Authors: Judith Nicholson, RN, BS Susanne S. Warfield, BS
Judith Nicholson, RN, BS has over 20 years experience in the laser industry with major companies such as Xanar [Johnson & Johnson], Coherent, and ESC (Lumenis). As a Clinical Laser Specialist, she provided laser education, marketing and research support for the industry and their clients.She co-authored several laser physics and safety training manuals as well as a recent article forArchives Of Dermatology and assisted on an abstract for the American Society of Laser Medicine. In her recent consulting capacity, she coordinated and monitored several FDA Laser studies for various companies to bring new product applications to market. Judi currently is a Clinical Application Specialist for Lumenis. She resides in Massachusetts with her husband, Gordon, daughter Katie and lively Cairn terrier, Gus.
Susanne S. Warfield, President/CEO of Paramedical Consultants, Inc. (PCI) and publisher of the PCI Journal?, The Medical Journal for SkinCare Professionals© (www.PCIJournal.com). She is the leading expert on the business, legal and liability issues that affect physician and esthetician relationships. Ms. Warfield authored OThe Guide to Building a Medical Esthetic Practice,O OThe Esthetician's Guide to Working with Physicians,O OOSHA Manual on Bloodborne PathogensO and co-authored OLaser Safety for the Salon, Spa & Small Medical Clinic,O OPhysician's Guide to In-office Dispensing.O Chapter contributions include OThe Standard Textbook for Professional Estheticians?Revised Edition,O(Milady) OSalon Fundamentals Esthetics,O(Pivot Point) OThe Practical Application of Estheticians in the Plastic and Reconstructive Surgeon's OfficeO (W.B. Saunders) and OEstheticians in Dermatology.O (Dermatologic Therapy) PCI manages two associations and Ms. Warfield serves as the Executive Director of the National Coalition of Esthetic & Related Professional Associations (www.NCEA.tv) and the Society of Dermatology SkinCare Specialists (www.SDSS.tv).
Table of Contents
FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
LASERS?WHAT ARE THEY? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Diagram 1
Electron Excitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
LASER CHARACTERISTICS
Diagram 2
Coherent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Diagram 3
Collimated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Diagram 4
Monochromatic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
ELECTROMAGNETIC SPECTRUM
Diagram 5
Electromagnetic Spectrum A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Diagram 6
Electromagnetic Spectrum B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
LASER CLASSIFICATIONS
Device Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 15
Laser Hazard Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
HOW DO LASERS FIT IN THE SALON,
SPA OR SMALL MEDICAL CLINIC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
TYPES OF LASERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . 17
Table 1
Hair Removal Lasers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Table 2
Skin Rejuvenation Lasers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
REGULATORY AGENCIES
FDA And CDRH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 20
OSHA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 20
LASER SAFETY AT A GLANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
LASER SAFETY IN DETAIL
Regulatory Controls
State And Local . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Administrative Controls
Laser Safety Office or LSO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
The Small Medical Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Education and Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . 23
Policies and Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Laser Access Controls
Classification and the Laser Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Table 3
Control Measures for the Health Care Laser System (HCLS) . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Signage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Diagram 7
Example of Warning Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Control of Laser Beam Hazards to Tissue
Eye Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Skin Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Table 4
Wavelength Effects for Various Lasers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Control of Non Laser Beam Hazards
Respiratory Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Fire Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 30
Electrical Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
APPENDIX
Laser Safety Checklist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Patient Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 32
STATE BOARDS THAT LICENSE
HAIR REMOVAL SPECIALISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
STATE BOARDS OF COSMETOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
LASER COMPANY DIRECTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
LASER RELATED WEB SITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
LASER ABSTRACTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
GLOSSARY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
REFERENCES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
NCEA Laser Hair Removal Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
ASLMS Educational Recommendations for Laser Use by Non-Physicians. . . . . . . . . . . . . .53
