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Doctor Fish
Have you wanted to enjoy baby-smooth soles, free of dry skin and rough cuticles? Did the thought of tiny fish tickling your feet and filling you with laughter make you want to take off your shoes and dive right in? The answer to this for many was an astounding yes as the first Dr. Fish pedicure spa opened in Virginia.
Quickly, over five thousand Happy Feet spa owners throughout the United States were looking to acquire the Garra Rufa fish and introduce this new exfoliation and skin healing treatment. The fish used by the spa are tiny toothless freshwater fish that have been used and studied for many years for the treatment of Psoriasis. The procedure involves allowing the fish to nibble off the dead skin initially, followed by the standard process of pedicure.
This no-longer unique pedicure service is quite famous in Turkey and is popular all over Asia. Spa owners argue that the procedure is quite safe and hygienic as the fish are completely harmless and do not cause any infections. Overseas, this treatment is not only popular for pedicures, but many therapeutically use it for their entire body.
The Garra Rufa Fish Pedicure started according to a story in the early 14th century in Turkey when two brothers found a hot spring in an open field that had small fish swimming in it. They jumped into the hot spring to take a closer look.
To their surprise, the fish didn’t swim away but gathered around their feet and began to nibble their toes gently. The two brothers went to the hot spring every day. Amazingly, one of the brothers’ who suffered from beriberi began to recover gradually. The news spread like wildfire. More and more people came to this hot spring, enjoying the unique feeling and curing some of their skin diseases.
Garra Rufa Obtisa is also known as Massage Fish, Doctor Fish, Nibble Fish, Kangal Fish. These Massage Fish kiss human skin tender. And are one type of fish used in these spa pedicures. In Turkey, these fish live and breed in the outdoor pools of some hot spring spas, where they feed on the skin of patients with Psoriasis or dry skin.
The fish only consume the affected and dead areas of the skin, leaving the healthy skin to grow, with the outdoor location of the treatment bringing beneficial effects. The spas are not meant as a permanent cure, but only as a temporary alleviation of symptoms. Patients with Psoriasis usually will revisit the spas every few months. Only a fortunate few report a complete cure
Experts who have studied the fish and the positive results in alleviating psoriasis symptoms have found that this kind of fish can help to remove the dead, dry skin on human bodies, aspirate bacteria in pores, release enzymatic secretions and dithranol into the skin. It allows the skin to repair and regenerate faster, improve the absorption of mineral substances, and finally reach the goal of curing some diseases.
With the recent concern of nail spa pedicure safety and sanitation, the introduction of the Garra Rufa Fish Pedicure, in the United States. It may be like swimming upstream against a strong current as many states begin to shut down the fish pedicure before the fish get even to see their first feet.
If you are a spa owner who is looking to add this service to your spa menu, or a consumer wanting to experience the joy of happy, smooth feet, Spavelous sheds some light on the current status of state regulations and safety concerns. Adding this to a spa menu may cost anywhere from $10,000 – $40,000. For consumers, the cost is anywhere from $25 – $50, depending on the length of the service. The lower end is for 15 minutes of fish exfoliation.
Dr. Fish Pedicure Experience
what’s all the fish fuss about
You may have read about the Dr. Fish pedicure last year on Spavelous, seen it featured on the internet, Good Morning America, The C.B.S. Early Show, Tyra Banks Show, or a local news channel. However, if you are one of the few who haven’t, here is a video that will give you an idea of this fishy spa experience.
The Client Spa Experience
The Dos
You will begin your pedicure by having your feet washed and sanitized before placing them into the tanks filled with fish. While Garra Rufa fish in other countries may be used in large pools, hot springs, or multi-people foot spas, Most spas in the United States are erring on the side of safety with a Fish Pedicure, a tank built for one.
The fish, as many spa-goers say “kiss the skin,” ridding it of all affected and dead skin areas, leaving the healthy skin untouched to continue to grow and repair. The process is both painless and strangely enjoyable, leaving behind a unique, pleasant tingling sensation. Many spa clients have been skittish or find it to be ticklish at first.
However, they soon get used to it. Once feet have been placed in the warm water, the Doctor fish begin to investigate. Once you have passed the point of feeling ticklish, the fish begin to act as a stimulating, yet relaxing massage with one hundred twenty-five of them running their little suction cup mouths along with your feet and toes. Rest assured, these inch-long fish have no teeth!
They seek out and remove dead skin, bacteria, and calluses while rejuvenating healthy skin. The initial feeling of trepidation dissipates quickly as the tingling sensations mimic a massage.
It is best to have your feet dangling in the water so the fish can clean the hard callus skin on the bottom of your feet and heels. Some spas use large stones at the bottom of the tank, so you may rest the arch of your foot on them. Either way, your skin is left smooth, glowing, and looking healthier.
Although also used for individuals who have Psoriasis, fish treatments are not a cure for the disease but a temporary treatment cure that can aid in preventing symptoms if repeated every month. Nonetheless, there have been some individuals who claim to have been completely cured of Psoriasis after undergoing fish treatments. The fish treatments are also recognized as treatments utilized to release fatigue, increase blood circulation, and aid in relaxation.
The Do Nots
So why not immerse yourself in a hot spring or fish pool, or enjoy afoot, or body fish treatment before a massage? Some states indicate that this may not be sanitary, as you do not know what the fish may carry or transfer from person to person. States where The Fish Pedicure is Illegal.
The Spa Association of Singapore has said that banning fish spa treatments is the way to go. The association, an umbrella body representing 75 spa or related business outlets, said that as far as it knew, none of its members offered fish-spa services.
An industry insider reckons that at least 20 shops in Singapore do the fish spa treatments, the more well-known names being Kenko Reflexology & Fish Spa and Qian Hu Fish Farm. Business operators said they were unaware of licensing requirements binding the business of using fish to nibble away dead skin.
In Singapore, they said, that they use filtration systems and ultraviolet light to kill bacteria in the water; they also said they check that their customers are clear of wounds. The Agri-Food and Veterinary Authority of Singapore confirmed that it did not have regulations on fish being used this way and that its priority was to ensure that the fish were unharmed.
So far, there have been reports that at least two complaints emerged this year against fish spas – the Consumers Association of Singapore received one, and The New Paper ran a report on two sisters who caught fungal infections from a fish spa. Some operators said they believed the complaints came about because of “black sheeps” in the industry who are in the business due to low entry requirements.
Setting Up Fish Pedicure
The Fish Spa Experience
Spas in the United States did not enter into adding the Fish Pedicure lightly, as it is a rather costly addition. John Ho, the owner of what is thought to be the first U.S.A. spa to introduce Dr. Fish into Arlington, Virginia declined to elaborate further about his care for the fish because he doesn’t want future fish-pedicure competitors to latch onto his methods.
He has had to learn much about the fish on his own because Garra Rufa isn’t easy to come by here. He purchased the fish from a store in China after failing to find anyone in the U.S. who sold them. Currently, John Ho is offering Doctor Fish Licensing Agreements for spas that want to use his process and the equipment needed.
State regulations in Virginia make no provision for regulating fish pedicures. But the county health department – which does regulate pools – required the salon to switch from a shallow, tiled communal pool that served as many as eight people to individual tanks in which the water is changed for each customer.
Ivette Cauceglia, owner of Glow Skincare, Fort Meyers, FL, indicated, “The Nibbles pedicure is completely safe and sanitary. After each Nibbles pedicure, the spa is drained, cleaned, and sterilized. It is then refilled with fresh, clean filtered water, which is also sterilized. Our ‘Nibbles Techs’ are then replaced where they eagerly await the next client.”
In Texas, Zen Luxury Nail & Beauty Bar spa owner Kate Caldwell’s “koi pedicure” as she dubbed her fish pedicure requires a water temperature between 85 and 90 degrees. Ms. Caldwell developed an elaborate system designed to keep both fish and clients healthy. She also worked with agents from the Texas Department of Licensing and Regulation (TDLR) to develop safety protocols.
After each pedicure, Ms. Caldwell explains, the free-standing basins are emptied and cleaned with an EPA-approved disinfectant. Fish, meanwhile, are transferred to a “hospital tank,” where they are treated with an antimicrobial agent approved by the Food and Drug Administration and isolated for at least a day. They then go to “a hotel tank to rest” for about 12 hours before returning to the service tank.
Tanks are cleaned the water is changed completely twice weekly and fish get a meal of “regular fish flakes” every three days. Despite these precautions, Texas decided to ban the fish pedicure in Texas.
The spas do need to care properly for the fish, by checking the pH of the water, to ensure that it’s between PH7-8. In addition, the water ideally needs to be between 80-92 degrees Fahrenheit. Too hot or too cold and you will start losing fish.
One website on the fish indicated that when the Garra Rufa is happy with the water or its surroundings, it will change to a darker color and it will always be swimming around and looking for food. A pale-looking Garra Rufa is either frightened or sick. The fish will seldom remain in one position, but will always be swimming around. This fish has a high metabolism that makes it hungry all the time. A Garra Rufa that hides or is inactive is a sick fish.
Fish Pedicure will be the real Garra Rufa swim-up
It is reported that there are three types of fish used:
- Garra Rufa is the “Real Doctor Fish”, they have no teeth and exfoliate the dead skin by performing a gentle sucking motion while releasing a beneficial enzyme that results in softer skin.
- Garra Rufa “hybrid” is also a toothless fish from the same family as the real Garra Rufa. They perform the same gentle exfoliation without the benefit of the enzyme.
- Chinese “Chin Chin”, often mislabeled as Garra Rufa or Doctor Fish is a completely different type of fish from the Tilapia family. Chin Chin has teeth and is much more aggressive in the exfoliation process. It is recommended that once they reach a size of 3 inches they should be replaced with new juveniles, as their bites can start to cause damage.
Importing tropical fish is not always easy, and it can be stressful for the fish. In addition, officials at the Washington-based U.S. Fish and Wildlife Service say they have concerns about the fish in part because the Garra Rufa doesn’t originate in this country. They say such fish are likely harmless if contained but if released into the water alive could pose a threat to plant and animal life.
“Whenever you have a non-native plant, insect, or fish brought into the country, there is always a potential threat,” said spokesman Joshua Winchell. “There is always a lot of uncertainty about what a non-native fish can do to our environment if it gets established.
Fish and Feet do not mix in these states:
Texas
Garra Rufa Fish Regulation:
The Texas Department of Licensing and Regulation (TDLR) issued a statement announcing that the fish pedicure would not be permitted in Texas under TDLR’s health and safety rules. A spokeswoman with the Texas Department of Licensing and Regulation said that because the foot baths and holding tanks are home to live fish, they can’t always be properly cleaned and disinfected. However, officials noted they know of no actual cases of fish pedicures causing health problems.
The following is from a statement by the ever-watchful Texas Department of Licensing and Regulation:
The issue is whether cosmetology and barber establishments may offer this procedure in Texas.
TDLR concludes that this procedure is not permitted in Texas under TDLR’s health and safety rules.
TDLR researched the health and safety aspects of the procedure, including seeking the opinion of officials at the Texas Department of State Health Services. Based on this research, we believe that the procedure poses an undue risk to public health and is not consistent with TDLR’s health and safety rules at 16 Texas Administrative Code, Sections 82.100 – 82.114 (barber) and 83.100 – 83.114 (cosmetology).
TDLR rules do not permit this procedure because the same fish are used on multiple customers and could transmit infectious diseases. Additionally, the use of live fish does not allow for the footbaths and the holding tank for the fish to be adequately cleaned and disinfected following the rules.
Washington
Garra Rufa Fish Regulation:
Washington state officials have also banned a procedure that uses tiny fish to nibble dead skin off the feet of customers getting pedicures. Peridot Nail Salon in Kent, Washington began offering the procedure several weeks ago, with customers paying $30 to have small, toothless carp tickle their toes for 15 minutes.
But the state Department of Licensing decided the procedure was unsanitary and potentially unsafe, and declared it illegal. An Agency spokeswoman Christine Anthony says state law requires that all implements in pedicures be sanitized, and there’s just no way to sanitize live fish.
The main concern of the health agency lies in the fact that since pedicures are procedures involving exfoliation of skin where tiny unnoticeable cuts or bruises or abrasions on the skin are bound to happen, the whole implements involved in the service need to be well sanitized; which is not possible in case of live fish. As a result, the chances of any kind of infection increase manifold.
While the Peridot was the only salon in the whole of Washington, that was offering this unique pedicure service, the procedure is quite famous in countries like Turkey and all of Asia. Salon owners argue that the procedure is quite safe and hygienic as the fish are completely harmless and do not cause any infections.
Mississippi
Garra Rufa Fish Regulation:
The Mississippi News Center indicated the following:
“FISH” PEDICURE – The use of fish in pedicures has recently been aired on “Good Morning America”. This “procedure” uses tiny carp to nibble away dead skin. The technique/procedure is prohibited in Mississippi where disinfection standards require that all instruments and supplies which have come in contact with a patron cannot be used on another patron until they have been properly cleaned and sanitized (Rule 808.I.)
Further, Rule 809. II. requires that all instruments, materials, and supplies used in direct contact with a patron, must be thoroughly cleaned with soap and water or other detergents, before disinfection. It is the opinion of the Board that the fish cannot be treated in such a manner.
Tennessee
Garra Rufa Fish Regulation:
Tennessee recently modified its sanitary rules by changing what defines animals allowed in an establishment:
Chapter 0440-02
Sanitary Rules
Amendments
Rule 0440-02-.10 Animals is amended by deleting the text “,(i.e. guide dogs)” so that, as amended, the rule shall read:
0440-02-.10. Animals.
(1) No animals, birds, or fish shall be permitted in any establishment except animals used to help disabled persons.
Authority: T.C.A. §§62-4-105(e) and 62-4-125(a)
Rulemaking Hearing Rule(s) Filing Form
Rulemaking Hearing Rules are rules filed after and as a result of a rulemaking hearing. T.C.A. Section 4-5-205
Agency/Board/Commission: Tennessee State Board of Cosmetology Division:
Contact Person: Terrance L. Bond
Address: Office of Legal Counsel
500 James Robertson Parkway
Davy Crockett Tower, 12thFloor
Nashville, Tennessee
Zip: 37243
Phone: (615) 741-3072
Email: terrence.bond@state.tn.us
Oklahoma
Garra Rufa Fish Regulation:
In Oklahoma, they are preparing for discussion and possible regulations on the “Fish Pedicure”. In their September minutes, Ms. Lewelling stated that she had emailed Board members a video to be better informed on this agenda item. She explained that the Board’s rules require specific sanitation and safety procedures to be performed after each pedicure service and was not sure this procedure would meet these requirements.
She said she also has some real concerns because the “doctor” fish often get large enough to suck hard enough to produce blood which creates more sanitation and safety concerns. Ms. Balzer stated that there is a lot to consider with this issue because fish in these numbers would require possible Wildlife Commission regulations, Health Department, City ordinances, and the Medical Board if the fish pedicure is done in a medical type spa or cosmetology salon.
Board discussion continued with audience participation. Chair Payne appointed a Fish Pedicure Research Committee that consists of the following persons: Kelon Carter, Chair, Michelle Huitt-Shook, Sherry Lewelling, and Jennifer McRee. The Committee will meet, research, and report back to the Board in November.
Arizona
Garra Rufa Fish Regulation:
It is a NO in Arizona. Court ruling upholds a judge’s rejection of a Gilbert salon owner’s lawsuit that challenged cosmetology regulators’ decision to stop her from offering pedicures using fish to nibble dead skin off people’s feet.
A representative from the Arizona State Board of Cosmetology has told Spavelous that “Arizona does not allow fish pedicures. Please see R4-10-112 F & G” These codes address Infection control and safety standards blood containment and disinfection of tubs and spas.
INTA Opposes “Fish Pedicure”
The recent flurry of media coverage of a “fish pedicure” being performed by a salon in Virginia reports on a service that, as described, is contrary to all standards and beliefs of the International Nail Technicians Association (INTA) and its Pedicure Equipment Cleaning & Disinfecting Procedures.
INTA strongly recommends that any nail professionals questioned by clients about this technique should caution consumers to inquire about proper cleaning and disinfecting of the fish tank for their safety. Disinfection of pedicure equipment is required between each pedicure client, among other procedures developed and adopted by INTA and the Nail Manufacturers Council.
Virginia
Questions about the procedure have been referred to the Virginia Board for Barbers and Cosmetology, which regulates businesses and individuals in the state who cut and style hair and perform shaves, manicures, pedicures, and nail applications. But William H. Ferguson, the board’s executive director, said that the board does not regulate the fish pedicure treatment because it is not addressed in its codes.
“It’s been drawn to us because they call it a pedicure,” said Ferguson, “but the Virginia code for barbers defines nail care as the manicuring of natural nails and the performing of artificial nail services.”
Florida
There are no regulations relating to fish pedicures in Florida at present, says Alexis Antonacci, spokeswoman for the Florida Department of Business and Professional Regulation. Spas offering the service are required to follow the health codes for pedicure stations, she says.
Ohio
There are no state regulations about fish pedicures in salons. Director of the State Board of Cosmetology Kevin Miller said the board might make rules about it.
This list was current at the time of publication. Please contact the State Board in your state to establish what their current policies are.
Kentucky
According to a state representative for the Kentucky Board of Hairdressers, “The topic (fish pedicures) did go before the Board of Hairdressers, and it was determined that we have no jurisdiction over fish pedicures, at this time.”
