John Oliver’s deep dive into medspas on Last Week Tonight pulled no punches. The 23-minute segment called out the industry’s lack of regulation, highlighted egregious real-world complications and questioned why treatments that involve needles and lasers can be performed in strip malls by nonmedical staff. The tone was sharp, but many plastic surgeons agree: the core message was important.
Featured Experts
- Dr. Robert Singer is a board-certified plastic surgeon in La Jolla, CA
- Dr. Jeffrey Antimarino is a board-certified plastic surgeon in Pittsburgh
- Dr. Chet Mays is a board-certified plastic surgeon in Louisville, KY
- Dr. Alan Durkin is a board-certified plastic surgeon in Vero Beach, FL
“He absolutely nailed it,” says La Jolla, CA plastic surgeon Robert Singer, MD. “It was long, but incredibly thorough. The truth is, just because a business has ‘med’ in the name doesn’t mean it’s a true medical facility. And that’s a distinction patients really need to understand.”
We asked board-certified plastic surgeons who own medspas themselves to break down what viewers should take away from the segment and how to protect yourself when booking your next aesthetic treatment.
“Medspa” is a vague term and that’s the problem.
“Medspas are the wild west with essentially no oversight,” says Dr. Singer. “In many states, anyone can open a medspa. There’s no requirement for physician ownership, direct supervision or even qualified staff administering treatments.”
While some are run by physicians with strict safety standards, others operate with little more than marketing and minimal training. “There’s a real danger in assuming every place offering injections or lasers is held to the same standard,” he adds.
Vero Beach, FL plastic surgeon Alan Durkin, MD, chief medical officer of national medspa franchise VIO Med Spa notes that the medspa industry itself is ready for standardization. “Consumers need to know that medspa owners undergo standardized training to maintain outcomes,” he says. “To date, standardization does not exist, but most of us want formalized training that is required for medspas to function. As Chief Medical Officer for VIO MedSpa Inc., I can proudly state that nearly 100% of our owners and providers constantly ask for advanced training and support. This space wants to evolve and grow.”
Look past the branding and ask who’s holding the syringe.
A beautiful Instagram page doesn’t equal clinical training. “Patients need to ask: Who is doing my procedure? What is their background? What happens if something goes wrong?” says Dr. Singer. “You’d never let someone do dental work without checking their credentials and this should be no different.”
“A beautiful website or a trending TikTok doesn’t mean the person doing your filler knows what to do in a complication,” says Pittsburgh plastic surgeon Jeffrey Antimarino, MD of Bellissimo Plastic Surgery & Medi Spa. “It’s not about scare tactics, it’s about safety. Patients deserve to know who is treating them, what training they have and what their plan is if something goes wrong.”
Pop-up medspas are red flags.
Dr. Durkin says patients should be wary of medspas that only operate by appointment. “If a facility can’t support itself during business hours, that’s what we call a ‘pop-up’ medspa,” he explains. “It’s usually an investment vehicle for someone looking for profit, not a true medical facility aiming to elevate patient outcomes.”
He adds that the biggest red flag isn’t visual, it’s emotional. “Do you feel safe? Do you trust the injector the same way you trust your primary care doctor or gynecologist? If not, walk away.”
Board-certified plastic surgeons aren’t against medspas, but they want better regulation.
Louisville, KY plastic surgeon Chet Mays, MD of Mays Plastic Surgery and Medspa says it’s not about bashing medspas. “There are excellent, high-quality medspas run by physicians with properly trained staff,” he notes. “But what the segment highlighted is the growing number of places where there’s no real oversight. That’s where patient safety gets compromised.”
A task force is working to change the system.
Dr. Singer is part of a national task force through Quad A (formerly known as the American Association for Accreditation of Ambulatory Surgery Facilities) working to develop formal accreditation standards for medspas. “The goal is to establish clear accreditation guidelines for medspas, something distinct from surgical facility standards, but still focused on safety and accountability,” he says. These guidelines would help patients identify which facilities meet basic safety criteria.
There’s a difference big between an in-office medspa and one in a strip mall.
“Patients need to understand the setting,” says Dr. Singer. “A medspa within a physician’s practice is far more likely to have protocols, safety equipment and experienced supervision. That’s very different from an independent medspa operating in a retail plaza with no physician on-site.”
“Look for medspas associated with medical directors with formal aesthetic training,” adds Dr. Durkin. “There are a profound number of qualified aesthetic providers in the medspa space, and they want to be found. Look for how they were trained and by whom.”
What happens if the unexpected happens?
“One of the most important things to ask your injector is: What’s your Plan B if a complication happens?” says Dr. Durkin. “It’s not just about reversing a filler. It’s about whether your provider is treating you with long-term success in mind, or just hoping they don’t mess up. Those are two very different mindsets.”
Dr. Antimarino agrees. “Too many patients come to me after an issue like burns, filler misplacement, even infections because they didn’t know what to ask. Always verify that your provider has the tools and training to manage complications.”
Don’t be swayed by deals. This is your face and body.
“Price and convenience shouldn’t trump safety,” says Dr. Mays. “If something sounds too good to be true, it probably is. You’re not just buying a service, you’re trusting someone with your appearance and your health.”
The segment is funny but the takeaway is serious.
“Humor aside, the segment underscores a real need for consumer awareness,” says Dr. Singer. “The message is simple: Do your homework. Know who is treating you, what their qualifications are and what systems are in place if things don’t go as planned. The goal of all this is not to fear aesthetic treatments—it’s to ensure they’re done safely.”
