Once upon a time, we lived in an analog world, when the name “Kardashian” was solely associated with a Los Angeles criminal defense attorney, influencers weren’t a thing, and filters were just used to make your morning pot of coffee or oxygenate a fish tank. It was a time when cosmetic procedures were treated like shameful secrets, a taboo tinkering of the face and body seemingly reserved for the rich and famous. Unless you were Joan Rivers, procedures were rarely spoken about openly. One day you woke up, and Frances "Baby" Houseman from Dirty Dancing had a new nose.
Today, TikTokers share everything from live Botox injections to butt-plumping procedures, medical professionals take to Instagram to advise on how many units of filler you may need, and HydraFacialists proudly show the floating funk collected from spending a half hour of vacuuming their client’s now-radiant pores.
We’ve come a long way, baby.
Mimicking much of the country, the cosmetic procedure industry in Rhode Island is thriving. One quick Google search and you’ll find pages upon pages of beauty outposts ready to prick, plump, resurface, and rejuvenate your skin – and other body parts – to help you achieve your best self.
Short for “medical spa” (and sometimes called medi-spa), medspas 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.” Treatments at these facilities can range from administering commonly known injectables – including Botox and Dysport, which are types of neurotoxins used to treat wrinkles and other conditions – to dermal fillers, like Juvederm and Restylane, for example, used to 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 even treat skin conditions like rosacea. Chemical peels, microneedling, 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 – body contouring via Coolsculpting (a popular nonsurgical fat reduction treatment) and Emsculpt Neo (an FDA-approved high-intensity electromagnetic therapy that uses radio frequency to eliminate fat and build muscle) are just some of the common procedures unfolding at local medspace here in the East Bay and Newport County. But who is performing these procedures, and is it safe?
“When people come in for a consultation about their skin, we can give them a lot of options,” says Jana Magarian, who founded Radiant Esthetics MedSpa in Newport in 2017. “We have other tools now – lasers, microneedling with radio frequency energy, facials, peels, and all sorts of things.” Magarian, an advanced practice registered nurse (APRN), started her practice as a one-woman show. Today, she oversees a staff of six at her office on Bellevue Avenue.
Market demand, she says, has risen meteorically since she first opened, with no end in sight. “I don’t think it’s quite so taboo anymore. People talk about it openly with their friends,” she explains. Magarian also credits national advertising campaigns promoting products that she uses in her own practice, including Botox and Juvederm, for bringing the conversation about aesthetic medicine, the term used to describe non-invasive to minimally invasive cosmetic procedures, to the forefront. “The other thing that I think drove patients to seek out medspas is the aversion to surgery,” adds Magarian. Recovery time, expense, and higher risk associated with going under the knife are all factors that have motivated people to seek out alternatives.
“Surgery has been the gold standard for years, but not everyone is a surgical candidate, but also, not everyone needs to have surgery,” explains Dr. Mary Christina Simpson. A board-certified OB/GYN for more than two decades, Simpson opened SeaMist MedSpa in Newport in 2020, an expansion of her flagship medspa by the same name in South Kingstown.
“These services have really blossomed and the demand for them has increased, as well as what’s available. I think the trend to transition to non-surgical cosmetic procedures has increased so much over the past five years because people really want a no-downtime procedure with the effects of being able to see a difference,” explains Simpson. “I think doing smaller procedures in a well thought-out plan is more of the trend people are moving toward as opposed to the one-and-done face lift.”
Every practitioner we spoke with says they start with a consultation with prospective clients so they can find out their long-term goals, review their medical history, and explain that not all services are a fit for all people. Budget is also a critical piece of the conversation as few procedures are “one and done” and most start at a few hundred dollars.
“A lot of people see things online and think that’s what they need or want, but having a consultation with a trained professional is key to making sure that the anatomy is really analyzed,” says Simpson.
“People will come in and pull the skin down by their jaw back to their ears and they will say, ‘I want this done,’ and I say, ‘Well, that’s a lower facelift,” says Meaghan Macrae, a board-certified primary care nurse practitioner who owns Macrae Medical in Middletown. “We turn people away a lot if we think that they are not a candidate for filler, or if it won’t look natural.” Other factors, including a client's lifestyle, can play a role in decisions about procedure. Diet, sun exposure, alcohol consumption, and smoking can all impact results.
For the unindoctrinated but interested, concerns about cosmetic procedures typically center around looking “fake” or “frozen,” but practitioners steer clients to procedures that will enhance what they already have.
Macrae calls making people look natural is her “bread and butter.” Living and working in the small community of Aquidneck Island, she says her clients are “walking billboards,” and she wants them to only look like their best selves. “It’s a small town. I don’t want people to be like, ‘What did you have done?’ I don’t want people looking like they had anything done, just looking refreshed,” she explains.
When Macrae opened the business in 2019, it was most focused on primary and preventative medical care, including annual physical exams, wellness exams for Medicare patients, treatment of acute and chronic diseases, and same-day sick visits. While these services are still a substantial part of the practice, it expanded to include aesthetics and has grown to a staff of five. “The demand is here for sure. From a business sense, it's profitable, and I personally love doing it,” says Macrae. “I could do it all day long. It gives a lot of people confidence.”
“I never tell people ‘You’re going to look younger.’ I tell them they are going to look rested and feel better about themselves when they look in the mirror,” says Simpson, adding that practitioners can't reverse aging, but help people age a little more gracefully.
Not all practitioners are created equal – and that’s okay, but it’s important for clients and patients to do their homework.
While their paths to medical aesthetics may vary, there’s a general consensus among practitioners that the rules and regulations of the industry in the State of Rhode Island are murky at best. Many are in favor of better oversight, and not necessarily because there are bad actors, but simply too much ambiguity.
Dr. Mary Christina Simpson of SeaMist MedSpa says it’s imperative to have either a physician or an advanced practice nurse practitioner on staff to monitor procedures. “Although we never think of procedures with complications, we do like to always plan ahead and really have that training under our belt. The surgical training that I’ve had, and being in an operating room the majority of my career, as well as seeing patients in emergency situations, has really prepared me to handle complications if they were to arise.”
Meaghan Macrae of Macrae Medical in Middletown says she thinks Rhode Island should implement better defined regulations, suggesting perhaps a required amount of training hours annually. “I think that’s totally fair to ask to have it as a requirement, and I do think some states are pushing for that.”
Jana Magarian of Radiant Esthetics MedSpa says along with her staff, she regularly attends trainings to stay on top of newer, better, safer ways to practice. “To take a basic Botox or filler course and think that you can come out of the gate and practice is not nearly enough. You really have to keep taking courses… It’s not atypical for someone at my level, with upwards of 50 patients a week, to be doing some sort of training a few times a month.”
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