Laser and energy-based devices in cosmetic clinics

A laser is a device that delivers a particular wavelength of light, in a particular pulse, to a particular target. Intense pulsed light is a broader flash. Radiofrequency and focused ultrasound deliver energy as heat without being “lasers” at all. Cosmetic clinics in Australia offer all of these, often under trade names that sound like procedures. The physics is older than the brand. The skin either absorbs that energy in the intended chromophore — melanin, haemoglobin, water — or it absorbs it somewhere else. Somewhere else is how people are burned.

This article belongs in the non-surgical hub. Energy devices are also discussed, in passing, wherever readers compare a clinic treatment with an operation. They are not a substitute for the procedures described in the facial surgery hub. Scar texture, which lasers are sometimes used to change, is a separate and limited subject; see scar revision: realistic expectations.

Classes of device, without the brochure

It helps to sort machines by what they are trying to hit, not by the word on the lease agreement.

Ablative lasers vaporise a layer of skin. Carbon-dioxide and similar systems can be used for resurfacing and for some scars or lesions. They create an open wound of a controlled depth. Recovery is longer than a “lunchtime” appointment. Infection, prolonged redness, scarring and pigment change are recognised risks. These are medical procedures whether or not they happen in a rooms setting.

Non-ablative lasers heat tissue without removing the surface in the same way. They are used for selected pigment and vascular problems and for some textural complaints. Downtime is usually shorter. The trade-off, when there is one, is that a milder injury may produce a milder change. No ethical account can promise that a non-ablative pass will do the work of an ablative one, or of an operation.

Intense pulsed light (IPL) is not a laser. It is a filtered band of wavelengths. It is widely used for hair reduction and for some redness and pigment. Because the light is broader, the chance of hitting an unintended target is not theoretical. Settings, skin type, recent sun exposure and the operator’s experience all matter.

Radiofrequency and ultrasound devices heat dermis or deeper layers to tighten or to change how tissue behaves over time. Some are applied to the skin surface; some use microneedles. Burns, fat atrophy, nerve irritation and contour irregularity are among the problems reported when energy goes where it should not. “No downtime” is a marketing phrase, not a physiological one.

Hair-reduction devices sit in their own high-volume category. They target pigment in the follicle. They work poorly on pale hair. They can burn pigmented skin if used carelessly. They are not a sterilisation of the follicle for life; maintenance is common, and results vary.

This journal does not name device brands. Many of the machines are therapeutic goods. Naming them in a consumer explainer is how advertising slips in through the side door.

Pigment, ancestry and the burn that is not a tan

Melanin is a chromophore. That is why some lasers can treat brown spots and why some can reduce dark hair. It is also why skin that contains more melanin can absorb energy intended for a lesion, a vessel or a shaft of hair. The result can be a blister, a crust, a pale patch (hypopigmentation) or a dark patch (hyperpigmentation) that lasts months or longer. People with deeper skin tones, people who tan easily, and people who have recently been in the sun are not “difficult customers”. They are people whose skin will take up light.

Australian clinics see a population that includes Northern European sun damage, Mediterranean and Middle Eastern skin, South Asian, African and Pacific ancestries, and every combination. A single default setting is not an assessment. Fitzpatrick skin typing is a blunt but widely used starting point. It is not a complete history. Recent tanning, hydroquinone or other lightening agents, isotretinoin, keloid tendency, and a prior burn from a device all belong in the notes.

Test patches, where a practitioner uses them, are a way of observing a small area before treating a face. They are not a guarantee. They are one more reason not to treat a whole face on a first visit because a voucher is about to expire.

Post-inflammatory pigment change can also follow a treatment that looked uneventful on the day. Sun protection afterwards is part of the treatment, not an optional extra. A device that is offered in the week before a beach holiday is being offered at the wrong time.

None of this is an argument that people with skin of colour cannot be treated. It is an argument that the operator must know the device, the wavelength and the person. If they cannot explain why a particular machine is suitable for your skin, they are not ready to fire it.

The eye is not a cosmetic surface

Laser and IPL wavelengths used on the face travel. The globe sits a few centimetres from a common treatment field. Injury to the cornea, lens or retina is a documented class of harm. Plume and reflection add risk for the operator and for anyone else standing in the room.

Protection means eyewear or, for treatments on the eyelid, corneal shields placed by someone who knows how to place them. The protection must be rated for the wavelength and optical density of that device. A pair of sunglasses on the counter is theatre. So is asking a person to shut their eyes while an IPL handpiece fires beside the nose.

Operators need their own eyewear. So does a bystander who has come in “just to watch”. A room used for energy devices should be controlled: signage, blinds, and a habit of not opening the door mid-pulse. These are ordinary laser-safety practices in hospitals. They are not less necessary because the invoice says “refresh”.

If a person reports visual change, severe eye pain or a flash sensation during treatment, the session stops. That is not a moment for another pass. It is a moment for medical assessment.

TGA inclusion and the machine of unknown origin

The TGA regulates many lasers and energy devices as medical devices. Supply in Australia may require inclusion on the Australian Register of Therapeutic Goods, with a sponsor who is responsible for the device. Clinics also have obligations around maintenance, calibration and the use of a device within its intended purpose.

A machine that arrived through an informal importer, that has no English-language instructions, that has had its safety interlocks defeated, or that is being used for a purpose the manufacturer never claimed, is a problem before anyone turns it on. Burns and eye injuries from poorly maintained or inappropriate devices are not theoretical. When a regulator later investigates, “we got a good price” is not a defence.

Readers will not usually see an ARTG number on a waiting-room wall. They can ask whether the device is TGA-included, what it is indicated for, how often it is serviced, and who is authorised to use it. They can notice whether the serial sticker is still on the box in the corner. A practice that is proud of its governance will not be offended.

Device regulation is not the same as practitioner regulation. A lawful machine in untrained hands is still a hazard. Ahpra’s advertising rules still apply to the service: no testimonials, no before-and-after images used to promise a look, no claim that a device is equivalent to surgery, no invented science. “Clinical-grade” is not a standard. “Hospital-grade” is not a standard unless a hospital is actually involved.

Not a substitute for surgery

Energy can change the colour of a spot, the visibility of a vessel, the quality of a scar, the density of hair, or the feel of a patch of skin. Some devices produce a modest tightening that a person may or may not notice in a photograph they were never going to publish. Surgery removes or repositions tissue. A blepharoplasty addresses eyelid skin and, where indicated, fat and muscle. A facelift addresses deeper structures and skin excess. An abdominoplasty addresses abdominal wall and skin. No handpiece does those operations.

Advertising that places a device next to a surgical photograph, or that uses the word “lift” as if anatomy had been rewritten, is the kind of claim Ahpra’s guidelines are designed to catch. This journal will not launder it. If you are considering facial surgery, read the surgical explainers as surgical explainers. If you are considering a device, judge it on the change it can actually make to the surface or the adnexa it can actually heat.

Combination plans — a device at one stage and an operation at another — are sometimes discussed in rooms. They are two treatments, two recoveries and two consent processes. They are not a reason to blur the categories.

Operators, training and the burn protocol

Who may use a Class 4 laser or a powerful IPL system is not uniform across Australia. States and territories have radiation and laser-safety arrangements that can include licensing, a nominated laser safety officer, and rules about supervised use. On top of that, the service may be a regulated health service if a registered practitioner is offering it as treatment.

A reader should be able to identify the responsible person, check them on the Ahpra register where they are a registered practitioner, and hear a plain account of what happens if the skin blisters. A burn protocol is not dramatic. It is cool dressings, analgesia, a decision about whether a medical review is needed, wound care, and follow-up for pigment and scar. It is also an incident that should be recorded. A shop that treats a blister as a “little crust that means it is working” is not describing a burn accurately.

Pain during treatment is information. So is an unusual smell of burning, a bright white flash on dark skin, or an operator who says “we’ll just turn it up, you can take it”. You can stop a treatment. You are not obliged to finish a package.

Aftercare and the limits of the evidence

Aftercare depends on the device and the depth of injury. Ablative resurfacing may involve dressings, petrolatum, antiviral cover in selected people, and weeks of redness. IPL or hair reduction may involve little more than cooling and sun avoidance. Radiofrequency microneedling sits somewhere in between. Follow the written instructions from the treating team. Do not add home acids, essential oils or another device because a video suggested a “stack”.

Evidence for many cosmetic energy treatments is mixed: small studies, industry sponsorship, short follow-up, and endpoints that are photographs rather than function. Where evidence is thin, this journal says so. A device can be lawfully supplied and still be a weak answer to the problem you brought in. An honest consultation includes the option of not treating.

Lasers and their cousins are tools. In a governed clinic, with a device on the register, an operator who understands pigment and a pair of rated goggles, they can be discussed like any other non-surgical treatment: indications, limits, risks, alternatives. In a room that has none of those things, they are a heat source aimed at a face.