There’s some mystique surrounding spa practices and spa patients. So here are four stories straight from physicians about their backgrounds and their customers.

Physicians who operate medical spas would like to clear a few things up for their non-spa-operating colleagues. First, they are not beauticians who are letting their hard-earned MDs go to waste. And they don’t cater to impossible, Beverly-Hills-housewife-type customers in their practices.

They’re doctors, and their patients have real medical needs. Indeed, the main difference between a traditional practice and a medical spa practice is that physicians have added ancillary services onsite for patients who want to combine clinical care and something a little softer—maybe a facial after the facelift or some photo rejuvenation therapy to go along with the reconstructive surgery on the nose.

Read on to learn more about what drives physicians and patients in this emerging environment.

Marc Mani, MD, M Aesthetics Spa,  Los Angeles
Like many medical spa practice physicians, Dr. Mani is a cosmetic surgeon by training. He performs many of M Aesthetics Spa’s most difficult procedures. Those services are combined with other spa services, including massages, steam baths, saunas, facials and laser hair removal. In addition, Dr. Mani offers a line of personally selected skin care products. “In our practice, I’m a doctor who offers spa services,” he says. “But there are many spas that happen to have a medical director so they can offer medical services.”

Dr. Mani says one advantage of operating a medical spa is the synergy between it and his surgical practice. “I can refer my postoperative patients for a wide variety of treatments—including facials and skin care treatments that enhance the results of surgical treatment,” Dr. Mani says. “And that means I get to see them more often outside of a surgical follow-up setting.”

There are personal benefits, too, Dr. Mani says. “If I’m operating three days a week for 14 to 16 hours a day, I need a massage at the end of that week,” he says. “I can go to my own spa and get reset every Saturday.”

Mignon Marquina, MD, Skin Suave Spa, Inglewood
Dr. Marquina graduated from Stanford University School of Medicine and expected to pursue a career in plastic and reconstructive surgery—which she abandoned after starting a family. “I settled into a more comfortable career choice with family medicine,” she says, “but I’ve always wanted the autonomy of designing my own practice.” She found it in her medical spa practice—Skin Suave Spa. “The hours and schedule are more flexible,” she says. “I appreciate the relaxed pace and lack of insurance companies and other forces driving my business. I can decide how many patients to see, how much to charge and what treatment is appropriate.”

Thus far, Dr. Marquina reports that the process of selecting equipment has posed the most challenge. “One of the difficulties is the vast amount of research required to evaluate technology and equipment that we often did not encounter in our residency training,” she says. “Furthermore, we must seek additional training and, although there are many courses out there, they are not all good. Many are just programs to prequalify buyers to market materials sold by the sponsors of the training courses.”

Dr. Marquina caters to people of color, which adds a level of complexity to her services as well. “I had to research extensively the technology that is safe enough to treat people with brown skin because of the healing irregularities when the skin is irritated or wounded,” she says. “Anticipating that, I selected products and services that address those issues and minimize the risk.”

In addition to grappling with product and service decisions, Dr. Marquina also worked hard to sort out the financial aspects of the business. She says the cost is generally higher to start a spa practice than a traditional practice. “By doing extensive research and selective shopping, I was able to furnish my office very tastefully, within a reasonable budget,” she says. “I opted not to put in expensive floors and extensive plumbing and probably saved $30,000 right there. That allowed me to spend more on equipment and durable goods. I didn’t go for a lavish design, which is almost becoming cliché. I chose instead to cater to the cultural tastes of the neighborhood. I have streamlined costs and tried to approach the financial infrastructure with some forward planning.”