A Cary skin doctor told the state's medical regulators Thursday that doctors should perform or closely supervise laser hair removal and similar cosmetic procedures to protect patients' safety.
Dr. Robert Clark's presentation to the N.C. Medical Board was scheduled two months ago. But it came days after the revelation that an N.C. State University senior died this month from an overdose of pain cream she used in advance of a hair-removal session.
Clark said a doctor should be on hand at each facility providing popular cosmetic procedures such as laser hair removal, laser facial rejuvenation, acne treatment and Botox injections to ensure that the treatment is appropriate for the patient, to oversee its administration and to diagnose and treat any harmful complications.
"My opinion is that physicians should be on-site to oversee these procedures," said Clark, a dermatologist who runs Cary Skin Center. "I don't think all these procedures need to be performed by physicians. But there needs to be direct oversight."
Clark ticked off infrequent but serious possible complications: burns, blisters, darker skin, lighter skin, scarring, medicine allergies.
"You can do wonderful things with lasers," he said. "But you can also have adverse outcomes."
The Medical Board, a state agency, is considering clarifying whether it classifies laser hair removal as a medical practice, which it would then have the authority to regulate. It also might say whether doctors have to attend or supervise treatment at clinics and spas.
The lidocaine overdose death of Shiri Berg, 22, on Jan. 5 did not prompt the board's review. But it has added a sense of urgency.
"We've had quite a few calls about it," said the board's lead attorney, Thom Mansfield.
Several board members asked Clark variations of this question: Does a doctor really have to be present for laser hair removal?
Clark, who makes his living partly off the procedure, said yes.
In the audience at the board's meeting in Raleigh, several electrologists shook their heads no.
In interviews after the meeting, they argued several points:
* A laser didn't kill Berg; a prescription drug did. And she suffered her reaction in her car, not at the medical spa she was driving to, so having a doctor at her spa wouldn't have helped.
* Electrologists -- nondoctors licensed to administer electrolysis -- insert needles into people's hair follicles, then jolt them with electricity, a procedure more invasive than many laser techniques.
* The underlying issues are training the providers and following proper procedures. Doctors, they said, aren't the only people who can do that well.
* Requiring doctors to provide the treatments would increase their cost for consumers.
* Doctors have a financial interest in getting the business. Of course, so do electrologists and clinic and spa workers.
"I think a lot of this is about control and money," said Trudy Brown, a Greensboro electrologist and chairwoman of the N.C. Board of Electrolysis Examiners. "The price of treatment would skyrocket. And I don't see how the quality would be better."
Brown, who attended the Medical Board's meeting, said her organization wants the state to adopt tough, uniform training and safety requirements for anyone performing laser hair removal. But, she said, don't limit it to the docs.
"If it's done by a properly trained professional, then it's safe for consumers," she said. "We're not saying that anyone can walk in off the street and do this procedure. But on-site medical supervision is just not necessary."
The Medical Board made no decision on the issue Thursday. It might decide today to begin reassessing its policy.
Staff writer Matthew Eisley can be reached at 829-4538 or firstname.lastname@example.org.