allure: Med Spa Nation
There are almost as many med spas as McDonald’s in the US, ready to serve you a smoother forehead, glowier skin, and fuller lips. Are you safe placing an order? By Deanna Pai
There are almost as many med spas in America today as there are McDonald’s locations. The industry has mushroomed from roughly 1,600 med spas in the US in 2010 to about 10,500 in 2023, according to the most recent trend report from the American Med Spa Association (AmSpa), which was released in November 2024. It also predicts that there could be as many as 13,000 med spas by the end of 2026. (There were 13,557 golden arches in the country at the end of 2024.) In recent years, the med spa industry has grown by at least $2 billion annually, says AmSpa, which is not so surprising when you consider that demand for the types of treatments offered at med spas (injectables, lasers, radiofrequency—things that don’t involve a scalpel) was up 79% over the last five years, according to the American Society of Plastic Surgeons (ASPS). Med spas provide the supply, in most cases, more conveniently and at a lower cost than a board-certified doctor would.
Like McDonald’s, people keep going to med spas despite what a lot of health care professionals say—fast filler, like fast food, isn't generally recommended by doctors. Or by Allure. Our stance since med spas arrived on the scene in the late ’90s has been simple: Don’t have any procedure that crosses the skin barrier if there’s not a board-certified dermatologist or plastic surgeon present. It’s a position that’s aligned with that of those doctors, many of whom raise serious safety concerns about the med spa industry. Their argument: These businesses offer medical procedures that come with medical risks, not low-stakes aesthetic tweaks. They should be administered by the medical professionals most qualified to perform them—and to handle their complications.
But let’s face it, med spas also pose a threat to the lucrative nonsurgical and aesthetic arms of plastic surgeons’ and dermatologists’ practices. These doctors certainly have their own skin in this game. On one hand, they’re correct: When availing yourself of a syringe full of hyaluronic acid that could block an artery or laser beams that can sear flesh, your safest bet is to be in the presence of the most highly trained medical professional possible. On the other hand, it could be argued that there is also somewhat of a turf war at play here.
Taylor, 31, has been going to Tiev med spa in Costa Mesa, California, for several months and getting neuromodulators in her forehead, around her eyes, and in her jaw. When she heard of the spate of counterfeit Botox last summer, causing side effects like breathing and vision problems, weakness, and incontinence in people who had been injected in non-medical settings, she says, “I did get nervous initially, but I did more research. I knew I wouldn't be affected by that, and I really do trust the medical people that I'm seeing.” She sees a registered nurse, whom she trusts “way more than just a normal injector.”
Who is a “normal injector”? Good question. Generally speaking, people with “prescriptive authority” (this usually means doctors, dentists, nurse practitioners, and physician assistants) can purchase injectables. But in terms of who can actually do the injecting? Or the lasering? Or the microneedling? I’ve been reporting this story for a year and can in no way give you a clear answer. I’m not alone. Dr. Hogan has been working on a paper that aims to lay out the med spa regulations in every state of the union: “Who can do what where,” she says. She and her research team, two dermatology residents and a medical school student, have been at it for a full year and won't have anything ready to publish before 2026.
“It’s a patchwork quilt of laws and regulations,” says Renee Coover, JD, founder and owner of EngageLaw, LLC, who’s been practicing in this space for 15 years. “In some states, there’s as much of a gray area as there was 15 years ago. In others, there’s a lot more regulation. But it’s really impossible to say, ‘In the majority of states, the rules and regulations are this or that.’”
