Dear Curious: The court ruling you mentioned is indeed "curious" as it does not seem to recognize the clear language in the Indiana statutes (IC 25-22.5-1-1.1) which defines the practice of medicine to include "performing ANY kind of surgical operation upon a human being... in which human tissue is cut, burned or vaporized by the use of a laser or any other means..."

Hair removal is accomplished by "selective photothermolysis" rather than by "cutting or vaporizing" unless you use too much energy resulting in a BURN. I think you would be "splitting hairs" to try to rely on the appellate court decision when the statute is so clear that the operation of a medical laser constitutes the practice of medicine. Period.

Thanks to Mr. Swain, in the prior post, for posting the meeting minutes of the NJBME, regarding Laser and IPL practice by non-MD's. Does Mr. Swain or anyone else know if Aesthetician (Skin Care Specialist) or P.A. practice in NJ for GLYCOLIC PEELS is limited by the strength of the peels? I cannot find any information on the NJ Board of Medical Examiners website or meeting minutes (as recommended by Mr. Swain). But I had "heard" that non-physician practitioners are limited to peels of less than 30%. The regulations for Skin Care Specialist permit "cleansing or stimulating the face...with or without cosmetic preparations...". Nothing more specific.
Information or citation most appreciated.

Rules for NC I understand that an RN PA or trained personel can perform IPL, or inject Botox, dermal fillers etc. I can't seem to find these answers on their website.

Jo: Try using GOOGLE to find the NC statutes -- in particular how the statute defines "the practice of medicine". In many states the operation of lasers and pulsed light devices is considered "the practice of medicine". If this is the case, you need to dig further into the stautues to see if they explain how- and under what circumstances physicians can delegate certain procedures to "mid level" providers. In New Jersey, for example, they cannot. This can be tricky research -- so it may be a good idea to retain a NC attorney to give you his/her legal opinion.

I believe the NJ medical association keeps referring to laser hair removal as a medical procedure to ensure that they receive all the income and keep everyone else out. I do not believe it has anything to do with safety. I have had laser hair removal perfomed on almost my entire body and went to new york to have it done by women who have been in business there almost 12 years. These women know as much or more about skin and laser hair removal than many of the doctors performing hair removal in new jersey. For examle, many gynocologists and pediatricians have begun perfoming laser hair removal just to add income to their practice. Also, when you call up many of the NJ doctors' offices performing laser hair removal and ask the receptionist who is actually going to do the procedure, they are truthful and tell you a technician will perform the service. New Jersey needs to open up this market. They should set guidelines and regulations and require certain trainnig but there is no reason they should not allow others to offer laser hair removal. In the meantime people just keep going to NY to have it done cheaper.

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I have been in the medical laser biz since 1981, sales,service, install train and inservice attend hundreds of courses taught by the leading laser Dr's. We on the equipment side are regulated by the FDA as to how we can market (510K premarket approval) for instance ,each device. Lasers (Light Amplification by Stimulated Emission of Radiation) are a narrow band with of electromagnetic radiation and are designated by power class I,II,II or IV. Class IV are high power prescription devices. I can only sell them to licensed medical practitioners.Those who have other intense light like IPL which means Intense Pulsed Light, If they are class IV same rule. There are in more recent years devices , not laser but light, like the Radiancy that are class Ii or III and can be used by non physicians. FDA allows laser to claim "permanent reduction" vs permanent removal by electrolsis.Some electrologists are anti laser, but both work, each differently. Laser hair removal is in its 15th year and not going away. Just pick a very experienced practice with no lawsuits.

In response to Andrew D. Swain, Esq (01.18):
Well summarized information but where is the wording that this "opinion" from the NJ medical board is actually a regulation? Sound like it's only a position statement and until it is a regulation it's not law. And also, because the nursing profession is licensed by it's own board, it has nothing to do with the medical board. And if you read (under the Nursing Practice Act of NJ) and nursing's scope of care, RN's are allowed to perform any medical procedure as long as they have been properly trained and are under the "supervision" of a licensed Physician!

This entire discussion is absurd. Making these simple procedures available by law, only through a licensed physician is just a money grubbing power grab. You doc's should come down from your high horses and face reality on this.

The person who removes hair or a tattoo with a laser shouldn't need any more qualification than the person who applies the tattoo...a business license and insurance. They can do more harm with the tattoo gun than the laser...consider the potential for the spread of disease.

Rebuilding an engine correctly is a hell of a lot more complicated than removing hair safely, and I know a few top notch mechanics who never made it to 9th grade. What is the need for an advanced degree (I hold two) to perform these processes?

Any reasonably intelligent individual with normal hand/eye coordination, and good ethics should be able to perform these effectively.

Dear "Tom D" : I would also take issue with your comment that "[T]his entire discussion is absurd.." The simple fact of the matter is that - whether you or anyone else likes it or not -- the use and operation of lasers (and everything else deemed by the FDA to be a "medical" device) is generally restricted to licensed physicians and-- in some states- various personnel whom the physician may be able to legally "delegate" the operation of the device to under his or her "supervision". The laws and regs regarding the legal use of lasers vary a great deal from state to state, are quite complex, and are there whether you like them or not.

The reality is, however, that literally thousands of people are operating lasers (and other devices) "illegally". Generally, most of these people never get "busted". But if you are one of the unfortunate ones who injures someone or gets "squealed on" the penalties can be severe. In most cases the operator would be sanctioned or penalized for practicing medicine without a license. Your comment that "making these simple procedures available by law, only through a licensed physician is just a money grubbing power grab" may in some cases be true as physicians do have considerable influence over the medical boards who often write the regulations and board policies. However, I am not sure you know enough about lasers to know if it would be a good idea to allow their use and operation to be regulated in a different manner. There are many reported cases of people who have been burned, scarred and harmed due to the incorrect use of these powerful devices. It is also possible to cause blindness to either the patient or the operator if proper safety procedures are not followed. It may seem very simple to pick up a handpiece, punch a couple keys and start emitting laser pulses, but there is a lot more going on than meets they eye. Not everyone is a good candidate for certain devices and certain procedures, "test spots" are essential before treating, and a thorough knowledge of adverse events and proper patient care in the event of problems are all essential. This is not a proper area for amateurs. Check the Internet for some of the books on the subject that are readily available. After you do some research you will find that the world of LASERS is really quite complicated and is no place for non-medical people who have not had a great deal of training AND are well supervised by a physician who also knows LASERS.

I'm a non physician owner of a MedSpa since 2005. I'm not able to legally use a laser however I've been certified (gone through vendor training) on all our lasers (have 7 of them) and I've gone through week long courses on lasers and their use. Also I've been in the high tech sector for over 20 years and have used various forms of lasers during that time. In short, I know about and how to use aesthetic lasers.

Knowing how to use them and providing patients services however are two very different different things. Like it or not, the law is the law. We've treated hundreds of patients from other centers with burns, hepatic breakouts, wounds and poor results. Some of the complications were from Doctors who only dabble in the use of lasers but many were from centers that had operators who were poorly trained and or supervised on the proper use of the laser. I'd say most of the burns we see were on patients in which improper settings were likely used.

Can a lay person be trained to do this? Of course but that's not the point. As stated I can certainly provide laser treatments probably as good as anyone. what I lack however is the ability to be able medically treat a patient. As an example a patient comes in for a Fraxel for acne scars. Medical History shows they have had a history of herpes. Who write the script. If they get a severe breakout who treats that condition. If patient lies about going out into the sun pre or post laser who treats the burn? IMO there should always be a laser trained doctor, Physician Assistant or Nurse Practitioner onsite at all times regardless of who is operating the laser. When you do thousands of laser treatments it's not a question of if but when a complication that will require medical treatment will happen.

This is a very complex issue and now home use lasers are complicating the issue further. As another doc said even a laser pointer can burn out a retina. IMO if your office can't treat a potential complication of an aesthetic laser you should not be offering the service.

I am preparing to go to electrology school and also searched the use of lasers and found this website. I find it curious that so many of you are on the side of doctors or medical professionals. I had laser surgery to remove capillaries from my nose and cheeks back in early 2000. I now not only still have capillaries, but also have what are called ice pick scars on my nose. The doctor that performed the surgery is supposed to be an expert in his field, so he told me. He did a lousy job and caused me to have more problems than I originally walked into his office with. My face was burned terribly and when it healed I had capillaries still and ice pick scars . So there!! Doctors are not the best at everything. I am walking proof. I would prefer to have someone that is passionate about what they do perform laser treatments on me and not chose them just because they hold a medical degree. Just because someone is a doctor, please...............that does not make them great.

In Texas you have to go thru a process of becoming legal to perform Laser Hiar removal. You can email krystal@avantemedispa.comor yvonne@avantemedispa.com and they can walk you thru the process.
It will start coming out that many companies are flying under the radar, but Texas believes that the person performing laser hair removal should be properly trained. Most states are the same.
So many Techs are just concerned with not getting caught, however, a good tech will concern themselves with treating thier clients with the best possible service. And you are only the best if you have proper training!
Hope this helps! Lin

Hi I'm a dentist in New York and want to hire an esthetitian to work in my office with lasers (IPL or vela) microdermabrasion and peels. My malpractice insurance covers me for dermal fillers and botox only. What are the regulations in NYS and how I can protect myself or any other useful information
Thanks

In NEWYORK can cosmetologist perform LASER or IPL hair removal legally????

can an esthetician open a business that offers IPL without any relationship to a doctor? i know estheticians can do a paramedical license extension class that trains them in IPL, laser hair removal, and laser treatments... but can they go ahead and open their own laser spa? what about devices that only use radiofrequency, not laser or IPL?

Laser Hair Removal may only be done under supervision of MD, DO in FL. The statute cited by med spa guy is very clear about the matter, he just doesn't know how to read law. Hopefully his clinical interpretations are markedly better than his ability to translate law. Good idea to stick to doctoring, leave the lawyering to attorneys! Hahaha!

Dear Sir: You have aroused my curiousity with your multiple comments (above) that I "just don't know how to read law"; that "my clinical interpretations are hopefully better than my ability to translate law," that it would be a "good idea for me to stick to doctoring and leave the lawyering to attorneys" etc. I would like to know exactly what comment(s) I made in this thread that you are referring to??? You might also be surprised that I have been a practicing lawyer in the State of Minnesota for over thirty years..... I don't mind criticism-- but you need to be specific to be fair. Please tell me exactly what I have said that you think is incorrect??? I always like to learn new things. Educate me.

I use to live in Florida as a manager of a Laser clinic. In FL only a MD (DO), NP, or PA can perforn laser treatments. Estheticians can perform other treatments that are not considered laser or IPL. This would allow estheticians in FL to perform radio frequency treatments for skin tightening/ body contouring etc.
In NY estheticians can perform laser treatments.
In CA the law is similar to FL, except RNs can perform also
In NJ ONLY a MD/DO can perform laser treatments. Granted not many physicians obey by this law, and some try to loophole around it by hiring estheticians from NY ( still doesn't make it legal)

As far as NC and otehr states I am unsure. I will say that "under Dr. supervision" does not require the Dr. to actually be present. In most cases it either means you have a medical director ( in FL and NY its some Dr. we pay to use his name and to eveluate are charts every so often), or the laser clinic most be partially owned by a physician.

and yes in some states ( I believe VA) anyone can perform laser treatments. When I was a trainer for another laser company, everytime I had a training in VA it would be with their receptionist, or a CNA.

I would also like to state that I have seen the worst burns, and misuse of lasers performed by physicians and NP. I feel this is because Drs, NP and PAs can perform these treatments with no proper training. They may know the best way take care of a burn after the fact, but in most cases they have little to no knowledge on how to operate them. I think each state should make it a requirement for any laser operator, physician or not, to have to undergo proper training. Being a plastic or a derm. does not provide you with laser training.

LR - About the only point you made that is accurate that regardless of the educational background of the laser performer, we should all undergo training. Beyond that, much of what you say is wrong. Electrologists can perform laser in FL, under direct supervision. PA or NP is required if performing laser without physician on site. Regarding your comments about burns, misuse of lasers is both a matter of ignorance and arrogance. I have had endless complaints from pts who transfer to us from other locations in our company about treatments done by nurses, etc who have either been treated at the same low setting for a over a year with little result, or have been burned multiple times. Suddenly when they come to us, who are competent enough to use the lasers properly, they suddenly get results and less adverse reactions. This is not to say that there are no good nurse laser providers out there, but I think there must be a difference for this to keep coming up. I even had a pt transfer to us who has been receiving double pass treatments from another clinic. This is specifically forbidden in our company's protocols - yet those doing the treatments there are arrogant enough to ignore that? And not only that, but admit it to us when we call to question them whether they have been doing that, as the pt states? What are they thinking?? I think all states should require a minimum of midlevels to do laser treatments based on what I've experienced with my company. Now imagine what is going on in the stand-alone places with no one to watch over them and no one to answer to!

Sounds like Indiana has its act together. If you can buy the darned things across the counter and use it on yourself with NO training whatsoever, it only makes sense that someone with proper training (it wasn't stated how much training is considered proper, btw) would be able to legally provide laser hair removal. A bearded tatooed lady with training can inject nasty ink all over your body, but in most states only MD's or directly supervised PA's, NP's, or in some cases RN's can provide laser hair removal. Just stupid really. It's all about the money and control. The AMA has had a monopoly on healthcare since the early 1900's and until there is an extreme shortage of doctors (which is coming) they will never relinquish their stranglehold on even such minor procedures as hair removal.

i m a registered Nurse in NC State. Can i Start my own bussienss with LAser treatmetns ? Can i do that please help me ????
.

To Pissed Off, Sean, Frankie et al,

Here are 2 links from the Medical Board of California website informing healthcare providers & consumers that the cosmetic procedures in Medical Spas should be performed by MDs, PAs & NPs.

For more detailed information, please click on these 2 links:

1) http://www.mbc.ca.gov/licensee/medical_spas-business.pdf

2) http://www.mbc.ca.gov/consumer/medical_spas.html

Happy reading to all!!!

Dear "Bahvi": The answer to your question about North Carolina regulations appears to be "no". See below--
http://www.ncmedboard.org/position_statements/detail/laser_surgery/
In July 1999, the North Carolina Board adopted a position statement that laser surgery is the practice of medicine and should be performed only by a physician or by a practitioner working within his/her scope of practice and with appropriate medical training under the supervision of a physician or other practitioner licensed to perform surgical services and preferably on-site. The statement was slightly amended in March 2002.
In August 2002, the Board amended its position statement on laser hair removal to state that laser hair removal should be performed only by a physician or by an individual having adequate training and experience under the supervision of a physician who should be on-site or readily available to the person performing the procedure.
In July 2005 the Board once again amended its position statement on laser hair removal. It is the Board’s position that each patient should be examined by a physician, physician assistant, or nurse practitioner prior to receiving the first laser hair removal treatment. The examination should include a full medical history and a focused physical examination. The position also defines “readily available” in terms of physician supervision.

In the state of NY, esthetician's can basically do whatever they'd like under the supervision of a doctor. We can do laser hair removel. we do it all the time. What is weird though, is that basically a cab driver can basically go take a 1week laser course and receive his laser license and then seek employment at a med spa. i do not agree with this. I feel people should at least be estheticians b/c esti's are trained in hair and hair cycles, and skin, skin types, dieseases and disorders of the skin, and care and maintenance of skin. My mom is a nurse, and she said during nursing school, she learned nothing about hair. Yet, so many states demand that nurses operate the laser. this makes no sense. this is like receiving a facial from a doctor. it sucks. anyways, I'm an esthetician and I perform laser hair removal daily and it is totally LEGAL here as long as the company puts a disclaimer on their consult form letting the client know that the service is not being performed by a doctor or nurse. They happily sign it and fork over thousands of dollars. The truth is, no one gives a sh*# about the person performing the hair removal. as long as they remove the hair the client is happy. as far as injuries and burns, clients have no rights b/c they signed away a consent form understanding that we are not doctors. In addition, the company/med spa is insured, and so are we personally. I know it's a little scary for some to grasp. but the state board of NY has approved this. Therfore, "hey esti's out there, come to NYC and do laser! you'll make a ton of $" as far as nurses go, stay away! You'll be outsold. BTW-just to piss you off even more, esti's can also inject botox here, as long as the doctor is on sight and the doctor showed them how. We practice on oranges....

Hi everybody!
i have been graduated medical university in Armenia ,i certified in obstetrics&gynecology i have 10 years experiences in medicine,
i am going to evaluate my medical diploma,may i open my own laser hair removal buissness in CA after that?

It is difficult for me to read these posts from "laser techs" as they obviously do not know what they are doing and now they have to worry about malpractice because they did not do their homework before buying a laser.

SURGERY is.... ANY PROCEDURE that ALTERS THE STRUCTURE OR FUNCTION OF THE AREA BEING WORKED ON. THAT IS CLEAR AND CONCISE. WHAT IS IT THAT YOU DO NOT COMPREHEND? SURGERY IS THE PRACTICE OF MEDICINE FOR WHICH YOU NEED A LICENSE IN EVERY STATE...... FOR YEARS.

I posted this WELL over a year ago. ALL STATES DO NOT ALLOW THE PRACTICE OF MEDICINE OR SURGERY WITHOUT A LICENSE, THIS HAS BEEN THE CASE FOR MANY YEARS, THEREFORE, ALL LASER "TREATMENTS" ARE SURGERY. LASER COMPANIES SHOULD BE SUED FOR SELLING THIS EQUIPMENT TO YOU. You can't buy an X-ray machine either. Lasers, an X-ray device and electrology devices are for surgery. YES HAIR REMOVAL IS SURGERY but we are licensed in many states.... NOT ALL OF THEM. A class action suit against the companies is in order because they sell across state lines and this comes under the FDA as they control manufacturers of all medical devices. FDA states here on their web site, "lasers are prescription devices that can only be sold to and used by those who are licensed to use them in the state where they are licensed to use them. A laser operator who is NOT an MD is breaking the law UNLESS they work for a doc who supervises the use of the laser by an assistant with the doc standing there to SUPERVISE. (NOT FROM THE GOLF COURSE, OR HIS HOME OR NEXT DOOR, OR THE HOSPITAL.) Too many docs want another stream of income and buy a laser without taking any courses. His hospital will not allow him to do these procedures in the hospital because he is NOT certified or qualified on the device but he can do what he wants in his office UP TO A POINT. Do any of you want this guy to treat you? That is the answer.

I like the way Indiana handles it; been trained to use the device? You're approved to use it. Common sense.

Operating a piece of equipment is not 'medical' in nature. If this was true in all instances a tattoo would be 'medical' in nature, as it uses a medical device, a needle. Thus, based on this rationale tatoo artists would need to be medical drones, er 'professionals' to perform their trade. One problem though... People have been doing tattoos since the dawn of time! Thus, their trade supersedes the existence of regulatory boards.

Retarded California regulations are here:
http://www.mbc.ca.gov/allied/medical_assistants_lasers.html#1

Having doctors run medical boards is akin to government subsidized monopoly. Whereby doctors decide what markets they do and do not want to control. Including their underlings - PA, NP, RN, and the like.

Remove the entrenchment of doctors and problem solved.

In the state of NJ is a RN allow to perform cosmetic botox treatments and derma fillers without a MD supervision

I have read through all the postings and I have seen nothing asking about Oregon State Law on Laser Hair Removal. I do hope I am not duplicating a question. I can not find where the legal info about who and under who and with how can operate a laser for hair removal. I am run under a doctor and the lady i work for is certified in the laser. I am a licensed attestation of 8 years and starting to wonder if this is ok for me to do. I dont want to be working doing this if i am in the wrong. I have been trained by my boss and have been doing this for 4 months now. Does anyone know???

Thanks so much. aldb

States have various laser regulations and predictably some are more lenient than others. HOWEVER, it really does not matter since virtually all efficacious light based devices for hair removal and aesthetic procedures are federally classified medical devices and as such, they are limited in use and ownership. Non physicians cannot own or operate these devices!! It is possible to arrange a business relationship with a physician, but this requires careful guidance

this aesthetician in Virginia is doing a erbiurm fractional laser on the face http://www.youtube.com/watch?v=-5pR1Y__d58&feature=related

Estheticians can rarely and legally perform most laser and light based treatments because doing so is the practice of medicine. Laser hair removal and tattoo removal is arguably not the practice of medicine but the devices that are being utilized are medial devices and they cannot be owned or operated by non physicians. There are many variables bit this is a guide

This is a running question. The problem lies in the vagueness in the laws and unfortunately it seems that only when a catastrophy occurs does the office of the professions do anything.

One problem is physicians very carelessly handing out their license for a few dollars a month compared to what they stand to loose in a malpractice situation.

These lasers except for IpL are class IV medical devices thus designed and supposed to be ordered by a licensed physician but often with used systems or doctors not really thinking it out wind up in improper hands.

The therapies that alter skin integrity at any level, ablate any tissue, alter collagen thus cause a skin tightening or remove pigments are all medical in every state. That means laser resurfacing, fraxil,co2, thermage, laser tattoo removal ( tissue alteration in the dermal level) , sun spot/age spot removal with laser skin tightening are all medical.

One problem is when a non medical person is performing a non medical procedure for instance laser hair removal with an alexandrite laser, now take that same laser change the parameters and position of the handpiece and remove solar lentigines , age spots etc and now you have slipped into the relm of medicine without a license and the operator may not even be aware of it.

The ultimate endpoint will reside in some global decision as to just who can and cant fire a laser at human tissue and untill then it will remain the wild west.