The Light Brigade

‘It’s wild. I’m in a daze. I can instantly see better,” said Janice Salmon-Buswell, bursting out of her doctor’s office after a five-minute laser treatment to correct her nearsightedness.

The $3,600 procedure she underwent this month landed the Fountain Valley businesswoman in an ever-expanding circle of Californians seeking the latest in laser technology to remove unwanted hair, wrinkles, moles or tattoos, to treat cancer, whiten teeth, transplant hair and even enhance sexual pleasure.

For certain conditions and ailments, experts say, lasers can do it better, faster, more precisely and with less damage or pain than traditional procedures. Recent advances in laser technology have led industry experts to forecast a huge market for the devices. And health, dental and cosmetic practitioners have seized on lasers as a tool for enhancing their livelihoods.

The trouble is, lasers don’t always live up to their promise.

They can cost practitioners hundreds of thousands of dollars, and they can be dangerous.

What’s more, regulators can’t keep up with all the new uses being hyped for lasers. It’s hard to police that use by health and cosmetic practitioners.

“People think you can do almost anything with a laser, and that’s certainly not the case,” said Dr. Michael Rabkin, an eye and cosmetic surgeon in Brentwood who uses them for skin resurfacing and eyelid surgery.

“It’s not like you pass a wand over the body and boom--everything [unsightly] is gone,” he said. “There are still risks of infection and scarring.”

Still, analysts say demand for laser procedures will explode as aging baby boomers seek painless, easy ways to rejuvenate themselves.

The Medical Laser Report, a trade publication, predicts that worldwide sales of surgical lasers, including those for skin resurfacing and hair removal, will jump 19% this year over last, to $765 million. Consultant Irving J. Arons expects that the use of innovative lasers for hair removal and teeth whitening will dwarf lasers’ role in other medical procedures by 2000.

And laser industry executives say there’s no better marketplace than California.

“Californians are trendsetters,” said Daniel Caruso, executive vice president of Premier Laser Systems Inc. in Irvine. “When you talk about the appeal of cosmetics--dermabrasion or teeth whitening--Californians are very aware of their physical presence.”

Last year, Premier got regulatory approval to market the first laser for removing dental cavities. Caruso said dentists from California and New York have placed the most orders so far.

What’s more, California boasts more major manufacturers of medical and dental lasers than any other state. It is also where the first laser was built--in 1961 at Hughes Aircraft.

Laser makers say health practitioners here like to experiment with new technologies. Doctors, under managed-care pressures, see new laser procedures as a way to boost revenue from patients who can afford to pay out of pocket.

A laser--the word is an acronym for light amplification stimulated emission radiation--is an extremely bright light composed of highly concentrated, parallel beams.

It’s formed when light or electricity enters a material and excites the molecules, causing their electrons to leap to higher energy levels. As the electrons lose energy, the molecules emit light, which enters other molecules and repeats the process. The light is bounced repeatedly between two parallel mirrors or other reflective surfaces, then let loose in extremely concentrated, focused beams.

A laser can work on the body in a variety of ways. Among other things, it can selectively target, cut and vaporize tissue; transmit shock waves to break up matter; or activate drugs.

Lasers have been used in surgery for decades, and today medical residents routinely train with them, using them as just another tool for common procedures on the eye or abdomen.

But as recent advances in the field have given lasers new cachet among patients, practitioners are finding sometimes unproven applications for the devices.

Dr. David Matlock, a surgeon at the Laser Vaginal Rejuvenation Center of Los Angeles, is promoting a laser procedure to enhance sexual gratification. Matlock said the $4,000 procedure, intended to tighten vaginal muscles, has traditionally been used after pregnancy as a treatment for incontinence.

Gynecologists have generally been unwilling to treat a decline in female sexual pleasure after pregnancy, Matlock said. Noting that most gynecologists are men, he added, “If this was a problem with men, it would have been corrected a long time ago.”

But there has been no research that proves the procedure works. Dr. Donald Gallup, secretary-treasurer of the Society of Gynecologic Surgeons, said that when the procedure is done to treat incontinence, “there may be a secondary benefit in selected patients. But I don’t think anybody has appropriately studied the issue.”

Experts say lasers aren’t for the untrained. They suspect far more injuries are caused than official figures indicate--and the handful that are reported indicate how serious the injuries can be.

Rockwell Laser Industries, a consulting firm, reports that in recent years, patients as well as physicians and other professionals have suffered burns, loss of facial hair and eye damage. Hospital curtains have been set afire. Faulty equipment, failure of safety gear, removal of safety goggles or equipment being accidentally switched on have been blamed.

Health consultants say oversight of laser use is inadequate. Though the Food and Drug Administration deems lasers safe and effective for certain procedures, physicians can use them in any manner they wish. Hospitals generally limit their use to selected doctors, but critics say nobody is watching how physicians use them in their private offices.

“By and large, the ads you see in the newspaper are for procedures doctors are doing in their offices or surgicenters, where you won’t get the kind of oversight you see in the hospital,” said Michael W. Berns, director of UC Irvine’s Beckman Laser Institute and Medical Clinic.

What’s more, advances are coming so quickly that practitioners question some regulatory approvals.

The American Dental Assn., which endorses products it considers safe and effective, has been lukewarm in its support for Premier’s laser, for instance. Though the laser was approved by the FDA in May, the Chicago-based professional group hedged in its endorsement this year. It said the laser could be used for small and medium-sized cavities, but it requested more data before passing judgment on using the laser for deeper cavities.

The organization cited potential risk to the pulp, the soft tissue that holds a tooth’s nerve and blood vessels, nourishes it and keeps it moist.

“The dental pulp is a fragile tissue that we’re very concerned about possibly getting damaged,” said Dan Meyer, the group’s associate executive director for science.

Meanwhile, health and cosmetic professionals are tussling over who can use lasers.

In December, the California Department of Consumer Affairs determined that only doctors--or nurses or physician’s assistants under a doctor’s supervision--can use a laser to remove hair.

That left about 2,000 electrologists throughout the state fearing loss of their livelihood.

“All these years the electrologists community has been enjoying this quiet, independent profession, and all of a sudden they faced losing control,” said Will Waterman, executive vice president of the Norris School of Electrology in Woodland Hills.

Waterman said Norris’ enrollment dropped more than 60% a year ago as prospective students worried that the profession might become extinct. He’s now trying to find a legislator to sponsor a bill that would permit electrologists to use lasers.

Waterman says the lasers are no more dangerous than the electrical probes electrologists have always used.

As laser procedures proliferate outside the hospital, experts worry about who is using them and for what. Jim Rockwell, president of the Rockwell consulting firm, said state medical societies should set standards for doctors’ laser use and monitor those procedures.

While it’s probably fine for a trained doctor to let a trained nurse or technician handle certain laser procedures, Rockwell said, the doctor must be within earshot if something goes wrong.

“If it’s something involving my body,” he said, “I want a physician being responsible.”

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Medical Laser Market

Worldwide sales of medical lasers are expected to jump 11% this year to $1.7 billion. Medical laser sales, in billions:

Worldwide: $1.7 billion

U.S.: $1.1 billion

Source: Spectrum Consulting

Market Segments

Surgical*

Accessories/services

Ophthalmic**

Diagnostic

Therapeutic

* Leading applications are skin resurfacing, hair removal.

** Commonly used for refractive eye surgery.