Spotting Cowboys: Aesthetic Laser Treatments in Scotland
Undergoing laser procedures is a fairly daunting thing for many people. There’s a whole lexicon of terminologies and brand names and lots of breathless claims about how a provider can radically change your life and fix all of your problems. How do you filter the nonsense from the reality? How do you know you’re getting value for money? How do you know that you’re going to be safe?
Laser procedures are entirely unregulated in Scotland
Health Improvement Scotland have a very thorough process for vetting independent health care providers, but this only applies to clinics that employ registered health care professionals. Although I have 20 years of experience in critical care I am no longer on the Nursing & Midwifery register and I am considered a layman. HIS has no interest in me.
Pretty much anyone can advertise and deliver aesthetic laser services. They do not need to have any medical experience, or even any training in laser treatments. They do not have to have insurance. They do not need to have any knowledge of basic hygiene or infection control. There are no standards that their laser equipment needs to meet. They do not need to follow any formal treatment protocols. There is no system of oversight or inspection. There is no governing body.
It needs addressed and there are a few folk in Scottish laser and aesthetics who are campaigning to some degree for change. Quality aestheticians find it depressing seeing the harm done to folk on a seemingly daily basis by some services. Particularly when we’re given the challenge of trying to fix it afterwards. But, change management is hard work, time consuming, politicised and often thankless. We’ve got businesses to run, families to raise and all the other normal challenges that life throws at you. Embarking on a crusade to try to clean up Scottish aesthetics is frankly a big ask, but maybe I will give it a go at some point in the future if I can find enough like minded individuals to make it a group effort.
In the mean time, caveat emptor (buyer beware!). Here’s some advice on how to spot the cowboys.
Spotting the cowboys
Is your provider clear about the risks of your procedure?
Any procedure conducted on the human body is subject to risk of an adverse event. This is a fact of life. Many procedures have a very low risk of anything going wrong and some have relatively high risks. We also have to consider just how bad the “going wrong” thing will mean to us in the short, medium and long term. It might be that the treatment does not confer any noticable improvement, or it might mean that it leaves you with a visible mark on your skin, which are clearly two very different degrees of adverse event.
Risks should be detailed in your consultation and referenced in your consent form. Information should be presented in a clear and realistic way. The key term is “Informed Consent”. You should be given useful and realistic information and an apportunity to discuss the treatment transparently in order to make an informed decision on what’s best for you.
A good clinician will only provide treatments with a good chance of success, a low risk of anything going wrong, and a very low risk of anything going seriously wrong. Other providers may tell you that success is pretty much guaranteed and nothing can possibly go wrong, and you should be very wary of that. If things appear too good to be true, then they probably are. If your provider only talks about sweetness and light I would be extremely suspicious of the quality of services on offer.
We never over-promise. If any thing, we under-promise. We do this because it’s the right thing to do, we do it because it’s our business model to replicate our previous NHS experience and always advise clients in their best interests. We don't want unhappy disappointed customers. The alternative isn’t a sustainable business or a fun way to make a living. I’ll probably talk more about business philosophy in another blog post.
Patch testing
Before proceeding with treatment, your operator should conduct a Patch Test to check for adverse reaction. This is where we carry out the treatment on a small scale, fine tuning laser parameters to your precise skin type and the problem we are treating.
Patch testing is a requirement of our insurance. If they are not patch testing you, they almost certainly don't have insurance!
What does the equipment look like?
Aesthetic laser is a technology driven business. The price of the technology is closely related to how effective it’s likely to be and how safe it will be on your skin. If it looks like it came out of a lucky bag then do you really want it shooting energy at your skin?
High quality medical grade branded aesthetic laser equipment is eye wateringly expensive, and you get what you pay for.
There is a lot of very cheap laser equipment built in China that can be bought online for 2 or 3 thousand pounds that is guaranteed to harm you. There’s a UK reseller that puts the same cheap technology in big white plastic housings to make it look more impressive. No, I’m not naming names.
If you don’t think the equipment looks right, do some due diligence on it. Try to identify the brand name and Google it. Gold standard laser brands have a very high online profile internationally and you will find them easily. Providers who fail to boast about their very expensive equipment, don’t have any.
Eyewear
We’re back to safety. High power lasers are extremely hazardous to eyes and eye safety needs to be taken incredibly seriously. If anyone is performing a laser procedure on your face, neck or chest you should be wearing total occluders that cover your eyes completely and seal well. You shouldn’t be able to see anything at all. Being blindfolded during laser procedures does make them a wee bit more challenging but eyes are too precious for it to be any other way.
For procedures on other areas you should be wearing approved laser glasses that match the precise wavelength of the laser or lasers being used on you.
Youtube and social media is full of video of the most appalling laser eye safety which frankly give me the fear. Although to be fair some of these videos come from quite prestigious clinics...
Aftercare
After your patch test aftercare should be discussed and written material provided to refer to at home. Failure to do this suggests a service that doesn't really care what happens to you.
Many reputable clinics will also use this phase in your client journey to try to upsell you a load of extraordinarily expensive lotions and potions. This is an important revenue stream for many clinics. We don't do this because we are not at all convinced that they do very much most of the time, and if they do then you’re likely to find them cheaper online. We’re big fans of Aloe Vera and Savlon cream.
Other Factors
I would be very wary of portable services that deliver treatments in your home. We have two laser platforms at Highland Laser Clinic. They weigh 150kg a piece and precision optics don’t like to be moved. Portable laser equipment is almost invariably cheap and harmful.
The medical experience of operators is important. I use my medical background daily to inform my treatment plans, particularly with more complex clients. Perhaps more importantly is the safety culture and approach that is drummed into anyone with solid NHS experience.
Summary
We hope this has been a helpful guide to spotting the cowboys. Essentially you need someone with really good equipment who knows what they’re doing and is honest about your prospects for success. All the rest is just window dressing