Laser Hair Removal

With the recent questions of hair removal, and with the summer approaching, I found it appropriate to post this article I recently read:
*note - if this is not the correct forum, please move it.
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Dermatologists can expect to see more patients presenting with complications from laser hair removal.

Many dermatologists report that they are treating patients who have suffered complications due to laser hair removal procedures done at salons, day spas, and hair removal centers that do not provide proper physician supervision of these procedures.

Indeed, 45% of respondents to a recent survey by the American Society for Dermatologic Surgery said they were seeing more complications from hair removal done outside of a physician's office. The survey recorded 110 incidences of complication between May 2000 and May 2001--more than reported from any other procedure or combination of procedures.

"Based on what I am seeing, people are getting harmed out there," said Dr. Roy Gercnemus, president-elect of the ASDS. "People are getting burned, people are getting scarred, and people are getting mistreated."

Laser hair removal has become one of the most popular cosmetic procedures performed, and the practice is expected to increase significantly in the coming years. Last year, more than 5 million laser or intense pulsed-light hair removal treatments were performed in the United States, about $1.3 billion worth, according to Michael Moretti, an industry researcher based in Mission Viejo, Calif. That was topped only by waxing in hair removal procedures.

Moreover, according to Mr. Moretti's figures, about 5% of 6,500 spas and day spas in the United States are planning to add laser epilation to their menu of services this year, and the number of hair removal lasers in physician offices, aesthetic centers, spas, and salons is predicted to double in 5 years.

The prospect of that many lasers out there is hair raising, many dermatologists say. In August, the ASDS launched a campaign to warn the public about the dangers of laser hair removal when not performed under direct physician supervision.

Currently, 15 states permit only physicians to perform laser procedures, and another 8 require direct supervision. The remainder of states have less stringent regulations or none at all.

Dr. Suzanne Kilmer, a dermatologist with a laser medicine practice in Sacramento, estimates that she sees a patient with a laser-hair-removal complication about every other month, and that the ratio of those patients who were treated at salons, compared with those treated by other physicians runs about two to one.

Given that experience and her own familiarity with lasers, Dr. Kilmer said she supports the position taken by the ASDS that laser hair removal ought to be regulated so that it is only done in a facility that has a trained and qualified physician on the premises.

Hair removal is not so simple and straightforward that it can be done with a cookbook method, and while many complications are not acute emergencies, a physician needs to be on hand, Dr. Kilmer said.

"We've had some unusual complications," she said, noting that they even had one patient who developed a urticaria reaction during a procedure. "Once you do enough of these [procedures] you will get some rare reactions."

The mishaps and misdeeds of nonphysicians performing laser hair removal are more than just the odd immediate reaction and/ or hyper- or hypopigmentation, and can be very serious, Dr. Geronemus said. They also extend to marketing pitches and to other uses of the laser. Many laser centers drastically exaggerate what they can achieve. Moreover, some are using the laser to treat veins and lentigines.

Most patients need a physician's evaluation or a physician-supervised evaluation before even a simple procedure like hair removal to be sure that no undiagnosed condition or contraindication to laser treatment is missed, he said.

These complications and questionable practices will affect the whole field, dermatologists included, because they taint public perception. "The dermatologic community has to stand up," he said. "We're seeing these people practicing dermatology. I think this is a major public health concern.

Some nonphysician laser hair removal practitioners say that the dermatologist's concern for consumer welfare smacks of self-interest, however. They say there is no concrete evidence that nonphysicians have any higher complication rate than physicians.

"It's about competition, and they don't want any," said Marti Settle, vice president of the Texas Association for Aesthetic Advancement.

Because the Texas State Board of Medical Examiners is currently reviewing the regulations governing laser hair removal practices, Ms. Settle examined the complaints regarding injury that have been filed with the state's radiation control board. From 1998 to 2001, the board received eight reports of an injury resulting from laser hair removal. Four were from individuals treated in a nonphysician salon, and four were from physician offices, she said.

The most serious case--a woman with facial burns who subsequently committed suicide--was treated in a doctor's office. "The numbers speak for themselves," Ms. Settle said. Laser hair removal is a safe enough procedure that trained, responsible nonphysicians can perform it, Ms. Settle maintained. Many laser manufacturers recommend that operators be trained and offer such training. Ms. Settle received four days of training when she purchased her laser.

In Texas, those who actually do the procedure do not currently need to be licensed, though the business does have to have a physician involved. Ms. Settle said she favors operator licensure, but requiring a physician to be on site would simply increase cost and decrease availability.

Her physician practices across the street from her laser center. Having a physician available by phone is really no different from having a physician on-site who is going to be performing surgery and is tied up with other patients much of the time.

Dr. David J. Goldberg, director of laser research at Mount Sinai School of Medicine, New York, is increasingly concerned about nonphysicians performing laser hair removal because of the seriousness of complications that he is seeing. Today's lasers are more powerful than those used just a few years ago.

"The most common scars are on the face. That is simply because hair removal and nonablative procedures are often performed [there]," he said.
-International Medical News Group
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