An excerpt from Med Spa Mayhem: The Good, The Bad and the Ugly Secrets of the Aesthetics Industry.

Over the last 20 years, the medical aesthetics industry has grown from infancy to a $20 billion industry. Botox was approved for cosmetic use in 2003, giving birth to a new Wild West of medicine. It may have started in the offices of plastic surgeons and dermatologists, but now there are med spas on almost every corner—and most of them are operating illegally. There are myriad people practicing medicine without a license, nurses operating without supervision, aestheticians and other non-medically trained individuals injecting Botox and fillers, and even administering IVs. Laypeople are illegally owning medical practices. Increasingly, there is the use of fake products purchased on the internet—leading to botulism, necrotizing infections, and death. While mainstream medicine is being increasingly squeezed by regulation and insurance companies, the cash-pay aesthetics industry is exploding, unregulated.

Arrests in Texas and California

In late 2018, there was a moment when I thought someone was actually going to enforce the law. Four people in Texas were arrested for the illegal practice of medicine. This included a nurse, the doctor who was supposed to be overseeing her, and the spa owner of Savvy Chic Medspa in Spring, Texas (which, by the way, in 2024 continues to operate and has a five-star rating on Google). There was a separate arrest of a medical assistant who was illegally injecting unsupervised on her own, in addition to illegally prescribing meds on a stolen prescription pad.

The charges against the three involved from the Savvy Chic spa were ultimately dropped. The action against the medical assistant was still pending as of the last information available. I could not find any resolution to that case.

Soon after the Texas arrests, there were two in Redding, California, in January 2019. Susan Ann Tancredo was charged with practicing medicine without a license in addition to eight felony violations, including mayhem, battery with serious bodily injury, and selling and transporting a controlled substance. Dr. Larry Richard Pyle also was charged with aiding and abetting Tancredo. The doctor illegally bought Botox® and other injectables from outside the United States and sold them to Tancredo, who offered illegal injections at a day spa. Patients thought she was a nurse, but she had no medical license. The spa owner was not charged, but then all three were sued by a disfigured patient.

Death in Texas

Jennifer Cleveland, a forty-seven-year-old mother of four kids, worked at a radio station in Texas, selling advertising. She was doing some social media marketing for “The Luxe Medspa by Amber Johnson.” On July 13, 2023, she told her friends she was going to the spa in Wortham, Texas, for an IV infusion treatment. She died a few hours later at the spa.

The med spa advertised on its Facebook page: “I (Amber Johnson) am behind this Medspa. I am a Certified Practitioner with all current licenses with a Medical Director, Dr. Gallagher MD from Dallas, Texas.” Her spa advertised many procedures that make no sense, such as “Laser Vein Threading” and “Body Extraction—Face.” It also advertised three different kinds of IV “therapy,” including “energy,” “hydration 1 treatment,” and “hydration (three pack).”

First, there is no medical reason a healthy human being needs an IV treatment. There are “IV clinics” popping up all over the country, charging you money for something you don’t need. Just have a glass of water, Gatorade, or your drink of choice. Second, there is no quicker way to kill someone than to stick a needle in someone’s arm. There are so many ways to do it. Hang the wrong thing—boom, you’re dead. Put the IV in wrong—boom. A superfast way to die is from an air embolus—that’s when a lot of air gets into the IV. Air does not mix with blood. It travels to the heart, and the heart can no longer pump blood—and you die.

Official reports are that Jennifer died of a potassium overdose in the IV. One thing I can tell you: IV infusions cannot be done by someone who does not know what they are doing! Hospitals source IV fluids from highly regulated medical supply companies. The IV bags are in proper storage, and every time an IV is hung, the nurse checks your ID badge twice before proceeding. There are tons of checks and balances to try to prevent medical errors. They can still happen. Med spas, especially those run by nonmedical people, get products from lots of nonmedical sources and have little ability for proper storage and no checks and balances. Plus, who is the person providing the service? Do you know what their credentials are, or what training the person doing the procedure has had?

Dr. Michael Gallagher, the medical director, had his license suspended for a few months, but it was later reinstated, and he returned to practicing anesthesiology.

The med spa industry will not police itself. Unfortunately, the authorities only react when someone is killed, as happened in Texas. Yet in that case, to date, there have been no charges. The next step is to form a national nonprofit that will provide med spa certification—to evaluate and confirm legal compliance. Like the label “Certified Organic,” this would tell consumers that the providers are licensed and properly supervised, legal ownership is established, and safe, legal products are used. Not a rating agency—but a certification board. If this becomes widely known, then the non-certified illegal practices will wither.

Kate Dee is a radiologist and author of Med Spa Mayhem: The Good, The Bad and the Ugly Secrets of the Aesthetics Industry.