“If something is bagging, sagging, or dragging, I'll tuck it, suck it, or pluck it,” Dolly Parton told British newspaper The Guardian in 2011. The country music singer-songwriter, actress, philanthropist, and businesswoman-turned-pop culture icon has never been shy about her enhancements, but she used to be the exception – not the norm. Today, women (and men) talk openly about their favorite fixes, treatments, and procedures that they employ to try and, as Cher famously sang, “turn back time.”
Look no further than social media, where TikTokers share everything from live Botox injections to butt-plumping procedures, Instagram influencers flaunt their filler, and HydraFacialists proudly show the floating funk collected from spending a half hour of vacuuming their client’s now-radiant pores on Facebook.
As technology has advanced and non-invasive treatments have become both more widely available and more affordable to the masses, cosmetic enhancements are no longer reserved only for the rich and famous. Medspas, short for “medical spa” (and sometimes called medi-spa), are defined by the American Society of Plastic Surgeons as “a combination of an aesthetic medical center and a day spa that provides nonsurgical aesthetic medical services under the supervision of a licensed physician.” A recent report valued the US medspa market at $14.4 billion. Here in Rhode Island, medspas can be found everywhere from Woonsocket to Westerly. But what kind of procedures are out there, who is performing them, what age is it appropriate, and is it safe?
The scope of treatments can vary, but typically, medspas are known for administering injectable neurotoxins popularly known under brand names like Botox and Dysport, among others, to treat wrinkles and other conditions. Dermal fillers, meanwhile, including Juvederm and Restylane, are used to soften facial creases and replenish areas that experience volume loss with age. Think fuller lips and smoothing the wrinkles around them. Many local medspas also offer laser treatments to address everything from hair removal to minimizing the appearance of age spots, sun spots, acne scars, and to treat skin conditions, like rosacea. Chemical peels, microneedling, and dermaplaning (a method of exfoliation that gently uses a scalpel to remove the face’s top layer of dead skin cells and fine hairs – “peach fuzz” – for a smoother, brighter, and more rejuvenated complexion) are in-demand, while body contouring includes Coolsculpting, an alternative to liposuction that freezes and eliminates stubborn fat, and Emsculpt Neo, an FDA-approved high-intensity electromagnetic therapsaid to eliminate fat and build muscle. Platelet-rich plasma, or PRP, is a form of regenerative medicine used to treat a variety of orthopedic conditions and injuries, but it’s also used in the cosmetic field to rejuvenate skin and repair signs of aging by using the patient’s own platelet rich blood cells to accelerate the body’s natural production of collagen and elastin. (The procedure is commonly called a “vampire facial.”) These are just some of the services offered at a medspa near you.
When it comes to who performs these procedures, there can be many options, so it’s more important than ever for clients and patients to do their homework. “I think there’s been not only an increased demand, but there’s just been a surge in the number of places offering cosmetic procedures,” says Dr. Alyssa Findley, a board-certified dermatologist and owner of Findley Dermatology in East Providence. Like many dermatologists, much of Findley’s practice consists of full skin exams, diagnosis and treatment of skin conditions, and medical and surgical procedures, but she says in the past 10 years of developing close relationships with patients, they’ve turned to her for cosmetic procedures. She says that injectables, fillers, laser treatment, and chemical peels account for about a quarter of her business today.
From dental offices and day spas to permanent makeup businesses and even private home parties, one doesn’t have to look very hard to get Botox or filler in Rhode Island. “It’s really important, whether it be surgery or cosmetic procedures, for people to be well informed and educated on who’s performing the procedures.” Findley personally performs all procedures at her practice, but more often than not, cosmetic procedures are being performed by a nurse practitioner or advanced practice registered nurse under the supervision of a board-certified physician or medical director.
Pamela Lutes, owner of Inspire Medical Spa in Narragansett, oversees a staff of eight and though she’s a nurse practitioner, says registered nurses with considerable experience shouldn’t be overlooked for cosmetic treatments. “I want to stick up for the RNs because it is within their scope, I believe, to do injectables,” says Lutes. “I’m a nurse practitioner now because I really felt forced to do it to protect my business, but RNs in the industry are the teachers, the educators… I always tell people, ‘go to somebody who does it all day long, every day.’ It’s their focus, and that’s usually your nurses.”
Like Findley, Dr. Valerie Tokarz, a cosmetic dermatologic surgery specialist and founder of Tokarz Dermatology in East Greenwich, treats myriad conditions and performs cosmetic procedures. She concedes the State of Rhode Island’s regulations are murky at best.
“All of us have this difficulty defining ‘what does the term cosmetic mean?’ Is it Maybelline eyeshadow? Is it a facelift? It all falls under the term ‘cosmetic,’” says Tokarz. “We are working on legislation in Rhode Island so that we, too, have this definition.”
Rep. Jacquelyn Baginski (D-Dist. 17, Cranston) along with Rep. Julie Casimiro (D-Dist. 31, North Kingstown, Exeter) and Rep. David Bennett (D - District 20, Cranston, Warwick) introduced House Bill 5844 in 2021 in an effort to better define who can administer certain procedures. “It’s not entirely clear who can do what, so the goal of the bill is really to put to paper some best practices and guidelines for establishing a medspa,” says Rep. Baginski. “It’s not to include or exclude any provider type from the practice; [it’s] just to make sure whoever is working at these places is doing so with the proper license. If they are not licensed to practice independently at a physician or as an advanced practice registered nurse (APRN), we want to make sure there is medical oversight if it’s required and to make sure anyone performing these procedures has the proper training to secure patient safety.” Baginski says she and other legislators recently met with representatives from the Rhode Island State Nurses Association, the Rhode Island Medical Society, and the Rhode Island Dermatology Society to sort out the bill’s language to, as Baginski put it, “make sure that any practitioner who is licensed by the State of Rhode Island can practice at their appropriate level.”
Lutes, who’s been in the industry for 25 years, says she’s witnessed the advancement, evolution, and expansion of cosmetic procedures from nearly the beginning. “What I do in my room now as an injector doesn’t even resemble 10, even five years ago,” she says. “This industry is growing so fast, and people are starting to understand they have some control.” She’s quick to explain that people age differently, but the goal should be to look natural, well-rested, and refreshed. She credits Gen Z with being the most proactive in terms of preventative care and a proactive approach. “People pick on 20-year-olds for doing Botox, but once the lines are embedded, they get on it,” she says. A proactive approach, she says, will lead to less procedures later, adding “these young girls will never spend the amount of money; they’ll never fight the lines” as people who’ve begun treatments later in life. “I tell people it's a marathon, not a sprint.”
“There’s definitely something to be said about starting early,” agrees Findley. “For example, we know that it helps significantly with fine wrinkles and lines, and I think it’s best when you get very natural-looking results and it’s hard to tell you’ve had much done.” She clarifies that there is no set age to begin procedures and that it’s up to the individual to evaluate their own wants, needs, and expectations. “I think the best compliment is that you just look well rested and refreshed,” she says.
While certain medspa procedures can lift, smooth, buff, and plump, permanent makeup (PMU) is a cosmetic technique that relies on tattooing that closely resembles makeup. Popular PMU services include lash liner, faux freckles, microblading and microshading (eyebrows), lip blush, and even scalp micropigmentation, which uses tattooing to make a client look like they have fuller, thicker hair by simulating follicles that fill in the white space on the scalp.
Marissa Daniels opened PVD Pretty Thing in Providence a little over five years ago and now has a staff of nine doing aesthetic services including PMU and lash extensions, last lifts, lash tint, brow lamination, face/body/brow waxing, and other services.
“Lip blush is a great service for clients who are aging, who are more mature and they’re starting to lose pigmentation in their lip skin. It’s great for my clients who get a lot of lip filler because lip filler actually pushes the blood vessels around in your lips and it kind of stretches them apart more, making them appear more pale,” she explains.
When choosing an artist, Daniels says it comes down to finding a pro who aligns with your personal style and reviewing the artist’s final product. “If you want good work, you should go to a licensed, insured, and experienced artist,” she advises. “Experience doesn’t necessarily mean time, either. I’ve met some artists who have only been working a year who are better than artists I have seen working for 10 years. I tell a lot of potential clients, I like to not only look at a potential artist’s work, but their healed work, because something that looks great when it’s fresh on Instagram doesn’t necessarily heal great.” Pigments implanted too deep in the skin, for example, can look darker and thicker, and undefined in places. She advises looking for an artist whose portfolio includes healed work and one whose style meets your goals.
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