Bad Botox, failed fillers: Unlicensed medical spas causing harm, Long Island doctors say

The seemingly insatiable demand for low-cost beauty enhancements has Long Island dermatologists and plastic surgeons seeing a steady stream of patients with botched Botox, failed fillers and burns from lasers.

The cause, according to state regulators and medical experts, is that procedures are often performed without a medical license in nail salons, hair removal boutiques and other storefront spas.

"At least once a day, I have someone come in with a complication, whether it’s a burn from some type of laser for anti-aging purposes, or unlicensed Botox or filler," said Dr. Raman Madan, a dermatologist who sees patients on Long Island and is director of cosmetic dermatology at Northwell Health. "You don't always know exactly what's being injected in you."

He said these cases have become more common over the last three or four years.

Medical spas typically offer cosmetic procedures in a relaxing environment with features like plush seating, warm lighting and calming tea. The treatments, though considered minimally invasive, are required under state law to be overseen by a physician or nurse practitioner, either as owner or medical director of the facility.

Reality shows such as "Keeping up with the Kardashians" and "Real Housewives," where the stars are open about their beauty treatments and surgeries, have helped smash taboos about plastic surgery, experts said. Consumers want less complex, more affordable procedures that can be done on an outpatient basis.

"Nationwide, we’ve seen a significant increase in med spas, driven largely by growing consumer interest in minimally invasive aesthetic treatments," Dr. C. Bob Basu, president of the American Society of Plastic Surgeons, told Newsday in an email. "Part of that growth reflects a broader cultural shift. Cosmetic procedures are far more normalized today than they were even a decade ago."

The number of medical spas in the country doubled between 2018 and 2023 to 10,500, according to an industry trade group. The "medical aesthetics market" is projected to expand from a $17 billion industry in 2024 to $41 billion by 2031, according to one analysis.

Seeing the rising interest, some beauty salons also bought lasers, ultrasound machines and other equipment to offer services more cheaply — but don't have the proper medical licensing.

No one state agency licenses businesses that provide medical spa services. But the Department of State launched an initiative last year to crack down on stores offering treatments without a license, inspecting 223 businesses across New York, including 22 on Long Island. Officials said 87 businesses were cited for possible violations including for "the unlawful practice of medicine." The majority of those cited haven't been resolved yet, but they could face penalties including fines, starting at $500 for a first offense, or even license suspensions or revocations.

"These are medical procedures that consumers should take just as seriously as they are getting a procedure on their hands or internal organs," New York Secretary of State Walter T. Mosley, whose agency helps oversee inspections of spas, said in an interview.

He said there have been egregious examples of harm to patients from ill-equipped and improperly licensed facilities and providers.

One woman received 128 to 140 injections at Princess Beauty in Flushing, Queens, of what she was told was Botox, stem cells and collagen treatments over a period of years, according to the Queens District Attorney's Office. She suffered blisters, pain, swelling and scarring from what the complaint called an "unknown substance." In February 2025, the operator, Fei Min, was arrested and charged with felony assault, unauthorized practice and reckless endangerment, according to the district attorney's office. She has pleaded not guilty.

Mosley said the department will conduct inspections annually.

"We know as more storefronts and businesses open up, the propensity for more violators will continue to increase," he said.

In a few hours online, Newsday found more than half a dozen spas across Long Island advertising skin and body procedures using ultrasounds, lasers and other technology that are required to be operated under the oversight of people with a medical license. The providers don’t appear to have those credentials.

In some cases, the spa operators referred to themselves as licensed estheticians or experienced cosmetologists. A license search showed one owner, who had boasted of her experience with body contouring machines, was a massage therapist. The owners and operators were not in databases of doctors or registered nurses.

Manhattan attorney Norman Spencer, who has represented spa owners cited with violations, said there is a lot of confusion over the rules.

"New York is extremely restrictive," he said. "When people call me, I spend 30 minutes every time just explaining the lay of the land to them and this is the first time they have ever heard about it. That’s not a defense but no one wants to break the law intentionally."

Laws and regulations governing medical spas differ from state to state. In California, medical spas must be owned by physicians. Pennsylvania requires they be owned by a physician or physician group, and that cosmetic procedures only be performed by doctors, physician assistants, advanced practice registered nurses or registered nurses.

Bad injections

 Many of the procedures designed to smooth skin, reduce wrinkles, tighten sagging jawlines and otherwise enhance looks need expertise and training, medical experts said.

The injection of facial fillers, for example, can be especially dangerous in untrained hands, said Madan, who is also assistant professor of dermatology at the Zucker School of Medicine at Hofstra/Northwell.

If the filler is injected into a blood vessel, it can block blood flow and cause the tissue to die, known as necrosis. Laser settings have to be calibrated based on factors like a patient's skin type and color. 

Dr. Kevin Small, director of plastic surgery for the New York Bariatric Group, has treated patients on Long Island suffering from infections and other problems because unknown substances were injected into their buttocks as part of a nonsurgical butt-lift procedure. In at least one case, the damage was severe.

"Surgically, part of their buttocks had to be removed because of how bad the infection was," said Small, who sees patients in Roslyn Heights and other locations on Long Island, as well as in Manhattan.

He’s also seen cases where silicone was injected into someone's buttocks, and then it "spreads out like a spider web." Bad injections can potentially cause blocked blood vessels, infections and strokes.

Experts said comparing prices among the different spas on Long Island can be difficult.

But there is no shortage of Nassau and Suffolk County-based spas advertising Botox and filler "bundles," Groupons, coupon codes and other deals on the internet. One promises 20 units of Botox — about the amount for an average forehead treatment — for less than $125. Some medically licensed spas generally charge closer to $300.

The American Society of Plastic Surgeons said the average cost for an equivalent treatment from a physician or surgeon is $435.

"You kind of get what you pay for," said Madan. "That's what ends up happening."

Alex Thiersch, a lawyer who founded the American Med Spa Association, said the "overwhelming majority" of medical spas with medical licenses know the rules and follow them but are sometimes unfairly lumped in with the others.

He said they support New York's crackdown.

"With any growth industry, you are going to, unfortunately, see the kind of underbelly of that," Thiersch said. "There have been some really bad actors that have hurt people."

Cited spas

The state cited two businesses on Long Island as part of its enforcement last year.

The Lunar Light Laser Spa in New Hyde Park didn't have proper licenses for some beauty treatments it offered, state officials said. One procedure, Cavi Lipo, uses ultrasound waves to destroy fat cells. Another, called high intensity focused ultrasound (HIFU) — which can be used to treat tumors — targets body tissue at different depths to tighten, lift and contour. Microneedling, which involves small needles puncturing the skin to boost production of collagen to ease acne scars and wrinkles.

The owner of Lunar Light Laser Spa, Asma Elftes, was charged by the Department of State with unlawfully engaging in the practice of medicine and acupuncture not covered by her license as an esthetician.

According to court records, Elftes said she thought the procedures were beauty treatments and not considered practicing medicine. After the state suspended her license to operate the New Hyde Park store, she continued operating another shop in Astoria, Queens. She told the state she thought the license suspension only affected her New Hyde Park location. Her license was suspended in June 2025 and later revoked after a hearing.

Elftes could not be reached for comment. Spencer, the attorney for spa owners who also had represented Elftes, said he thinks the state should give owners a chance to fix their mistakes instead of immediately suspending their licenses.

The Department of State last year updated its website with a section on med spas, which must be licensed to perform procedures, descriptions of the procedures and how businesses can comply.

"Our goal is to not put any undue burden on businesses, but all businesses have to play on a level playing field," Mosley said. "When someone performs a medical procedure, it could be the difference between life and death for a consumer."

Flirt Spa and Brow Bar in Manhasset was licensed by the state as an "appearance enhancement business," offering services such as nail specialty, waxing, natural hairstyling, hair removal and makeup application. But it also offered laser tattoo removal, Botox injections, microneedling and other cosmetic procedures on its website — services that require permits and licenses it didn't have, according to state records. An inspector went to the shop in April 2025 and saw it was also offering IV drip services.

One of the owners on site said a nurse practitioner was on call to help with medical services, but would not provide contact information, according to records.

Co-owner Dror Harsinay signed a consent order agreeing to pay a $500 fine and have her license suspended until the violations were fixed.

Newsday contacted the shop multiple times via phone and email. A woman who answered the phone and identified herself as the owner declined an interview request. 

The business has remained open and according to its website offers nail services, makeup application, facials and laser hair removal — all procedures covered by its license.