by registered nurses, licensed vocational nurses or physician assistants under a doctor’s supervision.

* Microdermabrasion (skin cell removal affecting only the outermost skin layer) may be performed by a licensed cosmetologist or aesthetician. But treatments that penetrate more deeply, including wrinkle reduction, may be given only by a physician or by a registered nurse or physician assistant under a doctor’s supervision.

Med-spa supervision

THE medical board disciplines physicians and investigates possible criminal actions on their part, referring the latter to the appropriate district attorney. Candis Cohen, spokeswoman for the board, said it gets “very few” complaints about patient harm at med-spas -- fewer than half a dozen in the last year.

The definition of physician supervision at med-spas is a major issue.

A new Florida law limits the number of satellite offices (such as spas) a physician may have and specifies that only dermatologists and plastic surgeons may give certain treatments.

“All these bills are started by dermatologists who are trying to restrict trade, to say, ‘This is my turf,’ ” said John Buckingham, co-founder and chief executive of Irvine-based Solana MedSpas and a board member of the International Medical Spa Assn. (Unlike the Medical Spa Society, primarily an association of doctors, his group represents a wide segment of the industry, including spa investors.)

He agrees that better standards for training and monitoring are needed, but he said, “These are aesthetic, non-invasive or minimally invasive procedures with an incredibly low incidence of any problems. It’s not like a scalpel’s cutting you open.”

But Dr. Bruce Katz, a New York dermatologist who chairs the medical advisory board of the Medical Spa Society, said: “A lot of people are being burned and scarred.” Meanwhile, he said, some med-spas are paying doctors who may “show up once a month, if at all. And that supervising physician might be a psychiatrist.”

Choosing a spa, whether it’s for rejuvenation or something more serious, requires the spa-goer to do some investigation on his or her own.

The International Spa Assn.'s Walker McNees suggests that customers first consider their expectations. “If you want a spa where you can get a glass of wine and have treatments all day,” she said, “you’ll be disappointed if you end up at a spa that doesn’t offer alcohol and is focused on early-morning hikes and fitness classes throughout the day.”



What to expect from the experience

A spa visit, even for a facial or massage, can be intimidating. The International Spa Assn. offers clients these tips for increasing their comfort level:

* Indicate whether you want a male or female therapist.

* Ask whether gratuities are included. If they’re not, be sure to tip.

* Wear under your spa robe what’s comfortable for you.

* Don’t feel obligated or pressured to buy products.

* Ask about qualifications of the practitioners.

Prospective spa-goers wishing to check out a spa in this or another state or another country may contact the International Spa Assn. at (888) 651-4772 or to learn about member spas. The association has a complaint system through which consumers can find out if a member spa has been cited for violations of its ethics or standards.

For medical spas, Candis Cohen, spokeswoman for the International Spa Assn. board, has this advice:

* Don’t do anything on impulse. These are elective procedures.

* Ascertain that the spa is physician-owned, get the physician’s name and make sure his or her license is in good standing by contacting the medical board at (916) 263-2382 or going to

* Ask who will perform your procedure and inquire about that person’s qualifications, including by whom they are licensed. Then call the licensing agency (RNs, LVNs and physician assistants each have their own).

* Treat a medical spa procedure as you would any medical procedure. “I think some people tend not to take these cosmetic procedures as seriously as they should,” Cohen said.

If you have a med-spa complaint, call the board at (800) 633-2322.

-- Beverly Beyette