If Terri Bowling had known that second-degree burns were part of the deal, she never would have gone for a laser hair removal last May at a Washington County spa.
 |
 |
| This photograph of Terri Bowling's legs was taken two days after she had laser hair removal treatment at a Washington County spa last May. |
|
When she saw the sale promotion at Steliotis Dental-Medical Spa in McMurray, Bowling had already had relatively painless laser hair removal at a cosmetic surgeon's office. She figured going to the spa would bring her the same results at a fraction of the price.
But once the treatment began, pieces of Bowling's skin started coming off as a technician zapped her leg hairs. The treatment hurt -- a lot -- and the laser left a trail of red and purple marks up and down her legs. The technician applied aloe lotion and assured Bowling that the pain would go away in a few hours and that the marks would not blister. She went on to remove hair from Bowling's armpits and bikini line -- the pain there was eclipsed by the sensation coming from her legs, Bowling said.
The $1,000 special for three treatments had been a Mother's Day gift from Bowling's husband and two children. The Emsworth family had planned to go out together after the treatment, but Bowling was in such pain that they went straight home.
"By the time I arrived and took my pants off, my legs were completely blistered from the knees down," she wrote to a state investigator. "I was also blistered on my bikini line and underarms where my skin was tanned. I got into a cold tub of water and stayed there for 1 1/2 hours. I just couldn't get out because they were burning so badly."
In the next week, Bowling, 37, went to the emergency room twice and finally landed back at her cosmetic surgeon's office. When the doctor saw her, she hit the roof. Just the week before, Dr. Karen Roche had spoken by phone with an investigator at the state Board of Medicine, urging him to act on two other cases of burns involving non-physicians.
Bowling's case is the subject of a lawsuit filed last year. But it also is part of a drive at the Allegheny County Medical Society to get the laser hair removal treatments regulated in Pennsylvania.
"What the Allegheny County Medical Society feels and what the American Society of Laser Medicine and Surgery feels is that this is the practice of mediacine," said Roche, who practices in the North Hills. "How can a dentist possibly supervise this correctly?"
The dentist in question, Ted Steliotis, said the technician who worked on Bowling made a mistake. But he disagrees with Roche's conclusion.
Very few patients ever suffer burns from laser treatments, Steliotis said, but those burns can happen in a doctor's office as well as in a spa. The issue is technician expertise, and at the Steliotis spa, his wife, Kimberly, was the hair removal expert.
"I think if she had been doing the treatment on Terri, it wouldn't have happened," Steliotis said.
The spa no longer offers laser hair removal, but Kimberly Steliotis performs laser hair removal in a separate facility. Regulation is needed, she said, but not the sort backed by doctors.
"It was an unfortunate incident, definitely," she said. "But it's apparent to me that people are trying to make the assumption that this only happens with non-M.D. providers. It happens to everybody and it has to do with, the more experience you have with a laser the better you are with it. ... I feel way more confident sending someone to myself than to a lot of the doctors."
A loophole in the law
The Food and Drug Administration requires laser manufacturers to sell only to doctors, dentists or other providers whose state licenses include the practice of laser hair removal. But once a laser is placed in the state, it can be sold and re-sold to anyone, said Lou Amberg, a product manager with Candela, a laser manufacturer in Wayland, Mass.
 |
|
| Terri Bowling's experience with laser hair removal was painful and resulted in blistering and splotchy skin. (Steve Mellon, Post-Gazette) |
|
Lasers work by targeting the melanin pigment in dark hair follicles, heating it until the follicle falls out The technique won't work on gray or blond hair because the follicles lack melanin. The ideal candidate, then, is someone with dark hair and very light skin.
But a person with dark skin or a tan -- someone like Terri Bowling -- has melanin in the skin. For these patients, the trick is to heat the melanin in the hair follicles while cooling the melanin in the skin.
"You have to treat tanned skin very, very carefully when you're doing hair removal," said Amberg. "A lot of it is just experience in using the laser and using the settings conservatively."
Light-based hair removal devices were introduced commercially in 1996, with more than 7,000 devices installed in medical, cosmetology and electrology offices around the world by 2000, according to Medical Laser Insight, a trade newsletter. By 2004, the number is expected to grow to more than 17,000 systems.
The newsletter's editor, Michael Moretti, estimated in a 2001 study that more than 5 million light-based hair removal treatments would be performed that year, generating $1.3 billion in fees for service providers.
Fifteen states allow only physicians to use lasers and another 17 have rules governing non-physician use of them, said Dr. David Goldberg, a past president of the American Society of Laser Medicine Surgery and director of laser research at Mount Sinai School of Medicine in New York. For example, Goldberg must perform laser hair removal himself in his New Jersey office, but in his New York office a nurse or physician's assistant under his supervision can do the job.
Goldberg said physicians should always be involved in delivering laser hair treatments, if only in a supervisory capacity, because lasers have become so much more powerful since they were introduced six years ago.
"I have no problem with a spa doing laser hair removal, as long as they have a doctor on the premises," Goldberg said.
The Allegheny County Medical Society first complained to the state Board of Medicine in February 2000. The society wrote again after Bowling's burn and was drafting a third letter last week, said Jack Krah, executive director.
"I think it's a public health issue," Krah said. "People ought to ask some questions before they look at an ad and go off and get this."
Who else can do this?
But other practitioners say doctors aren't the only ones who can safely provide laser hair removal.
Electrologists, for example, say they are plenty qualified to provide the service and hold up Florida as a model for regulation. There, laser hair removal can be performed either in a doctor's office or by an electrologist, said Lisia Cooley-Walch, president of the national Society of Clinical and Medical Electrologists.
"We are the hair removal experts," said Cooley-Walch, who is also an electrologist in Big Rapids, Mich. "We know what that thermal effect is going to be on the skin. We know when to treat and not to treat. We know when to refer to a physician and we want to partner with physicians."
Amberg, the laser manufacturer, says many non-physicians can safely operate lasers. And Dr. Nancy Leiland-Fisher, a dermatologist in Shadyside, said she has referred patients to non-physicians who have provided quality care.
Last November, Bowling's cosmetic surgeon reported that the laser burns left Bowling's legs with a square patchwork appearance. There seemed to be no pigment in the light square areas that had been scarred. That patchwork is still somewhat apparent today and Bowling is using a cream that costs $155 per month to even the pigment.
The state needs to stipulate who can perform laser hair removal and what training requirements those professionals must satisfy, Bowling said. And she wants the state to act before more people are hurt.
Bowling filed her complaint with the state Board of Medicine last year. Her doctor says she was told by a state investigator that he has compiled information on at least five other incidents from around the state. But a spokeswoman with the Department of State said she could neither confirm nor comment on pending complaints.
"Anybody can use these things and pretty much anybody is using them now," Bowling said. "The problem is, if you have a woman who has hair on her face, she won't be willing to come forward to report a problem because she's embarrassed. ... Nobody [at the state] is taking responsibility for this one."
