Another area of contention, at least for some core physicians, is how much training a doc should have in cosmetic medicine before being allowed to sign on as a "supervising physician." Carney notes that supervising responsibilities, often a "little fuzzy," are determined by the spa owner and the supervising MD.
Certainly, he says, some supervising physicians are skilled in providing the services they are overseeing. But there are also circumstances in which the supervising physician may never have performed a Botox injection or may not be knowledgeable in lasers or light-based cosmetic technologies. "There are responsible and conscientious physicians, and some neglectful ones, who are assuming the responsibility for the stipend, only thinking it may be a way to make a quick buck," Carney says.
As boomers age and Gen Xers migrate toward what they've been known to call "preemptive plastic surgery," there are plenty more bucks to be made. Now it may be a matter of who should be allowed to make them.
Top Five Nonsurgical Procedures Nationwide
| Procedure | Treatment For | Cost | Number of Treatments | Results | Total Performed in U.S. in 2006 |
| Botox injections | Frown lines and crow's feet | $417 | Repeat in 4 to 6 months | Temporary | 3,181,592 |
| Hyaluronic Acid Injections | Nasolabial folds, forehead wrinkles, smile lines, and lips | $532 | Repeat in 4 months to 1 year | Temporary | 1,593,554 |
| Laser Hair Removal | Unwanted facial or body hair | $373 | Multiple sessions | Ongoing | 1,475,296 |
| Microdermabrasion | Fine lines, crow's feet, age spots, acne scars | $162 | Multiple sessions at 2- to 3-week intervals | Temporary | 993,071 |
| Laser Skin Resurfacing | Sun damage facial skin, wrinkles around mouth and eyes, acne scars. Only works on fair, non-oily skin | $2,341 | One or more, depending on laser used and skin condition | Long lasting | 576,509 |
