DETROIT - From heated patient beds and calming commercial-free tunes to bottled water and contemporary decor, Dr. Robert Levine's practice isn't your run-of-the-mill, sterile doctor's office.

But it's not your typical day spa either.

"The whole experience matters," said Levine, who left internal medicine to design Elle Medical Spa in Birmingham, Mich., and offer patients medical treatments such as microdermabrasion in a tranquil environment.

Medical spas, which often offer pricey procedures such as Botox and laser treatments along with massages and manicures in a relaxed setting, are popping up nationwide.

But the spas, which can charge about $95 for a facial to upwards of $2,000 for more complex treatments, face scrutiny from critics who say they're dangerous because there are no state licensing requirements and virtually anyone can operate one.

While some spas, including Elle, employ licensed aestheticians or nurses who work under a doctor's supervision, others don't. That leaves some medical professionals questioning the safety of medical spas.

In fact, the American Society of Plastic Surgeons for Aesthetic Plastic Surgery issued a statement in January warning patients about the lack of oversight of medical spas.

"For those providing treatments outside of the physician's office, there are no national standards for medi-spas, no recognized definition of what constitutes a medi-spa and no oversight organizations that provide the information you need to make an informed, safe choice for your medi-spa experience," the statement said.

Even some medical spa workers are concerned about the lack of regulation of the industry. "It's just so obscene that anybody can open on the corner," said Hillary Lieberman, director of the Accents Cosmetic Surgery and Medical Spa in Sterling Heights, Mich.

REGULATION TRICKY

Regulation of medical spas is difficult in part because the niche market doesn't neatly fit established categories. And the task of regulating the spas could get even trickier _ and more necessary _ with the industry's growing popularity.

The number of medical spas in the United States has jumped from about 45 in 2002 to about 2,000 now, according to the International Medical Spa Association. Although no one keeps track of how many medical spas are in Michigan, the numbers are on the rise in this state, too.

"The industry is exploding," said Hannelore Leavy, executive director and founder of the New Jersey-based association. "Why should I go to a sterile doctor's office if I can do this in a very nice comfort luxurious environment, such as a spa?"

In Michigan, medical spas don't need a license.

The state does mandate that staff members be licensed for services they perform. But having a license to practice massage therapy, for instance, doesn't necessarily qualify a person to use medical equipment to perform laser hair removal.

Michigan stops short of having a team of inspectors make regular visits to ensure services are performed in safe and sanitary conditions.

"We're ultimately more reactive than proactive," said T.J. Bucholz, a spokesman for the Michigan Department of Community Health. "If somebody files a complaint with the state because of an adverse outcome, of course we investigate."

RESEARCH THE CENTER

Medical professionals say clients should do their homework and ask questions before agreeing to any services.

Patients like Cathy Michayluk also say research is important.

After having a bad experience with a face-lift elsewhere, the 60-something turned to Dr. Mark Berkowitz at Accents Cosmetic Surgery and Medical Spa in Sterling Heights. She said he gave her valuable advice such as to eat pineapple for its natural healing ability.

"I did have plastic surgery before, and it really didn't turn out right," she said.

Now a regular patient at Accents, Michayluk goes there to get Botox injections, topical collagen facials and other medical procedures because she likes the warm environment over a doctor's office. "It's just very comfortable," she said.

Diana Harper said going to Elle in Birmingham _ which offers 40-minute physicals, oxygen massages and aromatherapy is relaxing and has improved her health.

Levine discovered that Harper suffered from a vitamin deficiency, she said. Since learning of the problem, she has begun having vitamin IV therapy and treating herself to massages for relaxation.

"Honestly, it's the best I've felt in years," she said.

PROCEDURES AVAILABLE

Medical spas offer a variety of treatments and services, including:

• Chemical peels
• Microdermabrasion
• Laser hair removal
• Botox and other injections
• Various facials
• Massages
• Permanent make up
• Tattoo removal
• Aromatherapy
• Waxing

(c) 2007, Detroit Free Press.