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Getting intense

7 July 2021
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On average, New Zealanders look five years older than our northern hemisphere counterparts, says New Zealand Society of Cosmetic Medicine (NZSCM) education officer Dr Paul Nola. We have our thin ozone layer and lack of continental dust to thank for that, which allow high doses of harsh ultraviolet rays to reach us, he says. That’s why he is a big fan of intense pulsed light (IPL) – and not just for its cosmetic effects of permanent hair and skin pigmentation reduction.
“It has a proven clinical effect where the light energy stimulates the cells of the skin in such a way that they truly do behave 10 years younger – that’s been shown by measuring which proteins the cells make.”
Sometimes incorrectly grouped in with lasers, IPL releases light of different wavelengths, as opposed to a single concentrated beam.
IPL’s increase in popularity, however, is seeing an unwanted side effect.
New Zealand Laser Training Institute director Ruth Nicholson says that outside of Auckland, it is a largely unregulated treatment. Under its Health and Hygiene Bylaw 2013, the Auckland Council set out a code of practice that requires, among other things, that a provider must have the knowledge and skill to provide services obtained under specified training and experience as outlined in the code.
“Outside of Auckland, the reality is a member of the public can purchase any device, including lasers for vaginal rejuvenation, tattoo removal, lasers used inside the mouth – any sort of IPL or laser skin rejuvenation – over the internet, with absolutely no intervention from Medsafe,” Ruth explains.
“They can put it in their garage, put a sign up at the gate and start operating tomorrow, with no one intervening.”
Though she has been fighting this since 2011, she still sounds a little in disbelief herself when she says it out loud.
Dr Nola says it is an issue the NZSCM has raised “multiple times” with Medsafe, which regulates the area around medical devices.
A Medsafe spokesman says “at least in some contexts” IPL and lasers could be used for a therapeutic purpose, but in all other instances “it is likely” the products are used for cosmetic purposes only.
“Where used for a therapeutic purpose, these products are considered to be medical devices,” the spokesman says.
Under the Medicines Act, medical devices can only be sold and used if notified on Medsafe’s Web Assisted Notification of Devices database.
“Notification to this database does not imply any form of regulatory approval; there is no requirement for pre-market assessment of medical devices in New Zealand. The Medicines Act does not restrict who may use these products. Restrictions on access to and use of devices is a matter for consultation under the Draft Therapeutic Products Bill,” said the spokesman.
Dr Nola feels there is little interest in regulation generally because there is an “underlying misogynistic” response to the field on the part of regulators.
“Like, who cares what happens to these people [who opt for cosmetic procedures]? There are women and men who feel shame even having a cosmetic procedure and, if something goes wrong, they feel like they almost brought it on themselves,” Dr Nola says. “It is a real unacknowledged negative in this country.”
While rare, the things that can go wrong with IPL can include burns, subsequent scarring or post-inflammatory hyperpigmentation. You can also end up with striped skin, Dr Nola says.
“Unless you take care, you may not get good overlap and you can end up with stripes. Someone who has rushed to churn people through, this is where it can happen.” Ruth agrees with Dr Nola, and says the science behind the devices “is complicated”.
“Unless taught well, most incidents are directly related to the lack of understanding in this core essentials science. I see this regularly being the cause of adverse outcomes,” she says.
It also takes a trained professional to recognise when not to treat skin that has a lesion on it, which could potentially be melanoma, she says.
“The lesion has the potential to come back, but also go deeper into the skin, then into the blood stream and spread. It is frightening – this is an educational battle I have every day with our industry.”
She says it is important a person gets checked by a doctor before proceeding with IPL. A Ministry of Health spokesman said lack of training, particularly with lasers and IPL devices, “is a concern” in New Zealand and IPL devices pose risks “particularly due to their misuse, and duration of the pulsed light influences the risk of harm”.
“Each can easily disfigure when used incorrectly or for a condition for which the devices or the client are ill-suited. Medsafe and the US Food and Drug Administration have both warned against the use of lasers and other energy-based devices for vaginal rejuvenation purposes,” said the spokesman.

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IPL is a popular therapy for skin rejuvenation and hair removal, but it is largely an unregulated area. Photo: NZ Laser Training Institute

Dr Nola says that not all IPL machines are created equal. Sometimes cheaper machines do not deliver the light energy evenly.
“They might deliver that same amount of energy, just not evenly. It might have a super strong peak at the beginning and tail off, and that peak is where you are most likely to get burns.
“Sometimes you need to deliver that energy in a very short amount of time – that is the main thing you pay for, the ability to deliver the energy in a very short pulse. Cheaper machines can’t do that so treatments often do not work. When operators try to adjust them so that they can, the pulse becomes too long,” he says.
“It is a bit like holding something hot to warm your hands – it gets warm and you put it down, but if you keep on holding it you are going to get burns.” The New Zealand Board of Professional Skin Therapies chair Julie Martin says it is important if anyone experiences an adverse experience that they report it to the board in confidence.
Like the NZSCM and Ruth, she has been lobbying for regulation. In order to get further ahead on this, she says they need to know of these incidences in order to convince officials harm is occurring.
“What the public read on websites does not necessarily reflect the knowledge and duty of care that they will receive,” she says.
But consumers can protect themselves from this, by checking their practitioner has training from a reputable place. Because, while there is a way to go on regulation of the industry, it doesn’t detract from the effectiveness of the procedure.
“I think IPL should be done more in New Zealand than it is. The two types of treatment that cause the most natural tissue changes are IPL and needling – both of these are excellent treatments. I wouldn’t want people to shy away from IPL,” says Dr Nola. “Biopsy studies show IPL actually causes the cells to behave like they used to. I think that is great, but I don’t think everyone should be able to set up shop.”

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