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Up in the clouds of First Canadian Place, a small army of white-jacketed medical aestheticians toils away at the new downtown SpaMedica clinic amid luxe surroundings: space-age white chairs, expensive corporate Armani greige. It's a clinic dressed up, as plastic surgeon/owner Stephen Mulholland says, like his business clients, "with an oak-panelling, law-firm kind of feel."

The plastic-surgery game in this town has traditionally been played out in Yorkville offices (Dr. Mulholland's Avenue Road spread is meant to be "fashion-y," he says, "modelled after a W Hotel"), for clients who are, as the cliché goes, rich, bored and idle.

But in the past five years, with a flood of "breakthrough" technologies in the field ("non-invasive" injectables such as Botox, the forehead freezer; various line fillers -- Dermadeep for furrows, Restylane and Perlane for naso-labial folds; Juviderm the lip augmenter; and, most recently and vividly, fat-melting), the medical spa target market has grown to include workaholics.

This second Toronto SpaMedica location, open since July, is directly targeting the pocketbooks of the 400,000 office workers of the core five buildings connected directly to the underground PATH system and their immediate surrounds, Dr. Mulholland says.

SpaMedica may be headed up by Canada's most recognizable plastic surgeon. (Dr. Mulholland aggressively courts the media here and abroad -- his appearances on CityLine play in the waiting rooms and he has gone on The View and Good Morning America.) But a fierce battle for our bulge is coming.

This week, another heavy-hitter in the field announced that it was setting up a competing shop in the downtown core. Espada, "the medical spa," will be on the ground floor of BCE Place and offer direct access to a dermatologist and plastic surgeon.

Will there be enough worry lines to keep all these facilities going?

Botox use alone has been growing 40 per cent annually in Toronto, and Bay Street is now the big money future of the "medical spa" industry, as more business people look for convenient ways to stay younger-looking.

"My life is measured in minutes," says Stephanie (names have been changed), a 46-year-old lawyer at a big Bay Street firm and a downtown SpaMedica client who pops in for Botox and the Pan-G facial series (a made-up name for a combination of photofacials and myofacials, basically a machine that does deep muscle stimulation).

"It's damned expensive, but I wear my face every day," she says. "I haven't been to a regular day spa for a facial for years. They're a waste of money. SpaMedica is like going to the doctor's, but you never have to wait, which I just can't do."

Paul is another patient who would not go for these kinds of treatments if they were not super-convenient: "I'm not going to spend my lunch snaking up University in traffic. That's horrible."

He's also not a spa guy. "I'd go once a year to get blackheads removed," he says, "but these treatments are like exercise for the face." He now does monthly maintenance visits.

The new surgical spas also offer dermatological services, laser treatments, hair removal, face treatments, vein treatments and surgery consultations.

But both SpaMedica and Espada are now betting on the newest offering, the VelaSmooth. The non-surgical answer to liposuction, the $100,000, Israeli-made machine looks like a vacuum and uses radio frequency and heat (thermage) to break down fat, which is then excreted in a process called lipolysis (basically the same thing that happens naturally with caloric restriction).

"For years, we have been doing all this stuff for your face. Now, we can melt your fat," Dr. Mulholland says. "Could anything be bigger than that?"

The newest trademarked package Dr. Mulholland is peddling is called LipoLite, which involves twice-weekly sessions for eight weeks with the VeloSmooth.

For $3,999 you can get three "large zones" worked over (choose from "tummy, love handles, rub zones, saddlebags or male boobies," as Dr. Mulholland calls them). The package also includes some more traditional injectable fat burners (such as carbon dioxide and mesotherapy, which uses a chemical cocktail). VelaSmooth results are not permanent, but can last years if you eat carefully, he says from his Yorkville office, with a large-sized Lempicka nude on the wall behind him. "The fat cells, which are like grapes when they are full, are shrunk to raisin size.

"This is gonna be much bigger than Botox. If you figure there were 750,000 liposuction procedures in the U.S. last year, how many people are going to get a non-surgical version done? It boggles the mind."

Despite the cost, these clinics are not just targeting the elite -- they want a piece of every assistant's paycheque too. "Working people spend on average $2,000 a year on their appearance," Dr. Mulholland says. "I want a piece of that pie."

But not all business execs want to go to Botox parties with their assistants. "SpaMedica is on the 25th floor," says Stephanie, the lawyer, who visits weekly, "and that's good. At least it's not in the concourse where everyone can see you. And there is something else on that floor, so it's not too damning to press No. 25 in the elevator. But if it gets too popular, I won't be able to go any more."

As the treatments get more trendy, the city has more secrets to hide. Dr. Mulholland's Yorkville surgery is fitted with hidden back doors and strategies to get famous faces from here and abroad in and out in privacy.

Yes, things are changing somewhat. As Dr. Mulholland says, "In 1996, when I opened up, these procedures were all considered weird and freaky."

But even if the Botox stigma fades, there are still going to be people who want to keep their smooth foreheads (and now tummies) a trade secret. Guess he'll just have to build a secret entrance to the 25th floor of First Canadian Place.

ldelap@globeandmail.ca