One woman claimed she was left with a scarred face after getting cosmetic injections at a Tulsa medical spa where a nurse was later criminally charged, according to court records. A woman in Oklahoma City claimed in a lawsuit she endured severe burns and blistering at another medical spa where the doctor eventually had her license suspended. 

Some clients claimed they were injected with unapproved drugs or treated by workers without proper medical supervision, according to lawsuits.

State regulators have struggled to keep up as the medical spa industry has grown and more people seek trendy cosmetic procedures like microneedling, laser treatments and Botox. Oklahoma medical boards passed new guidelines this year on who can perform specific treatments based on existing state laws. 

“They’re more a suggestion and general understanding than a regulation or a law,” said Dr. Woody Jenkins, chairman of the Oklahoma State Medical Association Board of Trustees. 

But it’s still not clear how current laws affect some medical spa procedures and new cosmetic treatments are always being developed.

The new guidelines from the Oklahoma Medical Board and the Oklahoma State Board of Osteopathic Examiners recommend a licensed medical professional perform an initial evaluation with medical spa patients based on a state law requiring providers to establish relationships with patients prior to treatment. 

Oklahoma does not require medical spas to obtain any state permits to operate. Tennessee is currently the only state with specific permits for medical spas, according to the American Med Spa Association. 

 “We haven’t dealt with it in Oklahoma yet,” said Steve Mullins, executive director for the Oklahoma State Board of Osteopathic Examiners.  

A growing industry with few regulations

More than 1,500 new medical spas opened across the United States between 2022 to 2023, according to the American Med Spa Association. Medical aesthetics has grown into a $15-billion industry over the past decade. 

Most medical spa treatments are being done correctly, but the rise in popularity means there will be an increase in bad procedures too, said Alex Thiersch, CEO of the American Med Spa Association. 

Most states have only established legislation after a negative outcome at a medical spa occurs, usually with minimal research behind them, Thiersch said. Existing laws are often vague or difficult to apply to medical spa procedures, making it a challenge to educate providers on and enforce effectively, he said. 

The only legislation Oklahoma has enacted in recent years for medical spas treatments is House Bill 2998, which targets credentialing and training for laser hair removal. The bill was signed into law in May. 

Laser hair removal is one of the most lawsuit-generating procedures done at medical spas, typically because of an unlicensed provider performing the procedure, Jenkins said. 

The Oklahoma Board of Nursing guidelines recommend nurses use their own professional judgment to determine what procedures they can do based on relevant laws. 

Lack of supervision leads to botched procedures 

Oklahoma guidelines recommend that a doctor be onsite for procedures performed by other workers but the advice is often ignored, said Dr. Amanda Satterwhite, owner of Highwater Aesthetics, which has locations in Tulsa and Edmond. 

“Most supervising physicians are kind of in name only,” Satterwhite said. 

Serious complications can occur when some procedures are done incorrectly, Satterwhite said. Botox accidentally injected into a vein instead of the facial muscles can lead to a loss of blood flow and cause permanent damage if left untreated. 

Estheticians are not allowed to penetrate below the outer layer of skin, according to Oklahoma State Board of Cosmetology and Barbering rules. But Satterwhite said she has noticed estheticians at other medical spas often do Botox injections. 

She has complained to the Cosmetology and Barbering board, but it has not responded to her concerns, she said. 

Patients sometimes come to her for help reversing complications from treatments at other clinics, Satterwhite said. 

The U.S. Food and Drug Administration requires medical providers to purchase products like Botox directly from licensed entities. But Satterwhite said she often receives messages from companies outside the U.S. offering to sell her products illegally. 

Tulsa Medical spa owner and nurse Elisa Kaye Sanders was indicted in 2020 on federal charges for buying and using illegally-obtained prescription drugs, including Botox. 

Sanders maintained that the drugs were shipped from Canada to save money and were the same drugs as any from the United States, Mark Lyons, Sanders’ defense attorney, said in an email to The Frontier. 

While some of the charges were later dismissed, Sanders pleaded guilty in 2021 to misdemeanor fraud. She was sentenced to serve three years of probation and to pay a $25,000 fine. Sanders’ business, L’Chaim Medical Spa, is no longer open. 

A former L’Chaim client sued in 2018, claiming Sanders injected her with unapproved drugs without medical supervision, causing scar tissue that later required surgery. The woman also claimed Sanders falsified her medical records. The woman’s attorneys voluntarily dismissed the lawsuit in 2021 and agreed not to refile it. It’s unclear if there was a settlement in the case. 

Another woman sued Sanders in 2019 on similar claims, causing severe pain and disfigurement. A judge dismissed the case in March after the woman’s attorneys stopped actively pursuing the case in court.

Attempts to reach Sanders’ attorneys in the lawsuits were unsuccessful.

A client at the now-closed Pure Derma Med Spa & Contouring Center in Oklahoma City sued Dr. Amy Darter in 2022, claiming she was not informed of the risks before a treatment with intense pulse light therapy and microneedling. She claimed an esthetician also named as a defendant in the lawsuit performed the treatment without proper supervision or training, resulting in severe burns. The Morpheus8 microneedling device the esthetician used penetrates deep into tissue, although state rules prohibit estheticians from penetrating the upper layer of skin. 

The woman claimed she contacted the medical spa about pain and blisters following the treatment and was given skincare products. When she contacted Pure Derma for assistance as her condition worsened, she was told to continue using the products as instructed, the lawsuit claimed.

Eventually, the esthetician used a scalpel to scrape off the patient’s outer layer of skin, then applied an acid and used a suction device, the lawsuit claimed. The patient complained the procedures were causing more pain and the esthetician only stopped after using a fine grit to sand the patient’s face.

The woman was sent home with additional products to apply to her skin despite her concerns they would cause more pain. Following the appointment, the woman’s condition worsened, her face became so swollen one of her eyes was almost entirely closed, the lawsuit claimed. 

The lawsuit was settled, according to court records. The woman’s attorneys said they could not elaborate on how the case was resolved but said their client was happy. Lawyers for Darter and the esthetician did not respond to requests for interviews. 

The Oklahoma State Board of Medical Licensure and Supervision suspended Darter’s license in 2023. The action followed a month where the medical board received over 70 complaints regarding Darter and her allergy clinic, another medical practice she owned at the time. Most of the complaints were because Darter claimed she was unable to access important patient medical history information, which could cause complications for patients receiving treatments. Some of the patients saw her previously at the medical spa, as well. 

The Frontier could find no record that the Oklahoma Board of Cosmetology and Barbering pursued any disciplinary action against the esthetician, but it’s unclear how often the agency updates its website. The board did not respond to multiple requests for comment over several weeks.