There’s more than one way to skin a foot.

In his beauty salon wedged between a pizza parlor and a taco shop in a strip mall here, John Ho is letting small fish eat dead skin off his customers’ feet.

“Feels like a bunch of ants running across your feet,” said Bill Piatt, a Marine gunnery sergeant from nearby Fort Belvoir, after dipping his feet in a Plexiglas tank for 15 minutes of a fish-assisted pedicure. His wife, Leah, reclining on an adjacent chair, said the nibbling tickled — “a very odd feeling.”

Until Mr. Ho brought his skin-eating fish here from China last year, no salon in the U.S. had been publicly known to employ a live animal in the exfoliation of feet. The novelty factor was such that Mr. Ho became a minor celebrity. On “Good Morning America” in July, Diane Sawyer placed her feet in a tank supplied by Mr. Ho and compared the fish nibbles to “tiny little delicate kisses.”

Philip Shishkin Since then, cosmetology regulators have taken a less flattering view, insisting fish pedicures are unsanitary. At least 14 states, including Texas and Florida, have outlawed them. Virginia doesn’t see a problem. Ohio permitted fish pedicures after a review, and other states haven’t yet made up their minds. The world of foot care, meanwhile, has been plunged into a piscine uproar. Salon owners who bought fish and tanks before the bans were imposed in their states are fuming.

The issue: cosmetology regulations generally mandate that tools need to be discarded or sanitized after each use. But epidermis-eating fish are too expensive to throw away. “And there’s no way to sanitize them unless you bake them for 20 minutes at 350 degrees,” says Lynda Elliott, an official with the New Hampshire Board of Barbering, Cosmetology and Esthetics. The board outlawed fish pedicures in November.

In Ohio, ophthalmologist Marilyn Huheey, who sits on the Ohio State Board of Cosmetology, decided to try it out for herself in a Columbus salon last fall. After watching the fish lazily munch on her skin, she recommended approval to the board. “It seemed to me it was very sanitary, not sterile of course,” Dr. Huheey says. “Sanitation is what we’ve got to live with in this world, not sterility.”

Mr. Ho, a wiry 39-year-old, hopes the bans will lure pedicure tourists from fish-hostile states to the two Virginia locations of Yvonne Hair & Nails, which he owns with his wife, Yvonne Le. The salons charge customers $35 to have their feet nibbled by fish for 15 minutes.

When Mr. Ho was 5, his father put the family on a fishing boat, and like many others fleeing Communist Vietnam, floated out into the high seas, hoping to find a ship to rescue them. The Hos succeeded, and eventually settled in Virginia. Mr. Ho married his high-school sweetheart and the couple opened the Alexandria salon in 1997, while Mr. Ho continued to run a home-building business.

By 2007, they were looking for an alternative to pedicure razors, which are banned in many states as too prone to making dangerous cuts. Ms. Le heard from a customer about skin-eating fish in Asia, and Mr. Ho started doing research.

What he discovered, among other things, was an old Turkish legend about a shepherd who injured his foot and stuck it into a hot spring teeming with small fish. The foot healed. Word spread. A treatment center for skin ailments grew around the springs near the Turkish town of Kangal. From Turkey, the practice spread throughout Asia, employing garra rufa, toe-size carp that live in warm water, have no teeth and, according to those in the business, like to suck off dead skin. Another fish sometimes used to treat feet, called chin chin, is bigger in size and grows tiny teeth.

Last year, Mr. Ho and his wife traveled to a spa in Chengdu, China, had a full-body fish treatment and liked it. After returning, Mr. Ho wired the Chengdu dealer $40,000 for 10,000 fish.

At the back of the salon, he set up a communal fish tub for customers’ feet. The Fairfax County Health Department deemed the tub to be a public swimming pool and ordered it closed on health grounds.

Mr. Ho then designed individual Plexiglas tanks where water is changed after every use and fish can’t swim from one pair of feet to another. Since nobody is sharing the water, the county’s public-pool ordinance no longer applied. Virginia’s Board of Cosmetology has no jurisdiction over skin, unless it’s a face. So Mr. Ho was in the clear.

In Derry, N.H., salon owner Kim Ong heard about Mr. Ho on television, and traveled to his spa undercover, posing as a pedicure customer. She liked what she saw and bought 500 chin chin from a dealer in Washington state for about $6,000.

To New Hampshire regulators, Ms. Ong’s proposal to use fish for pedicures was nearly as unusual as an inquiry they once had about using snakes for massages. The answer, to both, was no, says Ms. Elliott of the cosmetology board.

Ms. Ong’s fish now swim in a decorative fish tank and eat regular fish food — or each other if they get too hungry. Ms. Ong says she plans to fight the pedicure ban.

State bans have disrupted Mr. Ho’s plans to build a nationwide franchise network. Currently, he has four active franchises, in Virginia, Delaware, Maryland and Missouri. But others have terminated franchise agreements. In Calhoun, Ga., Tran Lam, owner of Sky Nails, says she paid Mr. Ho $17,500 in exchange for fish and custom-made pedicure tanks. A few weeks later, in October, the Georgia Board of Cosmetology deemed fish pedicures illegal. “I’m very mad,” says Ms. Lam. “I lost a lot of money and the economy is so bad.”

In Kent, Wash., Bamboo Nails, another franchisee of Mr. Ho, is stuck with thousands of dollars of idle fish and equipment following a state ban last fall. The ban stemmed from a spot check of another salon where state inspector Susan Colard says she watched the owner — demonstrating the technique — stick her foot in a tank with so many fish droppings it was murky.

Proponents say fish pedicures are safe if the water is kept clean. “It is so out of the ordinary that the first reaction is to say ‘no,’ ” says Kevin Miller, executive director of the Ohio Board of Cosmetology.

In Nevada last month, state Assemblyman Tick Segerblom introduced a bill that would allow fish pedicures. Mr. Segerblom, who represents downtown Las Vegas, says he is acting upon the request of a Chinese constituent with a foot-massage business.

He made no prediction about the bill’s chances. But with everyone in the legislature obsessed with depressing things like deficits and the recession, Mr. Segerblom says, “It’s the most popular bill in the building.”

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N.J. Brazilian wax ban is dropped

Put away the sarongs and bust out the thongs, because the Brazilian wax is back in the Garden State.

Consumer Affairs Director David Szuchman, reacting to disgruntled salon and spa owners, may have rescued genital waxing by rejecting Friday a state Board of Cosmetology and Hairstyling proposal to ban the painful procedure.

“Thank the Lord. I can’t wait to run out there and tell the girls,” said Linda Orsuto, owner of 800 West Salon and Spa in Cherry Hill. “They’re going to be so happy.”

Last week, the Daily News reported that the board had introduced a proposal to ban genital waxing in New Jersey’s spas and salons, something the board claimed was already illegal but never spelled out in the regulations.

The board cited public safety as a main issue, saying that two women injured by Brazilian waxes had come forward with complaints. One of them filed a lawsuit.

Salon owners, including Orsuto, felt that the ban would strip women of a popular, albeit painful, procedure and only contribute to unsafe conditions. Many women, the owners claimed, would try to wax themselves or visit unlicensed spas to maintain hair-free.

A fax campaign was started to inform the New Jersey Attorney General’s Office that Brazilian waxes could be done safely with the proper training.

The state apparently listened.

Szuchman, in a letter written Friday, ordered the board to “re-examine” the issue.

“Many commenters have noted that the procedure can be safely performed,” Szuchman wrote. “I therefore believe that there are alternate means to address any public health issues identified by the board.”

Schuzman also encouraged the board “to begin an immediate review of the training necessary to safely provide this service, and to establish appropriate protocols and safeguards.”

New Jersey statutes permit waxing of the neck, abdomen, legs and arms, but regulators never enforced the omissions and most salons in the state offered genital waxing under many different names for $50 to $80 a session.

Orsuto said news of the ban made for a bumpy week in her busy Route 70 salon.

“It’s been chaos,” she said. “I’m not kidding. The girls have been in a state of panic.”

Rosemary Weiner, chairman of the Association of Salon and Spa Professionals in New Jersey, was cautious about Szchuman’s letter, noting that it was more of a recommendation than an order.

“This is very big news. It’s a very positive step,” she said. “Nobody else bans this in the entire country.”

Szuchman’s office oversees the board, however, likely meaning that a ban would never be approved. *

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Spas urge clients to fight for right to wax

Pubic hair may be natural, but a New Jersey salon- and spa-owners group say women should fight for their right to wax it off.

Yesterday the Daily News reported that the state’s Board of Cosmetology and Hairstyling planned to ban “genital waxing,” often known as a “Brazilian wax” from salon and spa menus.

The practice has never been technically legal, but spas and salons up and down the state have long offered customers the chance to go bare . . . down there.

The Association of Salon and Spa Professionals has unsuccessfully lobbied the board to legalize genital waxing and is now urging women to sign and send a petition to Robert Gilson, director of the division of law at the state Attorney General’s Office.

“This is not a third-world country, but you’re telling a woman what she can or can not do to their bodies,” said Feuza Reis, marketing director at Jaira’s Salon in Middlesex County. “There is a huge demand for this service.”

New Jersey statutes allow waxing of the face, neck, arms, legs and abdomen, but officials say that genital waxing has always been illegal, although not spelled out. That will change when the cosmetology board passes the proposal, a state spokesman said.

Reis, a member of the ASSP in New Jersey, said state statutes don’t spell out whether it’s legal to wax backs or chests either.

“You know how many men get their backs waxed?” she asked.

Regardless of the procedure’s legal status, most salons in New Jersey offer Brazilian waxes, often under different names. The state does not investigate infractions unless they receive complaints from consumers. A spokesman said two women reported injuries from having the procedure.

The ASSP, which Reis said has 200 members in the state, sent the board a position paper on the subject recently, highlighting the demand for genital waxing for women and men, the socio-economic factors of banning it, and even suggesting how statutes should be tweaked to include the procedure along with back and chest waxing.

The board read the paper in closed session at their meeting on Tuesday night, Reis said.

“They voted to keep it out,” she said. “How come we’re going to be the only people in the world banning this kind of stuff?”

The Attorney General’s Office did return requests for comment.

To sign the petition, visit www.brazilianbikiniwax.org. *

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Woman Claims She Was Sexually Assaulted At Spa
S. Fla. Spa On Probation For Unlicensed Workers

PLANTATION, Fla. — A popular South Florida day spa was put on probation for a year for having unlicensed workers, and a woman claimed she was sexually assaulted at the spa.

“We didn’t do anything wrong. Contour Day Spa didn’t do anything wrong,” said David Schottenfeld, an attorney for the spa.

Contour’s lawyer might feel that way. But members of the State Board of Massage therapy disagree.

The posh day spa and its owner are now on probation. Contour’s owner, Fanit Panofsky, would not talk  about her hiring practices, about the disciplinary action taken by the state or about hiring Ivson Brazil.

Panofsky hired Brazil to perform Turkish baths at Contour. Brazil allegedly fled the country after being accused of sexually assaulting a Contour client while performing a Turkish bath.

When questioned by police, Brazil called it an “accident,” saying that he slipped on wet tile, causing his mouth to make contact with a client’s “vaginal area.”

Brazil was not licensed as the state said he should have been. His prior job was working at a carwash.

When a state massage board attorney questioned Panofsky about the hiring, she said she hired him to “clean up.” As far as performing the Turkish bath, she said she told him, “She had no one else at the time, and that she trained him, had someone train him on the premises,” according to Sam Diconcilio, an attorney for the Board of Massage Therapy.

As part of the probation, the state will make four unannounced inspections at Contour within the next year to make sure everyone inside is properly licensed.

The massage board’s attorney had to convince the spa owner that the Turkish bath was a form of massage and needed to be done by a licensed, well-trained professional. Diconcilio said, “You can’t have somebody on a table with no clothes on, and nobody can touch them without a license.”

The Contour Day Spa was also fined. Their probationary period lasts until the middle of 2009.

The alleged victim in the case filed a civil suit against Contour for negligence, but a jury found Contour was not liable for Brazil’s actions.

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Water Safety

How you treat water areas and how water is treated are important aspects of maintaining a spa facility. Spas can optimize treatment results and increase sanitization in water treatment areas by incorporating a filtration system, says David Fowler, founder and CEO of the Newbury, Florida-based Wellness Enterprises.

      Fowler’s company has created one called the Wellness Shower Filter. It purifies and enhances water by adding trace minerals that benefit skin cells and increase their ability to absorb healthy nutrients. The device also helps resist the growth of bacteria and fungus at the point where water passes through the showerhead.

      Fowler suggests the following ways spas can purify and enhance water in typical treatment areas:
Pedicure baths Recent media attention has prompted the industry to embrace and intensify the practice of routine disinfecting methods. “The only way to keep that part of the spa safe is to ensure that water is, in fact, chlorinated,” he says.

Baths The piping and circulation that creates jets and bubbles is notorious for the accumulation of bacteria, even when water is drained between treatments. Unfortunately, there’s no way to completely avoid this risk, but some baths are now designed with pipeless air jet technology. Fowler expects this trend to expand in the industry.

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State proposal requires a license to massage

 

 

 

In 1983, Wilhelmina Blank was one of the first massage therapists in the area.

 

Now, Blank, the founder of the Pennsylvania Myotherapy Institute, says she sees massage therapists and day spas popping up all over the place.

That growth over the years has prompted State Rep. Keith McCall, of Carbon County, to sponsor a bill that will regulate the profession in Pennsylvania, one of 11 states that does not regulate massage.

State Massage Licensing Requirements

 

As an unregulated industry, people with little to no training are able to call themselves massage therapists. That also allows some people to practice the stereotypical parlor massage that trained therapists have worked to overcome.

 

The bill, however, would require massage therapists to obtain a

license under a newly established State Board of Massage Therapy. The license would require applicants to have 600 hours of training.

 

The bill was approved by the state House of Representatives and is currently under consideration by the Senate.

 

Bob Caton, McCall’s press secretary, said that this bill will go a long way in improving the massage therapy industry.

He said that untrained people are able to act as health-care professionals when they have no training, therefore giving reputable therapists a bad name.

 

Before there was “nowhere for the therapist or clients to turn,” but now they will be protected.

“The therapists will be given peace of mind and the client will have protection because they know they’re  getting well-trained professionals,” Caton said.

 

Blank said complaints sometimes come from clients that go to a massage therapist expecting relief from pain and just end up getting more pain because the therapist is not properly trained.

 

She hopes that the bill will make schools raise the standards of their training.

 

At PMI, students take a total of 725 hours in classes, 100 of which are clinical hours where students practice with clients.

 

PMI, runs his own massage therapy practice from Meadowview Family Practice in Hanover.

Rhodes said some therapists have a little knowledge of the practice, but pretend that they have a lot.

 

“A little knowledge is more dangerous than no knowledge,” Rhodes said.

He said the problem with a lot of therapists is that they get into a routine and perform the same massage on every client.

Jody Phillips has been in the health-care industry for 17 years and is an instructor at PMI.

 

Phillips believes that if someone is practicing “true wellness and true therapy and pain relief,” they cater to each client’s needs. Every person’s body is different and everything in their lifestyle, from their profession to recreation, has an effect on their bodies. Phillips said that even a person’s right and left arms need different therapy from one another, and to practice the same massage would not be effective.

 

“We want to produce excellent therapists with a higher level of training that are out there making a difference,” Phillips said. “If they’re not making a difference in a client’s pain, then its pointless.”

But as for the idea that licensing would do away with unethical massage therapists, Blank is curious to see if it will work.

 

“I think it will depend on whether local authorities choose to enforce it,” Blank said. She has had her fair share of experience, from reporting a spa in the area, she knows that they are out there.

 

She encountered one spa where the therapists were dressed in lingerie. She could only guess what was going on inside the massage rooms.

She has also had clients that expect more because they received a “happy ending” massage from another therapist.

 

“As a therapist you have to know where to draw the line,” Blank said “It’s just unethical.”

 

Blank said that the massage industry isn’t just for relaxation anymore. Spas have been and always will be popular, but massage is moving toward “corporate wellness” and medical use.

 

According to the National Massage Therapy Institute, consumers spend between $4 billion and $6 billion a year on massage therapy. It is one of the fastest-growing industries in the U.S.

 

Many employers are beginning to take their employees’ health and wellness into consideration. It is common now for companies to have incentive programs including campaigns to quit smoking, exercise programs and now corporations are recognizing massage as a way to improve health, Blank said.

 

Blank also said that massage is becoming more prominent in the medical industry. There is a growing need for relief from pain for medical conditions ranging from cancer to geriatrics.

 

She believes that the licensing program will give therapists validity in the medical field and with insurance companies.

“The credibility is now there,” Blank said. “It will also boost recognition and credibility among people that had their doubts about massage therapy.”

Phillips also believes that the license program will make massage more accepted in the medical field. She stresses that massage isn’t an alternative form of medicine but complimentary to doctors.

 

“We want to work together,” Phillips said. She has many doctors and chiropractors who recommend their clients for massage therapy.

Although Blank said the bill will help massage therapists, she did say it has a few drawbacks.

 

If the testing method is consistent with the federal method, it will be a 600-question computerized test, which she believes measures a therapist’s knowledge but “doesn’t truly measure their skill.”

 

She also said that some states with licensing programs have high fees for those licenses and hopes that won’t be the case in Pennsylvania. Caton said whether there is a cost and what that might be would be determined by the

State Board of Massage.

 

Sherry Chenault, practices massage therapy in Westminster, Md. A 2006 graduate of PMI, she has gone through both a state and federal license program and feels that a license makes a therapist worth more.

 

In Maryland, massage therapists are required to complete 700 hours of training. Chenault said that the application process took her six months, but it was well worth it.

 

Massage therapists in Pennsylvania have been waiting a long time as well for this legislation.

The bill has been in the works for more than a decade.

“It’s been a long journey, but it’s worth it.” Caton said.

 

AT A GLANCE

A bill that would regulate massage therapists has passed the state House of Representatives and is under consideration by the Senate. If the bill passes, newer massage therapists would need to do the following steps before getting a license:

 

Complete 600 hours training approved by state Department of Education

Pass a state exam

Complete 24 hours of further education every two years.

Therapists are grandfathered in if:

They have practiced for more than five years

They have passed a national certification test

They have passed a licensing exam or have completed 500 hours of instruction approved by the Department of Education.

 

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Medical spa rules to get a makeover

Bill would toughen penalties against absentee oversight

Sherry Deppermann spent two months reading up on a new, state-of-the art form of liposuction. And after identifying a local medical spa that offered it, she checked with the state medical board to see whether the doctors in charge had ever been disciplined.

Dr. Jason Helliwell prepares a patient’s abdomen prior to using a YAG (yttrium aluminium garnet) laser at the Advanced Women’s Health Center he runs with his wife, Dr. Siniva Kaneen, in Bakersfield. The laser is used in conjunction with a solution that numbs and melts the patient’s fat cells.

Dr. Jason Helliwell shines a YAG (yttrium aluminium garnet) laser on the palm of his surgical glove at the Advanced Women’s Health Center he runs with his wife, Dr. Siniva Kaneen, in Bakersfield. The laser is used in conjunction with a solution that numbs and melts the patient’s fat cells.

“I’m a nurse, so I probably did more research than most people,” she said. “I think there are a lot of people out there who shouldn’t be doing these procedures, and most clients don’t know who’s going to be working on them and what their training is.”

Deppermann’s diligence is unusual, but officials say it’s a good idea since a loophole in state law has led to alleged abuses at some medical spas.

A QUESTION OF OVERSIGHT

In California, as in many states, a licensed physician or surgeon must be the majority owner of a medical spa. The law even requires minority stake holders to work in a health-related field.

But under current rules, the doctor in charge need not be present when a medical spa is performing certain services. They merely must be “reachable” during the procedure, said Candis Cohen, a spokeswoman for the Medical Board of California.

As a result, some medical spas have physician oversight on paper, but the doctors in charge spend little or no time in the offices. Lawmakers in several states are addressing this safety concern.

A bill pending in the California legislature would strengthen penalties against such absentee oversight. Introduced by Alan Nakanishi, R-Lodi, Assembly Bill 2398 would expand penalties — which are now usually fines — to include license revocation.

The bill also would give an attorney general the option of filing criminal charges. Currently, any discipline is the sole jurisdiction of the state medical board.

But attorney David Shane says failing to require the supervising doctor’s presence at the medical spa means the bill doesn’t go far enough.

The physician’s name “lends an aura of respectability, but in reality, it’s misleading” if the doctor isn’t there, he said.

“What does ‘reachable’ mean, exactly?” he said. “In this day and age, everyone’s reachable if they have e-mail or a cell phone.

“That’s such a big loophole that it doesn’t really provide the care that consumers expect.”

Shane represents a 57-year-old Mill Valley man who is suing The Laser Center of Marin. His client alleges his skin became so hypersensitive to light after a botched laser hair removal treatment that he now suffers severe pain in the sun. There was no doctor at the facility to handle the complications of the treatment, Shane said, and the injury seems to be permanent.

The patient, Dom Martin, declined to comment and The Laser Center of Marin could not be reached late Friday.

MEDICAL SPAS COMING AROUND

The bill’s proposed changes to the Business and Professions Code regulating the state’s medical facilities has yet to win broad support from the medical spa industry.

“A lot of this is dermatologists and plastic surgeons trying to corner the market on medical spas because they don’t like the competition,” said Hannelore Leavy, executive director of International Medical Spa Association. “Some states are trying to restrict ownership to certain kinds of doctors, but if the person is properly licensed and trained, there’s no reason why they can’t perform these services.”

The association hopes to reduce the need for new laws by developing a national accreditation for medical spas, Leavy said. They hope the new system will be implemented in the next year or two, she said.

But Dr. M. Christine Lee, who is lobbying for the bill’s passage through a trade organization, says a lot of “misinformation” about the bill has “scared medical spa owners.”

“What opponents don’t realize is this doesn’t create a new law, it just increases the ability to enforce existing law,” said Lee, who runs a medical spa in Walnut Creek and teaches dermatologic surgery at the University of California, San Francisco.

That was enough to sway Jina Pappas, a nurse practitioner who runs Aescala Skin Care, a cosmetic division that High Grove Medical Center opened more than three years ago in its downtown building.

“I do agree that doctors should be accessible and aware of what’s happening at medical spas,” she said. “Some of these treatments are serious medical procedures. I do a lot of laser tattoo removals, and they work by burning off the skin, so it heals like a burn.”

Bakersfield’s Dr. Jason Helliwell has already seen the benefits of close oversight.

“We used to offer our cosmetic and clinical services in two different locations, but we consolidated them at a new building in April,” he said. “It was for both safety and convenience.”

Helliwell co-owns Advanced Women’s Health Center on Brimhall Road with his wife, fellow OB/GYN Dr. Siniva Kaneen. About 20 percent of their clinic’s work is now cosmetic services such as the Smart Lipo he performed Friday on Deppermann, he said.

“My wife and I do all the Smart Lipo ourselves, and we use an R.N. (registered nurse) and physician assistant who are specially trained for the Botox injections and laser treatments and things like that that aren’t surgical,” he said. “But if anything goes wrong, we’re right down the hall, which makes me a lot more comfortable.”

SAFETY TIPS

Candis Cohen, spokeswoman for the Medical Board of California, says prospective patients should:

Find out the name of the medical spa’s director and check to see if the Medical Board of California has disciplined that person before undergoing treatment.

Find out who will be actually performing the treatment, and check that person for any disciplinary actions on their record. Also investigate their background and training, including how many times they have performed the procedure.

The medical board can also tell you which types of aestheticians, therapists and health care practitioners are licensed to administer a given treatment.

Visit before the procedure, if possible, and look around. Is it clean? Does it look sterile?

Trust your gut. If you’re not totally and completely satisfied with the answers to your questions, go somewhere else.

To check discipline records, call 800-633-2322 or see records online Note that the Web site doesn’t list pending complaints.

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