KANSAS CITY, Mo. -- Second-degree burns from laser hair removal, a droopy face after a Botox treatment. These serious injuries aren't common, but they can happen, even in a doctor's office.
What has many concerned is that these procedures are now being done without a doctor in sight, as FOX4 Problem Solvers discovered in an undercover investigation.
"There are patients who have gone blind after getting fillers," said Dr. Daniel Aires, head of dermatology at the University of Kansas Hospital.
FOX4 sent an undercover producer to a Johnson County spa for Botox and filler injections. She asked the registered nurse in charge if she would first need to consult with a physician before having the injections, and was told no.
Even though that medical spa and most others have doctors listed on its website, most patients will never meet them.
"In an industry growing this fast you are going to have people coming in that are not necessarily doing it for the right reason," said Alex Thiersch, CEO of the American Medical Spa Association.
Thiersch said a growing number of spas are owned by hedge funds and many government regulators aren't paying attention to what's going on inside.
Kansas and Missouri are known as the Wild West of the medical spa industry because there are so few regulations. In fact, even hair salons are better regulated. They have to be inspected, but medical spas don't.
That's what Angela Miles discovered after visiting a medspa for a Botox substitute to lift her eyebrows and fillers to plump her lips.
"I left the second time in tears," Miles said.
Her eyebrows weren't even. One was lifted, but the other was frozen in place. She believes the Botox substitute was injected in the wrong muscle.
"So it's kind of like two different eyes," she said.
Her lips, which were injected with a filler, were also uneven. She paid the first spa more than $1,000 and then ended up spending several hundred more at a second spa to have her lips fixed.
Both spas Angela used were operated by registered nurses with no doctor in the office.
Thiersch said that's a problem.
"Whether it's skin resurfacing, body sculpting, Botox, fillers, injectables -- those are medical treatments," Thiersch said. "You are injecting something into the body that is changing living tissue, and under the definition of the practice of medicine, that is purely under the scope of a physician."
FOX4 discovered one Jackson County medspa doctor who spends most of his time practicing on the East Coast. That could prove tricky if the spa needed him for a medical emergency.
When FOX4 Problem Solvers called another medspa's doctor, his office told us he was no longer affiliated with the spa. But he's still listed on the spa's website.
In Kansas and Missouri, state laws and regulations are so weak that even both states' nursing boards told us it was perfectly legal to have nurses running medspas.
But that's not what lawyers who are increasingly suing the industry say. Even the medspas' own association warns that it's not acceptable because it's practicing medicine without a license.
There's a good reason why nurses should not be diagnosing patients before giving them injections or laser treatments.
"From Restylane, I've seen patients who have had non-healing ulcers," Aires said at KU Hospital. "And patients who can get part of their nose dying off if they occlude the wrong vessel."
"You want to find someone who has not only has done a lot of it, but has an artistic sense and can look at your face and say, 'Here's where you are. Here's how we can enhance it.'"
Patients should also know exactly what's being injected and what processes are in place should there be a complication. Recently, in Texas, aestheticians, nurses and even physicians were arrested for operating illegally.
Thiersch said many nurses don't realize they can face legal jeopardy for practicing medicine without a license, and the doctor affiliated with the spa can place their own medical license in peril for encouraging the practice of medicine without a license.
Even medspa owners told FOX4 privately they would like to see stronger regulations to protect everyone. That's also a goal of the American Med Spa Association.