It's Botox at the mall as plastic surgery spas mushroom.

Call it plastic surgery for the masses.

While chemical peels, laser vein removal and Botox injections were once only available at doctors' offices, weary shoppers are now sitting down for the medical procedures during trips to the local mall.

A growing number of so-called "medispas," which meld spa services with cosmetic medical procedures, have opened over the past year in malls and shopping centers on the West Coast. The trend is also pushing east--all to the consternation of traditional plastic surgeons.

"You need to practice medicine in a medical setting, and a spa is certainly not one of them--especially these mall shops," said Dr. Jack Bruner, chairman of the American Society of Plastic Surgeons.

The potential profit that medispas can generate, however, seems to overshadow concerns in the medical profession, which is divided on the safety and appropriateness of the shops.

Over the past few years, spas operated by Nuvo International have opened in the Beverly Center in West Hollywood, the Westside Pavilion and elsewhere in Southern California, among 32 locations nationwide. The Henderson, Nev.-based company plans to be in 60 malls by year-end.

The spas offer everything from facials and manicures to laser vein- and hair- removal--as well as injectable treatments such as collagen, Botox and Restylane, most of which are used to reduce wrinkles and signs of aging.

They don't offer full surgical procedures, such as face lifts that require general anesthesia. Those still need to be done in doctors' offices.

But one of the attractions of the spas is that they are not medical offices, which can turn off potential plastic surgery candidates who have a fear of medical procedures.

"Some people would never pick up the phone to call a dermatologist, but if you're just walking around the mall, you might check it out," said Susan Gelnette, Nuvo's development coordinator. "We're just trying to make it comfortable for the masses, and affordable--like it's no big deal."

The stores also try to beat traditional doctors' offices on price. For a single microdermabrasion treatment, Nuvo charges $49, but it runs a special package of five treatments for $29.99 each. Individual Botox treatments might run $200, about half the cost of the same procedure at a doctor's office.

The company also defends its safety practices, saying that only doctors perform injections such as Botox or collagen, while technicians perform procedures such as microdermabrasion and chemical peels in which only the surface of the skin is treated.

California law requires each mall shop to operate under a medical doctor's license, though an individual doctor can oversee several different offices.

Howard Davidowitz, chairman of Davidowitz & Associates Inc., a retail consulting and investment banking firm based in New York, said the mall shops are starting to attract more interest from investors who agree that having plastic surgery done outside a medical office could greatly expand interest in the procedures.

"(Patients) want to be in an attractive, upbeat, non-harried environment--as opposed to sitting in a doctor's waiting room with 30 other people," he said.

While Davidowitz agrees that Botox injections may not need to be done in a traditional medical setting, he fears that the draw of big profits could lead to the establishment of too many spas, a lowering of medical standards and an eventual shakeout. "We are for sure headed for some train wrecks," he said.

If that happens, it would hardly be the first time. Several years ago body scan centers popped up all over Southern California, only to close in succession when it proved to be a fad and safety concerns were raised.

Still, the profits that the spas can generate are a big attraction--even for traditional plastic surgeons, who are now starting to branch out of their own offices to practice in spa-like surroundings.

Dermatologist Dr. Marcia Glenn recently opened Odyssey MediSpa in Marina del Rey--a 5,000-square-foot facility where patients can get facials and have moles removed. She said she modeled her facility, which is not in a mail, after the Ritz Carlton and the Burke Williams spas, and she is not as unsettled by the trend of mall spas as some of her peers.

"As long as education and options are provided by licensed medical providers, I'm not sure it matters so much where it is. We have a very savvy public," she said.