But Cassidy is not at a doctor's office for the medical procedure. The West Palm Beach resident is at a luxurious day spa inside a PGA Boulevard shopping center. She's one of an increasing number of women choosing to go to places such as Anushka at Advanced Aesthetics Institute, not only to get their hair and nails done but also to choose from a menu of nonsurgical cosmetic services such as Botox injections, microdermabrasion and laser hair removal.

Such procedures were previously only available in offices of cosmetic surgeons and dermatologists. But so-called "medical spas" such as Advanced Aesthetics — which also has a medical spa in West Palm Beach — are part of a fast-growing national trend of retail establishments combining medical services with massages.

And with its image of fretting over image, Palm Beach County has emerged as one of the hottest medical spa areas in the country. About a dozen have opened here in the past two years or are in the planning process. Most of the county's upscale shopping spots — including Downtown at the Gardens, the Town Center at Boca Raton and the Mall at Wellington Green — have a medical spa or are getting one.

"Med spas" — the faddish short name for this new wave of establishments devoted to self-pampering — marry several consumer trends, including the move of health-care services out of medical offices into retail settings and the growth of less-expensive and less-invasive cosmetic treatments over full-fledged plastic surgery, such as face-lifts.

For the spas, the medical services provide another source of revenue. For doctors, it's a chance to bill patients directly rather than through insurers, which may be more stingy than they prefer. And for customers, largely women over 35, they can avoid going to the doctor, where they often have to wait and intermingle with sick patients.

"It's just very convenient to go one afternoon and get all my maintenance taken care of," said Cassidy, who works in sales and marketing for a local property developer.

The spas focus on pampering clients with everything from mood lighting to soothing music and plasma televisions. Most also offer a line of skin-care products. And unlike most doctor's offices, they are open nights and weekends.

To be sure, some doctors worry the med spas may provide medical treatment without enough physician supervision. In Florida, like most states, a doctor doesn't have to provide injections such as Botox, but must oversee the physician assistant or nurse practitioner who does.

But spa owners insist that if their doctor doesn't perform the medical procedure, then their nurses or technicians are just as well trained.

Dr. David Dedo, a Palm Beach Gardens cosmetic surgeon, welcomes the new competition from the spas, which he thinks will increase awareness of many new, nonsurgical procedures. "The flip side is, you have to be aware of who is administering the treatment and is it done under supervision of a doctor," he said.

Dedo raises another yellow flag for potential customers: The nonsurgical techniques produce only a temporary improvement that typically lasts no more than six or nine months. "You can pay me now or pay me later," Dedo said, stressing that several nonsurgical treatments stretched out over two years can cost as much as a face-lift.

"There is big money coming into the industry because of the medical component," said Hennelore Leavy, founder and executive director of the International Medical Spa Association.

Indeed, nationally, there are an estimated 1,500 med spas — up from 400 three years ago and just a dozen five years ago — according to the spa association.

Nowhere is that growth more evident than in Palm Beach County and the Treasure Coast, home — and second home — to some of the wealthiest folks on the planet.

Europa Medi-Spa in Boca Raton opened in 1986, when it focused on providing treatment for cellulite. It now offers everything from Botox to acupuncture to chiropractic care, and has noticed increased competition in the past few years.

Several national chains also have entered the potentially lucrative arena. That includes Radiance Medspa, which, through franchisees, recently opened medical spas in Downtown at the Gardens and Boca Raton, and plans to open franchises at the Mall at Wellington Green and Boynton Beach. Two local anesthesiologists — Dr. David Salvador and Dr. Jonathan Rubin — own the operations in Downtown at the Gardens and the yet-to-be opened Wellington mall site.

Even as spas add medical services to compete with doctors, some plastic surgery offices have begun offering nonsurgical treatments now found at spas.

Hass Plastic Surgery in Palm Beach Gardens, during the past year, has added medical spa-type services including chemical peels, laser hair removal and Botox. The practice has also started selling a line of skin-care products.

"It's one-stop shopping, and since our patients already trust us, they now feel comfortable trying other age-defying options," said Dr. Andrea Hass, who runs the plastic surgery practice with her husband, Dr. Brian Hass.

Adding the other nonsurgical services complements their surgical treatments, she said. "They often go hand in hand in giving patients overall beauty rejuvenation," she said.

Prices of medical services vary considerably among spas. Botox typically costs about $400 per treatment area. Laser hair reduction costs about $700 for a bikini treatment or up to $3,000 for a back. Microdermabrasion costs about $150. Restylane costs about $600 to $1,200. Having the medical services done at a retail setting has led to some price competition — something typically unseen in the medical field.

"Part of the allure of these services is that people don't want surgery or to have anything drastic done," said Dr. Shawna Flanagan, a Jupiter dermatologist who provides treatments at Advanced Aesthetic. She said some younger customers see the services as preventive techniques.

Doctors have partnered with spas to provide the services because the spas can help in marketing new patients and in paying for expensive equipment.

Dale Smith, a Hobe Sound attorney and former Enron and Florida Power & Light executive, later this year plans to open the True Glo Med Spa in the Oakbrook Square Shopping Center in Palm Beach Gardens. He said the location, now under construction near a Publix Super Market, a hair salon and Starbucks, will mean customers can get a cosmetic service while doing their other errands.

"Botox, bagels and banking," he said, noting how people can get the medical service on their lunch hour. Smith said the Palm Beach Gardens site will be the first of four he plans to open in Palm Beach County and the Treasure Coast.

Laura Silagy, 35, of Palm Beach Gardens doesn't like to go to a doctor's office, particularly when she's not sick. That's why she prefers the spa setting. She had her hair styled and had facials at the Advanced Aesthetic.

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