By Olivia Hart

"It's more important who's behind the syringe than what's in the syringe." That is the verdict of Grand Rapids, MI plastic surgeon Bradley Bengtson, MD, and it frames the seven-point checklist that dermatologists, plastic surgeons and patient safety experts now want patients to run before booking a medspa treatment.

Medspas rank among the fastest-growing segments of aesthetic medicine. Oversight, by most accounts, has not kept up. Patients, meanwhile, still choose providers on social media followings, before-and-after photos or the lowest price. Experts say that habit needs to stop.

Who should hold the syringe?

An experienced injector knows facial anatomy, screens out poor candidates and can treat complications on the spot. Before booking, ask how often the provider performs the treatment in question, what training they have received and who handles emergencies when they arise.

Southfield, MI plastic surgeon Mariam Awada, MD reports no serious injectable complication in 23 years of practice. But she does not sugarcoat the risk. "Adverse events include vascular occlusion, blindness, tissue necrosis, infection and permanent injury," she says.

Vienna, VA dermatologist Brenda Dintiman, MD puts the standard plainly: "Any provider worth trusting should be able to say, 'I am with you through the whole process.'" She says she regularly sees patients with side effects who feel they cannot call or be seen by whoever treated them. Access, in her view, should not end when the patient leaves the treatment room.

What does the device tell you?

A trending laser is not a credential. "When choosing a provider, look at their years of experience and training," says Shreveport, LA dermatologist Skylar Souyoul, MD. "Devices aren't created equal, and the person behind the controls matters just as much because they're the one dialing in your settings and operating the machine."

Rules vary by state. In California, an aesthetician license does not permit laser treatments or other medical procedures. Last year the FDA warned of serious complications from certain uses of radio-frequency microneedling devices — burns, scarring, disfigurement, fat loss and nerve damage — and emphasized that the procedure is medical.

The pre-booking questions are simple:

• Which device will be used?
• Who will operate it, and what training and licensing do they hold?
• Why is this treatment appropriate for you?

Can accreditation close the trust gap?

Thomas Terranova, CEO of QUAD A, argues the industry has outgrown its oversight. "The industry has grown explosively, but oversight has not kept pace," he says. "There has been no consistent, independent framework defining what safe, high-quality medspa operations look like."

QUAD A has now extended its health-care accreditation program to medspas. On-site surveys cover infection prevention, staff qualifications, medication management and emergency preparedness. "For patients, QUAD A's accreditation fills the trust gap," Terranova adds. His advice on medspas that dodge questions is blunt: "If the medspa is not enthusiastically transparent about showing you how compliant they are, leave."

Why is one medspa so much cheaper?

Newport Beach, CA dermatologist Jennifer Channual, MD tells patients to weigh safety, training and transparency over price alone. A dramatically lower figure often signals something. "Differences in cost can sometimes reflect the provider's experience level, the device or product brand being used, the number of units or treatment pulses administered, or what is actually included in the package," she says. Compare like with like, or the comparison means nothing.

Does a big following equal expertise?

No. "Medical aesthetics is not cosmetology. It is where technology meets biology," says Vero Beach, FL plastic surgeon Alan Durkin, MD. "Experts are created by elevated outcomes over decades—not by social media followings." Check where a provider trained and how long they have performed the treatment you want.

New Orleans dermatologist Mary Lupo, MD offers the closing comparison: "Experience matters, so patients should do as much research on who they choose to hold the needle as they do to pick their car, their electronics or their curl cream." The alternative, as she notes, is doing the research after a treatment goes wrong — when the stakes, and the bills, are considerably higher.