Living in the age of airbrushed celebrities and the ever-present selfie, it's no wonder that laser beauty treatments are a tempting prospect for many.
There are multiple clinical treatments to choose from, such as laser hair removal, laser tattoo removal, carbon dioxide and erbium lasers, and intense pulsed light (IPL) treatments – the latter two are used to 'rejuvenate' skin and reduce wrinkles.
But are these treatments safe? And how can you protect yourself?
In the wrong hands, laser or IPL can cause a range of injuries.
"I see a lot of scars, burns and pigmentary changes; 'stripes' of white or brown," says Sydney-based cosmetic and medical dermatologist Dr Ritu Gupta, from Platinum Dermatology, who's also a media spokesperson for The Australasian College of Dermatologists.
"If people are treated at incorrect doses, it can also cause an increase in hair growth rather than a decrease. Or it might turn the hair white, so it will never respond to any form of laser or light therapy hair removal. That's just the tip of the iceberg."
If used incorrectly, laser devices can cause disfigurement, permanent laser eye injuries, and infections
Most lasers used in Australia are Class 3B or medical-grade Class 4, which puts them in the highest categories of risk to public health.
IPL is not actually a 'laser' treatment: it produces a beam of broad-spectrum white light, most often used to treat skin pigmentation, broken capillaries and excess hair.
If used incorrectly, laser devices can cause disfigurement, permanent laser eye injuries, and infections. Laser treatment to remove moles may also mask signs of melanoma, delaying diagnosis and treatment.
"If people go to a a nurse, lesser qualified doctor, beautician or beauty therapist for these treatments, and an injury occurs, it's dermatologists like me who are left to pick up the pieces," adds Gupta.
Recent controversy over some cosmetic surgeons (such as Dr Daniel Lanzer) has raised questions about how poorly regulated the industry is, especially in regards to practitioners who may call themselves cosmetic physicians (when they're not trained physicians) or skin specialists (when they're not trained as dermatologists).
Dr Gupta says, "The public is potentially at risk, particularly as non-specialists may appear to be physicians, surgeons or skin specialists, when in fact they are not. True specialists need to be accredited by the Australian Medical Council, do entrance and exit exams, and have a minimum of four to five years of training just in their speciality."
Complaints and injuries
In 2017, NSW Fair Trading received 287 complaints about beauty services, mainly regarding consumer dissatisfaction with the quality of the service.
And although more recent figures aren't available, an anonymous survey in 2012 by the Radiation Health Committee identified 416 cases of injury over the preceding 12 months due to unsafe use of cosmetic lasers and IPLs.
Of these cases, 268 of the injuries, including burns and scarring, were classified as severe, and there were 62 reported cases of skin cancer being delayed or missed (and in 22 of those cases, the cancer was identified as melanoma).
"The public is potentially at risk, particularly as non-specialists may appear to be physicians, surgeons or skin specialists, when in fact they are not," says Dr Gupta.
Studies reporting injuries from home-use (or at-home) devices are limited, says Dr Rick Tinker, director of assessment and advice at the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA).
"[But] there is potential for harm to the eyes from exposure to these intense light sources, or skin injuries from inappropriate use," he says. "ARPANSA's health advice for consumers about lasers and IPL applies only to consumers seeking treatments in service provision settings – but the health risks associated with home-use devices may be similar to those detailed within our advice."
Lack of independent assessment
At-home laser and IPL devices that are used for various cosmetic applications, including hair removal and skin rejuvenation, are readily available for consumers to buy.
According to ARPANSA, there are no regulations around the import or marketing of home-use cosmetic devices that emit intense light. There is some evidence that such devices are generally less powerful, but this information is provided by manufacturers and is not independently assessed. At-home devices are also often lower cost and poorer build quality, with less robust safety features.
Because consumers aren't trained to know what they're doing or what they're treating, you can potentially make [skin conditions] worseDr Ritu Gupta, medical dermatologist at Platinum Dermatology
Gupta believes all laser and IPL devices – whether for use by a consumer or trained professional – need to be regulated, even if at-home devices are cheaper and less powerful.
"IPL hair removal devices work by a wavelength of light targeting the hair follicle, and because consumers aren't trained to know what they're doing or what they're treating, you can potentially make [skin conditions] worse," she says.
"Laser devices can cause the hair to become depigmented – it will lose its colour and will never respond to any laser or light. An IPL device can also cause hair growth. So I think if you're serious about hair removal, you should go to a specialist practice."
As Dr Gupta and Dr Tinker warn, the risks associated with at-home devices may be similar to those used in clinical settings. But if you still want to use one, we've tested a small number of IPL devices.
An industry on the rise
In 2017, there were over 35,000 beauty therapists employed in Australia. The non-surgical cosmetic health services industry generates over $1 billion annually, according to figures from the Committee on the Health Care Complaints Commission Report (2018).
Demand has led to laser services popping up everywhere – from the beautician who used to do your facials, to laser clinics conveniently located in local shopping centres. Many advertise discounts, loyalty cards and buy now, pay later platforms such as ZipPay and Afterpay credit payment schemes to draw customers in.
However, this rise in non-specialist laser providers is putting consumers at risk, warn experts.
What type of training is required to operate a laser?
Currently, there's no standard for training – a beautician could do a one-day online course or weekend workshop to operate a laser. There are also concerns that many laser operators aren't trained at all, or are operating cheap devices that 'aren't tunable' and essentially have an 'on and off switch', according to Gupta.
"If you go to a specialist dermatologist, you're getting someone with 16 to 18 years' training," she says. "What happens when you go to these non-specialists is that they're not equipped to diagnose or treat [skin blemishes or conditions], and they don't follow the proper duty of care. So much can go wrong."
What if you suffer an injury?
You also need to consider what will happen if you sustain an injury, as non-medical therapists may not be able to cope with follow-up and care.
"Patients who've sustained an injury and returned to the clinic are often told it will 'get better by itself'," says Gupta. "And it won't get better by itself. It needs to be treated, often with medicine, which requires writing a script. And these people aren't doctors. They can't write a script. And even if they could, they wouldn't necessarily know what script to write."
Don't be fooled by a white coat
Another issue is the rise in commercial establishments over clinical ones, and laser operators being able to call themselves a 'laser specialist' or 'skin specialist' when they're not accredited.
Personal injuries lawyer Kate Avery from Kare Lawyers in Brisbane has dealt with claims arising from laser treatment injuries. She believes the line between the business model and the medical model in cosmetic beauty services is becoming increasingly blurred.
"There's this move towards what would be regarded as semi-medical procedures being carried out by people who don't have medical qualifications, and the community doesn't seem to recognise that difference," she explains.
"This is partly because of the way these clinics are marketing themselves and using the language of medical centres, which leaves consumers confused."
Be aware of the risks from the start
Avery says she's also seen injuries emerge from cosmetic surgery clinics.
"From a consumer point of view, it's important to remember that cosmetic surgeons aren't qualified surgeons unless they have FRACS after the doctor's name, so make sure you check this before any procedure," she says.
It's important to remember that cosmetic surgeons aren't qualified surgeons unless they have FRACS after the doctor's nameKate Avery, Kare Lawyers, Brisbane
"Secondly, some cosmetic clinics appear to operate on the basis of the surgeon – even if they are qualified – flying in from interstate to do multiple surgical procedures, then flying out again. This leaves the postoperative care to nursing staff, which increases the risk to patients, many of whom don't know about it in advance."
She adds that it's important to know well beforehand of all risks associated with the procedure.
"Some cosmetic clinics provide information about the risks of the procedures on the day of the procedure," says Avery, "when consumers don't have time to consider them properly."
Who regulates your local laser clinic?
It's complicated. Queensland, Tasmania and WA have regulations in place for the use of lasers, while IPL is currently only regulated in Tasmania. In the other states and territories, there are no regulations in place at all, which means anyone could essentially 'set up shop'.
Often the devices used for cosmetic treatments can be bought cheaply online, and aren't necessarily approved by the Therapeutic Goods Administration (TGA) because their use for cosmetic purposes is not considered medical.
Still no national standards
In 2015, a Regulatory Impact Statement by ARPANSA found that the industry would benefit from a system governing the use of lasers and IPLs for cosmetic treatments. But not enough information was given in submissions to support a national regulatory framework. ARPANSA is currently collaborating with Monash University to investigate the health burden of cosmetic laser and IPL treatments.
And the push for national standards continues, with a new initiative by the Committee on the Health Care Complaints Commission tabled in 2018, containing 16 recommendations to the NSW Government. These included the regulation of lasers and IPL devices used for hair removal, tattoos, pigmentation and skin rejuvenation – preferably at a national level, but at the very least in states and territories currently without regulation.
Ask your GP for a referral to a cosmetic dermatologist or plastic surgeon. "Or look up dermatologists in your area," says Gupta. "They'll have the letters 'FACD [Fellow of the Australasian College of Dermatologists]' after their name – and phone to ask if they perform specific cosmetic services such as laser or IPL. If they don't, they'll refer you to someone who does."
Also, be aware that cost isn't necessarily an indication of expertise, as some laser clinics may well have untrained operators and charge hundreds for treatments you don't need.
Be aware that cost isn't necessarily an indication of expertise, as some laser clinics may well have untrained operators and charge hundreds for treatments you don't need
"In some cases I've seen, clients whose hormonal pigmentation was incorrectly diagnosed and treated as sun damage by laser or IPL was made much, much worse, when an inexpensive cream would have treated it," says Gupta.
Another resource is ARPANSA's advice for consumers and advice for treatment providers. "The consumer guidance offers advice on what quality service they should be looking for, the types of questions they should be asking a service provider, and where they should go if they want to make a complaint," says ARPANSA's Dr Rick Tinker.
If you've suffered an injury at the hands of a non-medical laser or IPL operator, you should consult a medical professional as soon as possible and report your adverse reactions to the Health Care Complaints Commission in your state or territory. You can also lodge a complaint with the ACCC.
Getting legal advice may be another avenue. But Avery warns, "establishing negligence can be a bit of a hollow victory if these operators aren't insured and have no money to pay compensation.
You should consult a medical professional as soon as possible and report your adverse reactions to the Health Care Complaints Commission
"Larger or more reputable providers are more likely to have insurance, so it's really important to carefully consider whom you go to for treatment, both for quality assurance and insurance.
"If you do suffer an injury as a result of negligence on the part of a beautician, beauty therapist or laser clinic, you should consult a solicitor promptly about the possibility of recovering compensation, as there are time limits applicable in every state for lodging claims."