URL: http://www.nytimes.com SUBJECT

1190 of 1231 DOCUMENTS

The New York Times
January 13, 2008 Sunday

Late Edition - Final

Having a Little Work Done (at the Mall)
BYLINE: By JANET MORRISSEY
SECTION: Section 3; Column 0; Money and Business/Financial Desk; Pg. 1
LENGTH: 2096 words
ANDREW RUDNICK snickered when he first saw a medical spa offering Botox and laser hair-removal services on a visit to a Las Vegas mall in 2002. He laughed at the thought of someone -- anyone -- shopping for the latest fashions, grabbing a bite to eat and then, oh yeah, strolling in for a quick shot of Botox to zap out a nasty wrinkle.

''I couldn't understand why anybody in a mall would walk in and have their legs lasered, never mind Botox,'' he recalled. He parked himself on a bench near the spa and watched in amazement as shoppers strolled in. He owned a weight-loss and laser center in Boston at the time, and the sight was a revelation. ''I counted the traffic in and out and saw the revenue, and said, 'Wow! This is a retail business.' ''

Returning to Boston, he scouted retail locations. He dropped the weight-loss part of his business to focus on skin care and laser treatments, renamed the company and opened his first Sleek MedSpa that same year. He has since opened six more -- near Boston and in New York and Florida, all in upscale malls or retail areas. ''It took off like a bat out of hell,'' he said.

Thanks in part to television shows like ''Extreme Makeover'' and ''Nip/Tuck,'' the number of Americans seeking chemical peels, laser procedures, Botox shots and wrinkle-filler injections is soaring. According to the American Society for Aesthetic Plastic Surgery, such ''noninvasive'' treatments have increased more than 700 percent since 1997. Botox received Food and Drug Administration approval in 2002.

THE stampede of doctors and entrepreneurs rushing to fill that demand has left some doctors and plastic-surgery trade groups wondering about the expertise of some of the people providing these services. For many Americans, price and convenience come first, with few questions about the experience and qualifications of the person injecting the treatments.

For its part, Sleek MedSpa says some of its outlets have on-site physicians while others have doctors as medical directors off-site, and nurse practitioners and physician's assistants who handle day-to-day treatments. If there were an emergency a nurse couldn't handle, the nurse would call 911, Mr. Rudnick said. He added that no such emergency had ever arisen.

Kim Wanderley, 39, a stay-at-home mom from Parkland, Fla., said she thought it was ''great'' when she spotted a Sleek MedSpa at the Town Center mall in Boca Raton in 2006. ''If it had been in Ohio, people might have blinked twice, but this is South Florida,'' where vanity rules, she said. ''People do not take aging lightly, without a fight, here.''

While Sleek MedSpas lack the feng-shui ambience of a traditional beauty spa, they don't exude the sterile atmosphere of a doctor's office, either. The spa in Boca Raton is contemporary and sophisticated, Mrs. Wanderley said, with videos of cosmetic procedures streaming across a flat screen, skin-care products lining another wall and before-and-after picture brochures scattered around the waiting room.

And it's convenient. ''I can be in and out in a half-hour,'' she said, and ''it gives me an excuse to go to the mall afterward to do a little shopping.'' If a procedure causes redness or bruising, the spa offers a convenient back-door exit to the parking lot.

Mrs. Wanderley acknowledges that 10 years ago, she would have thought this ''way too excessive and ridiculous,'' she said. ''But now I'm one of the bozos on the bus.'' She started out requesting microdermabrasion facial treatments and has since added Botox shots and Restylane filler injections to her medspa repertoire.

Mr. Rudnick estimates that 50 percent of his company's mall clients are walk-ins like Mrs. Wanderley. Sleek MedSpa's revenue, which was $1.5 million in 2002, surged to more than $14 million in 2007, Mr. Rudnick says, and he expects that total to double this year. Profit margins are in the 20 to 25 percent range, he said, and over the next four years he expects to open 40 more locations in 25 cities.

Sleek MedSpa is among dozens of companies operating medical spas, often called medspas. Hannelore Leavy, founder and executive director of the International Medical Spa Association, estimates that there are 2,000 to 2,500 medspas nationwide, up from 25 in 2002.

There has also been a surge in the number of nonsurgical cosmetic procedures. Of the 11.5 million cosmetic procedures performed in 2006, more than four in five were noninvasive treatments, according to the aesthetic plastic-surgery society. From 1997 to 2006, the number of surgical cosmetic procedures rose 98 percent, and noninvasive treatments jumped 747 percent.

Nonsurgical treatments ''are effective, they're safe and they're affordable -- and there's no down time,'' said Dr. Foad Nahai, a plastic surgeon in Atlanta and president of the society.

Some doctors' offices are joining in. In New York, Dr. Bruce K. Moskowitz, an ophthalmologist and oculofacial plastic surgeon, says demand on the cosmetic side of his business has skyrocketed, to 50 percent of his business, from 25 percent 15 years ago. To meet demand, he opened a medspa in his office; patients in the waiting room can read brochures about Botox and fillers when they come in for eye checkups.

Dr. Moskowitz's qualifications for cosmetic procedures run long and deep, given that he had been using Botox for facial twitching disorders as far back as 1991, long before the F.D.A. approved it for cosmetic use. And his oculofacial expertise gave him insight into how facial muscles and nerves respond to filler injections and other cosmetic treatments.

Industry experts attribute the surge in cosmetic procedures to aging baby boomers as well as to television shows.

Marian Salzman, author of more than a dozen books on cultural trends and current affairs, said she predicted 10 years ago in ''Next: Trends for the Near Future'' that cosmetic procedures would become mainstream.

Affordable and walk-in cosmetic surgeries were among the trends she had forecast, Ms. Salzman said. ''I used to say they're going to be as prevalent as salons,'' she recalled, adding that ''people used to roll their noses up at me and say it's obscene, it's ridiculous.''

The youngest boomers, those born from 1955 to 1964, are driving the trend, she said. ''They will do absolutely anything to prolong youthfulness to stay in the game,'' she said, ''and if that means a filler here or Botox there or hair implant there, then so be it -- they'll do it.''

At the same time, television shows helped make cosmetic procedures appear safe and stylish. By the time the Motley Crue frontman Vince Neil went under the knife in 2005 before millions of viewers on ''Remaking Vince Neil'' on VH1, cosmetic surgery had truly arrived in mainstream America.

''Virtually every office patient I see talks about the reality TV shows,'' says Dr. Paul Wigoda, a plastic surgeon who runs a cosmetic surgery business in Fort Lauderdale, Fla., owns the MeDaySpa in Miami Beach and is medical director of two Sleek MedSpas in Florida. After watching the shows, he says, patients feel more comfortable about the procedures.

DR. NAHAI and other plastic surgeons worry that shows like ''Extreme Makeover'' gloss over the risks, and edit out the bruising and recovery. ''I tell every patient -- forget the word 'cosmetic,' and remember the word 'surgery,'<0>'' he said. ''And there's no such thing as surgery without risk.''

Lou Gorfain, an executive producer of ''Extreme Makeover,'' which was broadcast on ABC, dismissed such criticism, saying, ''We did show the bruising and the pain and risky surgery that it is.'' And Linda Klein, a producer and medical adviser of ''Nip/Tuck'' on FX, said the series tries to show that surgery is ''not a pretty sight'' -- and emphasized that the show is fictional.

The death of Kanye West's mother in November, from complications following a tummy tuck and breast reduction surgery, pushed concerns about procedures into the spotlight.

Sometimes, surgical horror stories can make noninvasive procedures look more attractive. Still, even nonsurgical procedures, like Botox shots and laser treatments, have their own risks, especially if the person giving the treatment isn't fully trained, cautioned Dr. Richard D'Amico, president of the American Society of Plastic Surgeons and chief of plastic surgery at the Englewood Hospital and Medical Center in Englewood, N.J. In the wrong hands, he said, lasers can burn and Botox can cause drooping eyelids or paralysis until the toxin wears off in three to six months.

In the most dire case, if an injection gets into a blood vessel and the product gets into the retinal artery, a patient could be blinded, Dr. D'Amico said.

He said it was crucial that people check the credentials and experience of those who offer cosmetic treatments.

Even the kind of doctor needs to be scrutinized, he said. In the past, cosmetic procedures were done solely by plastic surgeons, dermatologists and ocular plastic surgeons. Today, even podiatrists and dentists are moving into the field. No federal or state laws regulate what doctors can or cannot do once they have state licenses, according to the American Society of Plastic Surgeons.

Some just take weekend courses on cosmetic procedures and then set up shop, Dr. Nahai said. Only those certified by the American Board of Plastic Surgeons have undergone formal training of at least six years in plastic surgery and passed an exam on the procedures, Dr. D'Amico said.

Taking a weekend course or watching someone on a DVD isn't enough, Dr. Nahai said. ''If an airline told you the pilot had simply watched someone fly a plane as his only training, would you want him to take you up in the air?'' he asked.

Many people are attracted by the price, savoir-faire settings and convenience of medspas. Unlike doctors' offices, most are open seven days a week.

Kristen Salera, 24, from South Weymouth, Mass., started getting chemical peels after seeing a Sleek MedSpa in Braintree, Mass., last year. Troubled by acne, she had been curious about cosmetic procedures but had never consulted a plastic surgeon. After dropping into the medspa, she was impressed with the staff and the cost.

''Friends who went to a medical office paid double what I was paying,'' she said. Later, she signed up for mesotherapy, in which injections go into areas of fat, to dissolve hard-to-lose cellulite on her upper thighs.

Many experts say medspas are in their infancy, with tremendous growth potential. Aging baby-boomers are driving much of the demand, with 12,000 Americans turning 50 every day, or one every eight seconds, according to AARP. ''This is a huge market,'' said John Buckingham, chief executive of Solana MedSpas, a development and consulting company that helps doctors and entrepreneurs set up medspas.

New drugs on the horizon may bring more price competition, thus attracting more consumers. The Medicis Pharmaceutical Corporation is awaiting F.D.A. approval of a Botox alternative, Reloxin; it is expected to get the green light in 2008 and will compete head-to-head with Botox, from Allergan.

Most of the youth-enhancing effects of Botox and cosmetic fillers wear off within three to nine months, making it necessary for patients to get repeat shots. This aspect makes industry experts view the business as largely recession-proof.

The treatments are also seen as a stepping stone to possible plastic surgery. ''This is a gateway drug. I started with microdermabrasion and already I'm doing Restylane as well,'' said Mrs. Wanderley, who doesn't rule out plastic surgery at some point.

IN addition to Sleek MedSpa, the industry includes chains like Sona MedSpa International, Pure Med Spa, Dermacare Laser and Skin Care Clinics and American Laser Centers, which was recently sold to two private equity firms for about $230 million.

Despite the boom, some other medspas have flopped. Skin Nuvo International, which operated 40 mall-based clinics, had problems with its hair-removal equipment and wound up filing for Chapter 11 bankruptcy protection in 2005. And HealthWest Inc. and SkinKlinic have closed shop.

Mr. Rudnick is bullish on the sector's growth and is already planning a network of full-service cosmetic surgery facilities. The first opened adjacent to his New York medspa in October.

''We know one thing for sure: people aren't getting any younger,'' he said. ''We know another thing for sure: they all want to look younger.''

URL: http://www.nytimes.com
SUBJECT: MEDICAL LASERS (91%); LASERS (90%); HAIR REMOVAL SERVICES (90%); NURSES & NURSING (89%); PHYSICIANS & SURGEONS (87%); SURGICAL PROCEDURES (78%); SURGERY & TRANSPLANTATION (78%); DRUG & MEDICAL DEVICES APPROVAL (78%); RETAILERS (77%); SKIN CARE PRODUCTS (76%); COMPANY NAME CHANGES (73%); FDA APPROVALS (69%); COMPANY STRATEGY (68%); ENTREPRENEURSHIP (68%); PHYSICIANS ASSISTANTS (67%); TELEVISION PROGRAMMING (50%)
ORGANIZATION: AMERICAN SOCIETY FOR AESTHETIC PLASTIC SURGERY (59%)
GEOGRAPHIC: BOSTON, MA, USA (90%); NEW YORK, NY, USA (79%) FLORIDA, USA (94%); MASSACHUSETTS, USA (90%); NEW YORK, USA (79%) UNITED STATES (94%)
LOAD-DATE: January 13, 2008
LANGUAGE: ENGLISH
GRAPHIC: PHOTOS: At the Sleek MedSpa in Aventura, Fla., Martha Mena undergoes a procedure to dissolve cellulite. Lorianne English, a nurse practitioner, gives the shots as Ms. Mena's friend Erika Galan looks on. (PHOTOGRAPH BY BARBARA P. FERNANDEZ FOR THE NEW YORK TIMES) (pg.BU1)

Lorianne English schedules an appointment for Martha Mena, left. The Sleek MedSpas have a contemporary, high-tech style.

Danaisy Gonzalez, right, hands out information about MedSpa to mall shoppers as they walk by. (PHOTOGRAPHS BY BARBARA P. FERNANDEZ FOR THE NEW YORK TIMES) (pg.BU8) CHART: EYE OF THE BEHOLDER: Various types of nonsurgical - yet still medical - cosmetic procedures have grown rapidly in the past decade. (Source: American Society for Aesthetic Plastic Surgery)
PUBLICATION-TYPE: Newspaper

Copyright 2008 The New York Times Company

1191 of 1231 DOCUMENTS

The New York Times
January 13, 2008 Sunday

Correction Appended

Late Edition - Final
New Listings With Your Decaf?
BYLINE: By LISA PREVOST
SECTION: Section 11; Column 0; Real Estate Desk; IN THE REGION CONNECTICUT; Pg. 9
LENGTH: 1054 words
DATELINE: SOUTH NORWALK
BEFORE deciding on a location in town for her new real estate office, Lisa Jones packed her two young children into her oversized Mercedes van for a brief exercise in market research.

She drove to the heart of South Norwalk's entertainment district, a hot spot for Fairfield County aficionados of restaurants and clubs. Then, as she stopped her beloved ''blingmobile'' in front of each of the three office spaces she was considering, Ms. Jones made a tally of the number of people who walked past the storefronts within one minute.

At two of the stops, barely a handful wandered by. But at the third -- a former art gallery on Washington Street between Sweet Rexie's candy store and the sleek restaurant Ocean Drive -- Ms. Jones counted more than 40 passers-by. The experiment settled the question of where to open an enterprise she calls the Real Estate Lounge.

''Foot traffic,'' she said, ''was all I wanted.''

A former chef who once tended the galley on motor yachts and made appearances on the Food Network, Ms. Jones is one of a handful of real estate sales agents taking a more entrepreneurial approach to luring clients: her Real Estate Lounge is effectively a sales office in disguise.

Though still a rarity, the office-camouflaging tactic is being tried in several parts of the real estate world. ''You're starting to see a lot more creative ways to reach out to people,'' said Joel Burslem, a marketing expert in Portland, Ore., who founded a popular blog called Future of Real Estate Marketing. ''It's an awakening to the fact that agents really need to court buyers these days. They're looking for ways to entice and engage.''

Of course, sooner or later, visitors to Ms. Jones's plush coffee-bar-style lounge (which is open until 9 p.m. five nights a week) figure out that it is merely a comfortable place to browse property listings on the Internet, either via a 40-inch flat-screen television or at one of several desks outfitted with personal computers and designer lamps. The high-style atmosphere is a lure to get them in the door, something real estate agencies everywhere are finding harder to do as the house hunt increasingly goes virtual.

A similar experiment has been undertaken by Rick Higgins, founder of the Higgins Group (where Ms. Jones is a managing partner). A company storefront in Westport's chic Main Street shopping area resembles a Chamber of Commerce information center. Visitors to the cozy wood-beamed space will indeed find useful local data, but a sales agent will also offer to walk them through the search technology on the Higgins Group Web site.

''It's a nice icebreaker, without requiring a commitment emotionally of the people coming in,'' Mr. Higgins said.

Thaddeus Wong, a co-founder of a company in Chicago called @Properties, has taken an even subtler approach. Last year, in the city's River North neighborhood, Mr. Wong's agency went into partnership with a Starbucks-style coffee shop; eventually, patrons logging into the cafe's free Wi-Fi service will pull up the brokerage's Web site.

Called @Spot, this is foremost a coffee shop (owned and operated by one of the company's agents) that simply features the @Properties logo on its cups and sleeves. ''It's just another form of branding,'' Mr. Wong said. ''It's just a little bit more of a progressive form of marketing.''

Not every such venture has met with complete success. In 1995, Bill Wendel pioneered an enterprise called the Real Estate Cafe about three blocks from the Harvard campus in Cambridge, Mass. The cafe invited buyers to look through property listing books on their own at a time when listings were not publicly accessible on the Internet. The agency operated on a fee-for-service basis, and sponsored networking events like a Roommate Rendezvous.

The need for such a clearinghouse dissipated after 2000, however, when listing and other real estate-related data became more readily available online. Mr. Wendel eventually went virtual.

In 1998, the Pacific Union Real Estate Group (now Pacific Union GMAC Real Estate) opened a subsidiary in San Francisco called SOMA Living that featured boutiquelike storefronts with Internet kiosks for customers to browse for homes or chart their house searches. SOMA (an acronym for South of Market, referring to areas south of Market Street in San Francisco) was solely a buyer brokerage, meaning it did not take listings. Agents were paid as employees, rather than as commissioned independent contractors.

Despite early plans to roll out hundreds of franchises, SOMA fizzled after a few years. A primary reason, said Avram Goldman, Pacific Union's chief executive, was that when the real estate market took off, ''it was better to be a listing company rather than a buyer company.''

''Properties were selling very quickly,'' Mr. Goldman said, ''and working with buyers could get rather challenging and frustrating. I think it didn't make it because it hit the wrong market at the wrong time.''

Ms. Jones, who wears a large rhinestone ''Sold'' pin on her lapel, exudes confidence in her approach, which she views as especially suited to her pampered Fairfield County clientele. ''It's a concierge lifestyle here,'' she said. ''They want to be served properly, and they don't want aggravation.''

She likens her office's living-room-like design to the upgrading over the last decade of once-mundane retail environments like nail salons and supermarkets. The front of the 1,500-square-foot office is taken up by a brown leather sofa strewn with zebra-print pillows, as well as several cushioned chairs, a coffee table and the flat-screen TV.

Framed photographs taken by the designated ''artist of the month'' dress up the beige walls. A free coffee station is in the works.

Such a high-visibility showroom also serves to garner more attention for her listings, which are displayed in a rotating lineup on a monitor in one front window. If a strolling pedestrian pauses to take a look, Ms. Jones isn't above wandering out to strike up a conversation. The lounge concept may not get everyone through the door, but she can always fall back on her endless tales of life as a high seas chef.

''If I talk to you long enough,'' Ms. Jones said, ''there's a real estate deal in it for me. I'll find it -- believe me.''
URL: http://www.nytimes.com
SUBJECT: RESTAURANTS (90%); REAL ESTATE AGENTS (90%); RETAILERS (89%); REAL ESTATE (89%); MARKET RESEARCH (89%); SALES FORCE (87%); MARKET RESEARCH & ANALYSIS (77%); CHILDREN (73%); ENTREPRENEURSHIP (73%); INTERNET & WWW (65%); BLOGS & MESSAGE BOARDS (63%); PERSONAL COMPUTERS (50%)
COMPANY: FOOD NETWORK (55%)
PERSON: MICHAEL MCMAHON (82%)
GEOGRAPHIC: PORTLAND, OR, USA (78%) OREGON, USA (79%) UNITED STATES (79%)
LOAD-DATE: January 13, 2008
LANGUAGE: ENGLISH
CORRECTION-DATE: January 27, 2008

CORRECTION: An ''In the Region'' article in some copies on Jan. 13 about real estate sales offices that camouflage themselves as other businesses to lure customers referred imprecisely to a service offered at the Real Estate Cafe in Cambridge, Mass., in 1995, before listings were publicly accessible on the Internet. Buyers could peruse listings in the cafe on a computer terminal, not in books.
GRAPHIC: PHOTO: CAMOUFLAGE: Patrons of the Real Estate Lounge in South Norwalk might be forgiven for mistaking the place for just a cozy spot to chat. (PHOTOGRAPH BY THOMAS MCDONALD FOR THE NEW YORK TIMES)
PUBLICATION-TYPE: Newspaper

Copyright 2008 The New York Times Company

1192 of 1231 DOCUMENTS

The New York Times
January 13, 2008 Sunday

Late Edition - Final

The Right Hires
BYLINE: By RANDY COHEN
SECTION: Section 6; Column 0; Magazine; THE ETHICIST; Pg. 18
LENGTH: 571 words
To afford to start a new business, I must use low-cost foreign manufacturers, some of whom likely maintain unsafe working conditions. It is difficult to be certain from here. In the relevant country, many workers doing the tasks I'll require receive low wages and face serious health problems including chronic colds , fever , stomach disorders, chest pains and tuberculosis. Is it wrong to start my business in this way? -- NAME WITHHELD, NEW YORK

It is your moral obligation to see that those who work for you even indirectly -- those from whose labor you profit -- receive decent treatment. While wages and working conditions vary internationally, nobody's idea of ''decent'' encompasses ''chronic colds, fever, stomach disorders, chest pains and tuberculosis,'' even in developing nations, even where people badly need jobs.

I concede that it can be difficult to monitor things from thousands of miles away. Fortunately, you have other options. There are labor organizations, both governmental and private, that address this vexing problem and can assist you in hiring workers who will be treated fairly. Or you might reconsider conducting at least your initial operations domestically. Local governments, trade unions and manufacturers are eager to add industrial jobs. You can consult all of them.

What you may not do is simply throw up your hands at working conditions overseas or fob off this duty on those with whom you contract. You must strive to learn whose sweat provides your equity and how it is extracted.

UPDATE: The entrepreneur hired an outfit in Uttar Pradesh whose labor conditions are unknown to him. If the project advances, he vows to travel to India to inspect the manufacturing facilities.

I am a graduate student and hire undergraduate field assistants for our research on waterfowl. We only accept people over 5-foot-5, since the work involves walking in waders in deep water. If a person is too short, water can get in over the waders -- uncomfortable and dangerous. We could accommodate shorter students by letting them work in wet suits, but it would slow down their data collection. Is height a legitimate job criterion? -- D.S., CALIFORNIA

You've hit on the essential point. You may consider an applicant's height only if it is a necessity of the job. If you were getting a master's in piano moving, you could pass over the frail and hire only those undergrads robust enough to heft a Steinway. Is a certain body type important here? Apparently so.

But before rejecting shorter applicants, reasonable accommodations -- ways to arrange the work that would enable them to do the job -- must be made for size. Is wader technology so primitive that higher, bib-style, boots won't do? Is a wet suit really unusable? ''Reasonable'' is an ambiguous but not a meaningless word. You must make a good-faith effort not to capriciously reject potentially qualified candidates. Ethics demands ingenuity.

UPDATE: D.S. hired someone near the cusp, just over 5-foot-5. She could reach many of the nesting sites, and there was enough work to be done to assign the taller assistants to sites in deeper water.

Send your queries to ethicist@nytimes.com or The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018, and include a daytime phone number. Randy Cohen's podcasts of The Ethicist are now available at NYTimes.com, iTunes and Yahoo.com.

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