Reading: Looking to Laser? Tips to Keeping Your Skin (and Self) Safe

“If you do not see a board certified physician, and just see a nurse or laser tech for the consult — RUN,” says Dr. Mary Lupo of the Lupo Center for Aesthetic and General Dermatology in New Orleans. 

With some 600,000 laser skin resurfacing procedures done in the US annually, Dr. Lupo wants you to make sure that if you are seeking laser treatment for your skin, you’re doing it right. Such treatments, ideally performed by specialized dermatologists in a doctor’s office, or by dermatologists or physician-supervised aestheticians at a medical spa with an on-site doctor, can reduce the redness of rosacea, remove tiny capillary veins, reduce the appearance of wrinkles, or help smooth out skin that got dimpled with acne scars, among other skin concerns. Other laser treatments are great for removing unwanted hair. There are non-cosmetic uses for laser as well, including removing precancerous growths.

They are all generally safe and provide excellent results. But, when not properly administered, laser treatments can result in skin damage such as burns, scars, or hyperpigmentation (when patches of skin become darker than surrounding skin) or hypopigmentation (when patches of skin become lighter). In fact, laser damaged skin is now one of the top causes of aesthetic lawsuits in the US, Dr. Lupo notes.

How to Repair Laser Damaged Skin: When Procedures Go Wrong
“The one [misconception] that makes me nuts is that you do not need to see an expert in [skin care] to get laser,” Lupo says. “Every malpractice case I have seen in mediation was from a Med Spa or an untrained physician practice. Bad doctors and health care providers make it so hard for the good ones.”

People turn to laser procedures to improve their skin because these treatments work, notably by remodeling or stimulating collagen, a protein that provides strength and support to organs, bones, muscles, and tissue. There are two main kinds of laser treatments: ablative laser — a strong resurfacing technique such as the CO2 treatment, removes the outer layer of skin and heats the lower layer by using a constant wavelength of light on the skin; and non-ablative laser (also known as laser light therapy) — the fractional kind, meaning that the laser beam is delivered in a pixelated manner, which is less harsh and has a shorter recovery time. The treatments are delivered by a variety of sophisticated devices, often with variable settings that are meant to be customized for each patient. Which is why, in the wrong hands, there are accidents. 

“I have seen my fair share of patients who have come to me after experiencing a laser complication elsewhere,” says Dr. Leah Ansell, a cosmetic, surgical and medical dermatologist with Treiber Dermatology Associates who practiced in New York City and is now in Rye, NY. (Full-disclosure, she’s my doctor.) Her list of skin damage includes depressed scars on the face from Vbeam settings that were too strong, permanent hyperpigmentation after laser hair removal on a patient who was tan, and hyperpigmentation following PICO laser for brown spots. “Fortunately, I have been able to help many of these patients, but it can take months and cost a lot of money correcting laser complications.”

Ironically, many laser mishaps can sometimes be corrected by laser procedures with or without a rigid skin care regimen. For example, Dr. Ansell treated textural changes post-Vbeam with non-ablative fractional resurfacing. It’s not, however, formulaic. The same kind of scarring on one skin type cannot be treated in the same way as on other skin types.

Dr. Lupo has had similar experiences. “Deep resurfacing that has complications that are not recognized and treated early and promptly can cause scars,” Dr. Lupo explains. She successfully used a vascular laser and Fraxel Dual (a non-ablative procedure) to reverse scars from a treatment that resulted in skin damage, and encourages patients who have suffered damage to seek out a skilled dermatologist who is an expert in laser procedures.

Why Is Laser So Popular?
If there’s even a small risk of laser damaged skin, and a chance of having to repair laser damaged skin, why is the procedure so popular?

Laser is a sought-after treatment because for one, it is noninvasive and, in general, the rewards outweigh the risks. If you could remove that port-stain birthmark that has plagued you since middle school, wouldn’t you do it? What about making those freckles you find not-so-cute disappear? Yes, they can be successfully zapped away with a laser. Eliminate or diminish some pockmarks from teenage acne when you’re 60? Sign me up!

People I know (including myself) who have opted for a laser treatment are very happy with their results. One young woman was fed up with the irritation and ingrown hairs she would get after shaving her bikini line. While laser hair removal isn’t permanent, nor can it work effectively on light-colored hair, a series of treatments at a hair removal spa five years ago has left her relatively hair-free. I opted for laser treatment to remove underarm hair. No more shaving or waxing irritation, no more five o’clock shadow, and I go back to my aesthetician for touch-ups maybe every two years since my initial treatment. I’ve also started with laser for my face to remove tiny capillaries and even out my skin tone. This first treatment had signs of success, and I’m looking forward to continuing the protocol. 

The ease with which someone can have a laser procedure is also making the treatment increasingly popular. Instead of seeing a physician, you can go to one of thousands of medical spas, also known as med spas, that have sprouted up across the US in recent years. 

The medical spa industry, worth an estimated $15 billion, according to The American Med Spa Association (AMSA), is a booming, lucrative business. In 2022, there were 8,841 medical spas registered, more than double the number in 2017, according to AMSA’s most recent figures; and a medical spa’s annual revenues average $1.9 million. Certain kinds of licensed aestheticians are also allowed to practice a limited amount of laser treatments in a beauty spa. This kind of accessibility, combined with efficacy, makes laser procedures tremendously appealing. But, not without controversy.

Before You Laser…Do Your Research!
A physician friend of mine drives one hour from New Jersey to her dermatologist in  Westchester, NY, to have her rosacea treated by laser. I asked her why she travels so far and she responded: “You’ve got to go where the talent is.” 

A patient must do their homework. You should read up on the kinds of laser treatments that exist for specific conditions and what could be successful for your personal skin type. Researching practitioners, whether they be highly trained cosmetic surgeons or a physician-supervised aesthetician or nurse, is critical. 

A medical spa without medical supervision or on-site physician in a skin-related specialty? Dicey. Also, med spas are not regulated consistently from state to state, as is the case with the field of medicine in general, making the treatment landscape particularly confusing for potential patients.

“Historically, medical physicians who specialize in aesthetics (plastic surgeons and dermatologists, oculoplastic surgeons and Ear, Nose, Throat facial plastics) performed lasers,” Dr. Ansell explains. “Over the last several years there has been an explosion of med spas and private equity–owned groups where there is little to no oversight by a medical physician and other providers perform the lasers. Lasers are complicated devices and require understanding of physics and years of use to understand the best outcomes and risks. Medical doctors who specialize in aesthetic medicine have dedicated a minimum of four years of internship/residency and fellowship into understanding the nuances of energy based devices.”

Dr. Roy Geronemus, the director of the Laser & Skin Surgery Center of New York, dubs this conundrum “imitation dermatology.” In a 2021 article that addressed poorly administered injectables and laser treatment, he noted that some patients assume all laser technology is the same since they seem to address similar problems. The different kinds of treatments, the quality of the tools, how they are used, and by whom determine the success or failure of a treatment.

He explains, “An inexperienced provider using subpar laser equipment, such as old or improperly maintained devices, can leave your skin irreparably damaged, putting you at risk of burns and scars.” 

Last year, the American Society for Dermatologic Surgery (ASDS) published a few studies on the operations of many medical spas. In one study, 127 Chicago-based medical spas were surveyed, revealing that non-physicians executed the most cosmetic medical procedures. Moreover, patients were largely unaware of the difference in medical training and supervision between the doctors and those who administered the aesthetic procedures. A whopping 81 percent of the spas surveyed reported there was no on-site physician. 

Of course, there are medical spas that are properly managed, with on-site dermatologists and a properly trained staff. There are also cosmetic spas with highly trained and skilled aestheticians who, in some states, are licensed to do laser hair removal and other light-based treatments. But in the absence of regulations on medical spa operations, the ASDS created The Medical Spa Safety Act, a model bill for states on how to legislate medical spas. It addresses everything from training for supervising physicians to stipulating that non-physician providers wear an identification badge stating their profession and kind of license they have to perform the procedures.

Is Laser Right for You?
Really, the only way to successfully navigate this skin care terrain and enjoy the benefits of laser treatments (and hopefully avoid having to repair laser damaged skin) is to be an especially informed patient.

If you’re considering laser, there are some questions you can ask your doctor:

• Who is administering the treatment and what are their certifications? If they are not a physician, will there be a supervising physician on-site and readily available?
• What are the risks? How long is the recuperation period? What post-treatment care will be required? (Be sure to discuss your medical history with your physician, including previous medical or cosmetic procedures, current medications including herbal remedies and vitamin supplements, history of scarring or skin infections.) 
• Has the particular laser procedure been approved for your skin type, and for use on that area of the body?
• What are the expected results? Will your condition improve after just one treatment or will you require multiple treatments for optimal results?
• Do they do patch testing? If you have sensitive skin, it will be much easier to treat a complication on a small patch of skin.