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Facing Facts

A consumer's guide for finding the safest clinics and spas performing dermatologic procedures

Part two of two parts

SUNDAY, Dec. 16, 2001 (HealthDayNews) -- What you see isn't always what you get.

That's the bitter lesson for an increasing number of people who've been harmed, disfigured or scarred from what should have been relatively risk-free cosmetic and dermatologic procedures.

The American Society for Dermatologic Surgery warns that thousands of consumers have suffered disastrous results after enduring a variety of procedures gone wrong. They include chemical peels, Botox wrinkle injections, tattoo and wart removals, even complex laser skin resurfacing or hair removal techniques. Problems range from severe burns, to disfiguring scars and significant skin discoloration, and more.

The reason for the rash of injuries: Almost all the procedures were done by technicians with no medical training, the ASDS says.

"Patients are being enticed into glamorous day spas, skin clinics, beauty salons, and even some unscrupulous doctors' offices with promises of qualified medical care. What they are too often ending up with is untrained technicians and damage that can take years to repair," says Dr. Harold Brody, president of the American Society for Dermatologic Surgery.

So how do you tell the good guys from the bad guys in a world where beauty can be bought and is often an illusion? Ironically, the first rule of thumb is: never let looks deceive you.

"No matter how plush a salon, no matter how sophisticated or costly the advertising, no matter if technicians carry stethoscopes and wear white coats, don't assume anything and ask everything before accepting treatment," says Dr. Jeffrey Dover, an associate professor of dermatology at Dartmouth Medical School.

Among the questions you should ask: How many procedures does the center regularly perform; how long has it been in business; what's the specific training of the person doing your treatment; and has that person previously performed the procedure on the part of the body where you're having it done.

Among the answers you should expect: The center should be performing at least several treatments a day; the technician should have at least several years' experience, and that training should include not only some medical schooling, but specific apprenticeships with board-certified dermatologists or plastic surgeons, Dover says.

Also important: Get a patch test for any procedure that involves a chemical solution on your skin. Doing so can help prevent an allergic or sensitivity reaction, which may also help reduce the risk of burns.

"If the center refuses, don't accept treatment there," says Dover.

Additionally, if lasers are involved, ask if the system has been specifically approved for someone with your skin type, hair color and complexion and for use on the area of your body where you're seeking treatment. And ask to see photos of previous patients who share your physical traits, says Brody.

If your questions aren't welcomed, Brody adds, that's a red flag you shouldn't ignore.

Equally important, never trust a center that lets you choose the treatment. Although you may have a good idea of the kind of result you are seeking, such as wrinkle reductions or scar removals, only a physician is qualified to tell you the best way to achieve it.

"Never accept any treatment that doesn't start with a one-on-one consultation with a board-certified dermatologist or plastic surgeon," says Dr. Roy Geronemus, a clinical professor of dermatology at New York University School of Medicine.

Although a well-trained physician's assistant or nurse may sometimes perform the treatment, be sure a qualified physician is on hand -- no farther than one room away.

"Many spas and salons use the guise of a 'medical director,' often a physician who serves as an umbrella for multiple centers who is not on the premises and may not even be a skin specialist," says Dr. Steven Mandy, president-elect of the ASDS. While this often provides the legal protection to meet state health department regulations, it does not serve the consumer well, he says.

Studies show the bulk of botched procedures occur at the hands of non-physicians. But bad results aren't limited to spas and salons. Sometimes, problems occur when the doctor who is advising or even treating you has a medical degree but no dermatology training.

"One of the fastest growing markets for cosmetic laser equipment are obstetrician/gynecologists and primary-care doctors," says Dover.

You wouldn't want your dermatologist to deliver your baby, Geronemus says. So think twice about having esthetic procedures performed by someone without specific esthetic training, even if she is an M.D., he adds.

"It takes years of dermatology training to do these procedures correctly," he says.

What To Do

Regardless of who does your treatment, or where it's performed, if you experience any significant pain, discomfort or discoloration, or sense that something feels or looks worse than common sense tells you it should, don't wait -- seek medical attention immediately.

Then do what you can to help others avoid similar problems.

"Write or call [your] state medical board, which regulates the practice of medicine in [each] state," says Brody. The address is usually found in the government section of your local telephone directory.

When appropriate, the State Board of Nursing or Cosmetology should also be contacted.

Brody says you should insist that your claim be investigated by the state medical board, and you should ask for written confirmation of what was found.

Finally, he says, send a copy of your complaint, along with a detailed letter describing your complication, to ASDS, 930 N. Meacham Road, Schaumburg, Ill., 60173, or e-mail the society at, to be part of a nationwide registry.

To locate your state medical board, or check on a doctor's credentials in your state, visit the Association of State Medical Boards, or the Federation of State Medical Boards.

To learn more about safety and dermatological treatments, and to see what successful procedures should look like, visit The American Society for Dermatologic Surgery, The American Academy of Dermatology, or The American Society of Plastic Surgeons. (To visit the Society of Plastic Surgeons' Web site, you'll need Adobe Acrobat Reader, which you can download by clicking here.)

For a brief overview of popular dermatologic procedures, click here.

To read Part One of this series, click here.

SOURCES: Interviews with Harold Brody, M.D., president, American Society for Dermatologic Surgery, and professor of dermatology, Emory University School of Medicine, Atlanta; Steven Mandy, M.D., president-elect, American Society for Dermatologic Surgery, and clinical professor of dermatology, University of Miami, Fla.; Jeffrey Dover, M.D., director, SkinCare Physicians, Boston, and professor of dermatology, Dartmouth Medical School, Hanover, N.H.; Roy Geronemus, M.D., clinical professor of dermatology, New York University School of Medicine, New York City
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