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Friday
Jun012012

Proposed Change In PA State Cosmetic Laser Regulations Would Force Laser Clinics To Close

New regulations proposed in PA and would require physicians to be on-site during all cosmetic laser and IPL treatments.

Notice to all physicians, nurses, nurse practitioners, physician assistants, estheticians and laser technicians in PA: I'm asking your help to oppose a new regulations in Pennsylvania requiring changes to who can perform cosmetic laser and IPL treatments.

This law is attempting to be passed through regulatory agencies and implies that estheticians are negligent with the use of lasers and cause harm to patients.  Many of the physicians I spoke with stated they have treated many patients harmed at the hands of other physicians.

The new regulation will stipulate that only physicians, nurses, nurse practitioners and physician assistants will be permitted to operate an aesthetic laser and if the operator is not a physician, the physician must be on-site during the use of the laser and must perform an assessment on the patient prior to treatment.

This would effectively eliminate the use of estheticans and laser techs from performing any laser-based treatment and could force many clinics to drastically change their business models, or close altogether.

Negative effects of this change in regulation will include:

  • Raising prices far above what they currently are by forcing even treatments such as laser hair removal to be performed by a physician or PA, RN, NP with a physician on-site and evaluating every patient.
  • Eliminating many options for consumers: Who is the MD who wants to push the trigger on every IPL pulse?
  • Driving patients outside of the state to get these treatments at a reasonable price.
  • Forcing many medical spas, clinics and phsicians offices to retire the use of such laser technicians, thus driving the unemployment rate up in Pennsylvania (primarily women)
  • Reducing the sale of lasers in the state of PA
  • Potentially causing the formation of "underground" laser clinics in the state making procedures potentially even more harmful (need I remind you of the bath tub caulk being injected into the butts of women in a hotel outside of the Philadelphia International Airport?)
  • Cosing of businesses (such as my laser clinic I own with my physician-husband because he can't be on-site during all hours of operation), thus closing another female-owned business in the state of PA

These are just a few of the negative consequences that would evolve if this law were to be passed. We are requesting your action in opposing this proposed regulation and are requesting the following documentation from each of you to make our case:

Estheticians and Laser Technicians

  • a credentialing statement (education, certifications, years of experience, types of lasers used, etc.)
  • a letter from your physician/medical director (addressed to the licensure committee)
  • education documentation
  • 10 patient testimonials (addressed to the licensure committee)
  • a letter to your local Senators, Representatives and our Governor for support and inviting them to come observe you perform a procedure
  • treatment logs on skin types 1-4 along with the initial condition before and the results after treatment. (To ensure confidentiality, when you submit the patient treatment records please de-identify them by completely blacking out the patient name and give a brief explanation of the treatment/procedure and what laser was used and the outcome.)

Physicians

If you value your laser technician in your practice and do not want to lose them and their talents/revenue generated for your practice, please write a letter addressed to the licensure committee on their behalf and copy to your local Senator and Governor.

Send this information directly to our lobby group –

Malady & Wooten LLP
Att: John Malady
604 North Third Street
Harrisburg, PA 17101

There is a significant amount of additional information forthcoming but this is our immediate priority.

Once you have mailed your information please, send us a message using our Facebook page (message button) so we can keep track of our cumulative response to stay abreast of the volume. We are working to form a committee to communicate information so we are all synchronized and linked with each other. Thank you in advance for your efforts and support of all our business' future.

www.facebook.com/PaLaserLawCoalition

Reader Comments (39)

Its about time. If you want to perform laser treatments on human tissue then get a medical education. This law should not be in PA but the entire country.
If those doctors who so redily "donate" their license to the non qualified really desire to practice laser medicine by all means do so, drop the high dollar medicine and start performing laser medicine.
I love when the argument is "doctors cause burns too"
As a malpractice reviewer its a constant un relenting sceniaro.....person works at a low level job in a chain store week one, week 2 they go to a laser classfor a few hours or maybe they take the big 2 day course, week 3 they find some friend to split a used laser and get some GP to sign on the line week 4 burns to the face and neck. Why no understanding of physiology, medicine, drug interactions, tissue tollerance and the list goes on.
Thats why this legislation is so important.

06.2 | Unregistered Commentergm

In reality PA is being kind. In NJ the only person who can fire a laser at human tissue holds an MD or DO degree.

06.3 | Unregistered Commentergm

Thanks for your input "gm", and yes doctors do burn patients too. So do nurses, nurse practitioners and physician assistants. Just because someone has a medical degree doesn't make them more experienced at performing laser treatments. If you are a college graduate I'm sure you are aware that even when everyone in the class graduates with the same degree, some are at the top of their class, and some are at the bottom. Plus, many physicians who have a lasers in their offices are very skilled with laser technologies, but they hardly perform them all day long. Most of the time they are moving from room to room from injectables, to lipo, to the O.R., etc. They are very busy practitioners. It is these cases where the laser technicians are very useful to the physician and their practice.

Many laser technicians undergo training on equipment from laser manufacturers, plus attend certification programs to learn about laser safety, various modalities of laser technologies and how they are used both safely and efficaciously, they learn about the differences in ethnicities and medical conditions that would be a contraindication to laser treatments. And, in many, many practices I know of, there is a physician on site and these technicians are required to work under their direction and tutelage with strict criteria on skin typing, physical assessment, itemized and detailed charting of laser settings, patient outcomes, patient followups, discussions of contraindications, pre and post procedural instructions, etc. I know many physicians who sign off on every single chart to verify that the settings and parameters used were correct. Even if they are not on site, I know many clinics that Skype or FaceTime the physician throughout the day, share electronic medical records so that the physician in charge is aware of every single treatment and the patient's complete treatment history. Some of us have laser technicians who have been safely operating lasers for 10-20 years and know more about these technologies than most would think because it is all they do all day long.

And, New Jersey, yes you are correct. A physician does have to perform laser treatments in that state. This is driving patients away from them to other states because the cost of the procedures had to be increased to compensate a physician for their time. Plus, many "underground" clinics have popped up and there is no supervision whatsoever in those mysterious places.

But you are a malpractice reviewer so you see things a bit differently. I'm sure in your position you're always looking for the worst in people because that is what you see all day and that makes you jaded.

Perhaps, if you are a man, you shouldn't go to a hair stylist because they are not a barber. Or, you shouldn't go to a chiropractor to adjust your spine because they are not an orthopedic surgeon. And then I wouldn't go to a gym if I were you because the fitness trainer there doesn't have a degree in kinesiology or sports medicine.

I don't mean to be flippant or disrespectful, I'm just trying to stand up for extremely talented and dedicated professionals who have been doing this for most of their lives, train physicians and nurses and PAs in the use of lasers, speak on behalf of laser companies, author books, participate on review boards, committees and national and international societies.

Thank you.

Paula
Thank you for the well thought out reply. I am a physician of almost 30 years and have never seen such a rampant misuse of medical therapy until the invention of the medi-spa around 12 years ago. The initial idea was interesting offering lower level medical cosmetic therapy in a spa setting. It was novel and a great idea. It started with great intentions but has grown into an epidemic of gross negelgence and persons with no qualifications what so ever performing medical procedures.
In a hospital setting inorder to have priviledges to use an ablative laser you would have to either be a dermaologist or cosmetic surgeon, ent,optho yet in the spa a person with a weekend course, no medical education or understanding of medical physiology can use one in some back room in a strip mall and it goes unchecked until someone is burned. The FDA approved what procedures a laser can perform and it is stipulated that these lasers are medical devices yet there dosent seem to be any medical brain operating it as long as on paper some physician endorsed that these non medical persons can use the laser.
Of course there are improperly trained MD's with lasers in their office and believe me when they get a complication they pay dearly for it. The problem lies with accountability and competence. In my years of reviewing malpractice cases thisng have arisen in the spa industry that would amaze you. Laymen posing as doctors, websites infering that the spa is a dermalological practice yet no one in the facility is a doctor, directors 75 miles away, technicians using ablative lasers, laymen injecting lidocaine and killing someone from a toxic vascular bolus!
Sure the doctor sets up the parameters if its a medical procedure it must be performend by a MEDICAL professional. Hey my grandmother coul make any type of dress in a weekend, I could have saved a bundle and had her close cases for me why not, isnt it the same thing. No thats crazy, why? Why is it crazy to have a layman perform a surgical closure yet to laser flesh thats just dandy.
The industry has gotten out of hand and it needs to be harnessed. Its a daily deluge of malpractice without accountability. Patients get injured by people doing improper procedures without the knowledge to handle or prevent complications and when it come to accountability guess what no malpractice ins, no home, no assets so often the injured party gets nill. Its unfortunate that some great practitioners will be financially hurt but if a procedure is medical then it must be a medical professional at the helm.

06.3 | Unregistered Commentergm

I agree with both sides of this argument... It is a difficult situation whereby you both are correct. Rather than having medical professionals ousted out of an industry that is rife with competition and opportunities, consider how the state of Texas is going forward. In the state of Texas, you must have a specific number of educational hours specific to laser safety and laser use, followed by having a preceptor watch and evaluate your work and technique before you can become "certified" to operate IPL and Laser devices in that state. In addition, there are yearly educational requirements that must be met. Just like any professional licensure, education is the key here. RNs, Physicians, PAs, Nurse Practitioners....we all have to continue our education on an annual basis to qualifiy to maintain our license. If one chooses to make a life in the IPL and Laser industry...why should that be any different. Operator licensure based on education, number of treatments per year, types and wavelengths of medical grade IPL and Laser products should be regulated. There are places where one can receive a certification as a CMSLO or other distinction based on hospital or aethetic practice bases, why not promote those types of certifications as basic entry into medical spa practice? Have a condition for licensing the facility be that all IPL or Laser operators must be certified. Make unannounced site visits mandatory to maintain facility licensure. Increase costs of facility licensure to facilitate having a state or local body maintain a strict policy of annual or more frequent site visits.

I am totally in favor of regulating this industry. I agree that the industry has grown far faster than regulatory interventions can handle the load...however, we must have ways that allow Licensed Medical Professionals to be a larger part of this industry.

I am not one who believes that IPL and Laser treatments can be "done by a monkey" if trained, but I do believe that limiting the scope of practice to physicians is not the answer either.

Dr. gm,

Undeniably, you make valid points that no one can argue with. Unfortunately, the public hears more about the negative results than they do the positive. Regarding malpractice lawsuits, I'm sure you also cannot deny that quite a few of them are exaggerated with the practitioner doing no harm, but it would be less expensive to settle it than fight it. I think the majority of physicians I have had this same discussion with stated that they had succumbed to a bogus lawsuit. In newspapers, magazines, TV commercials and even billboards you see attorneys soliciting "victims" of medical malpractice. It's a thriving industry. With the compliance rate of attorneys decreasing from 76.3% in 2008 to only 18.5% in 2011, there is an increase in reported lawsuits with the average attorney fee divided by the indemnity payment at 34%. Average fee paid to the attorney being $171,647 in 2011 (http://www.insurance.wa.gov/legislative/reports/2012-med-mal-report-attorneys.pdf).

Regardless of how long you and I can discuss this, and I have enjoyed this discussion as it has been respectful and professional, we do not have the final decision. What is disturbing to me is that reputable and closely monitored clinics are going to suffer the same demise. Primarily minority owned businesses such as mine. I own a laser tattoo removal clinic with my husband who is a physician and also my medical director. We opened this clinic because we have no room in our 2 medical spas (each with a physician on-site all day). Because he cannot be in my clinic when I operate a laser, it is going to force me to close. I will have to lay off 3 people as well. True, I may not be an M.D. or a D.O., but I am a medical professional with many years of experience, have written textbooks on this topic available here on MedicalSpaMD, and am quite active in the aesthetic industry with a position on the Board of Directors for the Medical Spa Society. Our protocols are meticulous, our paperwork and documentation intense, every treatment on every patient reviewed and signed or critiqued by the doctor, any questions or concerns are discussed with the doctor first with either Skype/FaceTime with the doctor and patient, or instant photographs of the tattoo in question to him for prior approval before treating.

Again, we can discuss our experiences and our accolades and debate this topic endlessly. I just have a hard time knowing I may be censored for the action of others. Thank you for your comments and insights, doctor, it's always beneficial to hear the opinions of others and appreciate the freedom we have to voice our opinions.

Respectfully yours, Paula

Paula, this proposed "physician on-site and immediately available" rule is preposterous and downright silly. The American Society of Dermatoligic Surgeons has been promoting this ruse for over 10 years trying to eliminate competition via legislative fiat. Since the doctors are ill-equipped to compete on a level playing field, they use their lies and baloney to try to convince a gullible public that non-physicians performing laser hair removal are "burning" clients.

That is an old ruse. To that I demand, show me the evidence because it's an out-and-out lie. I own a laser clinic in Texas and have performed laser hair removal since 2001. I cannot tell you the number of people who have come here after having ineffective and expensive treatments in doctors offices. Doctors do not hire trained lasertrologists. They get that young twit who answers the phone who is untrained to perform the procedures. I cannot even picture a doctor or RN wasting their professional time performing laser hair removal. In eleven years of practice, we have never burned or harmed a client. It would take a raging idiot to burn someone with a laser designed for hair removal using manufacturer's printed parameters and correct skin type usage.

It makes me want to puke to see this old "Red Herring" argument posed again. But, in Pennsylvania anything can happen. If the lawmakers in Pennsylvania are stupid enough to pass such a law the citizens are getting what they deserve. When you elect irrational liberals you get irrational regulations. They go hand in hand. Shutting down laser hair removal clinics in a down economy is as stupid as it gets. Paula, you need to know the truth. These doctors don't care a whit about the clients. It's all about their on-going turf battle and money. Follow the green, follow the greed. It never benefits the citizens. In a competitive, capatilist marketplace, a medical degree has become a license to steal. Why are they still squabbling over laser hair removal up there???????? Doctors aren't making enough money. Next they will want to have a doctor in every nail salon or supervising every haircut for goodness sakes.

I am leaving this post because reading this article is sickening.

I am one of the very people responsible for Texas' new regulation allowing trained and certified laser specialists to practice without a doctor on site. In the 12 years prior to the law the only records of injuries to the Radiation control Board were 100% from doctors offices,not professional laser centers. We never had a doctor on site. The doctor got paid a fee for every new client just to sign his/her name to a piece of paper. Honesty, dontcha think this is immoral? The customer and the taxpayers are the ones that are getting screwed by these phoneyl, unnecessary regulations.

I'm a non physician owner of a Medical Spa since 2005. This debate is simply about greed not patient safety. Now let me see if understand this. It's now ok for anyone to purchase an Diode Laser, IPL or even a Fractional Laser for home use (Triia Silk'n & Palomar Palovia) but someone that has gone through a 6 month education on lasers plus a state certification needs to have a doctor on site. Guess what, we have treated dozens of patients from doctors who have botched Botox or filler injections or from patients who have a poor outcome for laser treatments. Those don't get publicized. In South Florida last year 7 patients died from lipo procedures and still today, any MD or DO can offer these services or even perform a breast augmentation without any surgical training whatsoever.

The train has left the station folks. There are now 5 other home laser devices awaiting FDA approval for active acne, acne scars, body contouring and even cellulite. Protectionism is not a valid argument. Safety??? We've performed over 20,000 without a single incident (outside of normal predictable complications). That's not to say something can't happen tomorrow with us or the board certified PS or Derm down the street. I'll put my safety record against any center in the country physician owned or other. Are their centers owned by docs and non docs that give us all a black eye and cause most of the complications. Yes and they will be shut down eventually by the free market system. They don't need to be regulated out of business as the buying public will decide.

Safety is critically important and probably more so to me. As a non physician we cannot afford mistakes or out of the ordinary complications as it can and will be held against us.

06.6 | Unregistered CommenterBrian

You tell 'em Brian. I agree 100% with you. The horse is out of the stable and the train has left the station.

Professionally trained laser technicians can run circles around MD's and RN's trying to do what we do all the time on their "parttime" basis. Laser Hair Removal is a"profit center" for these doctors and they do NOT care about results. They want to put us out of business and have lied through the media and in writing for years. I even discovered photos of a person who was burned with an IPL but the purveyor was a plastic surgeon, not a profesional laser operator. The argument stinks to high heaven and Brian is correct. I will put my reputation and life on the line against these professional liars and greedy medical associations in a minute. Enough of the phoney baloney already.

If you practice in the State of Pennsylvania, I urge you to pass the word along to others who may be effected, write to your local and State Senators and Representatives, to the Governor and to the PA Medical Board. We also need to generate funds to pay for our lobbyist. I have updates on this situation and am posting to our Facebook page. I encourage all to join and participate and be up to date with the latest news.

PaLaserLawCoalition

That's just right guys. Four years of pre medical education, four years of medical school , five years of residency, board certification and 30 years experience cant hold a candle to the 30 hour intensive course.
lease bring those facts to the board.

06.7 | Unregistered Commentergm

There is not a physician on earth that could stand to spend the time and effort to get an MD or DO who would want to waste it on pushing the button on an IPL or doing laser hair removal of an endless row of axilla. All of us know that if you're borded in plastic surgery or you're a derm you can charge more for the Botox you inject. Does being a borded derm give the patient a better result? Nope. Do they do a better job. Probably not. It's all repetition and experience and I don't want to be forced to sit and push a button all day. I bring more value to the equation than that. A 30 hour course and direct physician oversight seems about right for that to me.

IMHO: Physicians should be required to be on site and inspect the treatment area but they should not be required to actually fire every pulse on non-ablative light technologies.

06.7 | Unregistered CommenterDermgal

This is a controversy over the states.
Currently in Washington state estheticians are able to use prescriptive devices while being licensed under the State of Washington and not licensed through the Department of Health.
This licensing allows the estheticians to use prescriptive devices while having NO medical education.
While many estheticians have been providing therapy prior to regulations, they have been using prescriptive devices and this is OUT OF THEIR SCOPE OF PRACTICE
As providers able to assess, diagnose and treat it is appropriate for MD, ARNP and PA's be present in the clinic while nurses perform the treatments following assessment and orders for treatment.
In many cases, estheticians believe they are able to diagnose and treat medical conditions that need medical attention
What estheticians do not learn in their 6 month esthetician courses is the limitations when it comes to their medical knowledge and the treatments they are performing
Knowing about the prescriptive device does not mean knowing about skin, diagnosing, assessing and treating.

06.7 | Unregistered CommenterTamala

GM: I have read all of your posts. Frankly, I do not believe a word you have written. First you claim to be a 30 year physician then you are a malpractice reviewer.(which is it?????) Here is what you are: stubbornly opposed to capitalism. You use scare tactics just like Obama. We are professional laser hair removal experts and we sure as heck do understand cellular biology and the stucture of the skin and hair. Further, I most certainly do understand laser physics and do not make outrageous claims about my competition as you do.

You give doctors a bad name. Sad to say that while we are laser professionals we are also possible future patients as well as great sources for referrals to physicians. If you were my doctor I would kick you in the shin on the way out of your office which, frankly, I do not believe you even have. If dermatologists would stick to the practice of medicine they would keep their greedy fingers off of cosmetic laser procedures. For generations derms never wanted to have anything to do with hair removal since it was being practiced by electrologists. Those docs could not waste their precious time using a needle (probe) to deliver a shock to each and every hair follicle to help miserable, unhappy people remove their unwanted hair. Then with the advent of hair removal lasers, electrologists and other people in the cosmetic industry naturally followed the shifting paradigm to upgrade from needle electrolysis to lasers for hair removal.

Aha, then,comes along the dermatologists and plastic surgeons saying: Lasers can be MY DOMAIN now. This crying and bellyaching came about AFTER professional electrologists CREATED the market in the first place. Now you moan and groan and complain about non-existent injuries. You pass around trophy photos of the same old cases of laser burns from one state to the other trying to put great technologists out of business, out of work because you want the money it creates for yourself and because you cannot compete on a level playing field.

Well, good buddy, I am the person who actually wrote the law in Texas. Yep. Right here in my little old office. I am the person who created the educational/training ladder which requires the 40 hours of training, then the preceptorship (my name, my words) and direct supervision right on up to the national board certification which is available through two organizations.

Unfortunately for Texans, doctors are not required to be trained to operate cosmetic lasers in our state which is a disgusting political oversight. So, unwitting clients in Texas who go to doctors are in for a sad surprise because that medicine man and his little elves are not required to be trained as long as a doctor is on site and immediately available. Since when does your sheepskin embue munchkins in your clinic (if you have one) with the training to safely and effectively operate a hair removal laser? I don't care how many hours you spent in medical school, you were NOT trained in laser hair removal. NOT in any medical school of which I am aware. Doctors are being trained to remove hair in which med. school. DUH???

For eleven years I have lurked online using every known search string and going from state to state to associaton to the ends of the earth comparing claims of injuries caused by lasers in the act of hair removal. To be sure, commonplace minor hyperpigmentation and an occasional slight burn are less than one tenth of one percent of all treatments performed. Serious injuries can be counted on two hands. Two deaths caused by the use of drugs and prescription topical in 15 years is just about all you have to complain about and one of those deaths was caused by a doctor who committed suicide. The other was a college student who applied 10% lidocaine cream to over 60% of her own body at home and,while driving to her treatment center in the winter with the heater on, she slipped into a lidocaine induced coma and later died. Unfortunate? Yes. Ignorant? Yes. No one should ever apply a 10% lidocaine topical let alone never to cover over 10% of the skin surface and never outside the clinic setting. But, GM, good laser clinics know better than to use strong topicals and NEVER apply it outside the clinic where a patient can be carefully observed.

The idea that a doctor must be onsite and immediately available is rubbish. When was the last time you treated an emergency blister?

When Barack Obama shoved Obamacare down our throats he did it with a series of lies (patient goes in for tonsilectomy and gets his foot amputated). In the same way, you are stooping to throwing out the same old red herrings the ASDS has done for the past decade. If people like you get their way, there would be no licences available other than MD. Well, whoop-di-doo old buddy. You are lightyears behind in your idealogy. I do not like baloney mongers and that is what I think of what you have written.

Last but not least, why not use your name? GM stands for what? Greedy man? Green money? General misfit?

Lord have mercy on the public when people like you start with this old ruse again.

I'm sorry, but I believe that aestheticians and non-medical people have to much freedom in operating not only lasers, but in some states injecting Botox and fillers!!! I don't know about a physician being on site, as I think nurses have been running the show, responsibily for a long time without the physician on site. However, the nurse whould be allowed to assess patient and contact doctor regarding same and perform treatments as the physician gives a phone order~this is standard with any medical facility. I was part of a 'laser training'/hiring session the other day and I was the only credentialled medical person there. The rest were aestheticians, emts and lay-people. A dentist was running a tattoo removal office and allowing inexperienced staff to run the laser. Yes they were 'certified' but even the certification process was a joke. No didactic training and shabby on-hands. I think this kind of operation is an embarrassment to the medical community and there are so many shady places like this popping up that it warrants legislation. Sorry to disappoint aestheticians and laser techs, but I DO believe that only credentialled medical people should be handling these procedures and NO it will not drive up the price~there are plenty of medical people who are trained in lasers and injectables who are being overlooked because docs can get an aesthetician for 10/hr rather than pay a fair wage to a nurse. Anytime there is an abuse of power, the government has to step in, so I say shame on the doctors who are allowing non-medical people to operate lasers/injectables just so you can line your pockets while putting patients at risk~tsk/tsk...

06.8 | Unregistered CommenterSandra

Sandra, I bet you are a nurse. And you want the world to run around the universe as you see it. NOT

Theres is NO reason to pay the big bucks to a nurse to perform laser hair removal (sorry Sandra) because the marketplace is just too competitive. The money is simply NOT there in a legitimate practice.

No, the government does not need to step in. Geez I hate when idjits start screaming for more regulation. Why not let the marketplace decide? If laser technicians are inept they will quickly go out of business. Let's stop playing Nanny to the world. Ralpha Nader has caused more grief and cost business more money than any amount of safety and health benefits his idealogy has ever benefitted from.

We must live in a world where a total free market exists. I think anyone who wants to practice medicine and has a willing patient should be able to do so. I am 68 years old and the recipient of physical damage at the hands of an a**hole surgeon who could have been replaced by a skilled meat market butcher.

Whenever I have been in the hospital the nurses practically make you kiss their behinds to get them to come to your room even if you cannot breathe and your airway is closing! Yep. That happened to me. Alas, in the middle of the night while I lay dying, I awoke from my hospital nightmare (closed airway) only to see my bed surrounded by nurses looking like deers in the headlights. They were frozen and did not know what to do. I had to use sign language to convince them that the sounds gurgling from my mouth were stridor and that I was dying unless they stopped staring at me like little lost kittens and performed emergency, life-saving treatment.

A well-trained aesthetician or RN can perform injectables quite well. At my business WE DO NOT because I am philosophically opposed to injecting botox and/or synthetic collagen into the human body. We practice "first do no harm" which means we don't perform procedures that fail my strict standards for efficacy, safety and longterm potential for genetic damage that may occur later.
I own a laser hair removal clinic. We do that very.

So, doctors and nurses: keep your hands off of our hair removal lasers and we'll let you keep you scalpels, surgery, drugs and so forth.

Pennsylvania should use the Texas law or even better, look at the regs in Arizona which, in my opinion, are the best in the nation.

I most toodle-doo. My client for the morning is a pulmonologist. (All of the physicians and their families in my hometown) come to my clinic for hair removal. Wonder why?

I review adverse events globally for a large laser company. The majority of injuries caused by laser and IPL are transient, although disfiguring scars can and do happen. I will say that both doctors and unlicensed individuals have incidents. The worst scarring I have seen was done by physicians.

I believe the answer is regulated education and licensing. Most physicians would be bored to death doing laser hair removal and IPL treatments. It is a tremendous waste of their time. Once they regulate these procedures to high level providers, the industry will see a decrease in availability of laser treatments and the winners will be the home devices which are not as effective.

With the proper education and the oversight of an involved physician, these treatments can be and are done safely thousands upon thousands of times daily. The proprietary attitude of physicians over these treatments reminds me of historical attitudes such as the days when only physicians were allowed to use a stethescope!

Come on people--let's understand that doctors are taught by nurses to do these procedures in most cases! Many nurses (and yes, medical estheticians) have more hands on experience and knowledge of these lasers than many so called experts. Lets get together and design excellent training venues. This will allow the proper and safe use of lasers for those that specialize in laser treatment and would have doctors using their time plying their medical knowledge treating disease as they should be. Did they go to school all those years to press a trigger on a laser? What a waste.

Someone sent me this link today and I have found it interesting. There are many things in previous posts I agree with and some issues I do not agree with. One thing I know for sure is that this is NOT a liberal thing as someone stated (Marti). After all most physicians are conservatives and the laws passed in other states have been by Republican legislators, true. I believe GM is a Dermatologist because of the many things he is saying. It has been the agenda of the Dermatology Associations to shut down as many competitors as possible through legislation. Yes, follow the money. They actually have a step by step protocol to teach dermatologists how to get legislation proposed in their states. I know this because I have been very active nationally on this issue. I have spoken in CA 3 times at medical board and nursing board task force meetings on the use of laser. We have sent representatives to Wisconsin, Georgia, Colorado, Nevada, Massachusetts to fight the fight. Now let me say it, I am a Registered Nurse in this aesthetic industry over 18 years. I have seen it all. I do believe there are things going on out there that are not right....there are business people out there looking only at the bottom line. They are in it for the money only, without concern for patient safety....or who they are hiring to do the treatments. These people make the legitmate trained individuals jobs harder, for when something bad happens everyone is lumped into the same pot. They are not good for our businesses. We should all care about this and who they are. There have to be guidelines, or it would be even worse than it is. Trust me, being in the business for so long, I have seen it all. I have to admit I was concerned about non medical people doing cosmetic laser treatments in the beginning. As a nurse and trainer in this industry for so long, I have watched it evolve I have come to understand that it does not matter what you have behind your name what matters is the training you have. I believe that the well trained person be they an aesthetician, laser tech, nurse, physician, np, pa whoever, should be allowed to perform laser hair removal treatments. Again, I don't care what initials you have behind your name, everyone (including physicians) wanting to operate a cosmetic laser NEEDS good training (and that does not mean only by the company that sold you the laser), period! I have followed this for so long and am sorry to say but there are people out there with little to no training; this includes all specialties. And yes, there are physicians using the front desk girl who was shown by the physician how to operate the laser in one hour; this is criminal. I think it is important that those operating lasers become involved in the process and push for requiring training in all states (which is not the case yet). Having studied this for years I have come to the conclusion that "GOOD TRAINING" can occur in a couple of days, unlike Dr. GM putting this amount of training down. He obviously knows nothing about lasers. Most all dermatologic lasers today are actually designed by their manufacturers for the "non-physician". We must all work together to promote safety and for this reason we must have guidelines and criteria for use of these devices.

06.8 | Unregistered Commenterssp

Congratulatons Lasernurse. You get it. We were originally trained by an RN and received full training at a laser school in Colorado. I have beena laser hair removal trainer for years and have written my own training manual.

GM (if he/she is a doctor) must be a weird lot to crave performing bikini line hair removal on women and men so much that he has to blog his very unhelpful and weird worldview. No. People are not being burned by the hundreds of thousands as one woman once wrote in a letter to the Texas Board of Medical Examiners. She actually used these numbers. No one had the wits to question her rank stupidity.

GM needs to present his bona fides before I will get off his back. The legislature in Pennsylvania needs to see these doctors for the phonies they are. This is not about patient safety. It's all about greed.

There a dermatologist in Tyler Texas who claims that he does all of his own laser hair removal. I have had clients travel all the way here from Tyler to tell me how creepy he was and that they did not want to go back there. I would like to see these marvelous physicians cozy up to a transgendering male for hair removal???????

Is that what they got all of the years of education to do? Bwa haaa haaa!

Great comment from LASERNURSE♥

06.8 | Unregistered CommenterLUMINITA

I'm just a little medical aesthetician. I do not make over 500,000 or 1,000,000 a year like many doctors do. I went to school for aesthetics, a separate school for laser, and have completed many additional classes and certifications for advanced skin care. I have a solid understanding of different skin types and a solid understanding of how to use the exact correct settings to get results while not damaging a patients skin. However many doctors unfortunately do not. Many doctors do not get proper training. Instead they buy a laser, have the rep go over the basics and go to town. I know this for a fact because a) I worked for doctors, and b) the majority of my skin care time has been spent correcting patients burns and scars. These burns have ALL been done by doctors. I work in Arizona. I work in a heavy Hispanic area where there are many different ethnic skin tones. Many people who's skin is light but because of their ethnicity needed a different setting or different laser tip. I correct what the doctors have done and then I complete what the doctors started except I do it correctly. I am not bashing doctors. I love the doctors I work for and have a few doctor friends. I am bashing the bad doctors. Doctors that are on a power kick. Doctors that know it all. Doctors that take full advantage of the legislation that allows them to purchase lasers and do whatever they want. Doctors that burn people, doctors that don't provide the service results the patient paid for, doctors that dont refund the patients money when they clearly ripped the patient off. I do not sell (for example) a package of 6 laser treatments for hair removal w out taking the time to explain most likely you will need more than one package w one or two touchup treatments after your last session etc. people come to me all the time telling me they had laser but didn't like it because it didn't work. They tell me they had four treatments! Of course it didn't work. They didnt damage the hair follicle. Why are there so many doctors doing this? Why don't you explain to your patients how many sessions they will most likely need to get the results they want? There are many fabulous doctors out there and this is not directed towards you. It is directed to the doctors that are not perfectionist, the doctors that do not care, and the doctors on power kicks that think they can do whatever they want. Passing legislation like this gives these guys more power to do what they want but you will be cutting out people like me that are busy correcting their mistakes and giving the consumer the type of care they should have got in the first place. Doctors make enough money doing what they went to med school for, which most likely, is not laser treatments.

06.8 | Unregistered CommenterSkinGirl

The continued unprofessional manner of this discussion that has now evolved to name calling and false accusations is doing nothing for the subject at hand. It is, however, proof of ignorance and lace of professionalism.
Estheticians using prescriptive devices that are not in their scope of practice is the subject.
Changing laws and regulations for the safety of patients is the important item.
As a nurse in dermatology, I, too, have seen the other side, as patients (clients) from estheticians come to my own office for treatment of the side effects of improper use.
It is the side effects and medical treatment needed for those side effects that are also out of the scope of practice of estheticians.
While it is very true that few M.D.’s (in some states ARNP’s and PA’s) want to push the button on the prescriptive devices, it is they who are responsible for those who do.
Like it or not, estheticians are not medically trained, and there is no state who acknowledges “medical esthetician” or licenses estheticians as such.
As an example, just because a nurse practices massage therapy on patients, for no matter how many treatments or how many years, she would not be “grandfathered in” as a massage therapist in any state. Massage therapy is still outside the scope of her practice. Just because she has done it, is the best at it, corrects muscle spasms caused by a licensed therapist, it is still outside of her scope of practice.
Departments of health or healthcare professional boards do not govern estheticians. With laws and regulations, an authority of regulations will simply govern and place a scope of practice on the therapies that include prescriptive devices used by estheticians.

06.8 | Unregistered CommenterTamala

I agree with Tamala. While others may have a differing opinion, this should be kept as a professional forum and I'd ask the site to block anyone who express themselves with decorum. You don't do yourself or your position any good treating a legitimate discussion like your Facebook page.

That being said I would put the following forward as being the de facto case in every state:

A medical license is required to purchase and use an IPL or laser.
The physician is the individual who assumes ALL medical risks for the use or misuse of these devices.

If you accept the two above statements as being true, the argument that anyone other than those who are legally and medically responsible should be involved in the decision making process about what should be allowed or prohibited is moot. You can not logically argue that you should have decision making control over any process or treatment for which you are not the individual that has these responsibilities.

Re: C Doyle MD

I do not accept your statement:

"A medical license is required to purchase and use an IPL or laser.
The physician is the individual who assumes ALL medical risks for the use or misuse of these devices.

If you accept the two above statements as being true, the argument that anyone other than those who are legally and medically responsible should be involved in the decision making process about what should be allowed or prohibited is moot. You can not logically argue that you should have decision making control over any process or treatment for which you are not the individual that has these responsibilities."

The FDA is vague in this "decree" and the control/purchase/responsibility clause is enforced differently on a state-by-state basis. In Texas, there is no law saying that only a doctor can purchase a laser.

Sorry.

@ Marti Settle,
It's not for you to accept or not. This is the practice of medicine and anyone who is not operating under the appropriate medical license is 'practicing medicine without a license'. There's nothing unclear about that. While it may be possible for a corporation or other entity to purchase medical technology, it will always be a physician who is ultimately responsible for how it's used. If you can proved some examples of where this is not the case, please do. I'd be very interested in finding out how individuals are performing medical treatments without oversight since I can't see how this could be done legally without involving a physician and operating under their medical license.

06.12 | Unregistered CommenterCHIMD

CHIMD

We live in a Republic, not a democracy. Laws and regulations vary from state to state. In The Republic of Texas, we have a consulting physician but in some states no physician is required for the daily use of a laser for hair removal. For your information, Laser Hair Removal is NOT considered the practice of medicine in Texas. It is not nor should it ever be considered the practice of medicine. Some states have regulations requiring the affiliation of a physician with a laser hair removal practice and even having a physician on-site and immediately available. However, under the definition of the practice of medicine, i.e. treating another person for illness or disease, hair removal is NOT the practice of medicine anymore than is cutting hair. The legislature in Texas refused to classify laser hair removal as the practice of medicine. And that IS A FACT!

And, I absolutely can choose not to accept this wording.
I absolutely do refuse to accept this misinterpretation as does the State of Texas.
Thank you CHI MD (another doctor afraid to use his/her real name). Bye bye.

Again, ignorance is bliss.

A device that causes cell change is a prescriptive device and is a medical device.
It does not vary from state to state.

06.12 | Unregistered CommenterTamala

Tamala, I guess that taking vitamins, getting a tan, drinking water, etc. are all "the practice of medicine" according to your definition.

You know it's funny, but in the years I have followed state regulation of laser use, I have not seen nor has anyone to the best of my knowledge ever provided any statistical data that would indicate rampant misuse of laser services by non medical individuals. Triple A insurance companies will insure we non-medical technicians for less then $8K. That should speak volumes about the risk of mis-use. The medical associations, accross the country, have preached "client safety" and utilized the same fear tactics and all of them have gotten away with it.

What most of you "medical only" advocates fail to address is the distinction between ablative and nonablative lasers. Ablative lasers should only be used by and under the direct supervision, if at all, physicians. Nonablative lasers should be ble to be used by properly trained and educated aestheticians.

There are FDA approved "Home Use" lasers being sold today on Ebay. These lasers utilize the same technology that you insist only medical clinics should have.

The aesthetic industry should be able to benefit from technilogical advances in the skin care industry. 15 years ago, lasers were not as advanced and you needed a highly trained physician to operate and supervise them. Today, these lasers are feature heavy, more advanced, easier to use and you don't have to be a Doctor to be trained to use one safely.

We are fighting the same battle in Tennessee. Over the past 8 years, our spa has been turned in to the Medical Board for the "Practice of Medicine". They dropped the complaints all 3 times. Of course, we incurred a heftly legal bill the first go around.

Tamala: You are proof of your own words, "ignorance is bliss." I am neither ignorant nor blissful. I am disgusted. You can't handle a legitimate debate without holier-than-thou responses. The sun causes cellular change. Drinking water causes cellular change. I could go on for hours with your reponse naming everyday items we do and use in our lives that cause cellular change. How about aging? Let's make that a "medical procedure" because the act of growing older causes cellular change. REALLY? Using lasers designed and sold for the purpose of removing unwanted hair cause such minimal cellular change that your argument is reduced to a red herring and a ruse. The laser causes cellular change by disabling the capilllaries which grow those hairs. SO WHAT????? And it takes a medical professional to do that? The medical "Monopoly" is the most expensive, destructive, over-protected industry in Western Medicine. I think doctors should come down to earth, climb down from their throwns and get over it. Doctors should be LIMITED to the practice of medicine and laser hair removal is NOT the practice of medicine. Not now, not ever.

Laser/IPL use appears to be treated differently from other medical practice currently. Why so? A country which so tightly regulates the practice of medicine for public safety should extend the same protection where light based treatment is concerned.

I am completely in favor of reigning in lamentably lax regulations that now exist. Take Oregon, where I could delegate my son's soccer coach to perform laser (no disrespect to him). We have a double standard which does not make sense. Either regulate the practice of medicine, or not. Pick one.

06.13 | Unregistered CommenterWa Derm

I agree with Wa Derm completely. These things have a way of pushing the boundaries until there's a headline with someone getting burned or the news picking up some story about a hair stylist operating a laser in the back room.

I think it's NY or NJ that prohibits anyone other than a physician operating these devices. It wasn't always that way but they tightened things up after some high profile mishaps. I'm not familiar with what the current regulations are in either TX or TN but I would suggest that the vast majority of physicians, even in these states, would think that allowing anyone to purchase and operate IPLs or cosmetic lasers could pose problems.

It always takes a problem that has to be dealt with to mandate a change and it's often the lawyers who actually act as the enforcement arm, usually by use of lawsuits. Once an insurance company has a major payout you because there's a lawsuit that points to the fact that "doctors think that there should be medical oversight but the business just went ahead and treated my client anyway", you can bet that insurance premiums may well go up.

Perhaps the hair salons in TX and TN are going to be buying Scitons and Palomars and firing away.

Of course the technology companies are finding new ways to increase the power of devices which is really where this discussion nets out. How much "power" should you put in the hands of a non-physician? It's a tricky area and the lines are somewhat flexible, at least in some states it appears.

There has been a long line of businesses who tickled the boundaries of 'medicine'. Few have fared well in the long run going up against what physicians see medical care and it is often the lawyers who are the enforcers.

06.13 | Unregistered CommenterCHIMD

Rubbish! Headlines that someone is operating a laser in the back room of a hair salon? Someone getting burned. These headlines ONLY reach the newspapers when the various medical specialty professional associations sends out press releases to editorial boards requesting that health writers investigate the "horrors" of laser hair removal in the wrong hands. ChiMD and Tamala I totally disagree with you. Hair Salons in Texas are not simply purchasing Scitons and Palomars and firing away willy nilly. For the record I have always used Candela lasers which I consider to be the best and most effective on the market.

Texas has passed tort reform. Very few lawyers will take a case for medical malpractice because the recovery limit is $250,000. We also have gun laws that offer us license to carry. Now that's powerful! Heck, even our Governor carries. People in Illinois, Pennsylvania and New York get what they pay for! Blue state = Nanny State.Oh my.

Frankly, the real danger to consumers is in their billfolds and purses, not their choice of service providers. Rubbish again.With the economy in the pits because of Obama, we are all arguing over a very small marke.t Todayour mutual enemy is those online coupons. In my hometown, there are two nurses who run shaky laser hair removal facilities. They are the ones who are offering 6 treatments for $99.00. After paying Groupon or whatever else service (Living Social?" these nurses only earn $7.23 for a 15-30 minute session. That's not enough money to pay the overhead.

Lasers are not that tricky. Lasers for the use of hair removal are non-ablative and it takes an nincompoop to burn someone. Following manufactures protocols and pre-testing skin for clinical endpoints is a most reliable indicator of patient response, efficacy of treatment and safety.

Why do you continue to disbelieve that there are people in the world with intelligence and people of good conscience who are safely performing laser hair removal day in and day out without incident?

Undocumented horror stories to of burns and damage clients with the intent to scare the public away from our businesses is part of a nationwide scheme of business interference which falls under Federal Racketeering.

Speaking of "tickling the boundaries of 'medicine'" In the1970's and 1980's the AMA fought against Chiropractors practically putting them out of business until the Chiropractors brought charges of Federal Racketeering and Anti-trust against the AMA. Eventually, the Chiropractors won in Federal Court and the MD's lost. Now, with an MD behind your name you believe you have a right to tittilate and horrify the public so they will not come to our businesses. I have been in touch with the Federal Trade Commission and placed medical societies under alert and watch for racketeering and malicious business conduct for writing such things. Be careful. I mean it. Get your documentation and verifiiable proof ready. The anonimity of the blogosphere is very thin skinned and can be traced.

It is imperative that we use our posts to tell the truth. Draconian, fabricated stories of innocent people operating their businesses legally in their home states amounts to serious business interference.

Nurses and doctors are free not to like the idea that people with other licenses are practicing laser hair removal. But, they may not intimidate or discredit people anonomously for the purpose of running them out of business and treating the competition like quacks. That dog don't hunt anymore. With over 3,000 clients, I can tell you that we operate well within the law, are licensed by the State of Texas and each and everyone of my technicians has been thoroughly trained and passed their national board exams.

Make sure you can back up your claims and please do not exaggerate to scare people needlessly.
.Shame on you.

people who are questioning tam las' definition are missing the keyword "device"...sun/ water are not devices...

as she said ---ignorance is bliss.

06.15 | Unregistered Commenterkey word

And around and around and around we go. The keywords are "turf, money, greed". The rest of the discussion is just the same old rubbish. Doctors should be limited to the practice of medicine. God knows they seem to have enough trouble getting that right in the first place without prancing into aesthetic, cosmetic procedures like little six-winged fairies.

Marti-easy there killer. I agree with every word you've written, but when you start to call doctors six winged fairies, you're not exactly helping our cause.

settle down and let's keep the comments to the topic at hand.

I know of at least four people who've been harmed/burned/damaged at the same Med Spa by an aesthetician in upstate NY. Yet, she continues to practice at the same spa harming others. Ridiculous. Maybe you should speak to some of those harmed by aestheticians and see what they think of opposing this law! This type of law should be mandatory in all 50 states and while it would not ensure the safety of these procedures, it would at least give the public/consumers a fighting chance that someone better trained and more accountable is at the helm.

06.19 | Unregistered CommenterDCNGA

Better-off now: Lighten up! That was a precious remark! ! Would you rather compare their magic knowledge to that of Tinker Bell?

By the way DCGNA: My guess that aesthetician in Upstate NY is probably using an IPL for hair removal. IPLs are dangerous and I personally don't like them. It is just too easy to burn someone. Is there anyway you can find out who he/she is and what kind of device he/she is using? Also, is your information first hand, second hand or just "in the wind?" And, did you find out the outcome?

Just so you will know, Intense Pulse Light devices are designed primarly for facial rejuvenation. This treatment is supposed to burn off the top layer of skin so a slight burn is considered a "good thing" when properly delivered. When a person goes in for hair removal they don't expect to have get skin burned, thus, you get complaints. Unless the burns were second degree or worse, it's really not as horrific as you make it seem. however, the problem is that the wavelength needs to be deep enough to affect the bulge of the follicle and IPLs do not have a pulse length deep enough to kill hair effectively.

Since you are reporting on this aesthetician, why don't you snoop around and find out the name, place and details so you can give us a thorough and meaningful report. Unless you can give facts, it's nothing more than hearsay.

I for one like FACTS.

After meeting with many PA State Senators and other parties with influence in the decision making process of regulation proposals with the Medical Board, we have learned that even if the regulation were to be passed, it would be quite some time before implementation. I am interested in hearing from other states who have successfully implemented a state-wide certification and/or licensing program for laser technicians.

I think no one has recognized that IPL's are NOT "true" lasers and are a Class II "laser" where as most every other true laser is a Class IV.

06.20 | Unregistered CommenterDermCRNP

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