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Tuesday
Mar242009

IPL Burns

The Independent newspaper in the UK has an article today in their Health & Wellbeing section from a reporter who was badly burned by an IPL treatment at a 'Top London Med Spa'.

The photos show the reporter with large uneven red welts on her chest and areas of redness on her face also. According to the story the correspondent was seduced by the promise of a `fast and effective way of removing the visible ravages of time without surgery’.

This is the second high profile newspaper report in recent times (see also News anchor gets burned by photo facial). I wish this were even less common than it is, but I've seen a number of IPL & laser burns before. These are often the result of rogue operations (Mesotherapy Lipodisolve Horror Stories) poorly trained staff AND physicians who intimidate their staff.

If your a plastic surgeon or dermatologist running a skin clinic, med spa, or laser clinic and your staffs first reaction is not to tell you somethings going wrong or they're not sure about an IPL or laser setting, you're just setting yourself up to have problems.

These types of IPL and laser burns are almost invaraibly the result of a physician who has medical estheticians or laser technicians who are afraid of confronting them with a problem or question. The doctor's defense? They were told what to do... but problems always arise and doctors who don't want to be hassled are the ones putting both their patitent and their laser clinic at risk. It's just a numbers game. If you treat 1000 patients at least some of them will have problems. Your staff should never be repremanded or belittled for ANY question.

The technician told me she would use a strong setting to get better results. As she passed the handpiece across my face the feeling grew hotter and hotter. By the time the device reached my neck, I could barely imagine continuing with the burning sensation. When she started on my chest the pain was intolerable and I had to ask her to stop repeatedly before continuing with what felt like torture. I'd thought of "no pain, no gain" and I soldiered on.

I got dressed, with a burning hot chest and a face that looked as if I'd been pulled out of a forest fire.

I was scheduled to return in two weeks for the next IPL treatment, in a course of six that costs £1,200. I went to a make-up shop and was dusted with a mineral powder, suggested by the spa, to camouflage the redness of my face.

A woman at the same counter asked me what the hell I'd had done. When I proudly informed her I'd had an IPL photo facial – she looked at me with total horror. "I don't mean to worry you, but I've had a course and it never looked like that." I largely shrugged off her words of warning. Why would I question the skill of a technician at the high end of the market? It's not as if I'd taken a chance and visited a high-street beauty parlour.

When I got home and looked in the mirror at my chest for the first time since the treatment - only an hour later – I was horrified. Angry red rectangular burns covered my chest in a random grid. Little did I know when I'd set off that morning that I would return after my first exciting treatment scorched and traumatised. What made no sense to me was that the treatment had not been done uniformly which was more obvious on my chest where I looked like I'd been branded with a hot iron.

The next day, on the advice of a friend, I called a top dermatologist – Dr Nick Lowe – known as the god of dermatology. He is also the man the rich and famous depend on when they need to be fixed, without resorting to the knife.

Dr Lowe saw me as a medical emergency the following morning. He works at the Cranley Clinic, off Harley Street, London, has a private practice in Santa Monica, California, and is clinical professor of dermatology at the UCLA School of Medicine, Los Angeles. He has his own skin care range and is the author of many books, including, most recently, The Wrinkle Revolution.

He was horrified by what he saw and concerned that no doctor was present at the IPL treatment – but it didn't surprise him. Along with other doctors, he is lobbying to get these types of treatments regulated in the UK. He believes treatments including Botox, line fillers, laser and light should only be conducted by doctors or administered under a doctor's supervision.

"The UK is one of the few countries in Europe that does not have sound legislation. It is much more regulated in France, Spain and Italy where only trained doctors can administer these treatments. The UK has failed totally to protect the public in this arena," says Dr Lowe.

Reader Comments (13)

Looking at this patient you wonder what the technician was thinking? Eh... and the burns clearly indicate that the tech was not performing a consistent treatment. I can see where any patient would have a problem with this result after coming in for a photofacial.

03.24 | Unregistered CommenterIPL Dr

Let’s not be so quick to leap to conclusions (Rush to Judgement) which may NOT be true and may leave the REAL problems unsolved.

I have an alternative theory based on my experiences with the US Laser Industry and the Cutera IPL.

“There for the grace of God go I”. That is how I feel when I see this type of picture. We have all been there and done that. Maybe not to that extent (and not with a reporter), but we have all over-treated from time to time and feel lucky that the patients recover without permanent problems.

Why would a cosmetic doctor (or someone on his/her staff) over-treat?

Rogue operations? Physicians who intimidate their staff?

No!

I blame the Laser Companies for selling inferior IPLs with a narrow therapeutic index, provide poor training, provide poor support and gouge their customers when they come up with upgrades to their systems that are better and safer.

Many IPLs have a very narrow therapeutic index. This means that when you treat too weakly you don’t get good results and when you treat a little stronger, you get burns, blisters and scars. This was my experience with Cutera’s Opus 560 IPL.

What is wrong with Cutera, the company and their IPL? A few things.

First, their IPL had a very narrow therapeutic index. Second, they did not train you very well (they did not suggest you wear magnifying loops to see the clinical endpoints and they did not clearly explain the clinical endpoints you should be looking for). Third, they created expectations that could not be met by their IPL (they showed great before and after pictures and suggested that this was the usual result you would get and it would be easy. Their Luminaries were not honest). Fourth, they offered the LimeLight Upgrade at a prohibitive cost (after spending $80,000 on their IPL, they wanted $35,000 more for their upgrade one year later) and finally their continuing education and facilitation of clinical exchange was terrible (it was non-existant). Continuing Education and Clinical Exchange are critical to safe and effective treatments. Talking to other provider and sharing information with them is very important (critical). Cutera didn’t want us to talk to each other because they were afraid we would find out that their IPL did not work very well. They suggested you were stupid if you questioned their "party line". They isolated you and made you feel like you were the only one having problems.

The problems with Cutera are not limited to Cutera. It is common in the whole Cosmetic Laser Industry.

I blame the Laser Companies for these burns. I don’t blame the operator or the doctor. I blame Laser Companies like Cutera who produce inferior products, over-sell those products, hire Lumenaries to mislead prospects and fail to support their customers with continuing education and clinical exchange. Then they have the audacity to charge you tens of thousands of dollars for upgrades which are better and safer!

My first question to this burned reporter would be, what type of IPL was being used and what company manufactured that IPL? Then I would ask ... what type of training and clinical support does that company provide!!!! Are other clinics using that laser and having similar problems? Are patients happy with their results when this IPL is used on them?

I think these questions would reveal a lot.

-- LetsNotRushToJudgement

Shocking. We are currently being sued becasue one of our patients got burned with laser hair removal. It's total BS but interesting to go through the process.

03.26 | Unregistered CommenterMax in SF

Max in SF,
What type of IPL do you use?

03.26 | Unregistered CommenterPI

Rush to Judgment,

My name is Barb Powers, RN, BSN. I worked in aesthetic practices for 8 years and have experience with multiple laser devices. I was a trainer for Cutera for 5 years and have worked at Cutera in the clinical department for the last 2 years.

First off, based on the aspect ratios of the burns, the adverse event displayed is NOT created with a Cutera laser.

I strongly believe safety with any medical device is important and consists of multiple elements - training, clinical support and engineering design. This training responsibility is shared equally between the manufacturer and the user. As a company, Cutera invests in a number of different training tools including on-site clinical training with every system, clinical training CDs (provided with the system and include videos and treatment examples), Clinical Forums and Users meetings, educational webinars and an archive to all past webinars on a customer VIP website, and clinical nursing staff to answer questions.

Cutera also invests heavily in clinical research. This is necessary to validate the parameters included in our treatment guidelines and taught during trainings. We ensure that we can provide clinical support for all parameters that are included in the trainings.

The Clinical Forums are unique events where we invite all our users to three day learning events. During these events, we provide equal time to presentations by user-physicians and to open discussion (with an open microphone). These allow attendees to ask questions to other users. We have invested in, and hosted these events for 5 years and hold them for customers around the world.

Finally, engineering quality and design are of paramount importance. Training and clinical research only matters if the system is designed to deliver consistent output. All Cutera systems include real-time monitoring and controls of both delivered energy and cooling. To my knowledge, no other IPL on the market monitors the energy as it is being delivered. Small, but critically important, features like these differentiate devices helping to reduce the probability of adverse events like those shown above.

Barb

03.27 | Unregistered CommenterBarb

That all sounds real nice, Barb, but Cutera sucks.
Theory vs Reality.
Cutera will be out of business within 3 years.
Marketing is all that keeps them alive.
Running out of suckers.
Their light devices stink.
Narrow therapeutic index.
Training sucks.
Terrible company.
I know.
Trust me!

Barb,

I have owned Cutera for over 5 years. the only time Cutera contacts me is when they want to sell me something. They have NEVER called me or e-mailed me or sent a letter defining new and better parameters.

their webinars are nothing but sales pitches and are only for sales purposes or early users of their technology.

Cutera charges to go to their Clinical Forums. You would think that would be included when you purchase a $200,000 laser.

Now I do not want to make it sound like Cutera is the only one that does this. I think almost all of the laser companies could care less about you once they have made the sale. I own lasers/systems from Cutera, Hoya ConBio, Reliant, Sciton, thermage and Lumenisand they all could do better. Some are better than others but none are perfect.

03.27 | Unregistered CommenterLH

LH,

All Cutera customers should receive multiple invitations to Clinical Forums (which are not sales events) both by both email and snail mail. Cutera is also holding regional trainings around the US for existing customers. You should have also received information about these.

Webinars serve two purposes; sales and education. Roughly one third of the attendees on our webinars are current Cutera owners attending to learn new information. This percentage has been maintained for over 5 years. To this point, the three webinars this year covered Pearl Fractional, Practice Marketing / Success and a new Titan treatment methodology. The next webinar is on vascular therapy.

Cutera does charge to attend to clinical forums, but collected fees typically cover less than half of the total cost of an event.

-Barb

03.31 | Unregistered CommenterBarb

"Cutera does charge to attend to clinical forums, but collected fees typically cover less than half of the total cost of an event." -- Wow! They don't charge BUT they do charge? They don't charge, but the do "collect fees"! Collecting fees IS NOT charging? Talk about double speak! Are we in the Solviet Union? Is this Animal Farm? (The Bull ...)

Barb, you are so full of crap Cutera charges $400 per person and they have hundreds of attendees!
They make money and they make lots of money on these Forums.
Barb, explain why they charge $15,000 per laser to provide support.
Explain why they don't sell parts so you can get you laser repaired by an independent agent.

Cutera stinks. They are all about the money. Their lasers do not work.
They have great marketing, but that is all they are good at.
They lie more than they tell the truth.
Their webinars are to sell lasers.
You have obviously been drinking their cool-aid.
You just repeat what their marketing people say (they don't charge but they do charge)

Give me a break!

http://www.medicalspamd.com/the-blog/2008/2/8/cutera-lasers-the-old-bull-the-young-bull.html

See Cutera Lasers: The young bull and the old bull. This blog thread will tell you all you need to know about Cutera.

Barb,

I attended one of your clinical sessions, then sent a couple of e-mails to one of the luminaries asking for clarification of something she had mentioned in her talk. She never even had the courtesy to respond, I was left hanging!
In addition, the hands-on training we received was from an aesthetician who talked about some "secret" settings that she had -- What the ....? That really made me feel uncomfortable, so I practiced on myself and am left with discolorations on my legs where I tried to treat my veins--Cutera is one company I would definitely avoid in the future!

04.1 | Unregistered CommenterFiona

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Hi all.
I recently had IPL on my chest and they did a wonderful job. Absolutely thrilled. So much so that i decided to do my arms.
They used the same setting as my chest and the pain was dreadful. She only finished the upper arms as the pain was too much.I now have really bad burns all over my upper arms. It is consistent though with no stripes. I have had 1 blister but that is all good now. The skin underneath is quite pale and pink. I have been to see the place that did this and I think they were rather shocked by the burns. they rang me later that night to say to come in as they want me to use some creams that will aid the healing. I am now worried that my upper arms will appear a lot whiter than the rest of my body.
What is the usual outcome re the skin from these types of burns. Does the skin colour blend with time. I would really appreciate any advise from anyone. Regards Jodi

09.22 | Unregistered CommenterJodi B

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