Now, thanks in part to a raft of TV shows such as "Extreme Makeover," all that has changed. And a new breed of doctors and entrepreneurs is bringing the quest for youth and beauty down to street level by opening medical spas, or "medspas," in retail locations.

Medspas offer spa services such as massage or facials, along with nonsurgical cosmetic and anti-aging treatments that require a physician's supervision -- such as Botox, chemical skin peels and laser hair removal. They don't perform plastic surgery, but provide referrals to doctors who do.

Only a handful of medspas operate on Long Island, but several more are in the works and a number of national companies are seeking locations here.

They're all eager to tap into the Island's affluent, status-conscious baby boomers. "I've had so many calls from doctors, chiropractors, all these people saying, 'I'm thinking of starting a medspa,'" said Nicole Suozzi, a real estate broker with Oxford & Simpson in Jericho.

Suozzi has been scouring Nassau's North Shore for the local franchisee of Solana Medspas, a Laguna Beach, Calif., company that plans to open 1,000 locations nationwide in the next seven years.

"I'm 42 years old," said Dr. Michael Kelley, a Franklin Square dentist and member of the partnership bringing Solana to Long Island. "People my age are starting to show a little wear and I know there's a significant population out there that's already behind closed doors getting these procedures done."

He's right. Americans spent close to $20 billion last year on plastic surgery, medspa and day spa treatments. The number of nonsurgical cosmetic procedures rose 51 percent from 2003 to 2004, according to the American Society for Aesthetic Plastic Surgery.

One needn't be an anthropologist to discern what's driving this trend. Hollywood churns out an endless supply of pretty young things and magazines are saturated with images of attractive, nearly ageless celebrities.

Adults also are living longer thanks to medical advances and attention to diet and health. Ponce de Leon's vision of a fountain of youth suddenly seems attainable to baby boomers who have grown up in an unprecedented era of affluence and entitlement.

"For the older generation, it was all about the grace of aging. But the younger generation, the boomers, they don't accept that," said John Buckingham, Solana's founder and chief executive.

The medspa also fits into consumers' time-crunched lives. Rather than spending weeks recovering from a face-lift, clients can pop in for a quick Botox treatment and be on their way.

"We have many patients who are only interested in noninvasive techniques," said Pat Baldwin, director of Spa Belle Meade in Setauket. "They don't want to have downtime."

Men make up about 10 percent of the industry's clientele. Laser hair removal is particularly popular among men. Even teenage boys are seeking the hairless look propagated on the covers of fitness magazines.

Right now, Buckingham estimated, there are only about 700 medspas in the United States. He predicts that nearly 10,000 will open in the next seven to 10 years, driven by escalating demand from customers and the realization that medspas offer significant profits.

Consider this: clients spend an average of $700 on each trip to a medspa vs. $150 for a visit to a traditional day spa, said Dana Caruso, founder of the Long Island Nail and Skin Care Institute in Levittown. Caruso is a partner in a medspa set to open next year in Woodbury.

Because medspa services are generally not reimbursable by insurance, they represent a far simpler -- and lucrative -- cash stream for doctors and owners. "The markup is high and overhead is low, so pre-tax profit is typically 30 to 40 percent on revenue," Buckingham said.

Obstacles do exist, though, including the lack of space in Long Island's most desirable towns. The market "is brutal right now," Kelley said, especially on the North Shore, where space is pricey and scarce.

Another barrier is the regulatory requirements, which can seem cumbersome to investors without medical experience.

Medspas are distinct from traditional day spas in that some treatments require medical supervision and can only be performed by aestheticians and nurses with special training. A variety of state and federal agencies regulate the procedures.

Every medspa must have at least one doctor affiliated with it, who supervises the aestheticians and nurses on staff, ensures that medical protocols are followed and can respond to emergencies.

At Solana spas, doctors don't perform procedures and are on site only a few hours a week, Buckingham said. Other medspas, such as Spa Belle Meade, are next to the offices of dermatologists or plastic surgeons who are more actively involved.

But one of the selling points of a medspa is that treatments are infused with the feeling of a day spa, so that patients experience them as beauty rituals rather than clinical procedures.

"We have high-tech equipment, but it's in a low-key, sophisticated environment," Baldwin said. "You get the sense of being in a luxurious spa, but with a medical spin to it."

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BY LAUREN WEBER STAFF WRITER