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Medspa Nightmare: Erbium Laser Resurfacing by Non-Physicians.

I had lunch today with a NP who had left a medspa chain a few months ago. (I won't identify him or the medspa chain since I didn't speak to him about posting this.)

moles2.jpgDuring our conversation we discussed why he had left the medspa he was with after only eight months. He reeled off a list of things that caused him to feel that he wasn't a good fit but there was one thing that took me by complete surprise. He told me that the 'estheticians were performing erbium laser resurfacing'.

I thought that I must have misunderstood, but no, this medspa chain has a erbium laser and the technicians are the ones performing the treatments. Not docs, not NP's not PA's... just estheticians on their own.

Errrr..... that's not good and I said so. In fact, as far as I know, it's illegal on any number of fronts.

I'm wondering what everyones reaction is to this?

Reader Comments (8)

While I do not agree with estheticians using this laser, they may very well be more trained on the procedure than a doc, NP, etc. Most everybody learns these techniques post-graduate and there is no reason why any human being wouldn't be able to handle this laser. However, I do believe it is illegal and should be avoided at all costs. It seems that a physician just has more to lose by burning somebody than Joe Technician someone found on craigslist.
03.29 | Unregistered CommenterL.A. D.O.
It all depends on the depth of the peel. We don't let our aestheticians do the peels but we will let our RN and PA. Our peels are usually between 4-20 microns which keeps them well within the epidermis basically a little deeper than the stratum layers. The laws probably vary from state to state.
03.30 | Unregistered CommenterDexter
We allow our estheticians to do several of our treatments (hair removal, skin tightening, IPL). We only allow one of them to do a fractional resurfacing. Our medical director is on-site and is actively involved and supervising.

I believe training is very important, but honestly most nurses, PA's and some MD's never got trained in these technologies in their programs. I definitely don't think most estheticians are knowledgeable or mature enough to do peels, but a few are. A few are much better with clients than many nurses and even some docs.
The one esthetician that we allow to do the fractional resurfacing is much more driven to learn and takes such better care for clients than most nurses I've come across.

I know a few plastics in our town are using medical assistants for many of their laser treatments also. Do people have the same reservations about medical assistants doing these treatments as estheticians?
03.30 | Unregistered CommenterR2
I am not sure about other states, but Minnesota law makes it clear that physicians can ONLY delegate laser operation to licensed MEDICAL personnel. I have not seen any state which ever recognized an "aesthetician" as a medical position. It has always surprised me that aestheticians have been operating lasers in so many clinics.
In florida only docs,pa's and ARNP's can operate lasers with one small exception electologist can use a laser but only for hair removal. Despite this I have a close "friend" who has personally met nurses, estheticians, medical assistants etc. who are doing these procedures illegally jeopardizing themselves ,their doctor and their patients.
How about Pure Med Spa ? They have managers that prescribe Botox and fillers,when the MD or nurse is not on site. They are not regulated health care professionals, however for some reason they will write down for you at a consult what you need, how many units of Botox and so on. This is really bad and I feel sorry for the poor patients.
04.24 | Unregistered CommenterJohn

I am a licensed Master Esthetician with extensive background and experience in laser and IPL aesthetic devices. Nothing about holding a medical license gives someone credentials to work with these devices - they are there own unique field of practice. Over the years I have worked with multiple estheticians, RNs, FNPs, MDs and DOs. Frankly, the industry is saturated with estheticians who are bimbos. HOWEVER, there are just as many incompetently practicing medical professionals who lack the prowess and education to perform these procedures safely and/or effectively. There are just as many patient injuries caused by negligence and operator error by medical professionals as estheticians -- I have witnessed this firsthand and/or been privy to several cases of injury and lawsuits within the marketplace.
I do believe in regulation concerning training and medical supervision of estheticians; and believe that physicians and estheticians may mutually benefit by collaborating job skills; but physicians and nurses are in no way more suited to practice these procedures based on their medical title.
Also, please consider the motivating factors of medical professionals who strive to control the marketplace - this issue is about money and exclusivity. It takes a free-thinking individual to read through the political b.s. in this debate.
I have TRAINED multiple medical professionals in theory and clinical applications of lasers and IPLs and am more advanced in skill and technique than many of the very doctors who aspire to revoke this from my scope of practice and licensure.

its illegal in most states to have non medical persons using any ablaitive laser, non ablaitive laser ( other than laser for hair removal) RF for skin tightening tattoo removal etc. Most of the time the physician who agreed to put their license on the line in ignorant of the laws and only finds out in the court room. I personally feel the laser reps should be held accountable for this because they know a lay person simply can not purchase a class IV laser only a physician they still say anyone can use it. Recently I saw a case where the rep said a doctor could use their receptionist if necessary. BTW that one went to court too bad it was non defensable and the plaintiff did not care to settle.

I find it amusing when the aestaticinas argue anyone can learn anyone can pull the trigger sure that is the easy part but the important part is the aftercare or handeling an emergency.

Do I think all MD's are inately prepared for laser . I believe it requires special training as an addition to their medical training which is extensive and not a few hundred hours.

Finally regarding controlling the marketplace when the one controlling the marketplace is the only one legally able to make the laser purchase then they can indeed control till their hearts content.

04.13 | Unregistered Commentergm

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