PHOENIX — Medical spas and retail clinics offer laser services that promise cosmetic fixes such as hair removal, skin resurfacing and age-spot elimination.
But the seemingly minor, aesthetic procedures have had major consequences for men and women across the country, ranging from common skin injuries such as burns and blisters to scarring from botched laser jobs. And two young women, including one from Tucson, died when incorrectly using medicine to prepare for laser jobs.
In Arizona, a consumer seeking a smooth or blemish-free body runs a more than 50-50 risk of entering a clinic that hasn't been inspected in more than a year, and a significant, though lesser, risk of being treated by a technician without proper licensing or training.
Metro Phoenix doctors say and records filed with Arizona regulators show that severe burns and blistering can occur when a laser operator uses improper techniques. More than a half-dozen reports have been filed with state regulators claiming minor injuries over the past year. Medical professionals say that many incidents are likely to go unreported.
"I see patients all the time getting burned from going to medical spas," said Susan Van Dyke, a dermatologist who also offers a range of cosmetic procedures, including lasers.
While the federal government has strict guidelines for the types of lasers that can be used for aesthetic purposes, it does not regulate who is authorized to provide laser treatments. That duty is left up to individual states with standards that vary widely.
Arizona has 923 certified laser technicians, who are allowed to perform minor procedures as long as they get a license. That process requires a total of 64 hours of training on powerful devices that remove hair, tighten skin or etch out skin spots, including 24 hours of hands-on instruction. Laser technicians must operate under the guidance of a medical director such as a doctor or nurse practitioner, but those licensed medical professionals need not be on site.
Technicians who perform aesthetic procedures at spas and retail clinics are supervised by the Arizona Radiation Regulatory Agency (ARRA), which also oversees X-ray equipment and monitors radiation exposure, rather than by the state licensing boards for doctors, nurses or other medical professionals. The state licensing boards for medical professionals oversee laser use for medical procedures.
The agency has two inspectors who are charged with inspecting laser clinics, among other obligations.
"There are more than we can get around to," said Aubrey Godwin, executive director of ARRA.
Of the facilities they are able to inspect, Godwin said that one in four has not registered with the agency as required and one in eight employs unlicensed laser technicians. The agency has issued dozens of notices of violations to laser clinics across metro Phoenix for failure to register, employing unlicensed laser technicians, not consistently using protective eyewear or not maintaining an injury-reporting policy, among other issues.
CONSUMER PROTECTION
Consumers often are left in the dark about whether the person waving a laser or energy device has been properly trained or certified. This information is not available on ARRA's website, though the agency will provide such details to consumers who call. Clinics and laser technicians must display their credentials, but ARRA's inspection reports show they often do not.
Some doctors who receive more extensive training on lasers through medical residencies and continuing-education courses question whether technicians get sufficient instruction.
In 2007, the Food and Drug Administration issued a safety bulletin warning about the use of an anesthetic drug that led to the deaths of Shiri Berg, 22, of North Carolina, and Blanca Bolanos, 25, of Tucson.Berg was instructed by a medical spa and Bolanos by a medical clinic to apply cream that contained lidocaine and tetracaine to their legs and wrap them in plastic to increase the drug's numbing effect.
Both women had seizures, fell into a coma and died from the toxic effects of the drug, according to the FDA, which also cited examples of people who suffered irregular heartbeat, seizures and coma from anesthetics used for cosmetic procedures.
Others believe that with proper training, non-medical technicians can perform quality laser treatments.
The National Laser Institute in Scottsdale trains technicians in the proper use of lasers and techniques for different treatments. It includes five days of classroom instruction and three days of hands-on training.
"Just like you can get a burn from putting your hand on a stove, you can get a burn from a laser," said Louis Silberman, co-founder and CEO of the National Laser Institute. "The people who are not properly trained are causing the consumers harm."
ARIZONA CASES
The state regulatory agency requires medical spas and other laser operators to report second-degree skin burns that are larger than 1 inch, third-degree skin burns or eye injuries from lasers or other aesthetic devices.
Still, the agency said that the types of injuries incurred by laser treatment often don't rise to the level of being reportable. Inspection records also show that several clinics were cited for failure to adopt policies that require them to report laser injuries to ARRA.
The Arizona Republic reviewed reports from more than a half-dozen consumers who claimed injuries from laser clinics. Some wanted their money back. Others said they wanted regulators to intervene so others would not be harmed.
One woman spent $4,500 for a package at Neos MedSpa in Chandler that she said left her with scars months after her treatment, in part because the technician did not adjust for her darker skin. The skin damage prompted her to delay her wedding.
"Neos has left me scarred physically and a wreck emotionally," the woman said in her complaint.
Neos owner Brian Connelly said he refunded the customer's money but disputed her claims that she had been burned multiple times.
"We get a lot of customers who like to complain, but it's more about money," said Connelly, who added that ARRA inspectors did not cite his spa following the complaint. "If somebody is repeatedly burned, I don't understand why they would ever come back."
Prescott Valley resident Patsy Hart has long used lasers to obscure a port-wine stain birthmark on her right cheek. The treatments, which needed to be completed once every couple of years, worked and provided an important emotional lift for Hart.
Her research showed a manufacturer, Candela, made a laser that was effective at obscuring such birthmarks. The manufacturer referred her to an online directory of clinics that used the lasers. She chose a clinic run by a father and daughter in Sun City. But after her June treatment by Devon Updegraff, she was left with red marks and scars on her cheek. Hart was devastated.
"People never looked me in the eyes. Their eyes always veered off to the right to look at my birthmark," Hart said. "I told her (Updegraff) you messed me back up."
Updegraff attempted to mitigate the scarring with another light treatment last month, but it did not remove the mark, Hart said. She filed a complaint with ARRA, which is reviewing the complaint.
Lisa Campbell, practice manager of Updegraff Clinic for Allergy and Dermatology, said Updegraff would not comment on the case because of patient-confidentiality laws.
Consumers also increasingly are choosing to sue clinics for injuries from laser treatments.
Chandler resident Erin Cowan was left "severely burned and scarred" after receiving treatment from technician Sharon Shearer at Timeless Laser and Skin, according to court documents filed in Maricopa County Superior Court.
Cowan's lawsuit alleged that Timeless Laser "negligently failed to properly train and educate" one or more employees.
An arbitrator awarded Cowan $40,000 to be paid by Shearer, who was a contract employee. The arbitrator did not make Timeless Laser and its owner, Dr. Edouard Mouaikel, pay anything.
Reached by phone, Cowan and her attorney said she could not discuss the case per terms of the arbitrator's award. Shearer could not be reached, Mouaikel did not return calls and Timeless Laser is no longer in business.
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