Spas used to mean oat masks, aromatherapy oils and sympathetic young women called Kirsty going on about your chakras. But something is afoot in the world of towelling, with less emphasis on R&R and more on “medispas”.

The old platitudes are being superseded by a shiny new pragmatism involving on the one hand speedy results-led treatments such as Botox, fillers and peels and, at the other extreme, the kind of nip-and-tuck interventions usually categorised as “work”. Kirsty and her ilk have been usurped by bright young medics with dermatology specialisations, glycolic peels have replaced lavender oil, and the pan pipes have been binned.

Medispas are busting out all over the UK. Examples include Renew Medica, which professes to be “bringing Harley Street to the high street” and has seven southern branches. Myspa clinics have established themselves as the footballer’s wife aestheticians of choice with outposts in Cheshire, Newcastle and Liverpool. Meanwhile, Harvey Nichols has put itself at the forefront of this trend in resolving that its Beyond Spa (beyondspa.co.uk), should focus on peels and injectables rather than mud wraps and Tibetan bells.

The medispa, then, could not appear more modish: a choice between rhinoplasty with the rhinos, or shopping and a filler fix at some ritzy department store. But is there a downside? Just how medical are medispas and should you be putting your face in their hands?

The rise of the medispa is not confined to these shores. A recent Mintel survey of health and wellness holidays argues that, where “once holiday makers were happy to return home with a suntan and a bottle of the local hooch”, today their mementos may include “a new look and maybe even new body parts”. It estimates that we spend about £60 million a year on medical tourism, half of which is cosmetic. The savings are remarkable: a facelift may cost as little as £300 in Bangkok, but several thousand at home. Plus the patient can pass off the transformation as a postholiday glow.

Typically, such packages are arranged by unqualified agents who meet patients in London hotel rooms, then escort them to spas in Africa and Eastern Europe. Belgium, Poland, Argentina, Malaysia, India, South Africa and Thailand have all proved popular, with America – home of 1,250 medispas and with a 33 per cent growth rate predicted this year – a more costly, but no less appealing, alternative.

Harvey Nichols’ take on the vogue may be called Beyond Spa, but the services it offers are not too far beyond.

Indeed, the brains behind the scheme, the American cosmetic surgeon Barry Cohen, is proud of his conservative approach. “I’ve seen fads in plastic surgery come and go. Some were completely ineffective or even harmful. Examples such as radiofrequency treatment which supposedly stimulates collagen using two electrodes, but instead it causes fat to atrophy and skin to hang off the face, sometimes requiring a facelift to correct the damage; permanent fillers which caused lumps and scars; and various light machines, again designed to stimulate collagen, but which had no real efficacy,” he says.

“My view is that, if I would not offer it to a member of my own family, then I won’t do it to a patient.”

So expect Botox, fillers, lasers, hardcore exfoliation, and teeth whitening, but not, say, mesotherapy (aka smart liposuction), which has been frowned on by the American Society of Plastic Surgery, and yet is all the rage elsewhere in the UK.

Only five months after its launch, Beyond Spa already boasts regulars, and prides itself on the relationship it has built up with clients. Dr Preema Vig, the spa’s medical director, tells me that she has already refused repeat Botox for one customer after an interlude of a mere three months rather than the usual four months. Her colleague, Dr Anil Budh-Raja, politely refuses me the needle too, explaining that I am in pretty decent nick.

We settle on a glycolic hand peel, a zapping of the odd vein, and microdermabrasion, which leaves me temporarily ruddy, but refreshingly unStepford. Moreover, given Anil Budh-Raja’s background as a GP, I get some general medical advice thrown in. I could not feel in safer hands.

However, this may not be the case in less professional medispas, some of which may offer more hazardous procedures. Cosmetic surgery proper is, of course, regulated. However, the Government announced that it has no intention of regulating the country’s estimated 4,000 providers of Botox and fillers, a move that had been anticipated for April this year. The justification for this volte face was that the industry has shown a genuine commitment towards self-regulation. “The Government bottled out,” says Jenny Driscoll, a health campaigner for the consumer association Which? “No one wanted this. Even the industry was asking for regulation. It’s an incredibly laid-back approach to people’s health.”

Botox is a prescription drug and can be administered only by doctors, nurses working under their authority, or dentists. Yet anecdotal evidence suggests that some spas may be offering injectables by itinerant practitioners with scant understanding of their impact on the face.

Wendy Lewis, an independent cosmetic surgery consultant and author, aka the Knife Coach (wlbeauty.com), argues that medispa disaster stories are “quite common”. “I saw one client recently who had laser work done at a medispa,” she recalls. “The technician was inexperienced, and she got a bad burn that blistered. She tried to complain, but the owner would not even speak with her.

“Another lady had a filler done in her lips. She wasn’t even told what filler, and it hurt terribly. She complained and was told that the woman who did it had been made redundant and there was nothing they could do. I ended up sending her to a proper doctor to have her lips corrected.”

Lewis’s conclusion: “Basically, any clinic or salon can call itself a medispa. All over the UK, untrained people are doing treatments on unsuspecting women. My advice would be to pick a doctor for your injections and laser therapy; pick a spa to have a facial or massage.” The situation abroad is still more uncharted. As long ago as June 2004 the British Association of Aesthetic Plastic Surgeons (BAAPS) was warning against the pitfalls of the ostensibly budget overseas options.

Norman Waterhouse, a former president of BAAPS, says: “Patients usually have no knowledge of the competence and experience of the surgeon, and there is very little prospect of follow-up. They are only meeting their specialist immediately before a procedure, at which point they are committed to and have paid for surgery. Patients then return to the UK without adequate medical records, if any.” The surgeons are not registered in Britain, and it is unlikely that there will be any revisional surgery.

Travel insurance is designed to cover events beyond the policyholders’ control, not planned medical procedures. Peter Staddon, of the British Insurers Brokers’ Association, advises prospective patients to “establish with the clinic what their protocols and expenses would be in the event of an infection or complications after surgery and look at some form of legal expenses insurance which is relevant within that country, to access justice should you need it.”

WHAT ARE THE RISKS?

For more information on cosmetic and noncosmetic treatments, what treatments to go for and what the risks are, take a look at which.co.uk/cosmetic Seek advice from an independent consultant such as Wendy Lewis: log on to wlbeauty.com

FOR UK PRACTITIONERS

For consultants specialising in Botox and Restylane in the UK, contact the British Association of Aesthetic Plastic Surgeons; visit baaps.org.uk/ To check out a UK medispa’s credentials: the Private and Voluntary Healthcare Directorate of the watchdog, the Health Commission, regulates all private clinics registered to provide cosmetic surgery in England (healthcare commission.org. uk/). Its yearly inspection reports should be available from any registered clinic. Outside England, the Scottish Executive (scotland.gov.uk/) and Healthcare Inspectorate Wales (hiw.org.uk/)

LOOKING FOR A SURGERY ABROAD?

The International Association of Aesthetic Plastic Surgeons (isaps.org) has an advanced global Surgeon Finder search tool. Consult the tips of US medispa doctors at spafinder.com/ spaguide/types/medical/ beautyandmedicine.jsp

Medispas by numbers

£30 million Amount spent in UK on cosmetic tourism annually

1,250 Number of medispas in the United States

£300 The cost of a facelift in Bangkok

700,000 The number of cosmetic procedures in the UK last year

£3,700 The average price of cosmetic surgery in the UK

3 months The minimum time most people spend researching a treatment

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