A patient came into my office recently and informed me that a well-known laser tattoo removal clinic in Los Angeles that she had gone to for years had suddenly shut down. All locations closed. No one answered the phone. No information about the remainder of the money in the package she bought. After researching online, she found that the Better Business Bureau did not yet have much information but doubted she would get her money back. This particular patient had not gone to the clinic in more than a year but had a residual tattoo and had looked into returning for more treatments and using the remainder of her package. She was one of the lucky ones. Other online discussion groups had entries from numerous patients who paid for packages (some costing thousands of dollars) for multiple laser treatments. Some had paid recently and had not yet received a single treatment and were left with no information about their options or where their money had gone.

I had heard of this tattoo removal clinic before, but like many of the Med Spas and nonphysician cosmetic clinics in this town, I hadn’t given it much attention. Upon further investigation, I learned that this laser tattoo removal clinic shut down suddenly, leaving only a piece of paper in the window stating that the clinic was being taken over by another medical group and would reopen soon. Months later, there is still no clinic. People continue to comment online that they have no information and have no way of contacting anyone to get their money back or receive the treatments they paid for. Multiple news outlets have reported this story.

It turns out the closed clinics were not just in Los Angeles but also included other laser tattoo removal clinics with the same name in multiple locations in Southern California and Texas. No notification was given to the patients in advance. Nor was any notification given to some of the staff members, who complained online that they suddenly lost their jobs. Ironically, the same clinics had posted a letter online several years ago honoring discounted first treatments and packages for patients of a different laser tattoo clinic that had suddenly shut down.

So how often is this happening? Are all these clinics owned by the same people? And what can our specialty do to protect patients from being scammed and, for that matter, receiving treatment from professionals who may not be properly trained or experienced to provide that treatment?

In a world in which insurance reimbursements keep getting cut, more and more medical professionals – physicians and nonphysicians alike – are looking to fee-for-service procedures and practice models for increasing income. Sometimes, this may involve physiciansdelegating procedures to nonphysicians. Franchised clinics open up with a physician to “oversee” the clinic, while extenders often perform the procedures (many times without the physician present). Physicians who are neither trained nor specialized to do certain cosmetic procedures start to perform them. Patients get used to receiving treatments from nonphysicians or from physicians who are not specialized to perform cosmetic procedures, and then may devalue the procedure, feeling it’s unnecessary for a physician or a specialized physician to perform it. For these types of cosmetic procedures, such as laser tattoo removal, which are not covered by insurance,patients also sometimes seek treatment at a discount (#don’tGrouponyourface), but often at the expense of being treated by a less well-trained or less-qualified individual. This happens with botulinum toxin injections, fillers, and lasers (particularly laser hair removal and laser tattoo removal). It spirals down a path that devalues both our specialty and the high level of training we have received. Then we – the highly specialized physicians – frequently are expected to manage the complications when they occur.

Much of this is the fault of our own specialty (dermatologists and plastic surgeons) in delegating physician cosmetic procedures to nonphysicians. When nonphysicians perform these procedures, then nonspecialized physicians may devalue the procedures and start to believe that a weekend course is enough to be able to learn them if a less trained individual can do them. In some instances, it is appropriate to have an extender help with a procedure, but where do we draw the line? How do we protect patients, maximize our practice, and maintain the value of our specialty for the level of training that we have? Should only specialized trained physicians (board-certified dermatologists and plastic surgeons) be allowed to perform certain cosmetic procedures? While this approach may decrease overall income to some clinics, it would maintain the trust between the patient and the physician, the quality of care, and the integrity of our training, education, and specialty. While opening multiple laser tattoo removal clinics may seem like a smart business idea, if the physician can’t be there to oversee and actually perform the procedure, the risk of all of the problems outlined above can occur.

Dr. Wesley and Dr. Talakoub are co-contributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com . They had no relevant disclosures.


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