Clinical philosophy · Newport News
Services we don’t offer — and why.
Most medspa websites are a long list of everything they sell. This page is the opposite: it’s the list of things we won’t sell, with the reason for each one. We do this for two reasons. First, we’d rather lose a patient who wanted a service we don’t believe in than offer it just to keep the appointment. Second, when you book a treatment with us, we want you to know it cleared a real evidence filter before it made the menu. Below are seven services other local medspas offer that we deliberately don’t — and one product line we won’t sell either.
Cryolipolysis (CoolSculpting and similar fat-freezing)
What it is
Non-invasive fat reduction using controlled cooling to damage subcutaneous fat cells.
Why we don’t offer it
Paradoxical adipose hyperplasia (PAH) — a known complication where treated fat tissue grows instead of shrinks. The manufacturer’s early estimate was about 0.0051% (1 in 20,000), but the published literature puts it materially higher: a single-center series reported 0.47% (about 1 in 211), and a 2025 systematic review and meta-analysis of 13,078 patients found a pooled incidence of 0.22% (1 in 455) — consistently above the manufacturer’s figure. PAH typically requires liposuction to correct, which means a non-invasive procedure becomes a surgical one. The modest fat-reduction effect (~20–25%) does not justify a complication profile that includes a non-trivial risk of an effect opposite to the marketed one.
What we suggest instead
Honest conversation with your primary care provider about diet, training, and metabolic workup. For surgical fat reduction, a board-certified plastic surgeon.
References: Jalian, et al. 2014 (DOI); Singh & Geddes 2015 (DOI); Mah, et al. 2025 (DOI); Ingargiola, et al. 2015 (DOI).
EMSculpt and other HIFEM “muscle building” devices
What it is
High-intensity focused electromagnetic stimulation marketed to build muscle and reduce fat without exercise.
Why we don’t offer it
An independent, GRADE-rated systematic review found only modest absolute changes — on the order of 5.5 mm of abdominal fat thickness and 2 mm of muscle thickness — with two of the included studies reporting marginal or no benefit, and noted that the evidence base is small and largely produced by manufacturer-affiliated investigators. The effect is also not durable: like trained muscle, it regresses within months of stopping. At $750–$1,500 per session and roughly four sessions per body area, that’s $3,000–$6,000 for a temporary, modest change that consistent resistance training can reproduce at no cost.
What we suggest instead
A structured strength training program. We’ll refer to local trainers and PTs.
References: Kohan, et al. 2023 (DOI); Samuels, et al. 2022 (DOI); Cohen, et al. 2024 (DOI).
Ultrasound cavitation for fat reduction
What it is
Low-frequency ultrasound delivered through a handpiece to disrupt fat-cell membranes.
Why we don’t offer it
The independent evidence is thin: the supporting studies are small, short, and frequently industry-associated, and rigorous sham-controlled trials demonstrating clinically meaningful fat reduction are lacking. Where reductions are reported, they’re modest and hard to separate from post-treatment massage, temporary edema, and regression to the mean. We don’t offer a fat-reduction device whose benefit hasn’t been demonstrated under rigorous, independent, controlled conditions.
What we suggest instead
Diet, training, and a plastic surgeon if surgical contouring is the goal.
References: Alizadeh, et al. 2016 (DOI).
Radiofrequency-only devices for fat reduction
What it is
RF energy applied to subcutaneous tissue with the claim of inducing fat-cell apoptosis. (Note: distinct from RF microneedling for skin tightening and collagen remodeling, which is a separate indication with a separate evidence base.)
Why we don’t offer it
Independent evidence is limited and heterogeneous. Reviews of non-invasive body-contouring devices find only mild-to-moderate effects for radiofrequency fat reduction — on the order of a few centimeters of circumference change — across small studies of variable quality, with large, rigorous sham-controlled trials largely missing. (RF microneedling for collagen remodeling is a distinct indication with a separate, stronger evidence base, and is not what we’re critiquing here.) RF-only fat reduction doesn’t meet our evidence bar, so we don’t offer it.
References: Alizadeh, et al. 2016 (DOI).
DiamondGlow and similar “infusion” facials
What it is
A device combining mild dermabrasion with a serum-infusion handpiece, marketed as delivering active ingredients deeper into the skin than topical application alone.
Why we don’t offer it
The fundamental claim doesn’t hold up. Skin penetration is governed by molecular size and the stratum-corneum barrier — the basis of the well-established “500-Dalton rule” — and a serum-infusion handpiece doesn’t change that physics. Most actives delivered this way stay in the superficial epidermis, the same place a properly formulated at-home topical reaches for a fraction of the cost. You’re paying for an in-office experience priced as a clinical “infusion” that isn’t meaningfully infusing.
What we suggest instead
Dermapen 4 microneedling for deeper skin texture improvement, or a prescription topical regimen — tretinoin and appropriate actives applied at home will outperform an in-office infusion that doesn’t reach the dermis.
References: Bos & Meinardi 2000 (PubMed).
Soft-shell hyperbaric oxygen chambers (the “wellness” kind)
What it is
At-home or in-spa soft-shell chambers at 1.3–1.4 ATA with ambient oxygen, marketed for recovery, longevity, and skin quality.
Why we don’t offer it
Real hyperbaric oxygen therapy works at higher pressures (2.0–3.0 ATA) with 100% oxygen for specific FDA-approved indications, under strict medical supervision. The soft-shell wellness devices don’t reproduce those conditions. The marketing leans on the real medical use to imply similar benefits — it does not deliver them.
What we suggest instead
If you have a clinical indication for HBOT, a hospital-based hyperbaric referral. Otherwise, sleep, training, nutrition, and our PRP / microneedling services.
References: FDA, “Hyperbaric Oxygen Therapy: Don’t Be Misled” (FDA); UHMS approved indications (UHMS).
“Stem cell” facial treatments and most exosome products marketed as stem-cell-derived
What it is
Facial serums, post-microneedling topicals, and injectable products marketed as containing “stem cells” or stem-cell-derived growth factors and exosomes.
Why we don’t offer it (yet, and carefully)
Two issues. First: most “stem cell” products do not contain living stem cells. The cells, if ever present, were lysed during processing. Second: the exosome category is in a complicated regulatory moment. The FDA has issued multiple safety communications about unapproved exosome products, including warnings about patient harm. There are legitimate research-grade programs underway, but they are not the products being sold by most medspas. We use autologous PRP — your own plasma, processed in front of you — for the same use cases instead.
What we suggest instead
Autologous PRP for microneedling combination, hair restoration, facial rejuvenation.
References: FDA Consumer Update, “FDA Warns About Stem Cell Therapies”; FDA public safety notification on exosome products (FDA).
Retail “medical-grade” skincare
Not a treatment — a product line, and the one product category we won’t sell. Almost every active sold in “medical-grade” or “physician-dispensed” skincare — vitamin C, retinol, niacinamide, hyaluronic acid, peptides, AHAs, sunscreen filters — is available over the counter at comparable concentrations from CeraVe, La Roche-Posay, The Ordinary, Maelove, Timeless, and Eucerin at a fraction of the price. The premium reflects distribution and branding, not chemistry.
The exception is genuine prescriptions — tretinoin, hydroquinone, compounded topicals — which we write when appropriate; those go through a real pharmacy, not our shelf. After in-office procedures that require specific aftercare, you’ll leave with a small aftercare kit included in the procedure price — not the $300 worth of “recovery” products patients commonly get sold on the way out the door at other practices.
For the full argument and the SkinCeuticals C E Ferulic case study, see Why We Don’t Sell Retail Skincare. For what we recommend instead, organized by skin concern, see Skincare We Actually Recommend.
Calendar opens Fall 2026 · Founding patients first
A candid second opinion, when the calendar opens.
If you’re considering a service we don’t offer and you want a candid second opinion, book a 15-minute consult. We won’t sell you something we don’t believe in — but we’ll help you think through whether it makes sense for you.
Join the Founding ListLast reviewed: June 2026. We update this page when published evidence materially changes the picture.
Brand names referenced are the trademarks of their respective owners and are used for identification and comparison only.