Tom Lister, Author at BMLA

Returning to cosmetic and laser IPL treatments after lockdown

Written by Tom Lister on 27th April 2021. Posted in Blog.

By Dr Tom Lister, Clinical scientist and executive member of the British Medical Laser Association (BMLA) and European Laser Association (ELA).

As the country continues its journey out of lockdown 3.0, you may have done very few, if any cosmetic laser or intense pulsed light (IPL) treatments over the last 12 months. Laser and IPL treatments are one of the most litigious areas of cosmetic practice, accounting for a significant number of claims at Hamilton Fraser Cosmetic Insurance. As such, it’s a good idea to take some extra steps to reduce risk as we return to practice.

I would like to share with you my top tips to ensure that there are no hiccups as you dust off the cobwebs and get going with laser treatments again. This April sees the return of cosmetic laser and IPL treatments across the UK for the first time in months. Even before you open the doors, there is plenty that you can be doing right now to ensure that you have a safe return to practice.

1. Equipment checks

If your laser or IPL has been left for some time without being used, now is the time to make sure it is in perfect working order. Before you plug it in and switch it on, make sure that any lenses or apertures are clean and undamaged. Any dust or smears can be removed in accordance with the manufacturer’s guidelines, using a soft, lint free and clean cloth and a cleaning fluid that does not leave any residue, such as an alcohol-based solution. Dust or debris left on the lens during treatment can result in pitting or marks on the glass. This will reduce the transmission through the lens and create cold spots in the treatment beam. If you do notice any damage, get in contact with your equipment supplier; lenses can usually be replaced without great expense.

You will want to ensure that your laser or IPL has been serviced within the last 12 months. Servicing is important to increase the longevity of your machine and to ensure the output is consistent, reducing the chances of overtreating or undertreating your clients.

Don’t forget to check your safety equipment too, including patient and practitioner eye protection, masks (more on those later), cold air machines and plume extractors.

2. Update your paperwork

Your ‘Local Rules’ and laser risk assessment should be updated by your Laser Protection Adviser every year. The BMLA website is an excellent resource and has information on what should be included. The Government now requires that COVID specific considerations are included in your risk assessments, so make sure that laser plume safety, mask wearing, COVID testing and test and trace are included.

3. Make sure that consumables are in date

Almost all consumables have a use-by date so make sure you check through your dressings, creams, and even facemasks to ensure that they are in-date. Client throughput will probably be lower than normal when you return to allow for more cleaning between patients and ensure fewer people are waiting together, so factor this is when ordering more stock.

4. Refresh your knowledge

You may not have carried out treatments for over 12 months, and might feel out of practice. Take some time to look through the settings you have used in the past, review any consultation forms you have and maybe even check out some videos of treatments on the internet to get you back in the frame of mind.

5. Protect your practitioners

The Government has provided guidance around bookings, ventilation and hygiene to help you run things safely when you return to the clinic. There is also more specific guidance available on the COVID-19 section of the BMLA website. For example, there is some specific guidance about the aerosols generated during some laser treatments and the use of PPE such as FFP2 or FFP3 masks to protect against these. Wearing a mask can cause your laser safety goggles to mist if it does not fit well, so it’s worth testing this out before starting treatments.

Make sure everybody you work with is aware of what is expected of them. You will also need to allow more time for each appointment. This will give practitioners the chance to get used to new ways of working and to clean thoroughly between clients. It’s also important to make time for consultations, as even your most familiar client’s situation may have changed since you last saw them – they may have experienced changes in health or medications or be spending more time in the garden and getting an unexpected sun-tan.

6. Get treating!

Machines in order? Paperwork up-to-date? Feeling confident? You’re nearly ready to go…

Just one more thing: I always make sure that I mention patch testing whenever I talk about laser and IPL safety and this is going to be even more important when returning to treatments after lockdown. Any new client or any client you haven’t seen for a long time should receive a small test patch before having a full treatment. Just three or four shots is usually enough, and make sure you leave at least two weeks for the area to heal fully before doing anything else. Ideally, the test patch should be in the area being treated as different anatomical regions respond differently. There will always be clients wanting to rush through their treatment but if you have ever had a claim against you, you will know that it is not worth the risk of skipping a test patch.

Laser and IPL treatments are an opportunity to connect with your clients and make a positive difference to their lives. These simple things have rarely felt more important than they do now. I hope that your return to practice is successful, enjoyable and, of course, safe.

This article was written for the Hamilton Fraser Newsletter, April 2021

About the author: Dr T S Lister PhD, MSc, BSc, PGCert

Tom is a clinical scientist specialising in non-ionising radiation physics at the Royal Berkshire Hospital. For over a decade he has worked as a specialist in skin and ENT laser treatments, with involvement in clinical delivery and development of treatments. Dr Lister’s field of work as an expert witness includes medical and aesthetic laser treatments. He is a certificated Laser Protection Adviser covering all areas of medical lasers. Dr Lister is an executive member of the BMLA, vice president of the European Laser Association, and a member of BSI’s EPL/76 group ‘optical radiation safety and laser equipment’

Clinical Guidance for Laser Procedures during the COVID-19 Pandemic

Written by Tom Lister on 3rd April 2020. Posted in Blog.

Please note that this BMLA advice and guidance is produced for practitioners undertaking elective laser procedures. As this is a fluid situation, the guidance may change in the next few days. These guidelines have been adapted from the British Association of Dermatologists, British Association of Dermatologic Surgeons and British Association of Maxillofacial Surgeon’s guidance.

Most laser procedures are classed as routine or elective procedures. Whilst these won’t be classed as frontline or essential procedures, patient and staff safety is paramount when such procedures are undertaken.

The BMLA recommends that the following guidance is implemented:

Consider cancelling all elective laser procedures.
Practitioners undertaking laser procedures during the COVID-19 pandemic should clearly state why the procedure could not be deferred and clinical need for the laser procedure.
Current government recommendations state that all non-essential travel and contact should be avoided. As such, routine maintenance of equipment and visits from laser protection advisors should be avoided unless absolutely necessary. This decision should be informed by a risk assessment with all other possibilities, such as video conferencing and deferral of equipment use, being eliminated.

Personal Protective Equipment – PPE

The limited supplies of PPE mean that any patient who does not need to come to hospital or clinic should not.
All patients should be treated as potentially COVID-19 positive.
Most laser procedures are aerosol-generating. Laser plume may contain carcinogens, bioaerosols, viruses, blood fragments, and bacteria depending on the type of the procedure. They also contain carbon monoxide, polyaromatic hydrocarbons, and various toxic gases and vapours. Plumes may contain chemicals such as formaldehyde, hydrogen cyanide, acrolein, and benzene.
For all laser procedures deem to be producing laser plume, FFP3 masks, eye screens, full sleeve, disposable fluid-repellent surgical gowns and gloves should be worn by all practitioners present during the procedure.
Smoke extractor systems, in addition to laser masks, are the most effective way to minimise risk, as standard surgical masks alone are not sufficient to act as the primary method of particle filtration.
Only the absolute minimum number of healthcare professionals required for the procedure should be present.
For high-risk or known COVID-19 patients or invasive procedures, NHS England guidelines should be followed and where possible, laser procedures should be abandoned or postponed.
This will remain the case until the current trajectory of COVID-19 has flattened.

Author: Tom Lister