Cosmetic laser treatments need tighter regulation experts warn as patients describe 'burns'

For Nic Dolbel, the red flags appeared the moment she arrived on the front doorstep of the 'clinic' three years ago.

PHOTO: Nic Dolbel immediately after receiving the cosmetic laser treatment in Canberra in May 2016. (Supplied)

PHOTO: Ms Dolbel, with what she and an expert describe as "burns" on her face. (Supplied)

"I thought I was going to a clinic and I ended up at a house," she said.
"I was just like, 'Oh, this doesn't seem right'."

She stepped inside anyway, having driven more than three hours from Parkes to Canberra to have some moles removed, and a laser treatment to her face.

And she was reasonably confident — she had dealt with the clinician before, who told her she was working out of a different clinic while her main clinic was being fixed up.

Ms Dolbel was shown into what seemed to be the main bedroom of the Canberra home, where the treatment would take place.

"And then she had certificates just around the room."

The moles were removed without much fuss, before the clinician moved on to the laser treatment.

Ms Dolbel said she wanted a resurfacing treatment — believed to reduce the look of wrinkles and scarring — but did not really know what she was getting into.

She said she felt like she was being pushed into more intensive laser treatments.

"I didn't ask questions because I thought 'well, she knows what she's talking about'," she said.

"So if it's not going to be a light resurfacing, the 'fraxel' was going to be better for my skin, or now the 'erbium', because it gets rid of fine lines and wrinkles."

Ms Dolbel said she went ahead with an erbium laser treatment.

A face-numbing cream was applied — but she said the treatment felt "excruciating".

"I had stress balls in my hands," she said.

"And I had divots in my hands from my nails because I was clenching that hard.

"I was in that much pain."

She went through with the treatment, worried that once it had started her face would look odd if she pulled out halfway through.

Then she climbed into the car — her face bloodied all over — for the long drive home to Parkes, unsure what had just happened, and if it was normal or not.

"My face was just on fire, it was like third-degree burns," she said.

"It was horrible."

Later Ms Dolbel spoke with Jo-Anne Fitzgerald, who studied a Bachelor of Health Sciences at Victoria University, and described herself as a "clinical dermal therapist".

Ms Fitzgerald reached out to Ms Dolbel, after hearing about her situation through others, and said, in her opinion, an accurate description would be that her face had been "burned".

"She'd been burned, burned by the erbium laser — that was a second-degree burn," she said.

Ms Fitzgerald was very clear about how she perceived her own ability, and the risks she was willing to take when it came to using technology like erbium lasers.

"I wouldn't even assume to be able to offer that treatment, or to use an erbium laser," she said.

She said the lasers should only be in the hands of plastic surgeons.

It was not the first time the clinician who Ms Dolbel said performed the procedure, Sarah Larkin, had encountered trouble with an erbium laser.

Two years earlier, in March 2014, a woman referred to in documents from the ACT Civil and Administrative Tribunal (ACAT) as 'Patient K' was treated by Ms Larkin at the Canberra Laser Biotheraphy Clinic.

Patient K cannot be named for legal reasons, nor can photos of her be published.

That treatment became the subject of legal disciplinary proceedings between the Medical Board of Australia and Dr Nathem Al-Naser, who was supervising the procedures carried out at the clinic.

ACAT found Dr Al-Naser breached the doctor's code of conduct on multiple grounds in his dealings with Patient K, including failing to assess the patient, failing to obtain informed consent, and failure to explore less invasive treatments.

Ms Larkin gave evidence at the hearing, and featured heavily in the ACAT decision documents — but cannot be dealt with by the Medical Board, as she is not a doctor.

The ACAT documents state that Patient K went to the clinic seeking treatment for acne scarring, and chose it due to its practice of clinical supervision by a doctor.

Initially, it was suggested she be treated with a low-intensity laser with the possibility of erbium treatment after review.

On the day of the procedure, Ms Larkin suggested an erbium laser would produce a better result, and that procedure went ahead.

The decision noted that Patient K was in pain during, and after the procedure and was deeply concerned by her appearance, especially as her son's first birthday was just three days later.

Patient K told the hearing she never met with Dr Al-Naser, prior to or during her treatment with an erbium laser operated by Ms Larkin.

She said she never signed a consent form.

The ACAT found if Patient K had been properly informed of the risks associated with an erbium laser treatment, it was highly unlikely she would have gone ahead with it.

The tribunal rejected suggestions from Ms Larkin and Dr Al-Naser that any alternatives were discussed with Patient K, and that she was fully aware of the risks and likely outcomes of the procedure.

It was also critical of Ms Larkin's suggestion the patient should have done her own research on the matter, right there on the day of the procedure.

"There was no utility in Ms Larkin's claimed suggestion that the patient do her own research, including looking at YouTube videos, for a patient who was minutes away from treatment," it found.

It is situations like this that are pushing calls for tighter regulation on the use of powerful cosmetic lasers in a booming industry.

Associate Professor Andrew Miller, a former president of the Australasian College of Dermatologists, has seen these kinds of cases before.

He warned there was essentially no barrier to anyone obtaining a powerful ablative laser, and joining the cosmetic laser industry.

"The only qualification that you need really, to be able to buy a clinical laser, is to afford the loan repayments," he said.

He is still a practising dermatologist in Canberra, and was involved in the industry at the time conversations were being had about strengthening regulations.

He is very clear about who should be operating ablative lasers, like an erbium laser.

"For the ablative lasers — they're the ones that burn a hole in you — then it's arguable that the person using the machine should understand a lot more about the skin, the skin processes," he said.

"And really, I think a doctor is probably the best person to be operating an ablative laser."

But he said when the regulatory body on these matters, the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), looked at the issue along with industry figures, it decided against tighter regulations.

He said part of the consideration was that the cosmetic laser industry was already well-developed, dominated by large players, and had a reasonable track record and an interest in maintaining a reputation.

Dr Miller said, in his view, the risks lay outside those large operators.

"The real danger is the little operators, the single set-up or very small chains, where there may be less of a potential for people to quality-control it," he said.

And he had a piece of advice for anyone who felt uncomfortable about the procedure they were about to undergo.

"If it doesn't look like if it doesn't feel right, it's not right," he said.

"And they should walk."

Ms Dolbel said she was left feeling the effects of her treatment by Ms Larkin for years afterwards, both through physical pain and altered appearance.

"For two years after, every day, my face stung," she said,

"And it would get worse when the weather would change ... but it was nothing compared to what happened that day."

She was never diagnosed with burns, as she never saw a dermatologist.

"I'm too scared to, because I don't want to meet another Sarah," she said.

"People have said there's a dermatologist here or there, they're really good — but how do I know they are who they say they are?

"I can't look at someone's certificate on a wall, and know what those numbers mean, how that qualification was attained."

Ms Dolbel believed she was left with post-inflammatory hyperpigmentation, affecting the appearance of her face.

"I felt like a monster, I had patches, different brown spots on my face," she said.

"I just wasn't comfortable in my own skin."

She too wants rules tightened around who can use the technology.

"In my eyes, you should not be touching a harsh laser or something that's going to remove wrinkles if you are not a medical practitioner, if you are not a doctor, if you're not a plastic surgeon," she said.

Sarah Larkin declined the ABC's invitation for an interview.

On her personal Facebook page, she lists her education including a Diploma of Dermoscopy and a Certificate in Skin Cancer Primary Medicine from the University of Queensland in 2018.

She also lists a Certificate in Advanced Dermatoscopy and Histopathology from UQ in 2016, along with another skin cancer certificate from UQ in the same year, and a Graduate Certificate in Dermatology and Scar Repair from the Australian Institute of Laser Therapy.
Her most recent Canberra-based cosmetic laser business, Dermaskin, has a live website and active social media accounts.

But Ms Larkin said the business was not operational.

Dermaskin's website offers treatments with erbium lasers.

"Our treatment expertise is based on extensive research and training, combined with our technical skills and experience in the use of our advanced Medical-Grade Class 4 Laser technology," it reads in its About section.

Ms Larkin told the ABC she no longer uses erbium lasers, and has moved into the field of dealing with skin cancers.

Category: Laser Treatment


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