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 here in South County.
Not all practitioners are created equal – and that’s okay, but it’s important for clients and patients to do their homework. We spoke to more than half a dozen practitioners for this story, ranging from board-certified physicians (including an obstetrician-gynecologist and dermatologist) to nurse anesthetists and nurse practitioners (NPs) with special concentrations and certifications, all of whom took their own path to aesthetic medicine.
Dr. Valerie Tokarz, a cosmetic dermatologic surgery specialist in East Greenwich, completed her residency at Naval Medical Center San Diego, where she was on the cutting edge of laser development while performing rigorous research and working on significant cases in her field. After becoming a civilian, she launched her own private practice here in Rhode Island, Tokarz Dermatology, where she treats myriad conditions and performs cosmetic procedures.
“You can treat a lot of skin conditions with lasers,” she says, pointing to rosacea, acne scars, and sun damage as just some examples. Tokarz, who has been a physician for more than 20 years, says she’s seen considerable demand for laser and aesthetic medicine in recent years, and as the industry continues to grow, she’s become an advocate for patient safety.
“I was there at the beginning, when a lot of these things came out, like Botox and Restylane. A lot has changed since then,” she concedes, and at her South County Trail office, Tokarz performs every procedure personally, ensuring she is with patients from consultation through recovery and follow up.
“You have an industry that has been making a lot of money, and rightly so. I think Botox is a really interesting medicine that we use for cosmetics, we use for medical purposes, and it has a lot of amazing benefits to it, but it’s a medication, and you need someone who understands the risks that are involved with it … there could be side effects and you need to be prepared to treat them, and for that you need a medical license.”
Before Dr. Mary Christina Simpson founded SeaMist MedSpa in South Kingston, she was a practicing OB/GYN. “I originally wanted to do well-women care, where I could do surgical care, and follow them through all stages of life, from teenagers to menopause,” explains Simpson. “As my practice evolved in obstetrics, I became more involved with focusing on the whole woman, and understanding it wasn’t just about the gynecological aspect only. Women have a huge psychological, spiritual, and emotional component to them, and so what improves that, in a wellness way, was very important to me.” Simpson bought the flagship medspa in South County Commons that had originally opened in 2008 in 2018 and expanded with a Newport location in 2020. Today, SeaMist has 15 employees.
“We never try to manipulate or change people. We try to enhance them and make them better, realistic versions of themselves,” says Simpson. “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.”
Simpson says it’s imperative to have either a physician or an advanced practice nurse practitioner on staff to monitor all of the 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.”
For Tara Phelps, a local Certified Registered Nurse Anesthetist, expanding her skill set to aesthetic medicine was a seamless if unexpected journey. “I have been a nurse for 22 years and an advanced practicing nurse specializing in anesthesia for 12 of those years,” says Phelps, owner of Subtle T Aesthetics in downtown Wakefield. When the hospital where she was working eliminated elective surgeries during COVID, Phelps was faced with two options: file a claim for temporary disability insurance or transfer to the ICU and work – with a pay cut. Neither was an attractive option for the single mother of two, who had always described her career as “recession proof.” A friend mentioned that with Phelps’ experience in anesthesia, aesthetics might suit her well. “She said, ‘There is no one else I would let touch my face,’ and that was kind of how the idea started.”
Phelps took money out of her retirement savings to start Subtle T Aesthetics as she wanted to ensure everything was set up properly, starting with securing a lawyer from the RI Department of Health. Creating an LLC, buying product, renting a commercial space and malpractice insurance – on top of paying off education loans and continuing education – has been pricey, so she hasn’t turned a profit just yet, but her passion for helping clients achieve realistic results, the right way, is palpable.
“There’s a lot of emotional intelligence to understanding why the client is here. Are they here because of something that truly upsets them, or are they just having a bad moment and trying to change something in their life externally? My job is also to be ethical and to treat the whole person, not just the one part they want fixed.”
While their paths to medical aesthetics may vary, there’s a general consensus that the rules and regulations of the industry in the State of Rhode Island are murky at best, and are in need of better oversight. The challenge isn’t so much bad actors, just ambiguity.
“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.” She had been working with interim RI Department of Health director Dr. James McDonald, but he stepped down in June of this year. Calling the department “underfunded,” Tokarz continues to advocate for broader industry guidelines clarifying which qualifications are required for which procedures and requiring medical aesthetics practitioners and medspaces to have malpractice insurance.
“I don’t know the percentages, but I think it’s pretty high that you have these practices, that they don’t have proper coverage, and that is also part of what we are trying to pass in Rhode Island – that anybody who is doing a cosmetic procedure has malpractice insurance,” says Tokarz.
The risks are real, particularly with fillers, says Tokarz. She says she’s working toward defining dermal fillers as gel implants that are meant for soft tissue implantation, in which case they’d be classified as semi-permanent implants.
Phelps agrees that regulations need better definition. “One of the risks of filler is, if you inject it into an artery or vein, you can cause what is called a vascular occlusion, and my guess is a lot of practitioners probably don’t educate their patients about that because it’s a very scary thing, but part of my job as a nurse is to let you know this procedure isn’t without risk, even if this is a very rare thing that can happen.”
Phelps explains that despite being an advanced practice registered nurse (APRN) with more than two decades’ experience, a medical spa in Rhode Island must be operated by a physician, nurse practitioner, or have a medical director.
Nurse Practitioner Brittany Iafrati, FNP-C, founded Bel Viso Medical Spa in East Greenwich in 2017. What started as a “me, myself, and I” business has grown into a thriving practice with four nurse practitioners in addition to herself, three estheticians, and a receptionist. “There are people that just want a doctor and that’s fine, but I think the questions people should be asking when they are calling and looking for a provider is, ‘How often are you injecting? How often are you going to conferences and training?’” Iafrati says her ongoing professional development includes attending and paying for six to eight trainings a year on average, and that people can sometimes underestimate the time and investment that goes into developing a successful practice.
“I get a little frustrated when people call me and say they’re a nurse and they just got their certification in Boston and they want to work out of a hair salon injecting part-time,” says Iafrati. Proper education and training is essential, she says. “It needs to be regulated for sure.”
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. “I want to stick up here for the RNs because it is within their scope, I believe, to do injectables,” says Lutes. “I’m an NP 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. [A RN] could be doing something for 30 years and then all of a sudden, because she’s only a RN and not a nurse practitioner, an advanced practice nurse, she’s cut out.” Lutes says she’s been trying to band people in the industry, which she admits can be competitive, for the betterment of all. “I have been reaching out even to my direct competition and trying to group us together, and get us to collaborate together.”
In 2021, 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. “A number of practitioners reached out to me and said there are some regulations, but 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 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.”
Every practitioner we spoke with says they do free consultations with prospective clients so they can find out the client’s long-term goals, review their medical history, and discuss what procedures may or may not be a good fit. Budget is also a critical piece of the conversation as few procedures are “one and done” and most start at a few hundreds dollars.
“People should not be price shopping [in this industry],” warns Iafrati. “We say ‘search for a deal on your purse, not your face.’”
Dr. Tokarz’ office manager and director of patient relations Maria DiSimone has similar advice. “Don’t be a Grouponer when it comes to these procedures. People are looking for a bargain, and in the end, you get what you pay for.” Tokarz advises anyone interested in getting a procedure to hop on the internet and research credentials. “You can go to the Department of Health and you can look up someone’s license. They should have their credentials on any website,” she says, “and make sure they have malpractice insurance.”
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