• Tri-active laser works with suction to reduce cellulite, while the handheld device for Endermologie sucks and squeezes the dimpled areas of the skin between rollers.

• In sclerotherapy, a solution is injected into spider veins to make them less visible. In laser treatments, laser energy targets the vein wall, causing it to collapse and close.

When Pepe Hanif wanted fuller lips, smoother skin and fewer lines on her face, she skipped the usual trip to a dermatologist or a plastic surgeon's office. Instead, she spent about two hours getting minimally invasive cosmetic procedures supervised by Dr. Bernard DeBerry at in Newport Beach.

"It was wonderful," said Hanif, 51, who recently moved from Irvine to Corona. "I felt pampered. That's the big difference between a medical spa and a doctor's office."

Until it's time for a facelift, Hanif expects to be scheduling regular visits to the medical spa, better known as a medspa, for cosmetic maintenance.

Medical spas are booming, in part because they blend the creature comforts of a day spa with elective cosmetic procedures that, until recently, were performed almost exclusively in a plastic surgeon's clinic or a dermatologist's office.

And that's caught the attention of lawmakers. Two state bills target how medical lasers are used in medspas and who should be allowed to use them.

"I've been getting calls at my district office from consumers about how they've had injuries and other problems with laser procedures that weren't performed by a doctor at a medspa," said Sen. Liz Figueroa, D-Fremont, author of both bills.

Figueroa said laser and intense pulse light procedures are just the starting point for what she hopes will be a more comprehensive law that will cover existing and future medspa medical procedures.

About a dozen medical spas have opened or are slated to debut in Orange County this year, mirroring what industry executives call an explosion of medical spas in metropolitan areas across the U.S.

Irvine-based , one of the largest medical spa developers, has opened at least 27 locations across the nation and is slated to open four in Orange County this year.

of Irvine opened its first location this year in Irvine and expects to open six more locations in Orange and San Diego counties by the end of 2008.

"It's the fastest-growing category in the spa industry," said Dr. Bruce Katz, chairman of the advisory board of the Medical Spa Society, a spa trade group based in New York. Katz' group pegs the number of medspas at between 400 and 1,600, depending on how narrow or broad one defines a medspa.

Whatever the actual number, the recent growth stems from a combination of two key factors, said Shiu-Yik Au, senior analyst at Millennium Research Group in Toronto.

Second, many baby boomers are disenchanted with the idea of looking their age, a trend that has created a huge potential customer base for medspas.

"The most billable of these procedures is Botox," Au said. "When the FDA approved it for treating facial lines, that removed the stigma of getting it."

Indeed, Botox has been the hottest of the so-called "minimally invasive" procedures that have fueled growth in the cosmetic medical business. Though the popular image of cosmetic surgery involves breast enhancements and facelifts, the hottest cosmetic surgeries since 2000 have been the minimally invasive variety. The category, in fact, jumped 13 percent last year, to 8.5 million procedures, according to the American Society of Plastic Surgeons.

Until the advent of medspas, baby boomers such as Hanif who wanted more than one procedure had to go to several locations. They went to laser centers for hair removal, the dermatologist's office for skin peels, the plastic surgeon's office for collagen injections. And if they wanted to relax after all that, they went to a day spa for a Swedish massage.

But it's not just baby boomers who are potential customers, said Robert Fisher, CEO of New You Luxury Medspas. New You targets entire families – the mother who wants Botox, the dad who needs hair removal and the teen who needs acne treatments.

Orange County is one of a handful of urban spots (Los Angeles and New York are others) viewed as fertile ground for a medspa boom, says John Buckingham, chief executive of Solana MedSpas.

Degam, for example, positions itself as a high-end luxury spa, with a plastic surgeon who performs all medical procedures. The company locates only in high-rise office buildings, said Maged Zakhary, CEO of Degam MedSpas.

But Solana's Buckingham sees a future that's less exclusive, in which medspas are easily accessible and operating in shopping centers, similar to the way optical chains already do business.

In another business model, plastic surgeons and dermatologists build or add a medspa next door, keeping it separate from their medical practice, Katz said.

An onsite spa called at Banner Desert Medical Center in Mesa, Ariz., is open to hospital employees, patients and the community. But the spa also takes some of its services, such as facials, beyond the spa doors and straight to where patients may need them the most – hospital beds.

While the boom in medspas is good news to the spa industry, some groups are trying to prevent potential problems and lawsuits. Katz says the Medical Spa Society is looking to set national standards for medspas to ensure people are well-trained.

"The industry is growing so rapidly, and there aren't many trained people nationwide to fill the demand," said Hannelore Leavy, executive director of the Medical Spa Association.

"Where are they getting the nurses, physician assistants and doctors? There is not much training available. And even the doctors themselves need training. Consumers need to remember that these are medical procedures and not a simple massage."

Two Bay Area women are suing medspa chain , charging that they were badly injured during laser hair-removal procedures. The state medical board is investigating the medspa chain.

The investigation underscores two thorny issues affecting the medspa industry: whether a medspa needs to have a doctor on-site and whether a doctor, nurse and physician assistant – not a trained esthetician or cosmetologist – should perform the procedure.

Many states, including California, do not require a doctor to perform the procedures. But most states require medspas to have a medical director. In some cases, the doctor does not have to be on the premises.

"That's good if everything is going well," Katz said. "But what if something goes wrong, there's a medical emergency and the doctor's office is two miles away?"

Having a doctor on-site is overkill and not a guarantee that problems won't happen, contended Buckingham of Solana Medspas. "Proper training ... not having a physician on-site, is the answer."

The bills on laser procedures, SB 1423 and SB 1474, address these issues. Under SB 1474, only doctors, nurses and physician assistants would be allowed to use laser devices for cosmetic procedures. The bill would make it a misdemeanor for a cosmetologist to use a medical laser.

Senate Bill 1423 essentially defines the concept of "supervision" when a health-care professional other than a doctor performs a laser procedure. If passed, a doctor would have to be on-site and available for consultation when a registered nurse or physician assistant is performing a procedure.

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