When it comes to spa treatments, the most important thing is that you feel comfortable and relaxed. You don't have to take off your underwear or bra during a massage, it's up to you and your comfort level. When you arrive, the receptionist will provide you with a robe so that you can cover yourself and remove all the clothes you feel comfortable with. For women, it's recommended to take off your bra as it can get in the way of a back massage.
You can keep the bottom underwear on, just take off your bra. However, you should always remove your shirt so that the beautician can access your face, neck and shoulders. You can leave your bra on if it makes you feel more comfortable, just make sure to lower the straps so that your beautician can give you a proper neck and shoulder massage. Many customers leave their pants on, but you can take them off if the robe is long enough and that makes you feel more comfortable.
If you're getting a full body massage, it's best to take off your socks as well so that the therapist can work on your soles. At the end of the day, it's important to remember that your esthetician won't judge you by what you're wearing, so wear what feels right. Whether you choose to keep your bra on or take it off during a spa treatment, make sure that you're comfortable and relaxed.