A med spa is a medical practice that offers aesthetic treatments, such as Botox, dermal fillers, and laser hair removal, performed by licensed clinicians under a physician’s oversight, in a setting that feels closer to a spa than to a hospital. The difference between a med spa, a day spa, and a dermatology office comes down to two questions: who is treating you, and what they are licensed to do. This article answers both, so you know which door to walk through for the concern you have.
The three settings at a glance
Med spa
What it offers: medical aesthetic treatments (injectables, device treatments, chemical peels), often alongside facials.
Who performs the work: licensed clinicians, such as registered nurses, nurse practitioners, physician assistants, and physicians, depending on the state and the treatment.
Medical oversight: a physician who serves as medical director or supervising physician.
Best for: cosmetic concerns whose treatment requires a clinical license. A med spa does not diagnose or treat skin disease.
Day spa
What it offers: facials, massage, body treatments, waxing, and relaxation services.
Who performs the work: licensed estheticians and massage therapists.
Medical oversight: none, because nothing on the menu is a medical treatment.
Best for: relaxation and skin maintenance. A day spa does not inject, prescribe, or operate medical devices.
Dermatology office
What it offers: diagnosis and treatment of diseases of the skin, hair, and nails; many also offer cosmetic treatments.
Who performs the work: a dermatologist, a physician with residency training in dermatology, often with nurses, nurse practitioners, or physician assistants on the team.
Medical oversight: the physician is the practice.
Best for: anything that needs a diagnosis, and cosmetic treatment where that office offers it.
What a med spa is
A med spa offers treatments that are medical in nature and cosmetic in purpose. Botox and the other wrinkle relaxers are prescription medicines. Dermal fillers, microneedling devices, and the ultrasound and laser devices used on skin are regulated medical devices. Because the treatments are medical, the people who perform them hold clinical licenses, and a physician oversees the practice. The spa part of the name describes the setting and the pace. The standard of care is medical.
At Savage Serenity MedSpa, our med spa in Fresno, treatments are performed by Angela Hash, BSN, RN, or by the injectors she trains, Michelle Perkins, RN and Candice Brantley, NP. Dr. Luis Lee is the practice’s medical director and supervising physician. Angela, who leads the practice and trains the injector team, describes her approach this way: “My approach is always full facial balancing rather than chasing one line or treating one area in isolation. I look at the face as a whole and create a treatment plan that restores balance, supports the way you’re naturally aging, and still keeps you looking like you.”
Each state sets its own rules for who may perform which treatment and how a physician supervises them. We cover California’s scope of practice rules for registered nurse injectors in a separate article.
What a day spa is
A day spa offers services that relax and maintain: facials, massage, body wraps, waxing, and similar treatments. Estheticians and massage therapists perform them under their own licenses, and no physician is involved, because nothing on the menu is a medical treatment. A good day spa is exactly the right place for an hour of care with no clinical decision attached to it.
The line between the two settings is easiest to see on a facial menu. Our Serenity Treatments are facials: cleansing, exfoliation, and the kind of care an esthetician provides. Our Savage Treatments are clinical skin treatments: microneedling, chemical peels, Sofwave, and laser hair removal. They sit on the medical side of the line because each one works below the surface a facial reaches and carries risks a facial does not.
A facial does not change what it is by being offered inside a med spa. What changes is that the same team can tell you when a facial is enough and when your skin needs something a facial cannot do.
What a dermatology office is
A dermatologist is a physician who specializes in conditions of the skin, hair, and nails. The American Academy of Dermatology puts the training at more than a decade, including a three year residency in dermatology, and says a dermatologist diagnoses and treats more than 3,000 diseases of the skin, hair, and nails as well as cosmetic concerns. A dermatology office is where a diagnosis happens: a mole is examined, a rash is named, a biopsy is taken, a prescription is written for a disease. Many dermatology offices also offer cosmetic treatments, including some of the same injectables and devices a med spa offers.
When to see a dermatologist first
Go to a dermatologist before anyone else if you have a mole that has changed in size, shape, or color; a rash; a sore that is not healing; a spot you cannot identify; or any concern where the question is “what is this” and not “how do I soften this.” Savage Serenity is a med spa, not a dermatology office. We treat the appearance of skin, and we do not diagnose skin disease. Bring the mole to a dermatologist first. The cosmetic conversation will keep.
Which setting suits you
Choose a day spa when you want to be cared for and nothing needs to change: a facial before an event, a massage after a hard month, skin maintenance between clinical visits.
Choose a dermatology office when something needs a name. Skin cancer screening, acne that has not responded to what you can buy, eczema, psoriasis, hair loss, and any new or changing spot belong there.
Choose a med spa when the concern is cosmetic and the treatment requires a clinical license: lines that move with your face, folds and lost volume, skin texture, unwanted hair. A good med spa plans that work around your whole face and tells you plainly when a treatment is not for you.
Many people use all three. A dermatologist for the yearly skin check, a med spa for injectables and skin treatments, a day spa for the afternoon off. None of them replaces the others.
What a med spa treats, using our menu as the example
Every med spa menu is different, and what follows is ours. Each treatment links to its own page, where the risks, what to expect, and who it suits are laid out in full. Injectables come first because they are what most people picture when they hear the words med spa.
Wrinkle relaxers. Botox, Daxxify, and Jeuveau are prescription medicines injected into the small muscles that fold the skin when you frown, raise your brows, or squint, so the line those muscles make softens.
Dermal fillers. RHA and Evolysse are hyaluronic acid fillers, gels injected beneath the skin to soften facial wrinkles and folds.
Biostimulators. Sculptra is a poly-L-lactic acid injectable used for facial wrinkles and folds and given over a series of visits.
PRF. Platelet rich fibrin is prepared from a small sample of your own blood.
Skin treatments are our Savage Treatments. Microneedling uses a device with fine needles to create controlled micro injuries in the skin. Sofwave delivers ultrasound energy beneath the surface of the skin. Laser hair removal uses light that is absorbed by the pigment in the hair follicle. Chemical peels apply an acid solution that removes the outer layers of skin. Each is performed after a consultation, and each page states who it does and does not suit.
Facials are our Serenity Treatments, and they are the part of the menu a day spa would recognize.
Pricing is set per treatment, and the consultation sets the plan and the quote before anything is done; payment options are described on our financing page.
How to choose a med spa
Ask these five questions anywhere you are considering treatment, including here. A good practice answers every one of them without hesitation.
Who is the medical director or supervising physician?
Ask for the name. A med spa should be able to tell you which physician oversees it, and you should be able to look that physician up on your state medical board’s website. At Savage Serenity, Dr. Luis Lee is the medical director and supervising physician.
Who will be treating me, and what license do they hold?
Ask for the name as it appears on the license and the license type, then look it up on the state board’s public search. Every clinical license can be checked online through the state’s licensing board. Here, that is Angela Hash, BSN, RN, who leads the practice and trains the injector team, and the two injectors she trains, Michelle Perkins, RN, and Candice Brantley, NP.
Will there be a consultation before treatment?
There should be, every time, and it should include looking at your face at rest and in motion, asking what bothers you, and telling you which of your concerns the treatment will not address. Every treatment here begins with a consultation, and you receive the plan and the quote before anything is injected.
Where do the products come from?
Ask whether the products are bought from the manufacturer or its authorized distributor in the United States, and ask to see the box if you want to. A practice with nothing to hide will show you.
What happens if something goes wrong?
Ask how complications are handled, who you call after hours, and how quickly the supervising physician can be reached. Every medical treatment carries risk, and each treatment page on this site states the risks for that treatment plainly. The answer you want is specific and calm.
Two things you will not learn from a website: how the room feels and whether you are listened to. The consultation answers both.
Frequently asked questions about med spas
Is a med spa a medical practice?
Yes. The treatments a med spa offers, wrinkle relaxers, dermal fillers, and laser and ultrasound devices among them, are medical treatments, which is why licensed clinicians perform them and a physician oversees the practice. The spa setting does not change that.
What is the difference between a med spa and a day spa?
A day spa offers non medical services such as facials, massage, and relaxation treatments, performed by estheticians and massage therapists. A med spa offers medical aesthetic treatments such as injectables and device treatments, performed by licensed clinicians under a physician’s oversight. Many med spas, ours included, also offer facials.
Should I see a dermatologist or a med spa?
It depends on your question. If you need a diagnosis, for a changing mole, a rash, a sore that will not heal, or a skin condition, see a dermatologist first. If your concern is cosmetic and you already know what it is, a med spa or a dermatology office that offers cosmetic treatment can both help, and the right choice comes down to the clinician you trust.
Who performs treatments at a med spa?
Licensed clinicians. Which license is required for which treatment is set by each state. At Savage Serenity, treatments are performed by Angela Hash, BSN, RN, or by the injectors she trains, Michelle Perkins, RN, and Candice Brantley, NP, under the medical direction of Dr. Luis Lee.
Do I need a referral to book at a med spa?
No. You book a consultation directly, and the consultation is where the plan is made. If what you describe needs a diagnosis, a dermatologist is the right first stop.
Book a consultation in Fresno
Book online and choose a consultation. You will leave with a plan and a quote for each treatment in it, and you decide from there.
Keep reading
Treatments at Savage Serenity MedSpa
What anti aging and aesthetic treatments cover
Sources
American Academy of Dermatology. What is a dermatologist? Last updated 10/05/2022. Accessed 09/30/2026. https://www.aad.org/public/fad/what-is-a-derm
American Academy of Dermatology. Best questions to ask when considering a cosmetic treatment. Last updated 08/28/2025. Accessed 09/30/2026. https://www.aad.org/public/cosmetic/safety/ask-questions
American Society of Plastic Surgeons. Appropriate Business and Clinical Management of Medical Spas. 12/15/2023. Accessed 09/30/2026. https://www.plasticsurgery.org/documents/Health-Policy/Resources/2023-medical-spas-appropriate-management.pdf
American Society for Dermatologic Surgery Association. Position on Physician Oversight in Medical Spas. Updated January 2024. Accessed 09/30/2026. https://www.asds.net/Portals/0/PDF/asdsa/asdsa-position-statement-physician-oversight-in-medical-spas.pdf
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