Every once in a while there is a headline in a newspaper or beauty magazines describing the hideous scarring that was induced upon an unknowing soul as they received a laser or similar procedure meant to enhance their beauty. In my office, I see these patients several times a week. Fortunately, for me, these were not traumas induced by my own hands. Almost always there is a story that involves a “medical spa” or “ Laser Clinic” or sometimes even worse……a hotel room or the back of a nail salon where someone was performing ‘beauty injections.” Although complications can occur with relatively safe cosmetic procedures performed by highly trained cosmetic physicians, the overwhelming majority of stories involve individuals who are not physicians performing the procedure. A laser is a fancy knife and minimally invasive procedures such as injectables are still technically invasive. An individual wouldn’t allow a non physician to perform surgery with a knife on them …so why do they allow aestheticians, “laser technicians’ , nurses , PA, or individuals with no medical training whatsoever to perform cosmetic treatments on them. I am still trying to figure this one out. As a physician, I am only as good as the experience I have performing a procedure. But most importantly the skill of a doctor shines through not when all is well…but how we perform during the hopefully infrequent occurrence of a complication. Unfortunately, individuals without medical degrees do not have the experience, the prescription pad, or the general tools used to handle complications such as burns, allergic reactions, infections and so on. Yet in many states, such as New York , loopholes exist that allow non physicians to perform several cosmetic procedures including lasers and injectables. When a problem exists patients are left out in the cold. Now sometimes these procedures are performed in a doctors office and sometimes not. Most of the time there is no doctor supervision and therefore quality control is lost. Now I am sure there are nurses and PA and pediatricians and internists who may give a good Botox shot and perform laser hair removal quite well, but if a patient has a unwanted reaction or a burn or a displeasing cosmetic result can they handle the medical , emotional , and legal ramifications of the that reaction…….my opinion is –usually not. Unfortunately, 5-10 percent of my practice is handling complications, most commonly of non physicians in spas or non core specialty doctors trying to “get into the cosmetic game’. In most states, including New Jersey, any individual that uses a laser that is not an MD can be arrested for impersonating a physician. There are no Laser Spas. As u can imagine, the horror stories are therefore fewer and farther between. What will decrease the number of sad stories? Either legislation that delegates specific training requirements of those performing procedures or public awareness of the stories that make patients steer clear of those non properly licensed.