Are clinical laser beauty treatments like IPL safe?

The risks of laser beauty treatments

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.”

Most lasers used in Australia are Class 3B or medical-grade Class 4, while IPLs produce a beam of broad-spectrum white light often used to treat skin pigmentation, broken capillaries and excess hair.

But laser devices can also cause disfigurement, permanent laser eye injuries, and infections. Laser treatment to remove moles may also mask signs of melanoma, delaying diagnosis and treatment.

“A 2012 survey identified 416 cases of injury due to unsafe use of cosmetic lasers and IPLs”

“If people go to a a nurse, lesser qualified doctor, beautician or beauty therapist for these treatments, and an inju- ry occurs, it’s dermatologists like me who are left to pick up the pieces,” adds Gupta.

In 2017, NSW Fair Trading received 287 complaints about beauty services, mainly regarding consumer dissatisfac- tion with the quality of the service.

And although recent figures aren’t available, an anonymous survey in 2012 by the Radiation Health Committee identified 416 cases of injury over the previous 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 report- ed cases of skin cancer being delayed or missed (and in 22 of those cases, the cancer was identified as melano- ma).

Are at-home IPL hair removal devices safe?

Studies reporting injuries from home use devices are limited, says Dr Rick Tinker, director of assessment and ad- vice 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.”

“Because consumers aren’t trained to know what they’re doing or what they’re treating, you can potentially make [skin conditions] worse”

At-home IPL hair removal devices are readily available at department stores and online. According to ARPANSA, there are no regulations around the import or marketing of home use cosmetic devices that emit intense light, and while there is limited evidence that such devices are generally less powerful, this information is provided by manufacturers and is not independently assessed.

Gupta believes all laser and IPL devices – whether for use by a consumer or trained professional – need to be reg- ulated, 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 explains.

“Laser devices can cause the hair to become de-pigmented – it will lose its colour and will never respond to any laser or light. An IPL device can also cause [excessive] 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 Com- plaints Commission Report (2018).

Demand has led to laser services popping up everywhere – from the beautician who used to do your facials, to la- ser clinics conveniently located in local shopping centres. Many advertise discounts, loyalty cards and ZipPay type 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’, says Gupta.

“If you go to a specialist dermatologist, you’re getting someone with 16–18 years training,” she adds. “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.”

“These non-specialists… they don’t follow the proper duty of care. So much can go wrong”

You also need to consider what will happen if you do sustain an injury, as non-medical therapists may not be able 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 treat- ment injuries, and believes the line between the business model and the medical model in cosmetic beauty ser- vices 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 ex- plains.

“This is partly because of the way these clinics are marketing themselves and using the language of medical cen- tres, which leaves consumers confused.”

Who regulates your local laser clinic?

It’s complicated.

Queensland, Tasmania and Western Australia 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.

In 2015, a Regulatory Impact Statement by ARPANSA found that the industry would benefit from a system govern- ing the use of lasers and IPLs for cosmetic treatments, but there was insufficient information given in submissions to support a national regulatory framework.

And the push for national standards continues, with a new initiative by the Committee on the Health Care Com- plaints 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 reju- venation, preferably at a national level but at the very least in states and territories currently without regulation.

How to choose a good laser provider

It’s a no-brainer, say experts: 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.

“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 Tinker.

What should I do if I’ve been injured by laser or IPL?

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, however Avery says “establishing negligence can be a bit of a hol- low victory if these operators aren’t insured and have no money to pay compensation”.

“Larger or more reputable providers are more likely to have insurance, so it’s really important to carefully consider who you go to for treatment, both for quality assurance and insurance,” she says.

“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 appli- cable in every state for lodging claims.”