Podiatrist Offering a Liquid Brazilian Butt Lift (BBL)

[00:00:00] Dr. Kate Dee: Would you let your foot doctor do your Botox? How about your butt? I’m not joking. That’s a real question, and a real patient had to ask it, not because she was confused. I’m Dr. Kate Dee, founder of Glow Medispa in Seattle and founder of the MedSpa Board and author of “MedSpa Mayhem,” and this is MedSpa Confidential, where we pull back the curtain on everything happening in medspas, the good, the bad, and the outright illegal, because you deserve to know the truth.

[00:00:28] So a few weeks ago, a woman [00:00:30] reached out to me through the MedSpa Board website. I’m going to call her Jenna. That’s not her real name, and she asked to be anonymous, so I’m keeping it that way, and I’m not naming the practice either. You’ll understand why in a minute. So Jenna had been going to a medspa in the Midwest.

[00:00:46] She’d been there more than once. Nice place, nice website, and the owner goes by “Doctor” on that website. So on one of her visits, she was offered something called a liquid BBL. So for those of you who don’t know, [00:01:00] BBL stands for Brazilian butt lift, and a surgical BBL takes fat from one part of your body and moves it to your buttocks.

[00:01:08] A liquid BBL skips the surgery. Instead, someone injects a product directly into your buttocks to add volume. In this case, Jenna was told that the product would be hyperdilute Versa, which is a hyaluronic acid filler. It’s the same filler that’s used in your cheeks or around your mouth, but in this case, they’re watering it down and injecting it [00:01:30] in much larger amounts into your backside. So she booked it, and then shortly before the appointment, it got canceled. She was not hurt. I want to be really clear about that up front.

[00:01:42] Nothing went in. But before she rebooked there or anywhere else, something was nagging at her, and she submitted a query, a complaint through the MedSpa Board website. Number one, is this person even legally allowed to do this? And then number two, [00:02:00] is it safe? ’Cause she really wanted to have this procedure done.

[00:02:03] So those are exactly the right questions to ask. Those are the two questions I want every single one of you asking before you book anything. So let’s take them one at a time. So I did what I always tell you to do. I looked the owner up. So every licensed healthcare provider in this country has a license on file with their state, and everyone who bills for care has what’s called an NPI number.

[00:02:27] That’s a national provider [00:02:30] identifier, basically like a Social Security number for clinicians. It’s public. Anyone can look that up. It takes about 90 seconds or so. And here’s what came back. The owner of this med spa, the doctor on the website, holds one active license, and it’s a license in podiatry. That’s right.

[00:02:49] She was a podiatrist, a doctor of podiatric medicine, a doctor of the foot and ankle. And I want to be fair here. Podiatrists are real doctors in [00:03:00] their lane. They go through a lot of training. They do surgery. But that lane is the foot and ankle. In some states, there’s a little bit of a debate whether they can touch the calf muscle, okay?

[00:03:11] But that’s it. So, I searched for anything else, an MD license, DO, nurse practitioner, physician assistant. None of those are associated with this clinic. Every public profile I could find, every directory in the federal registry lists this person as a podiatrist and only a podiatrist. [00:03:30] So, let’s look at what this med spa sells.

[00:03:33] Botox, dermal fillers, the liquid BBL, liquid lipo body sculpting, laser hair removal, microneedling with PRP, and supposedly a medically supervised weight loss program with hormone replacement therapy and peptides. So let me ask you something. How many of those things are on your feet? Right. None of them.

[00:03:54] Okay, so who’s on this team? The website’s Meet Our Team page lists the owner, [00:04:00] the podiatrist, a registered nurse injector, a client coordinator, and a licensed esthetician. That’s it. No physician, MD or DO, no nurse practitioner, no physician assistant. Nobody named as medical director other than the podiatrist, nobody named as the prescriber for the weight loss drugs or the hormones.

[00:04:20] So I really want you to sit with that for a second, okay? So let’s talk about what’s actually going on here because there are several separate problems, and they stack on top of each [00:04:30] other, and each one of these things matters on its own. So the first problem, practicing medicine without a medical license.

[00:04:36] So every state has a medical practice act. It’s the law that says who’s allowed to practice medicine. Injecting a prescription neurotoxin into someone’s face is the practice of medicine. So is injecting filler into someone’s buttocks. So is prescribing weight loss drugs and hormones. Those are medical procedures, and a podiatry license does not cover any of [00:05:00] that.

[00:05:00] Every state also has a podiatry practice act, and those acts define podiatry by body part. In this case, this state, the law literally defines podiatric medicine as the treatment of the human foot, and then it goes on to define foot to include the ankle. So last I checked, your face is not your ankle, and your buttocks are not your ankle, and in this state where this happened, practicing medicine without a license can get you a civil fine of up to $10,000 per [00:05:30] offense, and it’s also a felony, okay?

[00:05:32] It’s not a slap on the wrist, it’s a felony. So problem two, who’s allowed to own a med spa? So who can legally own a med spa, a medical practice? Okay, in most states, if a business is delivering medical care, it has to be owned by people who are licensed to deliver that medical care. So lawyers call this the corporate practice of medicine doctrine, and the point is that medical decisions shouldn’t be controlled by someone [00:06:00] who isn’t licensed to make them.

[00:06:02] So the state regulators in this case have actually put out guidance on med spas. They say a med spa offering Botox and filler has to be owned by a physician or a nurse practitioner with full practice authority in that state. And the guidance specifically calls out other kinds of licensees, people licensed in a different field, like dentists, chiropractors, and yes, podiatrists, as people who [00:06:30] cannot own or control that kind of business.

[00:06:33] So even before we ask who’s actually doing the injecting, the ownership structure on its face is also a problem. Okay, so let’s move on to problem three, the nurse who’s basically working with no one to answer to. So let’s talk about the nurse injector here. A registered nurse can absolutely inject Botox and filler.

[00:06:55] Great nurse injectors are some of the best in the business. But a nurse cannot decide on [00:07:00] their own that you get Botox. There has to be what’s called a good faith exam first. A good faith exam means that a licensed prescriber, a physician, a nurse practitioner, or a PA actually evaluates you, decides the treatment is appropriate, and writes the order.

[00:07:18] After that, a nurse can carry it out under a prescriber’s supervision. So who’s doing the good faith exam here? Who’s writing the order? Who’s supervising? You know, I’ve talked on this show about [00:07:30] an absentee medical director, right? The doctor who rents out their license and never shows up, and you know that the going rate for an absentee medical director is often as low as five hundred dollars a month.

[00:07:41] Well, in this case, as far as I can see from the outside, there isn’t even a five hundred dollar a month ghost. There’s no one listed at all other than the podiatrist, and as I’ve said already, that podiatrist is not allowed to practice medicine or supervise a nurse practicing outside their scope. So if that’s [00:08:00] true, the nurse here is exposed as well, because a nurse working without a valid order and real supervision is practicing outside their own license.

[00:08:11] Okay, so that’s two licenses on the line now, not just one. All right, let’s look at the next problem, problem four, the prescriptions. So a medically supervised weight loss program today almost always means GLP-1 like drugs like semaglutide or tirzepatide. Add hormone replacement therapy and peptides, and [00:08:30] every one of those requires someone with prescribing authority.

[00:08:33] Now, don’t get me started on peptides. That’s for another topic. But that means an MD or a DO or a nurse practitioner or PA with the proper supervision. So nobody on this team at this med spa holds prescribing authority for those drugs. So who’s writing the prescriptions, and where are they coming from?

[00:08:51] Okay, let’s look at problem number five, the doctor on the website. Now, the owner is a doctor, a doctor of podiatric [00:09:00] medicine. Using “doctor” is not a lie on its own. But put “doctor” at the top of a website that sells Botox, fillers, body contouring, hormone therapy, and never once say the license is for their feet.

[00:09:16] What do you think the average patient assumes about that? Okay. Jenna assumed it was a medical doctor, and of course she did. Most of you would too. I would too. I did until I looked up this [00:09:30] person’s license. So most states’ consumer protection laws care a lot about advertising that leaves people with a false impression of who’s providing their medical care.

[00:09:41] There’s no reliable way to know if a med spa is following safety standards or cutting corners, until now. The Med Spa Board certifies clinics that prove they’re doing things right, verified products, licensed staff, and actual medical oversight. It’s the difference between rolling the dice with your skin and [00:10:00] knowing exactly who’s holding the needle.

[00:10:02] If you’re looking for aesthetic treatments, go to medspaboard.com to find a certified spa near you. And if you already have a med spa you love and they’re not certified yet, please send them our link. Med spa owners, getting certified does more than build patient trust. It should also save you a ton on your malpractice insurance.

[00:10:23] Do the right thing and go to medspaboard.com. Keep listening, keep asking questions, and stay [00:10:30] safe out there.

[00:10:30] Okay. So Jenna’s second question: is a liquid BBL safe? Okay, now I’ve got to put on my physician hat here. Here’s the first thing you need to know. The FDA specifically recommends against using dermal fillers or any injectable filler to increase the size of the buttocks.

[00:10:47] They say the same about the breasts. Now, no filler is FDA approved for that use. None. The filler that Jenna was told about is approved in the US for injection into the skin of the face for [00:11:00] moderate to severe wrinkles and folds, like the lines that run from your nose to the corners of your mouth.

[00:11:05] We’re talking a syringe or two, but diluting it and pumping a much larger volume into the buttocks is what we call off-label. Off-label means using an approved product in a way that’s not on the official label. And let me be fair, off-label use is not illegal. Doctors do it every day, and sometimes for very good reasons.

[00:11:25] But off-label use is supposed to rest on a physician’s judgment and a physician’s [00:11:30] accountability. Take the physician out of the picture, and that safety net is gone. So off-label use is not necessarily the problem here. It’s the fact that only a physician practicing medicine is allowed to make that clinical decision to use a product off-label.

[00:11:44] And as we’ve determined, this podiatrist does not have the license to do that. To make this situation even more absurd, the treatment they’re offering makes no medical sense. So hyper-dilute hyaluronic acid filler, in this case [00:12:00] Versa, will not accomplish what they’re selling it for. Okay? There are many clinics that offer a liquid butt lift with biostimulators like Sculptra.

[00:12:10] I personally don’t think it’s worth it because the amount of Sculptra you would need to create enough volume for a satisfactory outcome would be extraordinarily expensive and essentially prohibitive for the vast majority of people. I was once in a lecture with Dr. Sheila Nazarian. She’s a very prominent and outspoken plastic surgeon [00:12:30] in California.

[00:12:31] She talked all about doing liquid Brazilian butt lifts and her experience with them. And she gave a price range of seventy-five thousand to a hundred and fifty thousand dollars in order to get enough Sculptra into somebody’s butt in order to achieve a substantial result that would even be noticeable, much less satisfactory.

[00:12:52] And that’s with a real biostimulator, okay? Hyaluronic acid does not have that kind of stimulatory response that [00:13:00] Sculptra does. And when I ran this situation by multiple colleagues about the effectiveness of hyper-dilute hyaluronic acid filler to accomplish a Brazilian butt lift, I was met with laughter and complete skepticism.

[00:13:13] Who would offer that? Well, in this case, it’s a podiatrist who is illegally practicing medicine. So let me be really careful here about what I know and what I don’t. What’s confirmed is that this owner has one license, and according to public records, it’s in [00:13:30] podiatry. Okay? The website lists no physician, no nurse practitioner or PA, no medical director.

[00:13:36] The website advertises injectables, body contouring, and prescription weight loss and hormone services. And a patient was offered and scheduled for a liquid BBL with a diluted facial filler. If there’s some secret absentee medical director that I don’t know about, it certainly isn’t on the website, and even if there were one, a ghost medical director creates more problems than they solve.

[00:13:59] So here’s what I told Jenna: “Nope, this place is not legit, and on top of that, what they’re selling you will not accomplish what you’re looking for.” And here’s what I’m telling you. Whatever aesthetics or wellness practice you walk into, first, look up the license. Every state has a free online license lookup.

[00:14:19] Type in the name. Look at what kind of license it is, not just that it’s active. Doctor is not a specialty. Ask, “Doctor of what?” Two, [00:14:30] ask who the medical director is and look them up too. Three, ask who’s doing your exam and who’s writing the order. If the answer is, “Oh, you just book with our injector,” that’s a red flag.

[00:14:41] For anything prescription-based, weight loss drugs, hormones, peptides, ask who the prescriber is and where the medication comes from. Ask to see the vial. Make sure it has a real lot number on it. Five, know the warning signs of danger. After any filler, if you have any [00:15:00] severe pain, skin turning white, mottled, or dusky, unusual hardness, redness that spreads, fever, or swelling that keeps getting worse, don’t wait for a call back.

[00:15:11] You need care urgently. And six, on the liquid BBL specifically, just don’t do it. Save your money. It’s not worth it. And so Jenna, even though I know that’s not your real name, if you’re listening, you did exactly the right thing. You asked before you booked. That instinct is the whole [00:15:30] reason this show exists.

[00:15:31] Regulators are slow and enforcement is spotty, and the most reliable safety mechanism right now is you, an informed patient asking the right questions. Stay curious, stay safe, and as always, know who’s holding the needle before you let anyone near you with one.

[00:15:49] Thanks for listening. If this episode opened your eyes to something you didn’t know before, share it with someone who needs to hear it. Subscribe so you don’t miss the next one, and drop a comment [00:16:00] telling me your biggest takeaway. I actually read them all. Join me on this mission to keep you safe and push this industry to do better.