Nurse practitioner aggressively advertises a plethora of aesthetic treatments, some of which are dubious. It’s legal, but is it ethical?
Facelifts by plastic surgeon improve appearance. Aesthetic nurse practitioner’s offerings are more dubious.
Larson Medical Aesthetics, an organization with three locations, is run by a nurse practitioner named Margaret Larson. It is being promoted through full-page ads in a local daily newspaper, the Tacoma News Tribune. A typical ad that appeared right before Halloween screamed “Spooktacular Special” and asked “Are You Ready for Holiday Parties, Gatherings, and All the Group Photos? Get ready with the aesthetic experts at Larson Medical Aesthetics”, a ploy apparently designed to make readers feel insecure about their appearance. It offers a number of special deals that will expire on Halloween (4 days away). The offerings are questionable and the advertising is over the top.
The full-page ad offers:
- Boo for Two: if you bring someone special for services and purchase $100 or more, you will get a Spooktacular Gift Bag.
- BooTox: 20 units of Botox for $199 and discounts on future purchases ($10 instead of the usual $14.)
- 20% off on Aladdin’s 3 wishes for Juvederm: lift the cheeks with 2 Voluma, plump the lips with one Volbella, soften the smile lines with 2 Vollure, then receive a complimentary Advanced Peel and lots of BD points.
- 20% off on Thor Hair Restoration Package: 4 PRP treatments, a Thermadome Laser Helmet and PhytoMultiGen supplement, and a turbo-charged HydraFacial.
- 20% off on the Captain America Package to “regenerate a strong jawline or more defined for others”: PRP-enhanced Bellafill Jawline Sculpting Treatment with a complimentary Bellafill syringe and Universal Peel. Add 2 Kybella treatments to reduce the hard to get rid of double chin and receive 1 kit free ($1200 savings).
- 20% off on the Wonder Woman Package, a 2-month plan that includes DermaPlaning, HydraFacial with Collagen Booster and SkinPen Microneedling and the Larson Recovery Kit, with one complimentary PRP treatment.
- Add PRP to most treatments for $350 and release your regenerative (healing) powers. Can be added to Bellafill Lift of Face, Neck or Derriere, Feminine Rejuvenation GAINSWave ED Treatment, CO2 Laser Resurfacing of the face and Decolletage Resurfacing, and SkinPen Microneedling Scar and Texture Treatment.
And there’s a Cool Night Out Event where you can learn about CoolSculpting and enjoy refreshments, live demos, personal consultations, and a chance to win a free CoolSculpting treatment. Attendees will get special pricing and 10 free units of Botox with gift bag.
Wow! Are you impressed? Does it make you want to call right now? In case you’re not impressed enough, a “News” footnote informs you that Margaret has received the prestigious BellaDiamond Award from Suneva Medical for being the Top US Bellafill provider and injector of Bellafill, and in 2018 she was recognized as The Top World Bellafill Injector, providing over 18,000 Bellafill Treatments!
None of this tells me what I want to know: what are these treatments? Have they been scientifically studied and shown to work? If they work, how well do they work? What do they cost? Are there risks or side effects? How do they compare to other available treatments?
What does the evidence say about these treatments?
Microneedling is a minimally invasive procedure that creates hundreds of tiny puncture wounds; the micro injuries are thought to stimulate the body’s natural wound healing processes, increasing cell turnover and stimulating the production of collagen and elastin. The literature supporting microneedling is sparse, with few large or high-quality studies; and is hard to interpret because assessment measures differ and studies frequently combine it with PRP and other modalities. A systematic review in 2018 “positioned microneedling as a safe and effective therapeutic option for the treatment of scars and wrinkles” but added that “The current literature does show some methodological shortcomings, and further research is required to truly establish microneedling as an evidence-based therapeutic option for treating scars, wrinkles and other skin conditions.” A study comparing topical minoxidil plus microneedling to minoxidil alone for androgenetic alopecia concluded that the addition of microneedling increased hair count and patient satisfaction but the response was not cosmetically significant. In a systematic review of microneedling for acne scarring all the studies showed some improvement but they concluded that more studies were needed to compare it to other minimally invasive treatments.
CoolSculpting or cryolipolysis is intended to remove areas of body fat. It freezes the fat cells but does not damage other cells. It takes 4-6 months for the fat cells to leave the body, eventually producing a 20% reduction in the area of fat. Fat can re-accumulate, and long-term studies are lacking. Paradoxical adipose hyperplasia is a complication once thought to be rare but now estimated to occur in 1 out of every 4,000 treatment cycles.
Bellafill is an FDA-approved dermal filler combining microsphere enhanced bovine collagen with the local anesthetic lidocaine. An allergy test is required 4 weeks prior to its first use. It can cause minor side effects and bruising, and, less commonly, lumps or granulomas. FDA-reported side effects included blindnessassociated with dorsal nasal injections. The microspheres are not absorbed and can only be removed surgically. User reviews include a few success stories but many more horror stories and reports of ineffectiveness.
Juvederm is a hyaluronic acid filler approved by the FDA, designed to help address the facial signs of aging. Juvederm Voluma increases the size of the cheeks; Juvederm Vollure fills out wrinkles and smile lines around the mouth and nose; Juvederm Volbella is for lip enhancement. The average cost is $620. Results can last 1-2 years.
Kybella is a fat-dissolving injection of deoxycholic acid approved by the FDA for the treatment of double chins. It was welcomed enthusiastically by dermatologists and plastic surgeons, but now it is facing a backlash. It requires multiple treatments, results are inconsistent, and a course of treatment costs over $6,000. It causes soreness and swelling (sometimes described as bullfrog-like) that can linger for weeks.
PhytoMulti is a dietary supplement containing a laundry list of vitamins, minerals, and phytochemicals that claims to recharge, nourish, and defend cells like no other supplement. It has antioxidant properties and has been shown to affect biomarkers but has not undergone clinical testing for efficacy and safety.
Theradome (not “Thermadome” as the ad says) helmets use lasers to treat the scalp for hair loss. There have been some positive studies of lasers for hair restoration, but more research is needed. Long-term safety and effectiveness have not yet been established.
Femilift is a laser treatment offered for vaginal tightening and reduction of urine leakage. The CO2 laser devices are FDA-approved, but not for “feminine rejuvenation”. Such treatments have been strongly discouraged by the FDA, and the FDA has issued warning letters to several companies. An article in The Guardian called it “a depressing load of nonsense“.
It’s legal, but is it ethical?
My first reaction was “a nurse practitioner”? But I soon learned that Washington State is one of twenty states that allow nurse practitioners to practice independently, without physician supervision. They are authorized to run their own aesthetic practices and to inject Botox if they have been properly trained. So what Larson is doing is legal.
But the way she is advertising makes me very uncomfortable. It may be creating medical “wants” and unreasonable expectations instead of responding to real medical needs. Some of these treatments are not medically indicated. Some report high rates of patient satisfaction but have drawbacks and only minimal objective improvements. All are very expensive. Important details are not divulged, and I worry that the average layperson may be misled and pressured into treatments that they might not choose with true informed consent. Of course, I don’t know what they are told once they make an appointment, but it would be in the interests of the aestheticians to give biased information to persuade customers to buy.
We don’t see similar advertising by mainstream medical doctors. Aggressive and deceptive advertising tactics are discouraged by medical ethics. Mainstream doctors who are offering medically necessary, evidence-based treatments like diabetes management or orthopedic management of broken bones can advertise to let the public know who they are and that they are available for consultations, but there is no need for them to hype their treatments with exaggerated claims, special offers, and discounts. (Imagine: your blood glucose levels will be spooktacular and if you call in the next 48 hours you will get a free diabetic cookbook! Or: 20% off on x-rays and a free cast, limited time offer!)
I showed the full-page ad to a non-medical friend. After perusing it, he said it impressed him as “odd”. I agree, but I probably would have chosen a different adjective.
This article was originally published in the Science-Based Medicine Blog.