Seth Gordons has been writing about The Scarcity Shortage in Fast Company. Scarcity is affecting medical spas in the same way that it does with every market. From the article:

"Scarcity, after all, is the cornerstone of our economy. The only way to make a profit is by trading in something that's scarce. This is why the music and movie industries are so terrified by the millions of people who download entertainment from the Internet every day. Downloading threatens to make supply virtually unlimited, and that could make their offerings about as valuable as those of some kids down my street who recently tried to run a stand selling freshly made mud.

The same thing is true for doctors, Web sites, T-shirt shops, sushi restaurants, thumbtack manufacturers, and brands of blank CD-ROM disks. There are 100 major brands of bottled water. Someone opened a fancy ice-cream parlor in Manhattan, and then there were six.

Medical Spas are right in the nexus of this change to cosmetic medicine.Where skilled dermatologists and plastic surgeons were the rule, medical technologies like IPL, lasers, Restylane, Thermage, Fraxel etc, provide scalable solutions that no longer rely on the 'scarcity' of physician knowledge. These technology solutions will put huge pressure on medical pricing in the future and it will only be those businesses/physicians who are able to distinguish themselves through brand that will survive. 

While the medical community has long been insulated from effects that other markets constantly deal with, that's no longer the case. Medical Spas will make most cosmetic medicine a commodity, no longer dependant entirely upon the skill of an individual physician but now offered as an 'almost' completely replicable solution. Medical Spas are changing, those that embrace the new paradigm have a chance, those that ignore it will follow the telegraph and full service gas station.