Services include Botox injections, laser wrinkle reduction, laser hair removal, microdermabrasion, intense pulsed light and chemical peels, and other procedures designed to reduce wrinkles, acne and other scars, freckles and spider veins.

Phoenix-based Dermacare Laser & Skin Care Clinics only opened in July 2001 and already has seven locations open, another seven opening in 90 days and contracts to open more than 120 in the country, according to Carl Mudd, president and chief executive officer. He said safer technology is driving the growth.

No one knows how many medical spas there are in Arizona. Roxanne Cottrell, head of the small American Association of Cosmetic Laser Specialists, which has 19 members, says there are at least 50 free-standing businesses in the state. She also owns Advanced Laser Training Institute in Mesa.

More growth is coming, because of customers like Roxanne Chitwood of Mesa. She looked in the mirror at her wrinkles and dark spots under her eyes and decided, like many other baby boomers, that since she didn't feel like she was almost 50, she didn't want to look it.

She began going to the Skinovative Laser Center at the Chandler Fashion Center for various intense pulsed light and laser treatments and even one where a thread was sewn around her face and pulled tight. She is thrilled with the results, which cost more than $3,000, and believes her more-youthful appearance helped her land a job as an administrative assistant at a Phoenix engineering firm.

However, dermatologists and some regulators worry that the medical spa businesses are growing so fast that some employees may not be qualified, that the businesses may not have doctors on site as required, or that workers could misdiagnose some skin conditions, such as skin cancer.

The Arizona Radiation Regulatory Agency adopted new rules in April that require anyone using lasers for cosmetic reasons to get 40 hours of classes, plus at least 24 hours of hands-on training. But John Lamb, the agency's sole inspector, said he runs into people all the time who don't know about the new law.

The number of surgical and non-surgical cosmetic procedures jumped by 44 percent last year from the previous year, to almost 12 million, according to the American Society for Aesthetic Plastic Surgery. Non-surgical procedures rose by 51 percent, with Botox, laser hair removal, chemical peels and microdermabrasion being the most popular.

Diane McGowan, a 45-year-old Ahwatukee Foothills woman who sells surgical trays to hospitals, spent more than $1,000 at a Radiance Medspa in Chandler to remove sunspots from her face and hands. "I work with my hands because I present on a daily basis. So they need to look good. I noticed they were starting to age and look like my mother's hands," she said.

Robert Wallen, a Phoenix man who is a regional director of managed care for a hospital, gets Botox injections every six months and said it is no more painful than a mosquito bite.

Sheila Zurn, 55 of Gilbert, has had microdermabrasion, photo facials and other procedures at Radiance MedSpa to erase years of sun damage and improve her skin texture.

Dermatologists remain leery at the proliferation of businesses outside traditional medical offices. However, the state boards that oversee medical doctors, osteopaths, naturopaths and cosmetologists have received relatively few complaints so far.

Sue Sansom, executive director of the Arizona Board of Cosmetology, said of the 700 investigations the board conducts a year, some have involved cosmetic skin procedures. "We have had several investigations of serious skin issues," she said.

Dr. Gary Henry, a Scottsdale dermatologist, said he treated a patient recently who had gone to a laser clinic for treatment of sun damage on her chest and had been burned by an intense pulse light treatment and developed scarring and an infection.

"It's a little alarming. I, as well as other dermatologists, am seeing an increasing number of complications from procedures like these done in spas and other non-physician locations. Five years ago, we hardly saw any.

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