If a laser spa treatment goes wrong, who’s to blame?

New evidence suggests that medical doctors who, in some cases, were not even present during the procedure are the most likely to take the heat from those who underwent the treatment.

Malpractice lawsuits related to laser procedures have surged over the last three decades, and dermatologists and plastic surgeons are faulted even if they were not involved in the procedure, according to a study by a pair of physicians at Massachusetts General Hospital.

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The researchers looked through one database and found that there were 147 reported botched cases between 1985 and 2012 connected to skin laser procedures. In 100 of the cases, the procedure was performed by a physician. However, 146 of the cases cited the physician as the defendant.

Laser hair removal was the most litigated procedure, the study published Wednesday in JAMA Dermatology found. Burning and scarring were the most common complications found, and the most common reason for the lawsuit centered on the failure to obtain informed consent from the patient.

Procedures such as laser hair removal, tattoo removal and facial rejuvenation are commonly performed by estheticians, medical assistants, and nurses, not physicians. Since these services are considered non-invasive, there are no federal requirements on who can perform the procedure. Regulations on professional licensing vary by state.

Massachusetts does not have laws regulating the amount of training any medical professional should have in order to operate the type of laser used for these types of cosmetic procedures.

“I think there’s an assumption that when you go to get a cosmetic treatment, that the person treating you wouldn’t be allowed to do it without being trained and qualified,” said Dr. Mathew Avram, director of Massachusetts General Hospital’s Dermatology Laser and Cosmetic Center and co-author of the study.

“Ultimately, the buyer needs to beware because there’s no supervision on who can do these procedures,” said Avram.

California had 27 lawsuits, the highest number of laser-related malpractice cases in one state. Half of all of the cases the researchers found fell in favor of the person who underwent the procedure, the study found.

“To minimize their liability, physicians performing these treatments should err on the side of caution and seek out the requisite training and/or licensing,” the authors wrote.

While complications can occur during any medical procedure, there are ways to minimize the risk, said Avram.

Before undergoing any type of laser treatment, ask about the qualifications of the person performing the procedure.

“Ask, what is your field of specialty? Are you a physician? What is your training? How many procedures have you performed? If it’s not being performed by a physician, are physicians overseeing the process?” said Avram.

“Since there’s no regulation, there needs to be patient self-education about these procedures and the provider who’s going to be performing these procedures,” he said.