Many people looking for the fountain of youth seek out "med spas" and laser clinics that offer laser treatments to get rid of unwanted hair, rejuvenate the skin by removing wrinkles and lines caused by sun damage, and treat acne scars.
A 12 News investigation uncovers dangers associated with cosmetic laser procedures which are essentially hidden from the public.
There is only one inspector for the entire state, and Arizona's 1,504 laser facilities are on the honor system when it comes to reporting laser burns to the Arizona Radiation Regulatory Agency.
Med spas and laser clinics must register with the ARRA and laser technicians must be licensed. The ARRA is charged with inspecting med spas and laser clinics in addition to investigating complaints filed by consumers with the agency. The ARRA also oversees X-ray equipment and monitors radiation exposure.
The state regulatory agency makes it mandatory for med spas and laser clinics to report second-degree burns that are larger than one inch in greatest diameter or any third-degree burn of the skin or any eye injury with any potential loss of sight.
Experts say botched laser procedures can leave scarring, hyperpigmentation and even lead to permanent disfigurement.
In Arizona, one can become a certified laser technician by completing a total of 64 hours of training on the devices, which includes 24-hours of hands-on instruction.
However, laser technicians must work under the supervision of a medical director, who is a prescribing healthcare professional, either a doctor or nurse practitioner. The medical director does not need to be in the room while the laser technician performs the procedure, but he or she does have to be on site for most procedures.
Our investigation found, while their name may be on the marquis, often the medical director is nowhere to be found.
The case of Aishah Al-Sowaidi
"It really has permanently scarred me until this day, so I deal with that," said Aishah Al-Sowaidi, claiming she is still dealing with the aftereffects of burns from laser-hair-removal procedures she underwent at a Chandler med spa in 2013.
"It felt like fire on my legs for days," said Al-Sowaidi.
Receipts show she paid $4,500 for treatment packages. Photos show permanent scarring two years later.
"You could tell from each pulse, there was a burn down my thigh, there was burn on my inner thigh, burn on my knee cap," Al-Sowaidi said. "I have hyperpigmentation all over my legs and still on my underarms."
Al-Sowaidi claims the medical director was not on site to supervise the laser-hair-removal technicians. That is not uncommon. In fact, for laser hair removal only, state law allows the doctor to direct the technician doing the procedure over the phone.
Al-Sowaidi says she contacted the plastic surgeon who was the medical director for the med spa but claims nobody wanted to do anything.
Records show on Sept. 1, 2013 Al-Sowaidi filed a complaint with the Arizona Radiation Regulatory Agency.
"As soon as I had the blistering burn on my knee that was a liquid-filled burn, that's when I reported it," she said.
Al-Sowaidi wrote her first priority was to report the med spa for "practices that are not conducive with set regulations by the ARRA."
In addition to her scarring, she claimed the laser technicians treat clients without wearing glasses and the patients are not required to wear them either. She complained of "constant burns," which she says were not reported, and what she called a lack of knowledge when treating patients with Mediterranean and Asian skin types such as hers.
Al-Sowaidi concluded her complaint by telling the ARRA she was "essentially a walking laser-burn victim by this establishment and out $4,500 to still have hair regrowth due to their lack of knowledge in treating ethnic clientele."
Al-Sowaidi's complaint with the ARRA was closed in September, 2013 after the facility was inspected.
Lauren Mayes, the State Health Physicist for the ARRA says there were no violations issued and it was determined that there were no reportable injuries. Keep in mind, laser facilities are required by law to report laser burns to the ARRA only if they are second- or third-degree burns.
The owner at the time sent Al-Sowaidi an email stating, "The ARRA has already investigated your claims and found no fault. I'm not sure what's left for you."
Ultimately, in March of 2014, the med spa entered into a settlement agreement with Al-Sowaidi. "Without admitting any liability but solely in the interest of compromise and resolution and customer service" it said, the med spa agreed to give Al-Sowaidi a refund in the amount of $477 for unused treatments.
Al-Sowaidi remains worried others will be harmed because no one is informing the public about the risks.
"I was just a guinea pig that they were testing their lasers on," she said.
Only one state inspector
Currently ARRA program director Jerry Perkins concedes the regulatory agency has only one inspector for the 1,504 facilities registered statewide.
"So we do at times not meet the inspection frequency," Perkins said. The inspection frequency the ARRA tries to meet is an inspection every two years.
As of Oct. 22, 2015 ARRA is late on its inspections 51 percent of the time, according to Perkins, which means that more than half the facilities in Arizona haven't been inspected in over two years.
"I have other staff members that are cross trained in this area from X-ray," Perkins said. "However that program is about 47 percent behind as well, so migration of an inspector from one area impacts the other."
Perkins says the numbers change every week as more facilities are added and some inspections are completed. "We are currently trending to reach closer to 60 percent by June 30, the end of the fiscal year."
Perkins says he's trying to put technological updates in place to improve efficiencies, but there are challenges.
"This takes funding, and programming time, so it will be months, if not years before I can see gains from that project," he said.
Perkins said the agency's database is not set up to determine the number of months or years on average a facility is overdue for inspection.
When the facilities are inspected, violations are often discovered.
"The laser hair technician or even a cosmetic laser technician is either working out of scope, meaning doing procedures they're not authorized to do, or the medical director, prescribing healthcare professional, is not present at the time anything is occurring other than laser hair removal," Perkins said.
Here are the top three violations, according to Perkins:
- Unlicensed or expired certifications for the laser technicians or conducting additional procedures they are not trained or certified in.
- Procedures other than hair removal being conducted without a medical director at the facility.
- Non-authorized individuals supervising laser technicians.
'I could smell my flesh burning'
On May 22, 2013 Tedee Berez went in for laser treatment at the National Laser Institute in Scottsdale to correct sun damage and freckles on her legs, arms and back. She says there was no reaction on her legs or back, but contends her arms were severely burned.
"I was burned badly," she told 12 News. "I had scars from my shoulders down to my wrists and on my left arm there was actually a hole that sizzled. It was zapped with the laser three times and I could smell my flesh burning and I could see my skin burning, like cigarette burns around the edges on my left arm."
Berez says she was given complimentary oxygen treatments on her arms by the NLI. This treatment helped, Berez says, but ironically led to another injury.
During one of those visits, on Feb. 14, 2014 Berez says she inquired about what could be done to correct a brown spot on her face.
"It was a different technician who seemed very confident," Berez said. "She had worked for cosmetic and plastic surgeons for many, many, years. She's also an instructor there and I trusted her. And when she said she could zap the little spot on my face I didn't question her knowledge of skin."
Berez says the technician zapped the brown spot three times with the laser and she had a large scab, "probably the size of a nickel."
After five days, the scab fell off revealing what she characterized as a hole in her face about half an inch in diameter and about a millimeter deep.
Berez would see medical director Dr. Briana Cain once. She's a naturopathic doctor. Berez says Cain gave her little round bandages and ointment and told her to put it on her face while she was at the institute. Then she was instructed to contact Cain in five days to let her know how she was doing.
Records show Berez emailed Cain a photo of the injury. Cain wrote her back, "From what I can tell in the picture, it looks nice and clean and like it's starting to close, which is good."
"How can you diagnose someone's face and say it's closing nicely when it's still a gaping hole?" asked Berez.
On March 6, 2014 Berez sent Cain another email asking for help.
"She didn't even answer me," Berez told the Naturopathic Physicians Medical Board after filing a complaint against Cain's license.
12 News was at the board meeting as members heard Berez's testimony and Cain's response.
Cain told board members, "I had one interaction with the patient and I provided her with wound care when she did have a wound on her face."
Then Cain told the board she discovered in Berez's medical records from her dermatologist that she suffers from a skin condition called prurigo nodularis, which she says causes intense itching to the point the person scratches until they're bleeding.
"That was not disclosed to us initially and so I think that, had I known that, we never would have treated her in the first place," Cain's response to the board said.
Berez claims she did not know she was suffering from any skin condition at the time of the laser procedure.
In her response to the board, Cain also accused Berez of using a cream her veterinarian had prescribed on the wound. Berez said Cain was mistaken and that it was actually bacitracin, for human use, a topical ointment for minor wounds.
Cain further told the board Berez did not comply with her advice to stop Kenalog injections, which she was receiving from her dermatologist as part of an unrelated treatment program. "I was concerned that Kenalog would further discolor or disfigure the tissue there and she, as far as I know, didn't comply with that and that was the end of our interaction until I heard from you all and here we are today," Cain said.
Berez receives apology
Naturopathic Physicians Medical Board member Dr. Amy Terlisner said, "I would like to see the patient compensated monetarily."
Terlisner then proceeded to apologize to Berez.
"Having issues with your skin is very psychologically traumatizing like that and I am sorry that you were burned like that with a laser, I am very sorry," she said.
The board issued what is known as a "letter of concern" to the doctor. It is not considered a disciplinary action, but does go in her file.
Naming the patient by initials only, it states, in part:
"The Board has concerns that while working in the position of Medical Director for the National Laser Institute, you failed to ensure the risks and benefits of a procedure performed on T.B. were not only verbalized to the patient, but the patient signed a consent to treat form specific to the procedure to be done on the facial area."
"The Board has concerns that you failed to supervise the esthetician performing the procedure on T.B.'s facial area [patients are identified by initials only], to ensure she had adequately explained the risks and benefits of the procedure, and that the patient had signed a consent to treat form specific to the procedure to be done on the facial area."
"The Board has concerns you failed to follow up with patient T.B. in person, after your initial evaluation of a burn on her face and your treatment recommendations."
READ: Full letter
Cain claimed she never received Berez's second email asking for help.
"I don't remember receiving the last email she's talking about and I did tell her in her treatment plan to call us if she had more questions and I never received a call from her," Cain told the board.
But that response did not sit well with Terlisner, who offered Cain unsolicited advice about patient care.
"I encourage you that if you ever have an issue with a patient to reach out to them personally and bend over backwards and do whatever it takes to make them feel like they're taken care of, because there is risks to putting lasers on skin," Terlisner said.
Matt Gould, a cofounder of the National Laser Institute who also acts as the company's attorney, has taken issue with 12 News' investigation into Berez's case.
Gould emailed 12 News several weeks ago, challenging Berez's credibility and disputing she was burned on her face. He claims the wound on Berez's face was self-inflicted due to her prurigo nodularis, which can cause excessive scratching.
Further, he characterizes her as a "constant complainer about any cosmetic treatment she has had," citing a past lawsuit Berez filed against a plastic surgeon. In that case, the plastic surgeon asserted that Berez exhibited a pattern of complaining about the results of cosmetic surgeries, according to court records.
Gould stands by his company's record, which he says has never faced a malpractice lawsuit since it opened 11 years ago, Gould says the NLI performed 72,613 treatments on 13,970 clients in Arizona in 2014.
Gould claims the clinic's safety record is over 99.997 percent, stating that complaints come from "generally people who overreact to the fact that we have intentionally ingested heat into their skin."
ARRA finds violations at National Laser Institute
Two years later, Berez filed a complaint against the National Laser Institute with the Arizona Radiation Regulatory Agency. The inspector showed up at the institute two days after Berez filed her complaint.
Three violations were initially found. In the end, two were substantiated.
"The medical director was not present even though cosmetic procedures other than laser hair removal were being conducted at the time," said Jerry Perkins, program manager for the regulatory agency.
The medical director at the time was still Dr. Briana Cain.
Perkins says the facility also did not have an injury-reporting policy on hand to show what they would do and under what circumstances would they report an injury to the agency. The National Laser Institute corrected the violations and the ARRA waived the civil penalties it was planning to impose as a result.
Complaints to the ARRA
Perkins says his agency receives 12 to 15 injury reports a year, but he feels the actual number of cases must be far higher.
There are an estimated 450,000 laser treatments performed at med spas and laser clinics across Arizona yearly, according to Perkins. That's not counting laser schools or dermatology clinics that may do a variety of procedures and have a higher volume.
Even though med spas and laser clinics are required by law to report second- or third-degree burns, Perkins say they don't always do so.
When asked if he believes there are other med spas and laser clinics whose laser technicians are burning patients, Perkins responded with a resounding, "Yes."
He estimates it to be at least 10 percent of providers are not reporting burns as required, and says it's problematic and frustrating.
The NLI refunded Berez's money for her treatment, $495.
Dr. Briana Cain is no longer the medical director at the National Laser Institute. She was asked to speak with 12 News, but has so far not responded to our request.
Due diligence for patients
If you choose to undergo cosmetic laser treatments, here are some tips:
- Contact the radiation agency to make sure the laser technician is certified; contact information for personnel dealing with laser clinics is listed on the agency's staff page.
- Ask if the facility is registered before you ever offer up your money.
- If you think you've been burned, notify the medical director immediately, don't wait. If you don't get an immediate response, go to your doctor and notify the radiation agency right away so it can send its one inspector in to investigate.
