IPL & Laser Safety - Regulate From The Ground Up!

Would it shock you to know that in NSW, you can buy and use a laser /IPL machine with NO training, NO industry regulation, and NO oversight? I know it’s shocked everyone I’ve ever told!

To date, anyone in NSW is able to purchase an IPL/laser or energy based device with NO TRAINING. These people do not need a degree in health, medicine, dermal science or physics… It’s absolutely dumbfounding and highly dangerous! What I’m really saying is that you can go out and buy yourself a machine, label yourself a laser technician and in NSW it is PERFECTLY LEGAL to do so! Moreover, there is no industry body that oversees training, skill, knowledge, or even that the machine you’re using is in working order!

Okay, now that I’ve scared you… Sorry… What does this all mean for you, the consumer? I’ve put it primarily down to RISK.

• A lack of regulation has led to a crisis in patient care, such that IPL and laser complications are now one of the top reasons for medico-legal claims in NSW.

• Regulation in the laser industry is, at present, in its infancy and still has a long way to go to regulating ALL medical grade devices.

• Safety and regulation is left to the practitioner, it is a voluntary exercise and one that the consumer should look into BEFORE undergoing treatment.

Now for the good news… Thrive Skin Clinic ensures that the only staff in our clinic who are allowed to even touch the IPL machine are our registered nurses, dermal clinicians, and Dr. Jemima Grant, who have ALL had the necessary and ongoing safety training needed to provide our clients with the best in care. We are not shy in saying that we have put a significant amount of money and time into staff training, machine servicing, and ongoing education. This doesn’t take into account the years of study our doctors, nurses and dermal therapists have spent at university or obtaining post graduate studies in physics, chemistry and basic skin science. Our equipment is medical grade (powerful) and TGA approved. While it is much more expensive to invest in this equipment and education, for us it's is a no brainer -  patient safety comes FIRST. Burning clients, blindness and scarring are UNACCEPTABLE outcomes for us.

Our clinical model is such that our medical director, Dr. Jemima Grant, ensures oversight to ALL clients. In practical terms, this means that Dr. Grant is available to advise, research current evidence, and can reach out to her aesthetic peers to provide safe protocols for clients. As an example, it is occasionally difficult to know the cause of pigmentation, the optimal laser setting, or to know what medications and medical issues are going to effect a treatment. In these instances, it is better to delay treatment, seek help and try a few test patches before proceeding. Or sometimes, it is safer to not treat at all.

Increasingly,  we are referred clients presenting with issues from other salons and clinics with laser and IPL related complications. The main issue we see is post-inflammatory pigmentation, where the face or body responds to a heat treatment with unsightly, dark pigmentation. Another issue we all too often hear about is blindness (YES! Blindness!) from NdYag laser. Lasers and IPL machines are not toys! As a community, we all need to speak up about this to try and improve patient safety. Regulation is under review, but it has taken years to achieve mere discussions… Unacceptable, really.

We believe that the best way to increase patient safety is to educate our client population: a grassroots kind of regulation! So, this is our #TopFiveTips that you can take with you if you choose to have an IPL or laser treatment in NSW.

1. Ask questions about the machine

   • “Is this machine approved for use in Australia?”

   • “How often is this machine serviced?”

   • “What kind of a machine is this, is it a medical grade machine?”

   • “Do these eye protectors comply with current industry standards?”

   If your technician can’t answer these simple questions without hesitation, it’s time to get out! It’s not worth playing with fire (literally) when it comes to your skin.

2. Ask questions about the technician

   • “What kind of training have you had in this field?”

   • “Do you have your laser and IPL safety certificate?”

   • “Can you show me evidence of your ongoing education and training?”

   If your technician can not show sufficient evidence that they are fully qualified for the job, you know what to do!

   Get out of there… It’s just not worth it!

3. As a patient, have you been thoroughly assessed?

   • Has the technician assessed your skin using the Fitzpatrick Scale?

   • Has your technician assessed your current medications, allergies, and medical issues?

   • Has your technician told you the risks or contraindications of your treatment?

   If your technician does not ask you a few simple questions to assess your suitability for treatment, you should reconsider! It’s important that your technician knows what is going on with your skin and health! This can effect the treatment outcome and it may not be in a positive way… These treatments aren’t cookie-cutter treatments! They rely on unique settings and patient care when it comes to an ongoing treatment plan.

4. Spot test?

   A spot test is when we check a small area of the skin to ensure laser or IPL settings are safe and optimised for your skin. For those of you with lighter skin, this is less important but still optimal if you’d like to do so. For those of you with darker skin tones or of Asian, Indian, Aboriginal or Mediterranean backgrounds THIS IS ESSENTIAL. These are the clients we are seeing weekly who present with dark scarring on their face and body from inappropriate settings… Not ideal!

5. Consider the cost

   You should always consider the cost of your safety. The cost of treatment should be the last point of order on your checklist! Yes, treatment might be $5 but have you weighed up how viable this price is? Will your cheap treatment cause you more financial pain in the long run? Please make sure you weigh up all your options before proceeding with treatment!

Let’s be clear - This post is not a rant stating that all laser technicians must be doctors and nurses. This is not the case at all! In fact at Thrive Skin Clinic, our medical team therapists work and collaborate all the time and our dermal therapists who are all extremely proficient at laser and IPL. Laser safety is not about operator’s background, but about training, experience, and the clinic culture of support and ongoing education to keep us clinician’s accountable and patients safe!

IMAGE: © THRIVE SKIN CLINIC

An Introduction to Injectable Biostimulators with Dr Jemima Grant

2024 will be remembered as the year Biostimulators took hold of the aesthetic market. But what are they? How are they different to dermal filers, and what is their place for patients wanting to acheive beautiful skin as they age? Dr Jemima Grant give us her independent advice including why she uses them routinely in her practice.

What are Biostimulators?

Biostimulators (AKA Injectable Collagen Stimulators) are substances that are injected into the skin, causing a low grade inflammatory response, and inciting an increase in natural collagen production. After a few months, the injected material decays into carbon dioxide and water, leaving a matrix of your own collagen behind to support your facial structure.

The most well known Biostimulators are PLLA (poly - L- Lactic Acid “Sculptra” ), PCL (polycaprolactone “Ellanse” and some soon to land in Australia) and Calcium Hydroxylapatite (CaHA). 2024 will see a host of new kids on the block, notably Rejran ( a polynucleotide, based from salmon DNA), which I won’t be talking about today (but I’m excited by this product to fact that it’s a low risk treatment that can be used to improve skin quality on the forehead and under the eyes).

What do Biostimulators Do?

Collagen Stimulating treatments increase collagen in the skin, and in doing so improve concerns such as skin laxity, thinning skin and scarring. Used at different depths, and in different dilutions, these treatments can also improve facial volume and skin laxity on the neck, decolletage and body.

How are Biostimulators different to Dermal Fillers ?

Dermal fillers are comprised of Hyaluronic Acid, a gel like substance that attract water. These substances are injected into the skin, drawing water into the area and improving facial volume through hydration.

While dermal fillers have their place in aesthetics, it’s primarily for volume restoration, not improving skin quality. While I am a fan of fillers, I have a measured approach - I use HA fillers if indicated, matching the rheology (composition) of the product to my patients skin type and their clinical concern, and always in combination with home care and other procedures. Used in this way, the impact can be natural and long lasting.

However, in many instances, fillers are over used and inappropriately applied - this has lead to large amounts of filler being injected, leading to strange, alien looking and puffy faces - they have too much hydration in their skin.

This is why I now incorporate Biostimulators in my practice - as they not only improve volume, they increase collagen in the skin, leading to improvements such as thicker more resilient skin, improvements in skin laxity and reduced pore size and acne scarring.

How are Biostimulators Injected?

Biostimulators are injected with a needle or cannula. I predominantly use cannula technique as this reduces bruising risk and has an improved safety profile for my patients.

What are the Risks Associated with Biostimulators, and how is this differnt to HA Fillers?

Like most things in life, the greatest strength of Biostimulators (natural collagen induction) is also their greatest weakness.

Because Biostimulators increase in your own collagen, the results are not reversible (e.g. if you don't like the look of them). This is in contrast to Traditional Hyaluronic acid based Dermal Fillers, which can be dissolved with an enzyme (Hyaluronidase) if needed.

Moreover, in the rare case of a vascular occlusion (where the injected product blocks a n artery in the face), or causes an inflammatory lump post treatment, these concerns can be very difficult to treat. While these risks are uncommon, you need to accept them as part of the consent process, and this means understanding the risks, how they are treated, and what your injector is doing to mitigate these risks.

With more clinics starting to offer these treatments, I do urge patients to fully inform themselves about the risks and benefits of Biostimulators, and be aware of some important aspects of care such as the experience and medical oversight of the clinician performing the treatment, their background grasp of facial anatomy and their experience with Biostimulators. This is not a treatment you should undertake using a groupon voucher. Read my blog on Questions to Ask Before Having a Biostimulator Treatment to get some tips on choosing the right clinician to treat you.

What are the Benefits of a Collagen Stimulator Treatment?

While there are some increased risks with Collagen stimulators, there is also a host of benefits.

For one, these type of treatments address the most important root cause of ageing skin- which is a reduction of collagen in the skin. Fillers don't do this, and repeated use or overuse of fillers can lead to an overfilled, puffy face. The results of Collagen Stimulators are very natural, due to the fact they increase your own collagen levels in the skin, and do not cause puffy or overfilled look.

What is the Normal Treatment Plan for Injectable Collagen Stimulators?

In general, after a consultation with my patients, my approach is to start with 2- 3 sessions every 6 weeks, (depending on your age and the severity of your skin concerns. The older you are, or the more severe your skin laxity or concerns, the more treatment you will need, every 6 weeks. with a maintenance session of 1- 2 vials every year. Financially, Collagen Stimulators work out to be the most cost effective injectable treatment as they last up to 2 years and the impacts are cumulative.

For all the reasons above, I prescribe Collagen Stimulator Injections for most of my long term patients over time, in combination with medical grade home care, in clinic treatments, hormone therapy and lifestyle advice to provide a consistent and holistic approach to age management.

Questions to Consider before having a Biostimulator Treatment

Injectable Biostimulator Treatments have risks and are not suitable for all patients, which is why a consultation is essential prior to considering this type of treatment.

With these types of treatments on the rise, here are some guidelines and questions you should be asking your provider before proceeding with a treatment.
It’s your face, not a facial - you are allowed to ask these questions and legally, you should be fully informed!

Start with a Consultation

All good clinicians will start with a medical assessment and thorough initial consultation including examining your face. Thi is also an opportunity for you to “get their vibe” and see if you align with their aesthetic look and values. Trust your instinct. Nobody “needs” medical aesthetic treatments., they should be a choice to empower you, not a substitute for insecurity or a silver bullet for your self esteem - treatments are just skin deep. They don’t make you a better person.

It’s also a good sign if you feel excited and ready to make the next step after your consultation.

However, if you leave feeling undermined, devalued, rushed or pressured into a treatment - or worse - with a host of issues you never thought you had, this is a a red flag.

What is The Experience of your Clinician?

Only an experienced clinician with advanced training skills should be injecting you with a non reversible agent such as an injectable Collagen Stimulator. This is an advanced treatment. This means at least 2 years of full time injecting, advanced training in anatomy, the ability to use different techniques such as a cannula and needle, and hopefully ultrasound training if they wish to inject high risk areas of the face.

Do they understand your Medical History and risks of the treatment?

The clinician should understand what things increase your risk of an adverse effect after a treatment- this means assessing your medical history, medications and surgical history. Your prescribing doctor or Nurse Practitioner should be having this conversation with you, as they have extra training in prescribing and medical knowledge. A regular nurse is not qualified to have this type of discussion with a patient.

What is Their approach to managing risks and complications for nodules occuring after Biostimulators?

Different Biostimulators have different risks, including the risk of nodule (lump) formation. You should ask them what product they are using, what dilution they are using, what the risk of inflammatory nodules is with their chosen product, and how they would manage a complication such as a nodule if it arose.

Again, your prescribing doctor or nurse practitioner needs to have this discussion with you as it involves specific knowledge that is not in the scope of practice of a Registered Nurse.

What is the risk of vascular occlusion and how would your clinician manage a vascular occlusion?

All practitioners should have an “emergency kit” in their clinic which contains an algorithm for managing an unexpected urgent event or complication. You should ask to see it.

Some areas of the face have a higher risk of blood vessel blockage than others. You should know if these areas are being injected, and how your clinician will mitigate these risks.

For example, in my practice, I use Ultrasound prior to injecting a higher risk area, change my technique according to evidence based protocols, and attend independent education annually to keep up to date with the ever expanding medical aesthetics industry. The staff that work with me undergo a stepped approach to injection area, starting with showing competency for a lower risk area before moving on. This is based on peer reviewed (but unfortunately not enforced) protocols - as we have no overarching oversight from a governing body that assesses competency.

While all of these things don’t give me, 100% coverage, they also provide me with the confidence to deal with any concerns. My medical degree and 20 years of experience as a doctor also help me to assess potential concerns independently.

What are the alternatives to Biostimulators?

It is now mandatory for all injectors to inform you about the options for treating your clinical concern. This includes not doing the procedure, non invasive options such as topical treatments and energy based devices/ lasers, different injection modalities options.

The most satisfying consults I have with my patients occur when we come up with the best options for them- and yes, sometimes that involves me opting out of treatment, referring for a surgical lift or blepharoplasty or just simply being honest that I can’t help them with their issue.

As always in medicine, YOU should be at the centre of the consultation, not the clinicians bank balance! Honesty is what brings patients back, and earns you more referrals than any Google Adword campaign!