From hair removal to skin rejuvenation, vein treatment to tattoo removal, vaginal rejuvenation and more, lasers can do a wide range of non-surgical treatments. However, it is important to make sure you find a practitioner who knows what they’re doing, with the right training. Dr Jayson Oates from Academy Face and Body in Perth and Sydney talks to us about laser safety from a patient’s point of view and a practitioner’s…

Trish: Hey, listeners. I’m here again today with Dr. Jayson Oates, and he’s from Academy Face Body in Perth. I’m going to try and get through this whole podcast with him today without doing an ‘um’. I know I just did one, but I’m going to try and avoid it.

We love catching up with Dr. Oates, ’cause he’s always got some really interesting information, and it’s great that he actually takes time out of his busy day to actually share some information with us. Today, we’re going to be talking about lasers. He’s just informed me there’s recently been some changes done in West Australia with regards to the rules about lasers, so we’ll get him onboard and have a chat to him.

So, welcome Dr. Oates.

Dr Jayson Oates: Hi, Trish. Good to be speaking with you again.

Trish: You too. You too. Now, tell us, there’s been changes, like really, really recent … I mean, there’s changes happening all the time, and it’s all about patient safety becoming really a big focus for the government at the moment, so what’s going on in the laser world?

Dr Jayson Oates: Well, WA has been different in regards to who can use lasers compared to the rest of the country. In Western Australia, you had to be a doctor to use lasers. Interestingly, in the legislation from 30 odd years ago, it did say that a doctor could delegate the use of a laser to somebody else. But, at some point, and even at the WA Radiation Safety Council didn’t know when or how, they changed it that only a doctor could use lasers.

We had this interesting situation in Western Australia that we didn’t have anything like laser hair removal clinics that are all over the East coast. Over the last decade, there have been these gradual changes and increases in rules. Queensland was perhaps the first state to increase the legislation and just not allow it to be a free-for-all. You had to have training and experience, and they were quite strict with that. The general belief is that a lot of people who are now licenced to use lasers in Queensland perhaps didn’t do the full training because it actually was very onerous and very difficult to do. We still have several states where there’s very little in the way of regulation. In fact, they don’t have radiation safety councils like we do in Western Australia, Queensland and Tasmania.

Then, around about three years ago, and I was working hard to get this to happen, ARPANSA, which is the national radiation and laser safety body, was trying to work towards having unified rules throughout the whole country and some minimum standards. So, they produced a big working paper and they collected lots of submissions, and lots of medical groups from around the country put in lots of submissions, and then it just disappeared. We didn’t hear anything about it until early last year. They went into deep thought mode for 18 months, and then eventually they came out and said, “This is all too hard. We’ll just let you self regulate.” So, essentially, we’re still in the same position, especially in Western Australia, that it was limited to only doctors being able to use lasers.

In some ways that sounds good and safe. The problem is it does really limit access to lasers and it makes it significantly more expensive if a doctor’s going to operate for everything. Then, very quietly, late last year, they decided that nurses could do tattoo removal laser. Interestingly, they didn’t really announce it, and the fact that I’ve written half a dozen letters to them over the last decade or so didn’t spur them to contact me. But, eventually, we found out that nurses with appropriate training, but they didn’t really make it very clear what that training was going to be, and experience, how they’re going to get this experience, nurses are allowed to use tattoo lasers. Then, a few months ago, it was announced that dermal therapists, if they’ve done the laser safety officer training and have 50 hours experience signed off by somebody who is certified, so essentially a doctor, at the moment anyway, would be able to do vasculine and pigmented spots.

So, we’re sort of in that position now, and it sort of stands like a step forward, except when we’re speaking to the WA Radiation Safety Council, they don’t really have any great idea on how it’s going to be implemented, who can sign people off and who’s auditing what kind of experience people have. We’re hoping it does make it easier for people in Western Australia to get access to lasers. The dermal therapists that we have in our practise have all done laser safety officer courses and have done advanced diplomas in cosmetic dermal therapy, which includes use of lasers. So, at least they’ve got the good background and they can get the experience in our clinic, but I can see it being difficult for therapists out in the wider areas to actually get those hours in using the lasers.

Trish: Yeah, ’cause, well, I’ve actually had, I’ve had a few laser treatments, and it’s different, of course, in New South Wales, but … So, I’ve had a few laser treatments myself, and I know for a fact that the people that have done the laser for me, that’s what they do all day. Do you know what I mean? So, surely someone who’s really experienced at it and good at it is going to be just as qualified, I would think, as a doctor if they’ve been taught in all the right … if they’ve got all the right laser safety certificates and-

Dr Jayson Oates: Yeah, so … This is what I was arguing all the way along, was that you need to have the correct underpinning knowledge, and, in fact, it doesn’t matter if you’re a doctor, a nurse or a dermal therapist. If you don’t have the basic understanding of laser physics, tissue interactions, assessment of the skin, what’s going to be important, the difference between a pale white skin, a tanned white skin, an Asian skin, an Indian or black skin, then just having a medical degree doesn’t make you safe with a laser.

I remember when I did my laser safety training at Sir Charles Gairdner Hospital, and that would be 25 years ago, and the laser technician at the hospital, they had a laser and they were firing it, and he was sort of demonstrating the invisible beam of a CO2 laser. It was an old laser that was sort of pulled apart, you could see all the workings and bits and pieces of it, and he could show us how it was firing through the air and hitting this screen. Then he leant forward and he got his head in the way, and you could see the aiming beam on the back of his head, and then he fired it and it didn’t light up this plate that he was aiming at. So, he fired it again and he fired again, and his hair caught on fire. This was our laser safety officer training certificate.

I was literally rolling around on the ground laughing. The funniest thing that I’ve ever seen. He sets his hair on fire in our safety officer course.

Trish: I would have joined you on the floor laughing. It’s hilarious.

Dr Jayson Oates: Even now, I just can’t believe it. You know, everybody passed that.

Trish: Yeah.

Dr Jayson Oates: Certainly I learnt don’t stick your head in the way.

So, there are some very limited courses that then sort of fulfil their current requirements, and, to me, that doesn’t really provide enough for somebody to really be safe in doing this kind of whole treatment. So, anybody, whether they’re a dermal therapist, nurse, really needs to have some appropriate training and knowledge, and then training using the specific laser and then being monitored to get some experience.

The new legislation in Western Australia doesn’t really accomplish that. The worry is that once somebody has been signed off and certified to use the laser, they could actually then train and certify the next person, and I can see there being this gradual dilution of information and knowledge as people are perhaps training the next person in their clinic who can then take over from them when they go on holidays or maternity leave or something like that.

But, I certainly believe that a nurse or dermal therapist with the right training, who’s doing a lot of the laser, tend to be very competent and very safe in doing the procedure. Now, I wouldn’t necessarily want them doing a fully ablated full face CO2 resurfacing like I sometimes do, but for lots of treatments, my dermal therapist will be much better at doing it than I will probably be doing it because they’ll be doing it on a daily basis and doing lots of these treatments.

Trish: Well, that’s true, and therein comes the question. ‘Cause there’s many different sorts of ‘lasers’ on the market, so I would definitely not want someone who wasn’t an experienced doctor or practitioner doing a really intense laser therapy on my face, whereas with the … Because there’s different levels of lasers as well, isn’t there? There’s like …

Dr Jayson Oates: There’s different classes, and when we’re talking, the ones that are licenced and restricted, it’s what they call 3B and class four lasers. These are lasers that potentially can damage your eye if you get shot in the eye, or they can burn the skin. So, they have the potential to cause injury.

The other thing is that now that there’s the potential for beauty therapists in Western Australia to buy lasers through unscrupulous dealers who are bringing in cheap machines, unfortunately I’ll say from China … We’ve looked at it sometimes, and sometimes we’re thinking, well, why do we want to spend $150,000 or $200,000 on a laser when you can buy one of these lasers for $30,000, and the salesman says it’s just as good? From experience, we know that nobody ever comes and tells you that their machine is no good, it’s dangerous, it’s going to burn people and you’re going to get sued.

So, at least we know, you trial these things, and when you’ve got experience with the good machines, you’ll fairly quickly say, “Ah, this is a cheap machine because it’s cheap and nasty and dangerous, and people are going to get hurt.” But, if you’ve never worked and don’t have the experience with the really good thing, then they bring you one of these machines and it looks fine, it’s got a nice box and it shoots a laser out the end … And it’s not that the first time you turn it on and use it that it’s going to cause a problem, it’s only one in ten has an issue.

But, yes, I’m worried that there is going to be an opening of these cheap, nasty machines being sold to people who don’t have the experience to know that this is not a great thing to be doing, and then we’re going to have a flood of problems.

Trish: Of course. So, from the consumer’s point of view, how can they be sure … I mean, I know that we have … On the plastic surgery hub website, we have lots of different lasers and treatments that are available, and we always, before we put anything on there, we do our research. I’ve always used the motto that if I would feel comfortable, and believe me, I’m very, very cautious with stuff like this, although sometimes I’m reckless with getting things done myself, but I’m really cautious as to what I would think that I’d have done, so I try and just put things on there that I feel … Actually, I always put things on there I feel comfortable with myself.

But, how does the average consumer … Like, how would the average person walk in and know … Because people aren’t going to know that … They’re going to think, oh, you can go to a beauty salon, why would I pay $250 to get this done with a doctor when I can get the same thing done for $100 at a beauty salon? Like, how are people going to know?

Dr Jayson Oates: Yeah. It is difficult. One of my original suggestions was that the way this would work best would be the way the original legislation in WA was written, is that it’s done by a doctor or in a doctor’s office by somebody that the doctor has delegated to. So, the doctor is still taking responsibility, and if there is any kind of issue, you’ve got the doctor to refer back to. I still think that is the absolute safest way to go. So, if they’re a nurse or dermal therapist, who’s appropriately trained and experienced, within a doctor’s office, I’m fairly confident that that is currently the highest level of safety that we have.

Then, if somebody has more advanced training … So, there is one organisation, Niche Education, the Academy of Cosmetic Dermal Therapies, they have a very extensive, like a one year advanced diploma that involves training in lasers. I think if the person using the laser has gone to that extent and got training, and then is signed off by an organisation like that, a proper registered training organisation, then you’re probably at that next level of safety. If it’s just a beauty salon and they don’t have any official recognised training, then that perhaps is slightly more at risk at this stage.

Trish: Mm-hmm (affirmative). Okay. Do you reckon … So, the legislation that’s just … So, that legislation is in … it’s written in … Like, it just is at the moment, and that’s all there is to it. Is that right?

Dr Jayson Oates: Yeah. So, it’s been documented and it’s been actioned in Western Australia. It’s just that, as far as I know, nobody actually has completed the requisite hours in gaining the experience. So, the therapists can be doing the treatment under the supervision of the doctors, like they are in my clinic, but I don’t think that there’s probably any beauty therapists out in public with lasers who have completed all the training as yet. But, it won’t be long. In the next few months, that’ll all happen.

Trish: Okay. So, once again, I come back to that same thing … So, customers should really look out … Can you give us a couple of things that they should look out for? So, number one, if you’re thinking of having some laser treatment … Like, if it was you, and you wanted to have some laser treatment, what would be the first thing that you’d be looking for?

Dr Jayson Oates: Well, is it at least done in a doctor’s office if not being done by the doctor, or they’ve got an association with the doctor, or do they have something like an advance diploma in cosmetic dermal therapies? Then at least you know they’ve got more extensive training in the background of lasers, the light, how it interacts with the skin, how to assess the skin. If somebody has gone to that much effort to get that much training, then the chances are they’re [inaudible 00:19:03] a lot more seriously than just a few hour course.

Trish: Yeah. True. I’ll give you a classic example. This is years ago, actually before I ever did anything to my skin or to my face, so it’s probably around about 10 years ago. A lady came from Sydney, she’d worked in these clinics in Sydney, and she came up to Byron Bay and bought her, at the time, which was a Fraxel and Thermage, but not the real thing. I think it was a copy. I’m not quite sure. She brought them in and had this wiz bang offer that you could get this stuff done, and I had the treatment done. I had the Thermage first and the Fraxel Laser, I can’t remember.

I just loved it. Like, the results were fantastic. But, what actually happened is, over the next six months or a year … I’ve got all this pigmentation just on my cheekbones on each side, and I just couldn’t get rid of it. Then I found out ages later that it was actually as a result of the fact that I just lived my life as per normal after that, went out to the beach, you know, no sunscreen and all that, and if the practitioner who did it, who was a beauty therapist that had come up from Sydney, if she had of just given me some aftercare instructions according to my skin, I wouldn’t have had that dilemma, ’cause it’s taken me years to get rid of that.

In fact, it probably will never really quite go, but it’s taken years to get rid of that, and it’s just about not knowing my skin type, and just thinking, hey, she lives in Byron Bay, maybe I should tell her about being careful in the sun. Because, being the average consumer, maybe not so much nowadays, but I didn’t know what was right and what was wrong, I just … She didn’t tell me anything to do, so I just did what I normally did.

Dr Jayson Oates: Yeah. So, that post-inflammatory hyperpigmentation is certainly one of things where, if you’ve got the proper grounding knowledge before you start doing the treatments, then you can avoid all of that, and, yeah, give you the proper post-treatment instructions, then you can avoid having that and, yeah, it would have made your life a whole lot easier.

Trish: Yeah. Yep. That’s so true. So, tell me, you offer quite a few laser treatments there at the clinic there. Do you want to just give us a quick run through of what you guys offer?

Dr Jayson Oates: Okay. Well, starting at the big end, we’ve got the CO2 laser, and that can include fully ablative resurfacing, and not everybody does that. In fact, not a lot of people still do that, but … I saw a woman yesterday, and she was just telling me how it’s transformed her life. The first seven or eight days is a little bit harsh, but it’s just made such a difference to her skin and it’s a one off treatment. It also does the fractionated treatments and all of the dots, dotting treatments, so you can do lighter treatments as well. We use it for scar treatment, so you can drill the holes into keloid scars and hypertrophic scars, burn scars, that sort of thing.

We do the snore stop treatment with it, which is using the laser onto the soft palate and getting some tightening there and reducing snoring. It also does the MonaLisa Touch treatment, which we’ve discussed a few times, for that menopausal vaginal rejuvenation. It’s just fantastic for that. We do have a tattoo removal laser, and use it a little bit for tattoos and a little bit for pigmentation.

Trish: Oh, yeah. Which one do you use? What’s the name of that device?

Dr Jayson Oates: The MedLite, the C6. That’s the nanosecond, so the billionth of a second pulses. It’s been the gold standard in tattoo removal for the last 15 or so years, but now we also have the picosecond lasers as well, which we don’t have one of those. In fact, a combination of the two is probably now the gold standard for the tattoos.

Trish: The pico nano?

Dr Jayson Oates: Yeah.

Trish: Yep.

Dr Jayson Oates: The pico by itself, I don’t think is necessarily the way to go. It’s probably best to have a nanosecond treatment first and then a picosecond treatment to follow. It’s all to do with the size of the particles, and the picosecond is really good at shattering the tiniest little particles. But, when the ink is first put in, the nanosecond lasers probably do a better first pass reduction in pigmentation.

Trish: Yep.

Dr Jayson Oates: We’ve got a long pulse 1064 laser, which is mostly a vascular laser. We don’t use it that much for vascular because we’ve got some really good IPL machines, intense pulse light, and they do a really good job on vascular. We’ve got an in-house pediatrist now, and he uses that laser a lot for nail fungus. So, if you’ve got that fungal toenail, sort of thickened and nasty looking thing, he zaps it with a 1064 laser and it kills the fungus. Instead of having to put these nasty toxic chemicals on your toenail for six months or twelve months, you have it zapped once or twice with the laser and it cures it, settles it all down.

Beyond that, we’ve not got so many lasers anymore. We’ve got various radio frequency devices, with the Reva. We’ve got the high intensity focus ultrasound, with the ultraformer for tightening skin. I had one of those myself about four months ago, and saw real improvement. Maybe one more and I won’t look like a 50-year-old guy, I’ll look like a 40-year-old guy.

Trish: But, aren’t you only 30 anyway?

Dr Jayson Oates: Sorry?

Trish: Aren’t you only 30 anyway?

Dr Jayson Oates: That’s right. Sorry. So, instead of looking like a 30-year-old guy, I’ll look like a 20-year-old guy. Yeah, I didn’t say 50, did I? No.

Trish: No. No. No.

Dr Jayson Oates: Can you edit that out? Just go back and cut that bit out.

Trish: So, basically, in West Australia, people know that if they’re going to come to you, you’ve got the proper practitioners doing laser treatments, and you’ve got quality lasers, and you’re going to help them solve their laser problems, I guess, for lack of a better word.

Dr Jayson Oates: Yeah. It’s always … I guess the important thing is not so much the tool that you use, but properly assessing the patient and the problem, and finding out what the outcome that they want to achieve and what they’re willing to do to get to that result.

I think I told you the story recently of a patient that I had, and I said, “Well, you need to have a facelift,” She says, “Oh, no, I don’t want to have any operations.” I said, “Well, okay then. We could use the laser, I could do the resurfacing, and that would at least get rid of the skin tightness,” [inaudible 00:26:53], “Oh, no. I don’t want any lasers.” I said, “Well, we could use some fillers here,” and then she said, “Oh, I don’t want anything with needles.” I said, “That doesn’t really leave me with that much to do.”

So, yeah, it’s working out what does a person want and what kind of treatment they want, ’cause some people want no downtime whatsoever. Other people, they don’t care about the downtime, they just want to get the best result that they can possibly get.

Trish: Yeah.

Dr Jayson Oates: So, speaking to the patient and then having a range of treatments and really experienced people so that they can advise the patients properly about what’s going to be the best for them.

Trish: Yep. And, you know, speaking from experience, ’cause I am so one of those people that just gets caught up in the moment and just wants to have everything done, do your research, find out what’s going to work for you and what’s not. Just do your research, hey.

Dr Jayson Oates: Yeah, absolutely.

Trish: Awesome.

Dr Jayson Oates: It’s so easy to do now.

Trish: I’m going to have to cut this short, ’cause it looks like I’ve just received a fire alert so we have to evacuate the offices.

Dr Jayson Oates: Okay. Good luck to you.

Trish: I’d better go before I get burned. Yeah.

All right. Well, thank you so much for joining us today.

Dr Jayson Oates: Yeah. And you, don’t run, but walk briskly towards the nearest fire exit.

Trish: I’ll walk briskly, yeah. Thanks so much, guys. You can find Dr. Jayson Oates at Academy Face Body in Subiaco. I’d better go. Bye.

Dr Jayson Oates: Good luck. Bye.

Trish

Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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