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Disfiguring Dangers

Medical group issues consumer warning on botched cosmetic procedures

First of two parts

SATURDAY, Dec. 15, 2001 (HealthDayNews) -- A 34-year-old investment banker is suing a posh New York City day spa for $100 million for allegedly botching a laser hair removal that left her face scarred and disfigured.

A young Atlanta woman suffering skin complications due to a thyroid disorder known as Graves disease sought treatment at a plastic surgeon's office for scars on her legs. She was given a chemical peel by an unqualified assistant and, eight hours later, her burning, blistered skin began falling off in sheets. One year later she is still in treatment to repair the damage, health officials report.

Isolated cases? Hardly. The number of people who find themselves harmed or disfigured from what should have been relatively risk-free cosmetic and dermatologic procedures is growing at such an alarming rate that it has prompted the American Society for Dermatologic Surgery (ASDS) to issue a consumer warning.

"We are trying to get the word out that there are a lot of unqualified people offering a variety of dermatological treatments without proper training or even adequate knowledge of the chemicals or equipment they are using," says Dr. Harold Brody, ASDS president and clinical professor of dermatology at Emory University School of Medicine in Atlanta.

In a recent survey of 2,500 ASDS members, 45 percent said they were suddenly seeing many patients seeking repair work for botched treatments. Although there are no firm statistics, estimates of the number of patients harmed by such procedures run into the thousands.

"We strongly suspect that the number who seek help for these mistakes is likely a lot smaller than the number who experience problems and are either too embarrassed or don't have the means to seek additional care," Brody says.

From laser hair removal and skin rejuvenation to Botox and collagen wrinkle injections, from tattoo and wart removals to chemical face peels, the ASDS reports problems nationwide. At posh urban day spas, small-town beauty salons -- even doctors' offices.

Clearly, not all spas or salons are irresponsible. Some, say experts, take their responsibility to clients seriously, using only experienced, well-trained professionals.

All too often, however, consumers are being lured into treatments with promises of high technology at low prices, usually under a doctor's supervision. But what many customers end up with is inexperienced technicians with little or no medical training. Often a doctor is not even in the building, let alone the treatment room, ASDS reports.

For Dr. Roy Geronemus, who helped develop and test much of the dermatological laser equipment used in doctors' offices and hospitals today, the problem is both heartbreaking and infuriating.

"Most upsetting is when a patient seeks help for a serious problem, such as a scar or disfigurement, and ends up looking worse after treatment than before, all because the person rendering the treatment doesn't have the experience or training to properly use the equipment or do the job," says Geronemus, a clinical professor of dermatology at New York University Medical Center in Manhattan.

Knowing how to use the equipment is only half the battle, however. Experts warn that many problems occur when non-medical people overlook a serious medical condition -- sometimes with potentially deadly consequences.

"The number of people who receive cosmetic treatments, such as wart removal, when they should be getting cancer biopsies is truly frightening," says Geronemus. "Serious, life-threatening medical problems are going undiagnosed because dermatological conditions are being treated by people without medical training."

So why are just plain folks doing what amounts to doctors' work -- and getting away with it?

One answer may lie in flimsy state health department regulations governing who can and cannot perform many of the treatments.

According to the ASDS, only 15 states require a licensed physician to operate laser equipment, and only seven states require a physician to supervise a procedure.

A dozen states permit doctors to use their discretion when delegating laser procedures to non-medical personnel, meaning anyone can do it, regardless of training or experience, the ASDS says.

And 18 states have no regulations at all for laser procedures.

The loopholes can be even larger when it comes to chemical peels or Botox wrinkle injections, even though both carry some risk of serious complications.

If a licensed physician is required to be associated with a center offering the treatments, the ASDS says irresponsible spas and salons frequently get around the problem with what some industry insiders refer to as the "rent-a-doc" program.

There's a "network of physicians that will be a 'Physician of Record' for your spa or clinic for $600 per month. It's called the "Rent a Medical Director Program," says Brody.

What To Do

For more information on a wide variety of dermatological procedures, visit the ASDS skin clinic. To learn more about laser hair removal, visit the American Institute of Laser Medicine.

Tomorrow: What to look for -- and what to avoid -- when shopping for cosmetic and dermatologic procedures.

SOURCES: Interviews with Harold Brody, M.D., president, American Society for Dermatologic Surgery, and clinical professor of dermatology, Emory University School of Medicine, Atlanta; Roy Geronemus, M.D., clinical professor of dermatology, New York University Medical Center; Complications From The Non-Physician Practice of Medicine, published by the American Society for Dermatologic Surgery
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