Article by Suzanne Sorrentino. 

If the soothing aqua color scheme and New Age music, along with the wall of falling water and the herbal teas offered in the waiting area, make you start to unwind and mentally prepare for your spa treatment, no one can blame you. It's not the kind of setting that calls to mind a visit to the doctor's office.

Welcome to the medical spa.

Ushered in over the past 10 to 15 years with scientific advances in the understanding of the skin's aging process, medical spas have been multiplying throughout Fairfield County. More women are seeking the nonsurgical anti-aging treatments, like Botox, that these facilities offer. Medical spa services are a step up from a simple facial or peel offered at a salon or typical spa, but not as drastic as a surgical facelift.

Many of the new techniques for tightening, plumping and smoothing out wrinkles can be performed by licensed medical professionals only. Yet in the minds of most people, these are still beauty treatments.

"People want to come to an environment that is not sterile, where there are not a lot of sick patients. So it's the experience. A soothing, comfortable environment, that's what people are looking for," says Marria Pooya, a managing partner at The Greenwich Medical Skin Care and Laser Spa.

The Old Greenwich medical spa offers peels, facials and exfoliating techniques, and sells beauty products, like a spa. But about 80 to 90 percent of its business is "medical aesthetics," Pooya says. "It's a medical facility that offers cosmetic aesthetic procedures in a spa-like setting."

"Medical spas differ from other spas in that they are run under the supervision of a trained and licensed physician," says Dr. Sohel Islam, a plastic surgeon with Advanced Cosmetic and Plastic Surgery, a practice that includes medical spas in Ridgefield and Danbury. "As a result, the treatments which can be offered are typically based on scientific principles and evidence. Over the last 10 years, science has discovered a great deal about the aging process of the skin and how to slow it down. Most of the treatments that work require the supervision of a doctor. Treatments at other spas may feel good but may not be as effective in slowing down the signs of aging."

Facial aging is three-dimensional, says Dr. Dana Brownell, medical director at Westport MediSpa. "Over the course of decades and exposure to the elements, our skin is not the same as it was when we were in our teens or 20s."

On one dimension the muscles change, leading to expression lines around the mouth and between the eyebrows, horizontal lines across the forehead and crows' feet. These can be treated with Botox or similar "injectables" such as Dysport.

On the next dimension, age causes changes in volume, Brownell says. This shows up as hollows under the eyes, "marionette" lines by the mouth and jowls along the jawline. So-called volumizers, such as Restylane, a formulation made with naturally occurring hyaluronic acid, are injected under the skin to plump it up.

The third dimension is changes to the skin texture and quality, a loss of elasticity. A new technology called Ulthera uses ultrasound to target high thermal heat energy at the connective tissue and superficial layers of muscle that store and make collagen. The technique can both repair damaged collagen and stimulate the creation of new collagen, Brownell says.

These new techniques, all procedures that can only be performed by medical professionals, can help men and women achieve an enhanced look, rather than the mask-like effects from earlier procedures.

"Fifteen or 20 years ago, there was a just a facelift. That pulls the skin, it doesn't change the quality of the skin," Brownell says. "Some people have procedures done and they don't look natural. ¦ My intention is to make you look like the best you at any age. You want to look refreshed, like you just had 14 hours of sleep."

Other treatments offered at medical spas can address fat cells, spider veins, hair removal, broken capillaries, enlarged pores, rosacea and sun damage.

None of these cosmetic medical procedures, of course, is covered by medical insurance, regardless of whether they

are performed at a so-called spa or in a medical office. They can range in price based on the technique and the number of treatments required from a couple hundred to thousands of dollars.

About 90 percent of Pooya's clients are women between the ages of 35 and 65, she says, although she has noticed an increase in male customers. Clients will come to her medical spa to see what's available. Many know what treatment they're looking for. But others will say, "'I just hit 45 or 50 and I'm not looking as refreshed as I want to. What can I do?,'" Pooya says.

Rose Pitasi, from Stamford, describes herself as "a typical woman of the millennium." She is 50 years old with a full-time job in financial services, one child in college and another in middle school, and she says she has no intention of giving into age the way the generation before hers did. "I look at pictures of my mother when she was 50 and I say, `Boy, was she old.'"

She says she's always taken care of her body by eating well and exercising, so taking advantage of medical aesthetic procedures is another way of taking care of herself. "I'm not going to get a facelift some day. But if I can help out along the way ¦"

Pitasi finds the medical spa experience to be part doctor's appointment and part beauty day. "It's a kinder environment. A doctor's office is a little harsh."

Brownell also is sensitive to her clients' needs for discretion. She spaces them out so they don't find themselves sitting in her waiting room with other clients. "No matter what anyone says, they don't want other people to know they do these things. They don't want to run into their neighbor or someone from their kid's school or sometimes their sister," she says.

Medical spa clients are seeking a higher level of service.

"These clients are typically discerning consumers with a high aesthetic demand, who value their time and want to be treated with extra comfort and care," Islam says. "These clients demand a high level of service and also want products and services which work to help them achieve their aesthetic goals."

Since the anti-aging field has exploded, Islam warns the buyer to beware and ensure that the treatments they seek have evidence backing up their effectiveness, and that the facility is truly run by doctors and doesn't just pay a doctor to use his or her name.

Pitasi, who has been a client at The Greenwich Medical Spa since it opened, says, "Women these days are looking at improving as they age." Who isn't? She adds: "I like to think of the medical spa as a fountain of youth."