The laser surgery business is booming for treatments like hair, tattoo and wrinkle removal. In 2005, the last year recorded, the American Society for Dermatologic Surgery said its members performed nearly 1 million such procedures, about 300,000 more than in 2003.
Board certified dermatologists, however, are not the only ones operating lasers on skin. Laser treatments are offered at local beauty salons, and are also a big part of the medical spa industry, which has grown by 160 percent in the last three years, according to the International Medical Spa Association.
The association says a medical spa operates under the full-time, on-site supervision of a licensed health care professional. It offers traditional, complementary and alternative health practices and treatments in a spa-like setting.
Some doctors are concerned that while these high-tech devices can produce amazing results, in the wrong hands, the outcome can be horrifying.
Eight years ago, computer programmer Julie Pak went to her neighborhood salon in Illinois to have the rose tattoo on her back removed, a decision she said that left her not only with physical scars but emotional ones as well.
Pak said a laser was used to peel back layers of the tattooed skin. She said she knew the procedure would hurt, but was not prepared for what she experienced --pain that was excruciating "beyond words."
"I was in tears for I believe a week, but certainly while she was doing it I didn't have any anesthesia or anything. She literally had a laser pen and was zapping across my skin," she said. And she said the tattoo was only partially removed.
The proliferation of medical spas and other clinics offering laser treatments worries the ASDS, which said botched laser skin procedures increased 41 percent from 2005 to 2006.
"We see a definite increase in the number of people being damaged by untrained individuals using these lasers and we think that this is just going to be more of a problem," said Alastair Carruthers, president of ASDS. He and other doctors say the increased demand for laser surgery is outpacing the number of people properly trained to use it.
"If you use them inappropriately, you can damage tissue severely. You're trying to damage very selectively, but you can do more than that, so that you can draw a hole in someone if you are being dumb about things," he said.
"Sadly, there are many people who are laser techs who have done very little, maybe a weekend course, maybe some other training. We believe that you require more information than that," Carruthers said. He thinks a physician should always be present during the procedures and that those performing it should have at least basic knowledge of the response of body tissue to lasers, like a registered nurse or physician's assistant.
The ASDS and organizations like the National Coalition of Estheticians, Manufacturers/Distributors & Associations, put the blame squarely on state regulatory boards for what they consider a lack of effective oversight in the industry. Regulation on who can use lasers and what defines "medical supervision" differs from state to state. Some states require a doctor on site, others do not.
According to the ASDS, Kentucky is the only state that requires a doctor to be present in the room while the procedure is taking place. Only four other states require that a physician be on site and available for consultation during treatments. The rest require less stringent physician involvement -- like simply being available by phone or beeper, for example.
"If we could get a clear definition from the state medical boards as to what medical supervision is, it would make our lives a lot easier and it would keep consumers much safer," said Susanne Warfield, executive director of the NCEA.
The salon that Pak said disfigured her back eight years ago has gone out of business. Since then, she has thought a lot about warning signs that should have stopped her from going there for laser surgery. For example, a woman at the salon gave her a price quote on the phone. "I mean, without knowing anything about my medical history, that right there should have immediately been a red flag."
Now, Pak again is enduring painful laser treatments to reduce the scarring and hopefully get rid of the rest of the tattoo
She also tailors her wardrobe to hide the scar.
"Summertime is probably my least favorite season because it's the only time either it's showing or I have to make special efforts to cover it up," Pak said. "Even for my wedding I had a strapless gown, but I had to have a really long veil to cover it up and it was something I was self-conscious about every evening. It affects every day of my life."