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Spa, MD: Client Safety First

By Elizabeth Roche, MD, with sidebar by Louis Silberman
Posted: March 26, 2008, from the April 2008 issue of Skin Inc. magazine.

Having practiced in the medical esthetic industry for more than five years, I have worked with numerous clients and treated each of them with customized plans. And while noninvasive treatment options, such as injectible fillers and cosmetic collagen enhancements, are still being used, laser treatments are quickly becoming one of the most popular services medical spas can offer. According to the American Society for Aesthetic Plastic Surgery, laser hair removal and laser skin resurfacing were two of the top five nonsurgical cosmetic procedures in 2006, and, of the top five nonsurgical procedures performed in the United States, 26% were laser procedures.
       This boom of new laser treatments that promote fast and effective skin rejuvenation, however, are increasing concerns about client safety in the medical esthetic business. With more people seeking these laser services and their more immediate results, medical spa practitioners must decide what technologies to use in an industry flooded with a variety of anti-aging options, as well as how to best implement incredibly important standards that ensure quality client care and safety.

Who’s using lasers?
       Depending on where a facility is located, physicians, physician assistants, nurses and licensed estheticians can use medical laser equipment and perform laser treatments. Unfortunately, in some states, such as New York, anyone can own and operate a laser. And before moving into laser-based treatments yourself, it’s a good idea to contact your state’s licensing board to learn more about who can use lasers in esthetic applications, as well as how they can use them.
       The International Medical Spa Association (IMSA) does recommend having a physician present, stating, “A medical spa is a facility that operates under the full-time, on-site supervision of a licensed health care professional. The facility operates within the scope of practice of its staff, and offers traditional, complementary, and alternative health practices and treatments in a spa-like setting.” That doesn’t necessarily mean only physicians can use lasers for esthetic purposes. However, professionals who perform laser treatments should receive proper training and education in the use of lasers, be licensed in their state, and retain sufficient malpractice insurance.
       Also, because physicians are responsible for any medical spa personnel who are operating the laser, it is extremely important they look into state requirements, review proper documentation for an employee’s training, and obtain legitimate certification before allowing anyone to treat clients. It sounds like a basic principle, but it is surprising to find how many physicians do not take the time to address this crucial step.

Knowing the law
       Licensing rules and government regulations differ from state to state, and it is the physician’s responsibility to track changes in rules and regulations, as well as to make sure all the medical spa’s staff members are aware of these, too.
  In the state of New Jersey, for example, the law states that a person must be a physician in order to perform laser hair removal—or even any other type of medical laser treatment. The Physician Assistant Advisory Committee of the New Jersey State Board of Medical Examiners determined that, “physician assistants may not perform laser treatments as these procedures are deemed the practice of medicine and may not be delegated to a nurse, or any other licensed healthcare professional other than a ‘physician.’ ”
       Be aware that each state creates different laws to ensure client safety, though, so it is important that practitioners be in accordance with their state laws and regulations at all times. As the number of medical spas has more than tripled to approximately 1,500 in the past four years according to IMSA, there are still growing concerns about client safety in regard to laser treatments, and while incidents are rare, practitioners should be cognizant of the fact that cases can occur if there is negligence.
       I am seeing an increase in the number of clients in my office telling me stories of how they were burned from a laser treatment they had in the past. Inquiring further, I find many of these clients were treated by someone who did not have the proper training, or that they were treated with inappropriate laser equipment, such as an intense pulsed light (IPL) system, which is able to be used on some skin types but can cause severe damage to clients with more pigmentation in their skin.

The first step to client safety
       One reference for laser safety is the American Society for Laser Medicine and Surgery (ASLMS). The ASLMS is one of the world’s largest organizations dedicated to promoting research, education and high standards in the field of medical laser applications, and it offers guidelines to meet standards on client safety, as well as formulating standards and guidelines for establishing safe, effective laser programs in hospitals and other institutions.
       Physicians working in medical spas should have “completed a basic training program devoted to the principles of lasers, their instrumentation and physiological effects and safety requirements,” according to the ASLMS. The society also explains that physicians should have hands-on sessions with lasers and recommend physicians continue their education under the supervision of an experienced operator even after completing basic training. The ASLMS also states that any physician who supervises other employees performing laser treatments must also be qualified to perform laser procedures themselves.
       In a busy medical spa setting, there may be times when clients come in to sign up for a laser treatment without consulting with an on-site physician. However, a consultation with a physician is necessary in determining whether the client is suited for the desired laser treatment. Each client should be evaluated by the physician, and the facility should keep records on file for other medical esthetic professionals to review prior to any service offering.
       All medical esthetic staff should also give clients instructions and warnings before the laser treatment, as well as inform them of the risks that may possibly arise afterward. There can never be a guarantee on laser treatments, as each client’s skin reacts differently to the procedure. Always be prepared to handle adverse effects, such as infections, pigment changes, pain, excess swelling, scarring and emergency situations.

Properly equipped
       As the ASLMS points out, “Laser treatment should not be compromised by lack of equipment required to perform the treatment.” Practitioners need to do research on what technologies and equipment best meet their needs before making an investment. Make sure the laser equipment you purchase is U.S. Food and Drug Administration (FDA)-approved and appropriate for the type of laser treatments you intend to perform, as well as for the clients you will be treating.

Laser guidance
       When combining laser treatments with other spa services, practitioners need to know the fundamentals of client safety before making a commitment to new technologies to meet ethical business standards. There will undoubtedly be further additions, amendments and changes in state and medical rules and regulations as these treatments become increasingly popular, and it is critical to keep a constant eye out for these changes—they can have a very direct and signifcant impact on your business.
As practitioners and medical esthetic support personnel, it is important to urge state and medical boards to work with medical spas and similar facilities in order to ensure client safety. Rules and regulations can help protect clients and institutions, and by collaborating, efforts can be optimized to improve client safety in this evolving industry.

Find more information about laser safety and regulations.