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The Light Fantastic?

Clients burned or scarred during laser hair-removal treatments at tony day spas have left doctors debating who should -- and who shouldn't -- be doing these procedures.

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In retrospect, the red flags were waving from the moment the young administrative assistant at a brokerage firm arrived at the East Side spa for a consultation last summer. There was the waiver she had to sign, absolving the clinic of any responsibility for burns and pigmentation changes; that seemed to be fairly standard. Then, a few days later, a blotchy brown spot appeared where the technician had done a patch test. Even that didn't deter her; after all, everything looked so clean and professional, and the price -- $400 per session to de-fuzz her underarms -- was right. As an added incentive, the manager not only offered reassuring words but promised to do the procedure herself.

But when the client showed up for her appointment, a technician began the procedure. "The minute he applied the laser, I felt excruciating pain," says the woman, who asked that her name not be used. "It felt like my skin was being ripped off. I told him to stop, and he said, 'Don't worry, your skin is just reacting to the laser. If you stop, we're still going to charge you.' So I let him finish. And when I got up and got dressed, my skin was burning and swelling. The manager gave me some cream and said, 'Well, you did sign the paper. You should have known people react differently. What credit card are you going to use today?' There was scarring all over, gigantic brown spots, skin peeling and burns.

"The blotches are still there," she adds now, months after the ill-fated procedure. "I can't wear anything sleeveless anymore."

Dermatologist Roy Geronemus is, I'm told, the go-to guy for all inquiries about the latest controversy in the skin trade: whether nonphysicians should be performing laser and intense-pulse-light hair removal. Technologies that have burgeoned into an extremely lucrative industry, they do a nice job of depilation on certain skin types (the ideal client has fair skin and dark hairs, and will typically require a minimum of three treatments for "permanent reduction of hair growth," experts say). In the wrong hands, however, they pose similar risks: pigment changes, burns, and scars while, adding insult to injury, still leaving you hairy.

Such mishaps at the dozens of spas in the city have sent a steady stream of patients to the offices of Geronemus and other skin specialists. Investment banker Kim McMillon, for example, who's suing the Greenhouse, a tony 57th Street day spa, for burns she says she suffered during a laser treatment to remove a few hairs from her cheeks and neck. (A spokesperson for the Greenhouse, now under new management, confirmed the essentials of the case.)

"You need training in the problem that's being treated as well as the device that's being utilized," says Geronemus. "You have to exercise clinical judgment, because lasers interact with the skin in different ways depending on the age of the patient, the skin type, the skin color. This is not like a point-and-shoot camera.

"Entrepreneurial types feel these procedures can be done with impunity because doctors have done them safely and successfully," he continues. "We disagree and have the data to support the fact that we're correct." Indeed, in a recent survey of 2,400 members of the American Society for Dermatologic Surgery, nearly half said they were seeing patients seeking help for botched laser and intense-pulse-light treatments. The number includes David Kriegel, who's treating a woman with both hyper- and hypopigmentation (white and dark spots) following laser hair removal at a spa. "She had the section done from her chest to her abdomen. It's a rectangular configuration, so the whole area looks abnormal," says Kriegel, director of dermatologic surgery at Mount Sinai. Geronemus has treated models whose careers have been cut short by burns from laser hair removal. One patient had a mole removed at a spa. "She came in with a large scar on her lip," Geronemus says. "There had been no biopsy taken, and we don't know if it was cancerous or not." Places like Skinklinic, Completely Bare, and Skin Ovations count on the skill of their nurses and aestheticians; a clientele eager for personable treatment ("We like to feel we're giving you a big hug while you're here," says Skinklinic's founder, Kathy Dwyer); and a major return on their investment in high-tech machinery.

"The yield is significantly higher than with a manicure, especially when they're not using physicians to perform the procedures," says Geronemus, whose own office, the Laser & Skin Surgery Center of New York, charges $300 to $800 per session of hair removal, compared with $150 per session and up at Skinklinic.

Some dermatologists have been more sanguine about sharing their territory. "The laser procedures fit well into a spa environment if done correctly," says David Goldberg, director of laser research in the dermatology department at Mount Sinai School of Medicine. When he was president of the American Society for Laser Medicine and Surgery, Goldberg took a controversial stand: "The Society said licensed health-care professionals under the supervision of a trained physician should be allowed to do less aggressive cosmetic laser procedures," he says. "I took some heat for that, but we felt they were fairly simple to do. So we started training LPNs, RNs, and physicians' assistants in hair removal with the assumption that they'd do them under a doctor's guidance.

"The problem is, it didn't work out that way," Goldberg adds. "Now you have them in these spas doing treatments without supervision."

In fact, it isn't only spas and self-styled skin clinics that are expanding their rosters of services to include high-tech procedures. Doctors with no dermatological training are looking for new revenue streams. Kriegel recently attended a seminar on laser treatment where he was joined by internists, endocrinologists, and OB/GYNs.

"A gynecologist deals with women who have hair-removal problems and spider veins, and they want to add features to their practice," says Goldberg. "They take those weekend courses, and I would argue that they're potentially no better than nonphysicians." In fact, Upper East Side dermatologist Stephen Kurtin recently treated a patient for burns sustained during a facial resurfacing performed by an oral surgeon.

Patients can be forgiven for their confusion as to when something stops being a beauty treatment and starts becoming a medical procedure. In fact, one could argue that dermatologists themselves are blurring the line -- particularly those practitioners who offer their own makeup and skin-care products.

"There has always been a fine line between nonmedical and medical beauty treatments," acknowledges plastic surgeon Alan Matarasso. "In the past, the worst thing that happened was that the nonmedical treatments didn't work. Now there is a whole new generation of treatments where the stakes are much higher. And the consequences much more significant."

What to consider when thinking about hair removal:
Make sure there's a supervising doctor on the premises, according to Geronemus and others. Ask the doctor if the recommended treatment is appropriate for your hair and skin type, and if the staff is prepared to handle unanticipated reactions to treatment. And find out as much as you can about the facility's track record before putting yourself in its care.


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