Who's Really Running Your Med Spa? (Probably No One)

Who's Really Running Your Med Spa? (Probably No One)

What if I told you the "medical" spa you're booking treatments at might not have a doctor anywhere near the building or even in the same state?

I recently spoke with a master esthetician I'm calling "Sarah" who walked away from a popular, successful med spa after just a few months. What she saw behind those treatment room doors made her physically uncomfortable coming to work.

This conversation confirmed some of my worst fears about what happens when business owners prioritize profit over patient safety, and I think every person considering aesthetic treatments needs to hear her story.

No Doctor, No Problem?

"Throughout the entire time she was there, she not once met or worked with a medical director. There were no physicians at the spa at all."
— Dr. Kate Dee, Medspa Mayhem Podcast

Here's what most people don't realize: a med spa is supposed to operate under a physician's license. That means a real doctor who's actually supervising treatments, reviewing protocols, and available to handle complications. But Sarah's experience shows how some facilities operate in a legal gray area or flat-out illegally.

At this particular spa, patients would book procedures without ever being examined by medical personnel. Sarah was repeatedly asked to perform treatments on people she'd never assessed, people who hadn't been cleared by anyone with medical training. She pushed back, but the message was clear: either do the procedures or find somewhere else to work.

Think about that for a second. You're paying hundreds or thousands of dollars for a medical treatment, and the person performing it has been told to skip the safety protocols that exist for a reason.

No proper assessment. No informed consent. No medical oversight.

On the MedSpa Mayhem podcast, you hear exactly how these spas structure themselves to appear legitimate while cutting every corner that matters for your safety.

The Bait and Switch

"HydraFacial is really well known and people will call and ask for HydraFacial by name. And so apparently this spa would run out of HydraFacial serums. And they were just using other serums or cutting corners and using stuff that they had in their back bar, and they would just not tell the patient that." — Dr. Kate Dee, Medspa Mayhem Podcast

Patients were calling specifically requesting HydraFacial treatments, a branded procedure with specific serums and a specific process. But when the spa ran out of the actual HydraFacial products, they'd just substitute whatever they had lying around and charge full price anyway.

Sarah was told to "just pretend it's the same." But it's not the same. That's like ordering a name-brand medication and getting a mystery pill from someone's medicine cabinet instead.

The same thing happened with their laser treatments. They had a Hollywood Spectra Laser that was partially broken. But they kept scheduling patients for the full treatment, charging full price, and Sarah was instructed to go ahead and use the broken equipment without telling anyone.

When she asked about it, the response was essentially "just do it anyway." No concern for the patient getting half a treatment. No concern for Sarah's professional reputation. Just get the money and move on to the next appointment.

I go deeper into how to verify you're actually getting what you paid for in the full episode, including specific questions to ask before any procedure.

The Price is... Negotiable?

"People would get different things and everything was negotiable. If you called the spa and you asked for the price of something and then you didn't book or didn't follow up, they would just say, 'whoa, whoa, wait, wait, wait,' and then cut the price in half."
— Dr. Kate Dee, Medspa Mayhem Podcast

I've actually experienced this myself when I was secretly shopping for laser devices years ago. I called a med spa, asked about pricing, thanked them politely, and before I could hang up they'd slashed their quote by 50%. It was like buying a used car, not receiving medical care.

Here's why this matters beyond just getting a good deal. When pricing is completely arbitrary and negotiable on the spot, it tells you something about how that business operates. Medical treatments have real costs, equipment, proper products, trained staff, insurance, safety protocols.

If a facility can instantly cut their prices in half just to close a sale, what else are they cutting?

Sarah even mentioned patients showing up drunk or high, and staff being told to perform procedures on them anyway. That's not just unprofessional, it's dangerous. You cannot give informed consent when you're intoxicated, and performing medical procedures under those circumstances puts everyone at risk.

The episode covers more examples of corner-cutting that should make any patient pause before booking.

Your Safety Guide

After hearing Sarah's story, I knew I had to record something practical that anyone could use before walking into a med spa. Listen to the full episode, hear me break down what to look for on websites, and the specific questions to ask during consultations. You'll also hear why Sarah was too afraid to speak publicly.

Plus, I share my number-one rule for protecting yourself as a patient. It's simple, it's free, and it works every single time.

[Listen to the full Medspa Mayhem episode here: ]

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The transcript

[00:00:00] Dr. Kate Dee: Hi, this is Dr. Kate d and today I'm sharing a story of a master esthetician who worked at a really successful, well-known medical spa. but what she saw behind the scenes will shock you and it made her leave that job in less than four months. You'll hear what really happens when there's no medical director, how treatments get cut short or faked.

[00:00:21] Dr. Kate Dee: Why patients sometimes are just put at risk. By the end, you'll know what the red flags are to look for when you're booking an appointment, and also [00:00:30] save hundreds if not thousands of dollars on pretend treatments, and hopefully not risk your life having them.

[00:00:36] Dr. Kate Dee: she really wanted to remain anonymous. She was worried about retaliation from this spa for speaking up. So I'm gonna call her Sarah throughout, So, Sarah graduated from Master Esthetician School. Now, master Esthetician is a designation that is an actual license certificate in only about eight states, and I'm really familiar with it because we have them [00:01:00] here in Washington, but there are.

[00:01:02] Dr. Kate Dee: eight states, mostly in the west out here, that have that degree. And what you can do with that is essentially, become a laser technician and perform certain kinds of medical treatments. Under a doctor's direction, they can't practice on their own, but they can do it under a doctor. she got this job at a really well-known med spa in the West, and the first thing that she found was that they wanted to pay her under the table, [00:01:30] and she felt very uncomfortable.

[00:01:31] Dr. Kate Dee: She knew that she herself would get in trouble if she didn't pay taxes on her income too. She balked at that and eventually they agreed to put her payroll through the regular channels. she said throughout the entire time she was there, she not once met or worked with a medical director. There were no physicians at the spa at all.

[00:01:53] Dr. Kate Dee: There was a male PA who came once a week to perform some procedures, and he did do [00:02:00] some. Good faith exams. And what that means is that's the initial assessment and treatment plan that has to be performed by a doctor or a pa could do it as long as the PA was working underneath the doctor. and again, according to this master esthetician, there's no doctor anywhere.

[00:02:16] Dr. Kate Dee: and my guess is that they could not possibly have been covered by malpractice insurance. Because a PA can't just work for themselves on their own. That's not legal. so The SPA would often have [00:02:30] patients schedule procedures.

[00:02:31] Dr. Kate Dee: That they were brand new to the spa and they had not had any kind of exam by a doctor. And this master statistician was repeatedly asked to perform procedures on patients who had not been assessed by medical personnel at all. and she felt super uncomfortable with this, but she was basically forced to do it.

[00:02:50] Dr. Kate Dee: Either you do it or. You can't work here. so she continued on for a while, but obviously, you know, it wasn't too long before she felt like she [00:03:00] couldn't keep doing this. There were two women who owned the spa, neither of whom were medical at all. They were both business people.

[00:03:07] Dr. Kate Dee: and they had some policies that made the esthetician brail very uncomfortable. So first of all, they had a HydraFacial machine, which is a really popular device. it gives you a facial, but it ha it's a device that infuses. Various fluids and serums into your skin and then vacuums it out. It's kind of like a wet vac for your face.

[00:03:29] Dr. Kate Dee: It's actually [00:03:30] really cool. it's an amazing way to, clean out your pores and do a facial. But anyway, I digress. so HydraFacial is really well known and people will call and ask for HydraFacial by name. And so apparently this spa would, run out of HydraFacial, serums. And they were just using other serums or, you know, cutting corners and, and using stuff that they had in their back bar, and they would just not tell the patient that.

[00:03:57] Dr. Kate Dee: They would just do the HydraFacial and pretend. [00:04:00] That it was the real thing. And when she asked about that, she was like, oh, just, just pretend that it's the same. so they were basically, you know, taking money for HydraFacial when they weren't really providing a real HydraFacial. The other procedure she was asked to do was, this laser treatment that's used for skin rejuvenation and resurfacing.

[00:04:23] Dr. Kate Dee: and treating, brown spots. It's called the Hollywood Spectra Laser, and that laser has two [00:04:30] wavelengths. in order to do the full treatment, you need to have both. Wavelengths as part of the treatment. And so this laser, it was half broken, so one of the wavelengths just didn't work. And, so she was asked to go ahead and perform that procedure and pretend that both wavelengths work.

[00:04:47] Dr. Kate Dee: And again, she's like, but, but it's only half. And so they provided this procedure and said that it was the real thing, but obviously it wasn't. so. They were using a [00:05:00] broken laser and she was said she was told to use it anyway, so at this spa, the pricing was never published. It was not on the website.

[00:05:10] Dr. Kate Dee: And people would get different things and everything was negotiable. If you called the spa and you asked for the price of something and then you didn't book or didn't follow up, they would just say, whoa, whoa, wait, wait, wait. uh, and then cut the price in half. And so she felt that, basically they would.

[00:05:27] Dr. Kate Dee: do anything to get people [00:05:30] in the door. I had my own experience with this exact thing many years ago when I was secret shopping, a laser device that, a rep was trying to sell me. And, I decided to find out, uh, what other places were charging for it. And I found that, you know, I said,

[00:05:50] Dr. Kate Dee: well, I had this treatment at another place, but I'm new to the area and I'm wondering how much it's going to cost. And they quoted one price. And then I said, well, okay, [00:06:00] that's, thank you so much. I'll call around. And then they said, wait, wait, wait. and then they have the price.

[00:06:04] Dr. Kate Dee: So apparently that's a procedure they've been doing for a good 10 years. So, she said that sometimes the patients would show up inebriated or under the influence of either drugs or alcohol, and she again was told she needed to do the procedure on those patients regardless of, of this. And obviously for a medical procedure, you can't show up drunk or altered.

[00:06:29] Dr. Kate Dee: You have [00:06:30] to be able to consent to each procedure. And actually, uh, when you are consented for a procedure, so if you're undergoing a laser or any other medical treatment, the doctor's supposed to consent, so get consent from you. So explain what the, procedure's all about, what the benefits are, what the risks are.

[00:06:51] Dr. Kate Dee: And you have to agree, okay, I understand what the benefits and risks are and, and sign a consent form. And obviously you cannot give informed [00:07:00] consent if you're drunk. So, but she was asked to go ahead and, you know, do these procedures without con conform informed consent on drunk patients and they were done anyway, couple more things.

[00:07:11] Dr. Kate Dee: She told me about, they did microneedling procedures and. Spa provided her very little training for all the procedures she was supposed to do. But one of the things they did provide was training to do microneedling. And she had just been through, training in her master esthetician [00:07:30] school for the microneedling.

[00:07:32] Dr. Kate Dee: And what she found was that the trainer for this med spa was telling her to do it in a way that she knew to be. basically old, like nobody does it that way. And, and so this trainer hadn't really, evolved with the times. so she was being taught an old technique even though she had just learned a new technique, in school.

[00:07:52] Dr. Kate Dee: and the last thing that she told me about was that they did, laser hair removal. But didn't use a [00:08:00] laser. so let me just explain how that's possible. a lot of places use an IPL machine rather than. A laser to do laser hair removal. Ipls, are called intense pulse light, and they're not really lasers.

[00:08:14] Dr. Kate Dee: a laser has one wavelength and IPL has a band of wavelengths. It's visible life light with a filter that, that provides a band of wavelengths. And IP l's actually quite, quite good at treating red [00:08:30] things and brown things. And we have. An IPL device. It's called PBL and it's excellent actually. If you have red splotches, if you've got, dilated blood vessels that are red on your face, or if you have sun spots or other sun damage that you'd like to get rid of.

[00:08:46] Dr. Kate Dee: I-P-L-B-L excellent for that. it can do laser, it can do hair removal. It's not the best. It's very, very slow. It will hurt more if you have, a lot of sun damage. it can [00:09:00] burn you, especially if you have darker skin, and you can only do light skin. People who have dark hair, unlike most, you know, most laser hair removal places will have an actual laser that has two wavelengths on it, that a, they're able to do any skin color and not any color hair, usually, you know, anywhere from.

[00:09:20] Dr. Kate Dee: Medium red to dark, lasers just can't do the blonde ones or the gray ones. But anyway, so there are a number of places that will offer laser hair removal. Call it [00:09:30] that, even though they're using an IPL. And, and that's not, completely wrong to do, but it is a little dicey because if you're advertising laser hair removal and you don't actually have a laser, and if somebody comes in and they're really not a candidate because they have medium to dark skin or they have.

[00:09:47] Dr. Kate Dee: Other conditions where they just can't have it, then it's a little more dangerous. And especially if you don't have a medical director deciding who's a good candidate for that, you very much run the risk of burning people. [00:10:00] So, bottom line, it's critical okay. To ask who the medical director is and will you be seeing somebody, either the medical director or.

[00:10:12] Dr. Kate Dee: A nurse practitioner or a PA who can do that good faith exam and make a proper assessment and prescribe to you the treatment that you're gonna have. any place that doesn't have a medical director, they are practicing. Illegally and dangerously, and so [00:10:30] really important to look at the website and make sure that they have the staff and the medical director listed on the website.

[00:10:38] Dr. Kate Dee: When I looked at this spa that this master esthetician worked at, they didn't list. Any providers or a medical director. So my guess is they don't have one. Or maybe they have rotating people who come and go because, they don't, I, I don't know. But, but that is really critical. So. Number one thing, who's the medical [00:11:00] director and can I see them?

[00:11:02] Dr. Kate Dee: and if not, find out who they are and find out who you're gonna actually see. If you go into a spa and see a mass esthetician and you've never seen anyone else in that spa and you have any kind of medical procedure that's illegal. So hopefully this gives you a little more information on how to avoid places like this.

[00:11:21] Dr. Kate Dee: And, and I, I wish that this person could have come on for an interview. the. Situation out there where people [00:11:30] are really afraid to speak up because they're worried of being retaliated against. They're worried that that someone's gonna go find them where their new place of work is and put fake bad reviews on their profile.

[00:11:43] Dr. Kate Dee: It's, it's really, really distressing to think that this is so common out there. So make sure you know who the medical director is and good luck finding your next med spa. And so thanks so much for listening today. I'm Dr. Kate d [00:12:00] and please check out dr kate d.com, and also med spa board.com.

[00:12:07] Dr. Kate Dee: Certifications for great med Spas are coming soon.

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