Lasers (Hair Removal)

Lasers

Laser Regulation

Virginia Board of Medicine

Laser Codes

Virginia Legislative Information System

Code of Virginia: § 54.1-2973.1. Practice of laser hair removal

(PDF) Code of Virginia: § 54.1-2973.1. Practice of laser hair removal

Laser Regulations in the News

Virginia lawmakers pass laser hair removal regulations

February 22, 2017

New law limits laser hair removal to professionals

June 30, 2017

VIRGINIA BOARD OF MEDICINE
GUIDANCE DOCUMENT
FOR
LIGHT-BASED HAIR REMOVAL IN PHYSICIAN PRACTICES

INTRODUCTION

Light-based hair removal is and has been available in Virginia in physicians’ practices and, as in other states, in nonmedical settings as well. The Board of Medicine receives a number of inquiries about the modality, usually in the realm of, “Does the Board of Medicine have laws or regulations governing light-based hair removal?” and “Is light-based hair removal considered the practice of medicine?”

There have been no Board of Medicine laws or regulations that specifically address light-based hair removal to inform the public, physicians and Board staff about this modality. Given the level of interest and lack of clarity in Virginia and across the nation on this matter, the Board determined that a review of the practice of laser hair removal should be undertaken. To accomplish this, an Ad Hoc Committee on Laser Hair Removal comprised of Board members and stakeholders was appointed to study light-based hair removal as it relates to the practice of medicine, public safety and the Board’s role.

CURRENT VIRGINIA LAW

There is nothing in Virginia law specific to laser hair removal, the use of lasers or the delegation of authority to use lasers. However, in Section 54.1-2400.01 of the Code of Virginia, there is a definition of laser surgery as follows:

As used in this subtitle, "laser surgery" means treatment through revision, destruction, incision or other structural alteration of human tissue using laser technology. Under this definition, the continued use of laser technology solely for nonsurgical purposes of examination and diagnosis shall be permitted for those professions whose licenses permit such use.

Additionally, Chapter 29 in Title 54.1 (the Medical Practice Act) has general law about delegation. Found in Section 54.1-2901, there are exceptions to the requirement for a license to practice medicine in (4) and (6) for:

…4. Any registered professional nurse, licensed nurse practitioner, graduate laboratory technician or other technical personnel who have been properly trained from rendering care or services within the scope of their usual professional activities which shall include the taking of blood, the giving of intravenous infusions and intravenous injections, and the insertion of tubes when performed under the orders of a person licensed to practice medicine;

6. Any practitioner licensed or certified by the Board from delegating to personnel supervised by him, such activities or functions as are nondiscretionary and do not require the exercise of professional judgment for their performance and which are usually or customarily delegated to such persons by practitioners of the healing arts, if such activities or functions are authorized by and performed for such practitioners of the healing arts and responsibility for such activities or functions is assumed by such practitioners of the healing arts;…

CURRENT VIRGINIA REGULATIONS

Again, there are no Board regulations on the practice of laser hair removal in physician practices, but 18VAC85-20-29 on practitioner responsibility specifies that:

A. A practitioner shall not:
1. Knowingly allow subordinates to jeopardize patient safety or provide patient care outside of the subordinate’s scope of practice or area of responsibility. Practitioners shall delegate patient care only to subordinates who are properly trained and supervised;

The foregoing laws and regulations make it quite clear that a licensee of the Board can delegate certain tasks and will be held accountable for the performance by subordinates.

What is not clear from the above laws and regulations is whether light-based hair removal is the practice of medicine.

MEDICAL OR AESTHETIC?

The statutory argument made for light-based hair removal not being considered the practice of medicine is the definition of the practice of medicine in the Code of Virginia. Section 54.1-2900 defines the practice of medicine as:

"Practice of medicine or osteopathic medicine" means the prevention, diagnosis and treatment of human physical or mental ailments, conditions, diseases, pain or infirmities by any means or method.”

Given that normal hair follicles and normal hairs are the target of services, there appears to be no prevention or diagnosis of pathological conditions involved that would make light-based hair removal the practice of medicine. Misdiagnosis is often used as the argument that these services should be provided by physicians. The most worrisome missed diagnosis would be a malignancy. There are no malignant hairs, but there are some rare follicular tumors.

If the practice of medicine involves diagnosis and pathology, and if it is true that pathology requiring diagnosis is rarely encountered in those individuals seeking light-based hair removal services, then the larger issue for patient safety becomes the use of the machine and its potential for patient harm. The energy from the light-based devices penetrates into the dermis and usually temporarily disables the hair follicle. In the hands of inadequately trained personnel, the machine becomes a greater risk factor, so proper training was seen by the committee as the most significant element in ensuring the public’s safety. Just behind training in its impact on patient safety was supervision, and supervision will always be an issue when these services are provided in a physician’s practice.

BOARD ACCEPTANCE OF COMMITTEE RECOMMENDATIONS

Based on the Committee’s recommendations and further review by the Legislative Committee, the Board adopts the following principles:

1. That the use of intense pulsed light devices solely for the removal of hair does not appear to be the practice of medicine.

2. That the use of light-based devices that involve revision, destruction, incision or other structural alteration of human tissue constitutes laser surgery in accordance with

§ 54.1-2400.01 of the Code of Virginia.

Given these two principles, coupled with the laws and regulations governing physician delegation and responsibility, the Board provides the following guidance.

GUIDANCE

Physicians who perform or delegate any aspect of light-based hair removal are fully responsible for the provision of such services and should maintain written policies and procedures to include:

1) Training and/or certification for staff involved in hair removal services

2) Initial assessment of patient

3) Informed consent

4) Energy or fluence setting

5) Management of complications

6) Emergency preparedness and procedures

7) Procedure if treatment results in an adverse reaction

8) Post-treatment follow-up.

The written policies and procedures should indicate the level of discretion granted to staff, as well as criteria that necessitated physician involvement.

Adopted by the Board of Medicine on February 21, 2008

Laser Guidance Document (PDF)

Laser Guidance Document (Word)

Virginia Board of Medicine Board Briefs (PDF)

HB 957 Laser hair removal technicians; licensure by Board of Medicine

Go to HB 957 on Virginia Legislative Information System website

SUMMARY AS INTRODUCED:

Board of Medicine; licensure of laser hair removal technicians. Requires individuals who practice laser hair removal to be licensed by the Board of Medicine. The bill defines "laser hair removal" and establishes the Advisory Board on Laser Hair Removal to advise the Board of Medicine on this discipline. The bill has a delayed effective date of July 1, 2017

Report on House Bill 957 (2016) | Laser hair removal technicians; licensure
View HB 957 Report (PDF)

Use of Lasers

Federation of State Medical Boards: Use of Lasers (PDF)

Use of Lasers/Delegation of Medical Functions
Board-by-Board Overview

	Laser Regulation Law, Rule or Policy	Requirements Related to Supervision and/or Delegation of Medical Functions to Unlicensed Individuals
AL	Ala. Admin Code 540-X-11 “Guidelines for the Use of Lasers and Other Modalities Affecting Living Tissue” Alabama Board of Medical Examiners “Use of Lasers FAQ”	Ala. Admin Code 540-X-11 “Guidelines for the Use of Lasers and Other Modalities Affecting Living Tissue”
AK	AK Department of Commerce, October 2007 “Guideline Regarding the Use of Lasers and Laser Surgery”	AK State Medical Board Guidelines, June 2004 “Guideline for Physicians in Delegating Procedures to Non-Physician Personnel When Performing Certain Dermatological Procedures.” AK State Medical Board Guidelines, January 2012 “Guideline: Delegating to Medical Assistants (Unlicensed Assistive Personnel)”
AZ-M	A.R.S. § 32-3231 et seq. “Cosmetic Laser & Injection Procedure” Ariz. Admin. Code R12-1-1440 “Medical Lasers”	A.R.S. § 32-3232 “Supervision” A.R.S. § 32-1456 “Medical Assistants” Ariz. Admin. Code R4-16-401 et seq. “Medical Assistants” Ariz. Admin. Code R12-1-1438 “Hair Reduction and Other Cosmetic Procedures Using Laser and Intense Pulsed Light”
AZ-O	--	A.R.S. § 32-1456 “Medical Assistants” Ariz. Admin. Code R4-22-402 et seq. “Medical Assistants Authorized Procedures”
AR	Regulations of the Arkansas State Medical Board “Regulation No. 22. Laser Surgery Guidelines”	Ark. Rev. Stat. § 17-105 et seq. “Physician Assistants” Regulations of the Arkansas State Medical Board “Regulation No. 31: Physician Delegation Regulation”
CA-M	CA Business & Professional Code § 2023.5 California Medical Board “FAQs – Cosmetic Treatments” California Medical Board “The Bottom Line: The Business of Medical Spas”	CA Business & Professional Code §§ 2069-2071 “Medical Assistants” California Medical Board “FAQs – Cosmetic Treatments”
CA-O	--	CA Business & Professional Code § 2459.6
CO	Colorado Medical Board, July 2010 “Policy: Use of Lasers to Provide Medical Services”	Colorado Medical Board, January 2011 “Rule: Delegation and Supervision of Medical Services”
CT	Connecticut Medical Examining Board “Declaratory Ruling on Use of Lasers for Hair Removal” Connecticut State Board of Chiropractic Examiners, August 2007 “Declaratory Ruling on Use of Lasers in a Chiropractic Practice”	CT Gen. Stat. § 20-9 “Who May Practice Medicine or Surgery”
DE	24 Del. Admin. Code §5100-14.0 “Health and Sanitation; Electric Nail Files, Hair Removal and Laser Technology”	24 Del. Admin. Code § 1700-11.0 “Delegation of Responsibilities to Non-physicians”
DC	--	--
FL-M	Fla. Admin. Code 64B15-14.007 “Standard of Care for Office Surgery” Fla. Admin. Code 64B8-56.002 “Protocols for Laser and Light-Based Devices” Florida Department of Health “Laser Information”	Fla. Stat. 458.348 “Formal supervisory relationships, standing orders, and established protocols”
FL-O	Same as FL-M	Fla. Stat. 459.025 “Formal supervisory relationships, standing orders, and established protocols”
GA	O.C.G.A. § 43-34-244 “Georgia Cosmetic Laser Services Act”	O.C.G.A. § 43-34-44 “Role of medical assistants clarified” Georgia Composite Medical Board Rule § 360-3-.05 “Medical Assistants, Polysomnography Technologists, and Radiology Technologists”
GU	--	--
HI	Hawaii Medical Board, August 2014 “Scope of Practice: Clarification Regarding the Use of Laser”	Haw. Rev. Stat. § 453-5.3(a) “Physician assistant; licensure required”
ID	Idaho State Board of Medicine, Sept. 2007 “Guidelines for Hair Removal using Intense Pulsed Light and/or Laser Devices by Supervised Medical Personnel”	Idaho Admin. Code § 22.01.04 “Rules of the Board of Medicine for Registration of Supervising and Directing Physicians”
IL	68 Ill. Admin. Code § 1285.336 “Use of Lasers” 32 Ill. Admin. Code § 315 “Standards for Protection Against Laser Radiation”	225 Ill. Comp. Stat. § 60/54.2 “Physician delegation of authority”
IN	844 IAC 4-3-2 “Surgical Operations”	IC 25-22.5-1-2 “Physicians; Exclusions”
IA	Iowa Medical Board, April 2006 “The Use of Lasers, Intense Pulsed Light Devices, and Radio-Frequency Devices”	Iowa Medical Board, April 2006 “The Use of Lasers, Intense Pulsed Light Devices, and Radio-Frequency Devices”
KS	K.A.R. 100-27-1 “Light Based Medical Treatment”	KSA 65-2872 “Persons not engaged in the practice of the healing arts”
KY	Kentucky Board of Medical Licensure “Opinion: Laser Surgery”	Kentucky Board of Medical Licensure “Opinion: Laser Surgery; IX: Non-physician Qualifications” LA
LA	La. Rev. Stat. § 37:1261(3) “Practice of Medicine” Louisiana State Board of Medical Examiners, Nov. 2001 “Position: Use of Medical Lasers, Chemical Skin Treatments”	La. Rev. Stat. § 37:1360.38 “Guidelines for certification and practice; Exemptions” Louisiana State Board of Medical Examiners, Nov. 2001 “Position: Use of Medical Lasers, Chemical Skin Treatments”
ME-M	32 M.R.S.A. §14202.7 “Practice of aesthetics”	32 M.R.S.A. § 3270-A “Assistants” Maine Board of Licensure in Medicine, Nov. 2013 “Advisory Ruling: Assistants (Unlicensed) Scope
ME-O	Same as ME-M	--
MD	COMAR § 10.32.09 “Cosmetic medical procedures” Maryland Board of Physicians, Fall 2004 Newsletter “Laser Hair Removal and Cosmetic Medical Procedures” Maryland Department of Health and Mental Hygeine, October 2002 “Declaratory Ruling: The Use of Lasers for Hair Removal”	COMAR § 10.32.12 “Delegation of Acts by a Licensed Physician to an Assistant Not Otherwise Authorized under the Health Occupations Article or the Education Article”
MA	243 CMR 5.01(2) “Practice of Acupuncture” 105 CMR 121.00 “To control the radiation hazards of lasers”	243 CMR 2.07(4) “Delegation of Medical Services”
MI-M	Michigan Department of Community Health, December 2005 “Position Statement: Use of Laser Equipment by Health Professionals”	MCL § 333.16215 “Delegation of acts, tasks, or functions to licensed or unlicensed individuals; supervision; immunity”
MI-O	Same as MI-M	--
MN	MN Statute §147.081.--3 “Practice of Medicine Defined”	--
MS	MS Board of Medical Licensure Admin. Code 30 § 2635.3 “Laser Devices”	--
MO	Missouri Board of Healing Arts, June 2011 “Guidelines: Medical Spas, Lasers, Botox”	--
MT	Admin. Rules of Montana § 24.156.501 “Definition” Admin Rules of Montana § 24.121.1509 “Implements, Instruments, Supplies, and Equipment”	Montana Code Ann. § 37-3-104 “Medical Assistants - Guidelines” Admin. Rules of Montana § 24.156.640 “Medical Assistant”
NE	Joint Board Dermatologic Workgroup Final Report, August 2011 “Scope of Practice Related to Non-Ablative Laser Procedures”	Joint Board Dermatologic Workgroup Final Report, August 2011 “Scope of Practice Related to Non-Ablative Laser Procedures”
NV-M	Nev. Rev. Stat. § 630.371 “Performance of laser surgery on eye without proper training”	Nev. Rev. Stat. § 454.213(22) “Authority to possess and administer dangerous drug” Nev. Rev. Stat. § 630.138 “Board authorized to adopt rules governing supervision of medical assistants” Nevada State Board of Medical Examiners “Medical Assistants and Administration of Prescription Drugs”
NV-O	--	--
NH	R.S.A. 329:1 “Physicians and Surgeons; Practice”	--
NJ	NJ Admin. Code § 13:35-4A.1 “Surgery, Special Procedures and Anesthesia Services Performed in an Office Setting” NJ Admin. Code § 13:35-12 “Electrologists Advisory Committee; Licensure of Electrologists and Electrology Instructors; Electrology Standards of Practice”	NJ Admin. Code § 13:35-6.4 “Delegation of Administration of Subcutaneous and Intramuscular Injections to Certified Medical Assistants”
NM-M	NMAC § 16.10.13.1 et seq. “Delegated Use of Devices and Procedures by Medical Assistants; Cosmetic Injections” New Mexico Medical Board “Policy: Lasers and Light Activated Devices for Hair Removal”	New Mexico Stat. § 61-6-17 “Exceptions to Medical Practice Act” NMAC § 16.10.13.1 et seq. “Delegated Use of Devices and Procedures by Medical Assistants; Cosmetic Injections” New Mexico Medical Board “Policy: Lasers and Light Activated Devices for Hair Removal”
NM-O	--	--
NY	NY PHL § 230-d “Office-Based Surgery” New York Department of Health “Office-Based Surgery”	NY Education Law § 6530 “Definitions of Professional Misconduct Applicable to Physicians, Physician's Assistants and Specialist's Assistants”
NC	NC Medical Board, July 2005 “Position Statement: Laser Surgery” NC Medical Board, Spring 2012 “Laser Hair Removal and Laser Tattoo Removal”	N.C. Gen. Stat. § 90-18 “Practicing without license” 21 NCAC 32S .0213 “Supervision of Physician Assistants” NC Medical Board, Spring 2012 “Laser Hair Removal and Laser Tattoo Removal”
ND	N.D. Century Code 43-38 “Electrologists and Electronic Hair Removal Technicians”	N.D. Admin. Code. 50-03-01-06 “Assistant’s functions limited”
OH	Ohio Admin. Rules 4731-18-01 et seq. “Standards for Surgery & Use of Light-based Medical Devices”	Ohio Admin. Rules 4731-23 “Delegation of Medical Tasks”
OK-M	Oklahoma Medical Board, November 2008 “Policy and Guidelines for Medical Spas & Aesthetic Procedures”	Oklahoma Medical Board, November 2008 “Policy and Guidelines for Medical Spas & Aesthetic Procedures”
OK-O	--	--
OR	Oregon Medical Board, January 2002 “Statement of Philosophy: Medical Use of Lasers”	OR Rev. Stat. § 677.505 “Application of provisions governing physician assistants to other health professions”
PA-M	--	49 Pa. Code § 18.402 “Delegation of Medical Services”
PA-O	--	49 Pa. Code § 18.402 “Delegation of Medical Services”
PR	--	--
RI	Rhode Island Board of Medical Licensure & Discipline, March 2011 “Policy Statements: Office based esthetic procedures”	RI Gen L § 5-54-3 “Physician Assistants; Exemptions” RI Dept. of Health, February 2014 “Guidelines Regarding Scope of Practice, Supervision, and Minimum Expectations of Conduct of Medical Assistants”
SC	South Carolina Board of Medical Examiners, November 2007 “Policy: Medical Devices/Delegatable Medical Act”	SC Code Ann. § 40-47-30 “Licensure Requirement; excepted activities” South Carolina Board of Medical Examiners, November 2007 “Policy: Medical Devices/Delegatable Medical Act”
SD	SD Codified L § 36-4-8.2 “Surgery constituting practice of medicine”	SD Board of Medical and Osteopathic Examiners, March 2012 “Laser Utilization by Nurse Practitioners and Physician Assistants”
TN-M	TN Admin. Code 0880-02-.14(10) “Use of Laser Equipment” TN Admin. Code 0880-02-.21 “Office Based Surgery”	--
TN-O	TN Admin. Code 1050-02.13(10) “Use of Laser Equipment” TN Admin. Code 1050-02-.21 “Office Based Surgery”	--
TX	TX Admin. Code § 193.17 “Nonsurgical Medical Cosmetic Procedures”	TX Admin. Code §§ 193.1-193.10 “Standing Delegation Orders” Tx. Occ. Code § 157.001 “General Authority of Physician to Delegate”
UT-M	Utah Code § 58-11a-102(28) “Practice of Esthetics” Utah Admin. Code R156-11a-611 “Standards for Approval of Mechanical or Electrical Apparatus”	--
UT-O	Same as UT-M	--
VT-M	26 V.S.A. § 4402(3) “Electrology” 26 V.S.A. § 1728(b)(1) “Use of therapeutic pharmaceutical agents”	--
VT-O	--	--
VA	Virginia Board of Medicine, February 2008 “Guidelines for Light-based Hair Removal in Physician Practices”	VA Code § 54.1-2901(6) “Exceptions and exemptions generally”
WA-M	WAC 246-919-605 “Use of lasers, light, radiofrequency, and plasma devices as applied to the skin”	WAC 246-919-605(10) “Delegation of LLRP Treatment”
WA-O	WAC 246-853-630 “Use of lasers, light, radiofrequency, and plasma devices as applied to the skin”	WAC 246-853-630(10) “Osteopathic Physician Delegation of LLRP Treatment”
WV-M	W. Va. Code § 30-3-4(3) “Practice of Medicine and Surgery” West Virginia Board of Medicine, February 2007 “Public Policy Statement on Surgery using laser, pulsed light, radiofrequency devices, or other techniques”	West Virginia Board of Medicine, February 2007 “Public Policy Statement on Surgery using laser, pulsed
WV-O	--	--
WI	Wisc. Admin. Code Cos2.025 “Delegated Medical Procedures”	Wisc. Admin. Code Cos2.025 “Delegated Medical Procedures”
WY	Wyoming Board of Medicine Rules § 1.3(zz) “Practicing Medicine”	Wyoming Board of Medicine Rules § 1.3(nn) “Medical Assistant”

For informational purposes only: This document is not intended as a comprehensive statement of the law on this topic, nor to be relied upon as authoritative.

Non-cited laws, regulation, and/or policy could impact analysis on a case-by-case or state-by-state basis. All information should be verified independently.