Complications rise without oversight

August 1, 2007

As lasers and injectables increasingly make their way into the hands of non-dermatologists, rates of complications from cosmetic procedures are taking a turn for the worse and keeping dermatologists busy in correcting the wrongs of poorly trained practitioners.

Key Points

National report - As lasers and injectables increasingly make their way into the hands of nondermatologists, rates of complications from cosmetic procedures are taking a turn for the worse and keeping dermatologists busy correcting damages caused by poorly trained practitioners.

A recent survey from the American Society for Dermatologic Surgery (ASDS) found that as many as 56 percent of dermatologists say they had seen an increase in the number of patients treated as a result of complications caused by a non-physician in the past two years. About 59 percent, meanwhile, reported an increase in patients seeking treatment for complications caused by a physician who was not a dermatologist. The survey included responses from 271 dermatologic surgeons.

"(Nonphysicians) don't pay attention to the medical reasons of things, like why a patient has excessive hair, for instance, or they will do a peel or a laser right over a melanoma," says Harold Brody, M.D., clinical professor of dermatology at Emory University Medical School in Atlanta.

Without the medical knowledge to spot, diagnose or even understand skin and device interactions, the potential for nonprofessionals to cause serious harm to patients is substantial.

"In the process of prolonging the diagnosis of melanoma, they can cause disfigurement or even death," Dr. Brody tells Dermatology Times.

At the root of the problem are levels of training that are as varied as the plethora of devices and procedures offered, says William Philip Werschler, M.D., assistant clinical professor of medicine and dermatology at the University of Washington School of Medicine, Seattle.

"We may see some of those same complications from core specialists as well, but I think at the end of the day, it comes down to training, and the core specialists have a lot more training in these procedures," adds Dr. Werschler, who is a past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS).

Importantly, dermatologists have the ability to catch problems early and prevent them from advancing to true complications, Dr. Werschler says.

Under the weather, under-treated

In addition to adverse reactions, another big commonality among patients who visit nonphysicians or nondermatologists has been under-treatment, Dr. Werschler says.

"I think sub-optimal care is where the biggest area of complications lies - patients get underwhelming results. Injectors will want to minimize side effects and risks, so they over-dilute the Botox (Allergan Medical) or under-treat the area or they don't put enough filler in to really get a good result, so it's an error of omission rather than commission."

More hard data needed

Aside from research like the ASDS' survey, there is no official tracking - and little motivation to do so on either the patients' or the practitioners' parts.