Physicians are becoming increasingly worried that Iowa’s tradition of loose regulatory oversight could compromise patient safety as more people outside the medical profession jockey for a share of the burgeoning cosmetic enhancement business.

U.S. consumers spent more than $9.4 billion on cosmetic surgery procedures in 2005, according to the American Society of Plastic Surgeons. More than a third of that was spent on minimally invasive procedures increasingly performed at spas and salons, such as Botox injections, chemical peels, laser skin alterations, microdermabrasion and other techniques that alter tissues.

Such procedures are heavily marketed and highly lucrative, a combination that can cause “people to lose sight of some of the consequences and side effects,” said Dr. Marta Van Beek, an assistant professor of dermatology at the University of Iowa who helped write a 2003 law that for the first time placed limits on who may perform laser and other tissue-altering procedures and gave the Iowa Cosmetology Board the authority to go after offenders.

The request for regulatory oversight came from the Cosmetology Board, one of 19 regulatory panels overseen by the Iowa Department of Public Health’s Bureau of Professional Licensure. Lois Churchill, the bureau chief, said she was aware of situations in which people with no medical training were going out of state to buy a $4,000 machine to perform laser treatments and setting up shop in Iowa with only cursory training.

“[The Cosmetology Board] came to us, which is phenomenal, in good faith because they were concerned and thought there needed to be some regulations,” Van Beek said. “We needed buy-in from them.”

Van Beek said she and her colleagues from the medical profession were satisfied that the 2003 law addressed their public health concerns, but problems with its interpretation surfaced after its passage. As originally written, the law didn’t explicitly list different tissue-altering devices because new equipment is constantly coming on the market, but prohibited their use without proper training and certification in more general terms. A 2005 amendment prohibited the use of intense pulsed light devices without proper training after such equipment became popular for permanent hair removal, photorejuvenation, treatment of rosacea, removal of spider veins and age spots, and wrinkle treatment.

Dr. Timothy Abrahamson of Des Moines said operating laser equipment doesn’t require any special medical expertise, but people without a health-care background may miss some important warning signs or fail to ask the right questions to determine if laser treatment is contraindicated by previous or chronic medical conditions, such as viral cold sores, abnormal scarring or dark pigmentation. “To fire the thing, start the unit and turn the key is not that complicated,” said Abrahamson, a dermatologist. “It’s a matter of knowing the complications and how to handle the complications. The average best-case-scenario patient may never have a complication, but not everybody is an average patient.”

Plus, he said, if treatments are repeated often enough, “expected complications will happen, and it has nothing to do with doing the treatment incorrectly.”

“If you’re using a surface laser, over a period of time, you’re going to get an infection,” said Abrahamson, who recently treated a patient who had received laser treatments and developed a severe staph infection, an unexpected complication a provider without a medical license would be unable to diagnose.

Like Van Beek, he said the current law is well-intentioned, but its interpretation by regulatory authorities may leave the public unprotected in a state that shies away from excessive regulation. “Across the board, we are fairly limited in supervision issues,” Abrahamson said. ‘We are trying to be involved with cosmetology legislation, but unfortunately, our state is very lax with physician oversight.”

Van Beek worries that because of the way the statute is being interpreted by regulatory authorities and lax enforcement standards, the law may have to be amended every time a new piece of tissue-altering equipment comes on the market.

In the meantime, she said, the best advice is “buyer beware.”

“When a consumer is considering cosmetic enhancement, they should ask or do research to find out if there really is good evidence to show the device or product really does reduce fine lines and wrinkles,” she said. “In medicine, we hold decision making to a high standard of evidence. Most of these devices are introduced without overwhelming evidence of their efficacy. They should be held to the same standards we see with drug trials.

“I think patients often don’t do the research and don’t seem to be as wary as they would with a new drug, but the complications can be just as devastating.”