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Cosmetic Laser Treatments

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Overview

Laser technology is available in Canada for a number of cosmetic treatments. Examples include skin resurfacing for wrinkle reduction and/or treatment of acne scars, and removal of pigmented blemishes (e.g., age spots and moles). Lasers are also used to remove tattoos.

If you are considering any of these treatments, it is important to look at the potential risks, the alternatives, as well as the potential benefits.

About Cosmetic Laser Treatments in Canada

There are several different types of lasers used in cosmetic treatments. Some of them are visible light lasers, while others are infrared or ultraviolet lasers. All of them share the same basic principle. They emit a beam of energy that is absorbed by the target tissue. The energy converts into heat, which causes damage to the target cells. Depending on the type of laser used, the damage may be permanent or temporary. In most cases, the damage is reversible. However, if the laser is applied incorrectly, the damage could be permanent.

Risks Associated With Cosmetic Laser Treatments

Even when the correct laser instrument is chosen for a given treatment, there is a risk of temporary effects, including immediate pain, reddening of the skin, bruising and swelling. Some lasers are equipped with cooling devices to reduce this risk. Other possible side effects include the formation of blisters, burns and infection. In some cases, there may be lightening or darkening of the skin, but these complications are rarely permanent.

If the wrong device is used or if a procedure is not done properly, the desired results may not be obtained and there is a risk of permanent scarring. There is also a risk of eye damage if you do not wear proper eye protection during laser treatments.

Infection risk:

Laser Tattoo Removal

While laser tattoo removal is generally considered a non-invasive procedure, laser treatment may cause superficial burn wounds, blisters, or scabs. Bacterial, fungal, and viral infections can occur if the skin layer is damaged and microorganisms are introduced to the site. The potential sources of these microorganisms are:

Use of contaminated and/or improperly reprocessed equipment.

  • Contaminated environment.
  • Client’s own bacteria on the skin
  • Unclean hands touching the treated area.

Common side effects of laser tattoo removal include pinpoint bleeding, edema, crusting of the skin and blistering. Blisters and pinpoint bleeding are generally more common in darker skin types.  Local allergic reactions can occur in the form of papules, nodules or plaques. Rarely, systemic reactions following laser treatment of allergic tattoos have been reported. In a large prospective study of laser tattoo removal, adverse effects were observed in 6.2% of patients with hyperpigmentation. Spot size, fluence, and pulse duration are important considerations in laser tattoo removal.

Laser Rejuvenation (PicoWay® Resolve Treatments)

Intense pulsed light uses high intensity pulses of visible light to improve the appearance of skin, such as acne and removal of unwanted hair. The energy penetration and wavelength in this procedure is generally longer than that of cutaneous and diode laser systems.

Infection risk:

Intense pulsed light may result in various side effects, including changes in skin pigmentation, blisters, crusts and folliculitis or infection of the hair follicle. With too much melanin in the adjacent skin, the light energy can be absorbed into the surrounding epidermis, causing epidermal damage. This is less common for intense pulsed light than for cutaneous and diode lasers.

The potential sources of infections are:

  • Contaminated or improperly reprocessed equipment.
  • The client’s own bacteria on the skin.
  • Contaminated environment.
  • Unclean hands touching the treated area.

Infections can be bacterial (e.g., Mycobacterium chelonae, Staphylococcus aureus, Pseudomonas aeruginosa), fungal (e.g., Candida spp., Aspergillus spp.) or viral (e.g., herpes simplex virus).67 Rare side effects include post-inflammatory hyperpigmentation and burns with blisters.

Source: Guide to Infection Prevention and Control in Personal Service Settings

Other Concerns

Incorrect Devices

Lasers that have not been licensed for use and sale in Canada should never be used to treat the skin. To find out whether your provider is using a licensed laser in Canada please search the device or manufacturer name in the Medical Devices Active Licensing (MDALL) database.

Absence of Intellectual Property Registration

Where a provider is using a laser device that does not have its brand registered in Canada this can pose a risk, since there could be counterfeit and harmful devices in the marketplace. You can search whether the device brand has been registered in the trademark database at the Canadian Intellectual Property Office "CIPO". A properly protected brand name offers protection since the brand owner is obligated to keep any counterfeit, or infringing (similarly named devices) off of the market.

Signs of Risk

If the device cannot be located in the MDALL database, and if the brand name cannot be found at CIPO then there is a good chance that the treatment offered from the provider is potentially unsafe.

Unregistered devices typically result in lower treatment price points, since the cost of the machine is substantially less when snuck into the Canadian marketplace. Some importers will attempt to circumnavigate detection from Canadian Border Services by providing direct to business sales with undeclared/misdeclared contents and values.

If the provider has not conducted a thorough consultation process, including precare and aftercare advice, this is also a sign that the treatment is high risk.

Finally, if the provider has not taken the necessary precautions of using personal protective equipment in the treatment, this is also a sign that the treatment is high risk.

Minimizing Your Risks

There are several important ways that you can minimize your risks in using laser treatments, and improve your possible treatment outcomes.

Precare and Aftercare

Your laser provider is required to include precare and aftercare instructions to support your treatment. Using these important instructions you will avoid certain products and lifestyle activities leading up to your treatment. You will also follow the aftercare instructions to support the best possible results, and to decrease your chances of negative effects. Following only those instructions from your provider will ensure that your aftercare efforts are relevant to your specific treatment. Never use aftercare instructions provided by a third party unless they are a qualified healthcare professional.

Physician Permission

When choosing laser treatments to resolve unwanted dark spots it is important to know that not all spots should be treated with laser.

The Canadian Cancer Society publishes the "ABCDE" rule to tell a normal mole from skin cancer. Skin cancer should not be treated with the PicoWay® laser.

The ABCDE rule helps health professionals assess different features to tell a normal mole from skin cancer.

A is for asymmetry. One-half of a mole does not have the same shape as the other half.

B is for border. The edge of a mole is uneven (irregular). It can look jagged, notched or blurry. The colour may spread into the area around the mole.

C is for colour. The colour of a mole is not the same throughout. It could have shades of tan, brown and black. Sometimes areas of blue, grey, red, pink or white are also seen.

D is for diameter. The size of a mole is larger than 6mm across, which is about the size of a pencil eraser.

E is for evolving. There is a change in the colour, size, shape or feel of the mole. The mole may become itchy or you may have a burning or tingling feeling.

7-point checklist

The 7-point checklist may be used to help health professionals find changes that may be skin cancer. It looks for 7 specific features in a mole or coloured area of skin. Each feature that is found is given 1 or 2 points depending on the type of feature. If a mole or coloured area scores 3 or more points, you are referred to a specialist or sent for more tests. The features are divided into 2 groups – major features and minor features.

Major features (2 points each):

  • change in size
  • uneven (irregular) colour
  • uneven shape

Minor features (1 point each):

  • more than 7mm in diameter
  • changes in feeling, such as itchiness, tenderness or pain
  • oozing or crusting
  • inflammation or bleeding

If your mole or treatment area meets any of the criteria above, you should not seek out laser treatment to resolve your skin concern. You should instead consult with your primary physician who can refer you to a qualified health professional.

If a health professional notices an abnormal area during a skin exam, they will decide if you should have further tests. You may be referred to a specialist, such as a dermatologist or plastic surgeon. A skin biopsy may be done to check for cancer.

Source: cancer.ca

Protective Equipment

It is extremely important that all authorized personnel entering the laser treatment controlled area be provided with eyewear. Fire safety equipment and ventilation must also be available to protect the operator and patient from other potential laser hazards. Protective equipment must be serviced and maintained as recommended by the manufacturer to ensure safeguards remain functional.

Eyewear

Eyewear is the single most important piece of protective equipment needed by persons within the laser treatment controlled area. Studies have shown that 70 % of laser eye accidents resulted simply because available protective eyewear was not worn, or inappropriate/damaged eyewear was worn.

Protective eyewear for both the operator and the patient needs to be able to stop laser radiation coming from all directions from striking the eye. This means the eyewear must have side and top guards and fit snugly around the nose. Laser protective eyewear for the laser operator must also allow visible light to pass through it so that the wearer can see adequately to perform their tasks safely, while at the same time preventing the wavelength emitted by the laser from passing through.

Protective Eyewear (Lasers)

The most important factor in selecting operator protective eyewear is that it must protect against the wavelength emitted by the laser. Therefore, protective eyewear must be labelled with the same wavelength that is emitted by the laser (i.e. 755 nm, 810 nm, 1064 nm, etc).

NOTE:Eyewear will NOT provide protection for lasers that emit radiation of a different wavelength from that which the eyewear is designed for. Simple safety goggles or glasses must NEVER be used for laser eye protection!

All laser providers at IVONNE have a baseline eye examination.

Canadian Regulations

Canada's federal government controls the sale, lease and import of lasers, as per the Radiation Emitting Devices Act and laser treatment devices must meet the requirements of the Act. Laser therapy facilities are advised that they should only purchase laser treatment devices that have an active Canadian medical device licence in accordance with the Medical Devices Regulations. Licence status can be verified.

Ontario Regulations

The province of Ontario under the general duty clause of the Occupational Health and Safety Act requires employers to take every precaution reasonable in the circumstances for the protection of a worker. To fulfill this duty, the Ministry of Labour accepts the ANSI Z136 series of standards (CSA Z386-08 for health care facilities) to protect workers from hazards associated with the use of lasers.

Key legal requirements

In Ontario, the Occupational Health and Safety Act covers the safe use of lasers in the workplace. There is no regulation specifically for lasers. Under the Occupational Health and Safety Act,employers must:

  • take every precaution reasonable in the circumstance to protect workers from hazards, including those related to the use of lasers
  • provide training on the safe use of lasers in your workplace to any worker who may be exposed to the hazards
  • when appointing a supervisor, appoint a competent person who is qualified because of knowledge, training and experience. He or she must also be familiar with the Occupational Health and Safety Act and any regulations under it that apply to the workplace, and know about any actual or potential health and safety hazards in the workplace.

Controlled Acts

In Canada laser treatments are not considered to be a "controlled act" under O. Reg 107/96. As such the treatment via use of laser for tattoo removal, benign pigmentation, and skin rejuvenation does not require the practitioner to be a regulated health professional. They do however, need to be compliant with the other regulations, namely those referenced in this guide.

Controlled Acts are otherwise defined and regulated under the Regulated Health Professions Act 1991 S.O.

 A list of regulated professions in the Province of Ontario.

More Information

For more information contact:

Medical Devices Bureau,
Therapeutic Products Directorate
Health Canada
Room 1605, Statistics Canada Main Building
Tunney's Pasture
Ottawa, ON K1A 0L2
Telephone: 613-957-7285 

and/or

Consumer and Clinical Radiation Protection Bureau, Health Canada
775 Brookfield Road
Ottawa, ON K1A 1C1
Telephone: (613) 954-6699

To report problems associated with the use of medical devices, including laser systems, call Health Canada's toll-free hotline at 1-800-267-9675.

Also, see the following Web sites:

The U.S. Food and Drug Administration Web site:

Treatments Available at IVONNE™

Now that you have been informed about how laser treatments are delivered and regulated in Canada, you may be interested in receiving your own laser tattoo removal or laser skincare rejuvenation treatment.

Laser Tattoo Removal

Laser Skincare Treatments

Disclaimer:

IVONNE™ is a personal care service setting regulated by O. Reg 136/18. Although IVONNE does not employ regulated healthcare professionals on its staff our treatments are delivered in partnership and through our excellent working relationship with regulators and regulated healthcare professionals. The information provided on our website, through our social media, and email campaigns are for information purposes only, is not intended to replace medical advice, and may not apply to every client, in every situation. Results are never guaranteed and will vary from client to client. Speak with your provider to learn more about the risks and benefits that are unique to you. First consult with your primary physician to explore any skin concerns before subscribing to any cosmetic treatments.

Sources: