Over the last decade or so, thousands of "medical spas" have popped up around the country, enticing consumers with a name that suggests a surgeon's skill mixed with the pleasure of a massage. Few states license or inspect them, and they rarely seek accreditation. Any place can call itself a medical spa. Anybody can operate one. "There is a bit of a Wild West out there," said Leo McCafferty, a board-certified plastic surgeon in Pittsburgh who is president of the American Society for Aesthetic Plastic Surgery. Though providing a facial or chemical peel is fine, he said, for a more invasive procedure like liposuction, "I think the risks would increase exponentially if you are getting it in a place that is not following the tried-and-true guidelines that have been put in place for safe surgery."