Who Can Perform Laser Treatments In Ontario?

The Issue

Laser technology is being used for an increasing number of cosmetic treatments. Examples include hair reduction, skin improvement for wrinkle reduction and/or treatment of acne scars, removal of pigmented blemishes (e.g., age spots and moles), and treatment of vascular lesions (e.g., port wine stains and spider veins). Lasers are also used to remove tattoos.

If you are considering any of these procedures, it is important to look at the potential risks as well as the potential benefits.

What are laser cosmetic treatments?

Lasers produce a concentrated beam of visible or invisible energy or light with a predetermined wavelength that is directed towards a particular kind of tissue (or pigment) in the area of the body that is being treated. The result is that lasers can direct its energy to remove unwanted hair, inspire rejuvenated skin, and eliminate tattoo pigment.

How can laser treatments help?

Laser treatments produce long-term or permanent results in the area of hair and pigment removal, and can improve the appearance of skin sometimes lasting for years.

How do lasers work?

Lasers, which stand for Light Amplification by Stimulated Emission of Radiation, work by emitting a concentrated beam of light. The specifics of how they operate can differ based on their intended applications, especially in medical and cosmetic fields. I'll explain the general mechanism of how lasers work, and then delve into specifics for the Picoway and Gentlemax Pro Plus, which are used primarily for dermatological purposes.

Stimulation and Population Inversion: Inside a laser, there's an active medium (like gas, crystal, or in some cases, liquid) with atoms that get excited when energy (usually via electricity or another light source) is applied. This process is called "pumping." It creates a condition known as "population inversion," meaning there are more excited atoms than there are atoms in their ground (or normal) state.

Stimulated Emission:

When these excited atoms return to their normal state, they release their excess energy in the form of photons (light particles). This emission can stimulate nearby excited atoms to emit photons of the same wavelength and direction, amplifying the intensity of the light.

Optical Cavity:

These photons travel between mirrors in the laser device. One mirror is fully reflective, and the other is partially reflective, allowing some light to pass through. As they bounce between the mirrors, they stimulate other atoms to release more photons, all traveling in the same direction and phase. This process creates a coherent, monochromatic, and collimated beam.

Emission of Laser Beam:

The built-up light eventually passes through the partially reflective mirror, forming a very concentrated and powerful beam of light, known as a laser beam.

Picoway Laser:

The "Picoway" system uses ultra-short picosecond (trillionths of a second) laser pulses. These pulses hit the skin and shatter their targets (like pigment or ink in tattoo removal) into very tiny particles without heating the surrounding tissue. This "photoacoustic" effect breaks the particles down so they can be naturally eliminated by the body. Because the pulses are so fast, they leave the surrounding skin undamaged, making the process safer and more effective for skin treatments.

Gentlemax Pro Plus:

The "GentleMax Pro Plus" is a dual-wavelength laser platform that combines a 755nm Alexandrite laser and a 1064nm Nd:YAG laser, allowing versatility in treating various skin conditions and types. The system can be used for hair removal, treating pigmented lesions, and vascular anomalies like spider veins.

Here's how it works for hair removal, for example:

Targeting Melanin: The laser light is absorbed by the melanin (the dark pigment) in the hair.
Heat Generation and Damage: The light energy is converted to heat, which damages the tube-shaped sacs within the skin (hair follicles) that produce hairs. This damage inhibits or delays future hair growth.
Preservation of Surrounding Skin: Because the laser is very focused and quick, it can selectively target the hair follicle while leaving the surrounding skin undamaged.

Each system's effectiveness can depend on multiple factors including skin type, the area being treated, and the skill of the practitioner. Always ensure treatments are performed by licensed professionals to avoid any complications.

Are Lasers radiation?

Lasers produce a type of energy known as "electromagnetic radiation," similar to radio waves, microwaves, X-rays, and sunlight. The term "radiation" often brings to mind the harmful, ionizing radiation associated with nuclear energy or medical X-rays, capable of removing tightly bound electrons from atoms, thus damaging DNA and potentially causing harm. However, it's important to differentiate between ionizing radiation and the non-ionizing radiation produced by lasers, especially those used in medical or cosmetic treatments.

Understanding Radiation:

Radiation is a process by which energetic particles or energy waves travel through a medium or space. There are two main types:

Ionizing Radiation: This type has enough energy to strip electrons from atoms (ionization), potentially causing chemical changes that can damage living cells and DNA. Examples include ultraviolet rays from the sun (UV-C and some UV-B), X-rays, and gamma rays. The health risks associated with ionizing radiation are the reason for strict regulatory standards in nuclear power, industrial, and medical fields.

Non-Ionizing Radiation: This form of radiation doesn't carry enough energy per quantum to ionize atoms or molecules. It only has sufficient energy to change the rotational, vibrational or electronic valence configurations of molecules and atoms. Common examples include visible light, microwaves, and radio waves.

Lasers and Non-Ionizing Radiation:

Lasers, including medical and cosmetic lasers like the Picoway and GentleMax Pro Plus, produce non-ionizing radiation. They emit light that is coherent (all waves are in phase with each other), monochromatic (a single wavelength), and collimated (the waves travel in parallel), allowing for a very concentrated and precise beam.

The radiation from lasers doesn't penetrate in the body to reach internal tissues, nor does it have the energy to disrupt atoms and molecules within the cells or DNA. However, that doesn't mean they are entirely without risk. The concentrated light from lasers can cause tissue damage, primarily through heat generation or photochemical reactions, depending on the laser's wavelength, intensity, and exposure duration. This is often the intended effect in medical procedures, where lasers target specific tissues without affecting surrounding areas.

Safety and Regulation:

Despite being non-ionizing, laser radiation can still be hazardous, particularly to the eyes and skin. High-power lasers are capable of causing serious eye injuries even from the reflection of a surface and can burn the skin. As such, various safety standards and regulations have been established worldwide to protect both patients and practitioners in clinical and cosmetic settings. These standards govern the manufacture, use, and maintenance of laser equipment, specifying necessary safety measures like protective eyewear, warning signs, and training for safe operation.

In conclusion, while lasers do indeed involve radiation, it is of the non-ionizing type and does not carry the same risks as ionizing radiation. Nonetheless, proper precautions are essential to prevent potential harm from their concentrated light energy.

Who can perform cosmetic laser treatments in Canada?

In Ontario, Canada, the regulation surrounding who can perform cosmetic laser treatments is guided by several regulatory bodies and legislation, primarily concerning client safety and professional competency. These regulations can change, and it's always a good idea to refer to the latest guidelines or consult with a professional body. However, below is a general overview.

Medical Professionals:

Physicians: Medical doctors are permitted to perform cosmetic laser procedures in Ontario. They are often involved in more complex or high-risk procedures and can supervise non-physicians performing these treatments.

Nurses: Registered Nurses (RNs) and Registered Practical Nurses (RPNs) may perform certain types of cosmetic laser procedures under the order of a physician. They must act within the College of Nurses of Ontario practice standards and guidelines, ensuring they have appropriate training and competence in the specific procedures.

Non-Medical Professionals:
Aestheticians and Other Practitioners: The use of cosmetic lasers by non-medical personnel such as estheticians is a bit more nuanced. These practitioners can perform some laser procedures, but there are strict regulations they must follow. They should have specialized training in laser safety and operation. Moreover, certain high-risk procedures may be restricted only to medical professionals.

Regulation and Oversight:

Regulatory Colleges: The regulatory bodies, such as the College of Physicians and Surgeons of Ontario (CPSO) and the College of Nurses of Ontario, provide practice standards and guidelines for their members. These organizations also have the authority to investigate complaints and enforce disciplinary actions if necessary.

Public Health Ontario: This organization sets health policy and works to ensure health services are meeting safety standards. They might be involved in setting guidelines for facilities where laser treatments are provided.

Ministry of Health: The provincial government can also have legislation regarding the use of medical and non-medical cosmetic procedures, including laser treatments.

Training and Certification:

Regardless of professional background, all practitioners need appropriate training in laser technology, which includes understanding the types of lasers, skin assessments, laser safety, potential complications, and first-aid measures in case of accidental injury. There are various certifications for laser therapy that professionals can obtain to demonstrate their competence and skill in this area.

What are "controlled acts"?

A controlled act is a healthcare activity that can cause harm if a person who is not qualified or skilled performs it. 

There are 14 controlled acts listed in the Regulated Health Professions Act (RHPA). The RHPA also outlines which activities can be performed by each of the regulated healthcare professions. 

The Regulated Health Professions Act defines a “controlled act” is any one of the following done with respect to an individual:

1.  Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.

2.  Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of teeth.

3.  Setting or casting a fracture of a bone or a dislocation of a joint.

4.  Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low-amplitude thrust.

5.  Administering a substance by injection or inhalation.

6.  Putting an instrument, hand or finger,
i.  beyond the external ear canal,
ii.  beyond the point in the nasal passages where they normally narrow,
iii.  beyond the larynx,
iv.  beyond the opening of the urethra,
v.  beyond the labia majora,
vi.  beyond the anal verge, or
vii.  into an artificial opening into the body.

7.  Applying or ordering the application of a form of energy¹ prescribed by the regulations under this Act.

8.  Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept.

9.  Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses other than simple magnifiers.

10.  Prescribing a hearing aid for a hearing-impaired person.

11.  Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning.

12.  Managing labour or conducting the delivery of a baby.

13.  Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response.

14.  Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning. 1991, c. 18, s. 27 (2); 2007, c. 10, Sched. L, s. 32; 2007, c. 10, Sched. R, s. 19 (1).²

Are laser treatments a controlled act?

Based on the definitions above, laser treatments using registered devices for the purposes of tattoo removal, removal of benign pigmented lesions, and to support rejuvenated skin are not controlled acts in the Province of Ontario (as of the time of publication of this article). Readers are encouraged to contact Public Health Office or Regulatory Colleges in their own region to determine regulations in their city or province.

What are the risks with laser treatments? 

Common Risks:

Burns or Scarring: High-intensity laser beams can cause burns if not used correctly. Although rare with experienced practitioners, these burns could potentially lead to scarring.

Pain: During the procedure, patients might experience discomfort or pain, although most modern laser treatments are significantly less painful than earlier methods.

Skin Pigmentation Changes: Hypopigmentation (lightening of the skin) or hyperpigmentation (darkening of the skin) can occur. These changes might be temporary or permanent. Individuals with darker skin tones are at a higher risk of pigmentation changes.

Eye Injury: This is a risk when lasers are used around the eye area, emphasizing the need for appropriate eye protection during any laser procedure.

Infection: Though not common, any damage to the skin can potentially lead to infection if not properly cared for post-procedure.

Swelling and Redness: These are common immediate post-procedure effects and usually subside within a few hours to a few days.

Blistering and Crusting: This can occur in the days following treatment, particularly with procedures that remove layers of skin or induce significant heating.

Bruising: This can occur, especially if the laser treatment is combined with other cosmetic procedures

Specific Risks:

Laser Hair Removal: Risks include skin irritation and pigment changes. Rarely, laser hair removal can cause blistering, crusting, scarring, or other changes in skin texture.

Tattoo Removal: Besides the above-mentioned risks, incomplete tattoo removal, or the darkening of some tattoo inks, can occur.

Skin Resurfacing: This procedure carries a higher risk of scarring, significant changes in skin pigmentation, and sometimes, activation of cold sores.

Risk Reduction:

To minimize these risks, several precautions should be taken:

Qualified Practitioners: Always ensure the procedure is conducted by a licensed and experienced professional who follows all necessary safety protocols.

Pre-Treatment Consultation: A thorough consultation should be conducted to discuss the individual's medical history, establish realistic expectations, and plan the procedure specifics.

Follow Aftercare Instructions: Adherence to guidelines for post-procedure care is crucial in managing side effects and achieving the best results.

Use of Proper Equipment: Ensure the facility uses well-maintained, state-of-the-art laser equipment, and that the type of laser used is appropriate for your skin type and the condition being treated.

Patch Test: For sensitive procedures or individuals with sensitive skin, performing a patch test to observe the skin’s reaction to the laser can be a precautionary measure.

What are the benefits of laser treatments?

Laser treatments have revolutionized cosmetic and medical procedures by offering a non-invasive or minimally invasive option for many conditions that previously required surgery or heavy medication. These treatments use focused light therapy to treat various skin conditions, remove unwanted hair or tattoos, and even correct vision. Here are some of the key benefits:

1. Precision:

Lasers can target specific areas accurately and intensely, leaving the surrounding tissues unharmed. This precision is particularly beneficial in treatments like removing skin imperfections (birthmarks, moles, or scars) or correcting vision.

2. Reduced Recovery Time:

Because laser treatments are typically less invasive than traditional surgery, the recovery time is often significantly shorter. Patients can sometimes return to their normal activities the same day or shortly after the procedure.

3. Minimal Side Effects:

Laser procedures usually have fewer side effects compared to traditional surgery or medications. There's less risk of infection, and patients generally report less pain or discomfort during recovery.

4. Versatility:

Lasers can be used for a multitude of cosmetic and medical procedures. They can treat skin conditions, remove tattoos, reduce the appearance of wrinkles or scars, eliminate unwanted hair, and more.

5. Improved Skin Quality:

In addition to addressing specific issues, laser treatments can stimulate collagen production, leading to firmer, smoother, and younger-looking skin. This benefit is often seen in laser skin resurfacing procedures.

6. Long-lasting Results:

Many laser treatments offer long-term or permanent solutions. For instance, laser hair removal can permanently reduce unwanted hair, and laser eye surgery can have lasting results for vision correction.

7. Non-Invasive or Minimally Invasive:

Many laser procedures are non-invasive or minimally invasive, meaning they don't require incisions. This feature reduces the risk of scarring and trauma to the body.

8. Cost-Effective in the Long Run:

While the upfront cost might seem high, laser treatments can be cost-effective over time. For example, laser hair removal might eliminate the need for a lifetime of shaving or waxing.

9. Customization:

Laser treatments can be customized for the individual's specific skin issues, desired outcomes, and even skin type. This personalization increases the effectiveness of the treatment.

10. Confidence Boost:

By addressing cosmetic concerns, laser treatments often provide individuals with a significant confidence boost, contributing to mental and emotional well-being.

What are the alternatives to laser treatments?

Both the PicoWay and GentleMax Pro Plus lasers are used for various dermatological and aesthetic purposes, including tattoo removal, pigmentation correction, and hair removal. While these laser systems are popular due to their efficacy and reduced recovery time, some individuals may seek alternatives due to skin sensitivity, contraindications, or personal preference. Here are alternatives to the treatments commonly performed with these lasers:

1. Tattoo Removal:

Alternatives:

Surgical Excision: This involves physically cutting out the tattooed skin and stitching the surrounding skin together. It's effective but invasive and often leaves a scar.

Dermabrasion: This technique sands down the skin to remove the surface and middle layers, fading the tattoo. It's less precise than lasers and can be painful and irritating.

Salabrasion: This method uses a salt solution to abrade the tattooed skin, facilitating the tattoo ink's removal. It's an older and less commonly used method due to pain and risk of scarring.

Tattoo Cover-Ups: Instead of removal, some opt for a new tattoo to cover the old one, which requires a skilled tattoo artist.

2. Pigmentation Correction:

Alternatives:

Topical Creams: Products with lightening agents (like hydroquinone, kojic acid, or vitamin C) are used to reduce hyperpigmentation. They are usually less effective on deeper pigmentation.

Chemical Peels: These involve applying a chemical solution to "peel" away layers of skin, which can help with conditions like sunspots, melasma, and other forms of hyperpigmentation.

Microdermabrasion: This is a minimally abrasive procedure that sands away the thick outer layer of skin to rejuvenate it and address pigmentation.

Cryotherapy: This involves using liquid nitrogen to freeze and destroy the pigmented areas, prompting new skin growth.

3. Hair Removal:

Alternatives:

Electrolysis: This method destroys the growth center of the hair with chemical or heat energy. It's a viable option for those not suitable for laser hair removal and can be used on most areas of the body.

Waxing or Threading: These are temporary hair removal methods that pull hair from the root. They need to be repeated regularly.

Depilatory Creams: These creams contain chemicals that dissolve the proteins in hair, allowing it to be wiped away from the skin's surface.

Intense Pulsed Light (IPL): While still a light-based therapy, IPL uses a broad spectrum of light with multiple wavelengths and is different from the concentrated single-wavelength light used in laser treatments.

Each of these alternatives has its own set of benefits, limitations, and suitability based on skin type, hair type, and individual health considerations. They may vary in effectiveness, cost, duration of results, and potential side effects. It's important for individuals to consult with a dermatologist or qualified skincare professional to determine which method is most appropriate for their specific needs and conditions.

How are lasers and laser treatments regulated in Canada?

Laser treatments, particularly in the medical and cosmetic fields, are subject to various regulations in Canada. These regulations are intended to protect both the patient and the practitioner by ensuring safe practices and the use of safe equipment. Here's how laser regulations are structured across different levels of government and within practices in Canada:

1. Federal Laws:

At the federal level, Health Canada plays a significant role in regulating medical devices, which include medical-grade lasers used for various treatments. The department ensures that devices sold or used within the country meet the necessary safety and effectiveness standards.

Device Licensing: All medical-grade laser equipment must be licensed for sale in Canada. Health Canada reviews the devices to ensure they perform safely and as intended.

Radiation Emitting Devices Act: This act sets out safety standards for devices that emit radiation, including lasers. It covers aspects like manufacturing, sale, and importation, ensuring devices don't pose unnecessary risks due to radiation exposure.

2. Provincial Laws:

Regulation at the provincial level can vary significantly, but it generally covers the operation of facilities and the qualifications required to perform laser treatments.

Regulatory Health Colleges: In provinces like Ontario, regulatory colleges for professions such as medicine, nursing, and esthetics set standards of practice for their professionals. These colleges may have guidelines or policies regarding the use of lasers in treatments, particularly concerning patient consent and practitioner competency.

Health and Safety Regulations: Some provinces may have specific health and safety regulations regarding the use of lasers in medical and cosmetic procedures to ensure patient safety and proper sanitation.

3. Municipal Laws:

Municipal regulations, while not as common for medical procedures, may be more pertinent to cosmetic or esthetic treatments, particularly in businesses like spas or beauty salons.

Business Licensing: Municipalities may require facilities offering laser treatments to obtain a business license, and they may impose certain health and safety standards as a condition of that license.

Zoning Bylaws: These are more about where a business can operate and may affect facilities offering laser treatments.

4. Other Regulations:

Canadian Standards Association (CSA): The CSA develops standards for a wide range of equipment and practices, including potentially those used in laser treatments. While adherence to these standards is often voluntary, they can be a benchmark for best practices.

Advertising Standards: These regulations can affect how laser treatments are marketed to the public, ensuring claims are truthful and not misleading regarding the safety or effectiveness of the treatment

5. Self-managed Practices and Other Built-in Safety Guards:

Professional Training and Certification: Practitioners typically undergo specialized training to use laser technology safely and effectively. Certification programs, often offered by reputable organizations, ensure a standard level of competency.

Informed Consent: Ethical practices require that practitioners fully inform patients of the risks and benefits of laser treatments, allowing patients to make informed decisions.

Safety Protocols: Facilities should have safety protocols in place, including protective equipment (like goggles to protect eyes from laser exposure), emergency procedures, and regular maintenance of laser devices.

Quality Assurance Practices: These include regular reviews of protocols, updating training, and ensuring compliance with the latest research and safety standards in laser treatment.

Regulations and self-managed practices work in tandem to maintain a high standard of care, ensuring that treatments provided are not only effective but also safe for both the patient and the practitioner. As laser technology advances, these regulations and standards are continually evolving to reflect new knowledge and practices.

Should laser treatments be restricted, or prohibited in Canada?

The question of whether laser treatments should be restricted or prohibited in Canada is one that involves careful consideration of public safety, professional standards, and the benefits and risks associated with these procedures.

Regulatory Foundations in Legislation:

Regulations are instrumental in delineating the operational aspects of new laws, and providing specific guidelines that are legally enforceable. These regulations, while carrying the force of law, are not crafted by Parliament itself. Instead, they are the creation of individuals or entities to whom Parliament has delegated regulatory authority through specific Acts. Such entities might include the Governor in Council or a particular Minister, depending on the stipulations of the Act.

Decision-Making on Laser Treatment Regulations:

The decision to regulate laser treatments, and the extent of such regulation, typically falls within the purview of governmental oversight. In certain cases, the government may establish a dedicated entity, either on a temporary or permanent basis, to supervise the professional standards and practices of those who perform laser treatments. This regulatory body might enforce stringent requirements, including mandatory registration, licensing, adherence to disciplinary protocols, and ongoing professional education, to ensure adherence to established safety and professional standards.

The government may also convene advisory panels composed of seasoned professionals and subject matter experts, such as physicians, healthcare practitioners, and aestheticians. These experts are often summoned to contribute their insights and expertise, informing the legislative and regulatory process with up-to-date, practice-informed feedback. Their guidance is crucial in shaping policies and regulations that are both current and comprehensive.

Purpose of Regulations and Legislation:

The implementation of laws and regulations in the realm of laser treatments, as in other sectors, is primarily motivated by the protection of public interests. These legal instruments are designed to safeguard the populace, ensuring the safety and efficacy of laser treatments. By setting clear guidelines, they help prevent potential harm associated with improper use of laser technology.

Furthermore, regulations serve to standardize practices across the field, fostering an environment of professionalism and competency. They also protect consumer rights by ensuring that services meet specific quality standards, thereby instilling confidence among those seeking such treatments.

In essence, these regulatory measures are not instituted to serve the interests of the government per se, but rather to fortify the safety, rights, and well-being of the public while also maintaining a stable and fair economic landscape for such services.

¹ Source: https://www.ontario.ca/laws/regulation/960107 

² The following forms of energy are prescribed for the purpose of paragraph 7 of subsection 27 (2) of the Act: 1. Electricity for,i. aversive conditioning,ii. cardiac pacemaker therapy,iii. cardioversion,iv. defibrillation,v. electrocoagulation,vi. electroconvulsive shock therapy,vii. electromyography,viii. fulguration,ix. nerve conduction studies, or x. transcutaneous cardiac pacing. 2. Electromagnetism for magnetic resonance imaging. 3. Soundwaves for,i. diagnostic ultrasound, or ii. lithotripsy. O. Reg. 107/96, s. 1.

Disclaimer: The information provided on this website is not intended to replace either legal or medical advice. The reader is encouraged to conduct their own research and corroborate their findings with other resources and authorities on the subject matter before making any decisions. Cosmetic treatments should never be used to mask or resolve what could be an underlying medical treatment, and any potential medical concern should promptly be reviewed with your physician. It is strongly recommended to first obtain a consultation with any laser provider to learn more about the risks and benefits that are unique to you before subscribing to any treatments.