Not pretty

Molly Ball

Sunday, Jan. 1, 2006 | 7:40 a.m.

Cosmetic treatments available at beauty salons or day spas might not be administered by a medical professional capable of ensuring your safety. Before you undergo such a procedure, consider these tips from the American Society for Dermatologic Surgery.

DO:

DON'T:

Laser hair removal, laser skin resurfacing and laser vein treatments are available everywhere in the appearance-obsessed culture.

But doctors say there's no guarantee that a medical professional is operating the dangerous instruments used in these procedures, and Nevadans are suffering injuries, some of them severe, as a result.

One woman suffered partial loss of sight when she underwent a laser procedure to eliminate unsightly facial varicose veins. Proper safety precautions weren't taken, and the laser beam shone in her eye, Dr. Robert Merchant, a Reno vascular surgeon, said.

Another patient of Merchant's had a laser applied to a large vein in her thigh and suffered a blood clot that caused her leg to swell painfully. Clots are a common complication, but the nonprofessionals who administered the laser treatment weren't equipped to fix the clot, and she arrived at Merchant's office in a panic.

To Merchant, both cases demonstrate that Nevada needs more regulation to protect the public.

"Lasers are dangerous," Merchant said. "Even in a medical setting, they can cause problems, primarily burns of the skin.

"Now they're being used by people who don't have adequate supervision or training, and it harms patients."

Recent years have seen a boom in the popularity of laser treatments for cosmetic problems. The most popular are hair removal, skin resurfacing, and the removal of skin discolorations and enlarged veins.

The invigorating effect of a successful laser skin resurfacing can be remarkable. The treatment essentially burns off the top layers of skin so they can grow in fresher, smoother and tighter.

But the procedure turns the face into a large open wound that can become infected, and such infections are not easily discerned by a nonexpert. If not treated in time, they can cause massive scarring.

In a 2002 survey of certified dermatologists, 41 percent reported they were increasingly performing corrective treatment to address damage caused by cosmetic treatments administered by nonphysicians. These treatments also included chemical peels and microdermabrasion, but laser treatments accounted for the largest single source of complications.

Burns are the most common complication from laser treatment, followed by changes in skin pigmentation that may be irreversible, Dr. Gary Monheit, American Society of Dermatologic Surgery president, said from his practice in Birmingham, Ala. Three deaths also have been reported from overdoses of the topical anesthetic lidocaine administered by nonphysicians.

"We really do have a serious problem, and the basis of the problem is a lack of regulation," Monheit said.

In Nevada, laser treatments operated by nonprofessionals are common at beauty salons, day spas and storefront operations, said Tony Clark, executive director of the Nevada Board of Medical Examiners. They apparently are unregulated, Clark told the board earlier this month.

Most states, however, regulate laser treatments tightly, according to the Federation of State Medical Boards. Those states commonly require either a doctor, a nurse or a physician's assistant to operate the instrument, and a physician to be either on the premises or on call.

Nevada's rules are not as clear. The medical board issued a vague opinion in 1998 stating that the use of lasers constituted the practice of medicine and that physicians could delegate laser treatments only to "employees qualified ... by way of special skills, education or experience."

What constitutes a qualified employee? How much experience or training is adequate to wield a laser? What sort of physician supervision should be present? The board's opinion doesn't say.

A rule spelling out such requirements could be in the form of a medical board regulation or a law passed by the Legislature.

In 2002, for example, New Mexico's medical board passed regulations specifying that trained medical assistants could use lasers only for procedures that don't cut into the skin or remove tissue. A doctor must examine the patient before treatment by an assistant, and must be on the immediate premises while an assistant is operating a laser, the New Mexico code states. It also indicates precisely what training assistants need to have.

The issue has heated up nationwide because laser technology has advanced and because cosmetic treatments can be extremely lucrative, said Dale L. Austin, senior vice president of the medical boards federation.

Nevada medical board member Dr. Cindy Lamerson, a Reno dermatologist, said laser businesses are savvy enough to set up operations in states with lax oversight.

"These companies focus on states don't have regulations," she said. "The complication rate is fairly low, but it's there."

Las Vegas plastic surgeon Dr. Benjamin Rodriguez, also a member of the medical board, said he, too, had dealt with complications from botched laser procedures. The problem, he said, is that storefront laser businesses are an unknown quantity.

"I don't know how many of these shops are out there, where they're getting their lasers or how powerful the lasers are," he said.

Rodriguez said most companies that offer laser treatments have detailed manuals that their employees follow. But if a laser operator "was just a little bit confused and gave someone an inappropriate energy, they could end up with burns that wouldn't show up until weeks later."

A doctor's diagnostic eye is also needed, Merchant pointed out. A layperson using a laser to treat a skin discoloration might not recognize a potentially cancerous spot. Merely removing the spot wouldn't stop the underlying cancer from continuing to grow and spread.

Doctors differ as to what should be done about lasers. Merchant believes the medical board should adopt a regulation about who can operate medical lasers.

But medical board member Dr. Daniel McBride said that approach might be seen as anti-competitive because it would restrict laser treatments to the very medical professionals making the regulation.

McBride said the board should ask the Legislature to regulate lasers. The board recently voted to consider a draft bill proposal at its next meeting in March.

Rodriguez believes the answer is for authorities simply to enforce what's already on the books and crack down on laser operations that aren't run by qualified professionals.

Because most complications from lasers take some time to appear, Rodriguez said the issue is not a physician's presence on-site but liability. No matter who administers a laser treatment, he said, there must be a doctor associated with the business who will be responsible if something goes wrong.

"The buck has to stop with a physician," he said.

Molly Ball can be reached at 259-8814 or at molly@lasvegassun.com.