Manufacturers of medical lasers must prove their safety and efficacy to the FDA, but individual states regulate who can purchase and operate them for various therapeutic procedures, and the concept of "licensed practitioner" varies from state to state. "It's the Wild West out there," confirms Dr. Rivkin. "There's minimum regulation, minimum oversight, no way of knowing if a physician is ever there. People walk into a piece-of-crap place in a mall for laser treatments and can be burned forever. It's not like buying underwear at Victoria's Secret. And nobody talks about duration and permanence: Will the effects last?"
That depends on what's being lasered. "Isolated blood vessels or a red spot sitting by itself are different from interlacing vessels on the face or nose," explains Dr. Fitzpatrick. "An isolated spot will go away and stay away, but interlacing vessels have a blood flow that is connected to bigger vessels underneath. It's like trimming a hedge. To some extent, you're going to have to consider this maintenance." Brown pigmentation is usually gone for good after lasering, says Dr. Fitzpatrick, but some of these spots have rootlike extensions beneath the surface of the skin and can return. And I'm surprised to learn that not all "spider veins" are even veins: Those in the face are arteries and must be treated differently.
As for hair, it depends on the strand's thickness (thin is easy) and color (blond, gray, and light red are hardest to burn away), as well as the body part it's growing on. "But there's a spectrum of response," says Dr. Fitzpatrick. "About 20 percent of the population is easily treated, and about 20 percent is difficult to treat. It's not dependent on hair color or location. It may have to do with the anatomical structure of the hair at the root. You can't know that ahead of time, so there's a certain roll-of-the-dice aspect to it."
All the more reason to make sure that whoever treats you has solid credentials. "In my province of Ontario, anyone can purchase, own, and operate a laser," laments Sharyn A. Laughlin, M.D., of Laserderm in Canada. "Laypeople who've never had any training are doing this. And the system is polluted because laser companies are marketing to nonphysicians." Until a few years ago, an outfit in Colorado offered a rent-a-medical-director program for spas so that nonphysicians could get a doctor to purchase a laser. (The program has been discontinued.) "Medical supervision" can mean that the doctor is licensed in California but lives in Utah and visits the spa only sporadically. "Commonly, there will be a physician director by name and nobody's there," says Dr. Fitzpatrick. "The board of medical quality assurance doesn't do anything about it. Insurance reimbursements are getting less and less, and more difficult to deal with; the baby boomer segment of the population adds huge buying power with needs and wants and demands. So a lot of physicians in many different specialties are looking to cosmetic procedures to supplement their income. Some are appropriately trained, and some aren't."
The other side of the coin is the type of procedure that is likely to do no harm but also no good, like a device sold for home use such as the Soft Touch Laser by Nulase. "I could aim a laser pointer at your face all day," says Dr. Rivkin, "and the energy coming through the machine is so small that it's not going to do anything to your skin. They make it to specifications that aren't going to harm anybody if it falls into the hands of a complete idiot." Then why will people buy it? "The beauty business defies the laws of business and takes full advantage of the placebo effect. Even if nothing's happening, you feel better."