The Medspa Industry Is Broken. Here's How We Fix It.
A healthy 47-year-old mother of four walked into a medspa in Texas for a routine IV vitamin infusion. She was dead minutes later. The person who administered the treatment had no license. The "medical director" lived over 100 miles away and had never set foot in the spa.
This is not an isolated horror story. It is a symptom of a $20 billion industry operating largely in the dark — where fake credentials are commonplace, medical oversight exists on paper only, and patients have almost no reliable way to distinguish a board-certified physician from someone who completed a weekend injection course.
I recently sat down with Authority Magazine to talk about how we got here, why the status quo is failing everyone, and what real, lasting reform looks like. I want to share the key points here, because this is a conversation I believe every patient, provider, and policymaker needs to have.
"Nothing in aesthetics is worth risking permanent harm."
From Breast Cancer Specialist to Industry Whistleblower
My path to this work was not a straight line. I spent 16 years as a breast cancer specialist at Seattle Breast Center — a Yale-trained radiologist guiding women through some of the most frightening moments of their lives. I transitioned into aesthetics in my forties, initially drawn by the intersection of needle technique I already had with the appeal of helping people feel confident rather than delivering devastating diagnoses.
What I found when I crossed into this industry was staggering. Illegal medspas operating in plain sight. Practitioners using titles like "double board certified" when no legitimate certification board for their claimed specialty even exists. Medical directors collecting monthly fees to lend their license to a business they never visit. Providers disfiguring patients and simply closing shop before any accountability could catch up with them.
After more than a decade of witnessing it, I wrote Med Spa Mayhem, launched the Medspa Confidential podcast, and founded the MedSpa Board — a national organization dedicated to certifying medspas against real, verified safety and legal standards.
5 Things That Must Change
When Authority Magazine asked me to name the five most important reforms for the health and wellness industry, here is what I said:
Enforce existing laws and create uniform national standards
Every state has different rules about who can inject, who can own a medspa, and what supervision actually requires. Some "medical directors" collect $500–$1,000 a month to lend their license while never visiting the facility — which is illegal in most states, but almost never prosecuted. We need federal baseline standards and real consequences for violations.
Require transparent credentialing and truth in advertising
Patients should be able to walk in the door and immediately verify who is treating them and what their actual qualifications are. Every medspa should be required to prominently display the verified credentials of every provider, and there must be severe penalties — not just warnings — for misrepresentation.
Mandate real medical oversight — not "paper" medical directors
True oversight means a qualified physician personally examines new patients, creates individualized treatment plans, and remains genuinely available for complications. It does not mean a nurse practitioner or doctor signing forms from another state based on a brief virtual consultation they never conducted in person. Liability must attach to the physician who is actually responsible.
Enforce existing laws to create real consequences
Currently, an illegal provider who harms or disfigures a patient can close up shop and reopen across town — or in another state — with no real consequences. We need law enforcement to arrest unlicensed people for the felony of practicing of medicine without a license. We need state medical boards to have the power to shut these illegal medical practices down and the law must require malpractice insurance.
Invest in consumer education and evidence-based research
Because aesthetic treatments are cash-pay, there is virtually no financial incentive for companies to fund clinical trials beyond minimum FDA clearance. This means consumers and providers alike are making decisions based on marketing, not medicine. Federal investment in aesthetic research — and accessible, plain-language education for patients — would fundamentally transform this industry.
What Every Patient Deserves to Expect
Beyond regulation, there is a cultural shift that needs to happen in how patients approach medspas. Consultations should be educational conversations with qualified medical providers — not high-pressure sales sessions run by a sales consultant whose sole job is to sell as many syringes as possible. You should never feel pressured. You should always understand what a treatment does, how it works, and what realistic results actually look like.
You also deserve real aftercare. If something goes wrong — an infection, an adverse reaction, an unexpected outcome — the provider should be accessible, responsive, and equipped to manage it properly. Too many spas go silent the moment there is a complication or, worse, refuse to share medical records with other providers trying to help.
"Patients deserve recommendations based on what will actually work for their goals — even if that's a less expensive option."
Why the MedSpa Board Exists
The MedSpa Board was founded precisely because patients currently have no reliable, independent way to sort safe and ethical providers from dangerous imposters. Our certification process verifies legal compliance, genuine medical oversight, transparent credentialing, and adherence to national safety standards — so that when you walk into a MedSpa Board-certified practice, you don't have to do that investigative work yourself.
If you are a patient looking for a safe provider, look for our certification. If you are a provider committed to doing this right, we want to work with you. And if you run a medspa that is ready to be held to a higher standard, we invite you to get certified at medspaboard.com.
The full interview — including my thoughts on the biggest roadblocks to reform, the role of proactive preventive aesthetics, and what I'd ask Oprah over breakfast — was published in Authority Magazine this month. I hope you'll read it.
