In the Wrong Hands, Hair Removal Can Cause Burns, Scars, Pigment Changes

By Sandra G. Boodman
© 2002 The Washington Post Company
Tuesday, May 7, 2002; Page HE05

Terri Bowling, a 36-year-old Pennsylvania office worker eager to be rid of the bother of shaving, wound up with deep second-degree burns that left stripes of checkerboard scars up and down both legs.

Kim McMillon, a 40-year-old vice president of Deutsche Bank, went to a posh Manhattan spa for eradication of facial hair. Some of the hair is gone now, but the right side of McMillon's face is disfigured by a zebra-like pattern of raised scars and discolored patches that heavy makeup and long hair only partly camouflage.

A 50-year-old woman was admitted to Washington Hospital Center recently with third-degree burns inflicted by a treatment to erase wrinkles. A doctor who examined her said the injuries resembled an acid burn.

A Northern Virginia woman in her thirties has spent $10,000 and consulted half a dozen prominent dermatologists in her quest to treat an indented purple scar across the bridge of her nose, the result of a botched treatment of a broken blood vessel seven years ago.

All of these women suffered disfiguring complications from a cosmetic laser procedure: The first two were hair removal treatments done by spa technicians; the second two were performed by dermatologists.

It's impossible to determine the frequency of complications from cosmetic laser procedures, because no one compiles such statistics. The American Society for Dermatologic Surgery found that half its 2,400 members reported seeing an increase in complications in the past year from laser procedures performed by nonmedical personnel, frequently spa aethesticians or cosmetologists who work on clients after minimal training with little supervision. The procedure most often cited was laser hair removal that caused irreversible pigment changes, burns or scarring.

Non-physicians aren't the only ones responsible. "Some of the worst damage we've seen was [inflicted] by untrained physicians" who thought they knew how to use a [cosmetic] laser, said Baltimore dermatologist Robert A. Weiss, director of the Maryland Laser, Skin and Vein Institute and an assistant professor at Johns Hopkins University School of Medicine. "There can be a really steep learning curve with lasers," added Weiss, who said that training typically consists of a four- or eight-hour course often given by a manufacturer's representative.

"The real issue is this false belief that these devices are simple and you can't go wrong using them," agreed Chicago dermatologic laser specialist Jerome M. Garden, an assistant professor at Northwestern University School of Medicine. "The truth is that even the most sophisticated user can run into problems. And sometimes these problems [such as pigment changes] aren't obvious for days."

There is little dispute that cosmetic laser injuries are hugely under-reported, often because people who suffer from them tend to be too embarrassed to complain. Lawyers say such injuries rarely make it to court, because juries typically have little sympathy for plaintiffs who have had treatment that is not medically necessary.

One notable exception is the lone death associated with laser hair removal. Two years ago a 20-year-old Coast Guard cadet died of an allergic reaction to drugs he was given by a plastic surgeon in McLean prior to a hair removal treatment on his back. His parents, who filed a wrongful death lawsuit, recently received a $725,000 settlement.
"Usually people who are hurt just slink into the woodwork," said Karen Roche, a Pittsburgh plastic surgeon who has treated several women, among them Terri Bowling, who suffered burns from laser hair removal treatments.

In May 2001, Bowling underwent a hair removal treatment on her underarms and legs at a Pittsburgh-area spa. She said in an interview that she had previously undergone several treatments in Roche's office, but went to the spa, which was cheaper and advertised heavily, because she wanted to save money.

At the time of her treatment, Bowling had a dark suntan. Many doctors advise tanned patients to delay treatment because most lasers target pigment in skin as well as hair, making complications are more likely. Bowling said the technician told her a tan wasn't a problem and that there was no need to wait.

Bowling said she was immediately concerned when treatment began: The procedure was extremely painful, unlike her other sessions, which were merely somewhat uncomfortable. Even more alarming were the pieces of skin she saw on the tip of the laser. When she questioned the technician, Bowling said she was told -- erroneously -- that this was normal. She gritted her teeth and endured the hour-long procedure.
"It hurt so bad I could hardly get dressed," said Bowling, who recalled telling her husband in the waiting room that they needed to go right home. Bowling said she immediately got into a bathtub full of cold water and spent several hours there. The next day, after the first of several sleepless, pain-wracked nights, Bowling said her legs swelled to twice their normal size and began blistering. Because it was Memorial Day weekend, Bowling said she could not reach her doctor. She wound up in an emergency room, where a physician diagnosed deep second-degree burns, gave her an antibiotic cream and warned her the lesions must be bandaged because they could easily become infected, "and then I'd be in a boatload of trouble." Several days later, Bowling was back in the ER with a blood clot in her leg, the result of impaired circulation caused in part by the bandage.

Bowling has filed a lawsuit against the spa, which has since declared bankruptcy. The Pennsylvania medical board, after repeated complaints from Roche and the Allegheny County Medical Society about patients injured during hair removal treatments, has recently charged the owner, a dentist, with practicing medicine without a license.
While the scars on Bowling's legs have faded, they are still visible and probably permanent. A New York specialist recently told her that a different laser procedure might make the marks less noticeable.

Bowling, who is considering the procedure, said she is particularly dreading a second summer in which she must avoid the sun, which could further damage her skin. She can't wear a dress or shorts, go to the beach -- her family's favorite vacation -- or even take her two young children to the community pool. "I got really depressed," Bowling said. "I'm just starting to come out of it."