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How Much Training Do Aesthetic Laser Providers Need?

Posted By Madilyn Moeller, Thursday, February 6, 2025

In most states, filler or neurotoxin injections must be performed by registered nurses, nurse practitioners, physician assistants or physicians (MD/DO). The rules for who can fire a laser are often very different. 2024 saw an uptick in legislation regarding laser training requirements for aesthetic practitioners, and while there is not yet a nationwide standard for training, responsible medical spas continue to invest in specialized training and ongoing education to ensure their providers are practicing safely. But can we put a number on how much training aesthetic laser providers need?

In an episode of AmSpa’s Medical Spa Insider podcast, AmSpa founder and CEO, Alex R. Thiersch, JD, is joined by Taylor Siemens, NP-C, vice president of operations at Vitalyc Medspa. They discuss the nuances of laser safety and the need for proper training and education in medical aesthetics.

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Find out more about the energy device education at Medical Spa Show 2025, taking place April 10 – 13, 2025 at the Wynn Las Vegas.

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*The below transcript has been edited for readability.

Introductions: The topic of laser safety

Alex R. Thiersch, JD: Okay. Welcome everybody. Alex Thiersch here. This is Medical Spa Insider. Another scintillating edition. And we are very, very happy to have a long time AmSpa contributor and multi-podcast-guest, the lovely and talented Taylor Siemens, who is a nurse practitioner. She's the vice President of operations for Vitalyc MedSpa, which has several locations down in Texas. She is also the clinical advisor for AmSpa, and she's been helping us quite a bit, understanding a lot of the various safety mechanisms that are going in place for these treatments in medical spas, as well as helping us with all the forms and the toolkits. She is incredibly experienced and someone who has a lot to offer. So, if you don't know of her, please look her up, and she's also going to be speaking at Medical Spa Show, so you can see her there. And she's a great friend of the program. Taylor, how are you?

Taylor Siemens, NP-C: I'm so good, so excited. Thanks for having me. This is one of my favorite topics, so hopefully I won't geek out too much during this.

Alex R. Thiersch, JD: No, no! Geeking out is what we want. We're talking laser safety here. And for me, you know, as a lawyer and entrepreneur. I know just enough to be dangerous, so I want to make sure that I don't overstep my bounds, and that's why we want to bring you in. Because the safety involved in these procedures, all medical spa procedures, but particularly lasers, is something that is top of mind right now in our industry. And I can tell you, as we were talking a little bit before we jumped on, there is some regulation and legislation coming in various states, or at least proposed, I should say, that would really limit our ability, potentially at least, to perform some of these treatments. And so, this is something that is really top of mind that we have to deal with as an industry. And as an industry I mean, as medical spas. So, dermatologists and plastic surgeons likely have their own kind of group, and they have their own interests protected. 

Medical spas, which are primarily non-core physicians, which are, you know, non-plastics and non-derms, as well as all of the NPs, RNs, PAs that have flooded into the industry that are making this industry what it is, we need to make sure that we have our own house in order, so that we can talk the talk and make sure that we're able to defend legislation that is not great, that goes too far. But at the same time make sure that we are propounding legislation or rules that put the safety of the patient first. And that's one of the things that we're talking about. And Taylor you've worked with I mean, and obviously you do injectables as well. But lasers, energy devices—particularly for Sciton—but, in general, are what you've been kind of known for for awhile. I would love to just get kind of a quick thumbnail sketch of how you really started getting into kind of the real higher end education and training for lasers and laser safety. And what do you like about it compared to other areas of this industry?

What do you like about lasers and how did you get into laser education?

Taylor Siemens, NP-C: Yeah, of course. So, I've been firing lasers for about 10 years now. Started off with a facial plastic surgeon for about the first four and a half of those before we opened Vitalyc. And really, you know, I love injectables. I inject just as much as I lase. But really, from the very beginning of my career, started focusing on the skin much more heavily than volume. And, to be honest, it started from a pretty selfish place because I realized my patients who we took care of their skin and did injectables. They love their injectable work even more. And so I really wanted people to take care of their skin because they complimented my work more. We appreciated the results so much more when the skin was healthy, and we were addressing really the deeper causes of aging through laser.

And laser is just so fun to me because laser physics obviously is just understanding how the devices are working. I mean, it was just a new part of my brain that I'd never really explored before on how just the energy and all of those different things, how you can change things to affect the interactions with the tissue. And so, when I started, I am sure you hear this all the time, like 10 years ago, the industry was not as collaborative as it is now. It was not a community. And so I really was self-taught in laser. And even then I knew like this can't be right. Like I shouldn't be just trying things out in the treatment room to see what works. There should be structured education around this to help people prevent complications and provide good results. And so that's really how I got into education. Once I got good at lasers is because I was self taught, I almost had to simplify how to teach it and dumb it down a little bit for myself that it served really well in teaching others, because, we can just deliver that information a lot more simply than going to a physics course.

Why do medical aesthetic practices lack guidance in laser safety?

Alex R. Thiersch, JD: Yeah, yeah, it is interesting. Why do you think it is that—and this is probably just a loaded kind of visceral question for some people that is unanswerable, I think—but I'm going to ask you anyway, just because that's what we do. Why do you think it is that, particularly for lasers, we don't have any real guidance? I mean, this is true for our entire industry when it comes to injectables as well. But lasers are, you know, I think there's probably an easier path to set up some training and some ways where we can follow certain standards. But the industry hasn't. The energy device industry has been innovating and creating new technology. And it's, most of it, if not all of it is very, very safe if in the right hands. But there can be burns, there can be infections. And so I'm just like, how have we got here? Do you have any idea, or any insight into that?

Taylor Siemens, NP-C: Yeah, some thoughts around it. I don't know specifically, if this is true, but most practices get into the industry because of injectables, right? And so there's a big focus on that. And we've seen, I mean, you guys, all of the vendors have put in so much to advancing education there, because that's typically what gets people in to the industry. And so there's just much more of a focus on it. I think laser is a little different, too, because it is expensive to invest in lasers. And a lot of times it's like the add-on to an injectables practice. They're open for a couple of years, then they add on lasers. And so it becomes a little bit of an afterthought. Also, while you're spending, you know, multiple six figures on these devices. So when that investment is so heavy, I think a lot of times people shy away from expensive training courses or something of that nature, because they spent so much on the device that they just rely on the vendor or the manufacturer to give that training because they don't want to invest more in that training right away. Which I get. They're expensive. It's hard to invest in more training right after that.

What is the state of aesthetic laser training courses?

Taylor Siemens, NP-C: But the fact of the matter is, these vendors can't educate it in a way that maybe those with experience can, in the same way [as] injectables right? If people think about the training you get when your rep comes in and talks about the rheology and how you're supposed to use it. They typically cannot get in the treatment room and show you techniques and talk about things that are technically off label, right? There's a bit of a golden handcuff there. It's the same with lasers. And so, if we're not investing in that kind of you know, quote unquote "off label" treatment, then it's really hard to become excellent with the devices.

How does combining laser skin treatments with injectable filler boost results?

Alex R. Thiersch, JD: So I want to dive into some of the safety aspects, the kind of the why and the what behind that. Before we do that, you mentioned something I've heard this before from you and from others that I think is important because I'm not sure that I mean, I feel like people know this, but maybe not quite as much as they should, or to the extent that they should. And that is, you mentioned using energy devices, lasers—and this, I think, also applies to skincare—tends to make your injectable work look a lot better, and it kind of completes everything. I've heard people say it's you know it's the frame for the picture, or it's, you know, making sure that you know you can have a beautiful painting, but if it's got dirt on it, and it's not, you know you can't really see it. How much of that do you really notice when you're doing laser treatments along with the injectables? Is this an appreciable thing that you can see and say this, I'm going to get better results if I'm combining these therapies as opposed to just doing one by themselves?

Taylor Siemens, NP-C: Absolutely, yes, extremely notable. And lasers are, yes, taking care of the canvas. But they're, again, addressing the actual causes of the aging, right? If you're wiping away sun damage before it has a chance to actually age you, you're helping your patient look younger and delaying those signs of aging. And, you know, producing collagen, helping produce Elastin. with some of the specific lasers that can do that. Really affect how your filler looks and how much filler you're having to use as well. And I think now, you know, I see these trends in the industry. Every four years or so, patients start to get scared of injectables or looking overdone. And so, they look for much more natural solutions. And so lasers are a really great way to be able to continue to serve your patients while helping them preserve the natural look that they're wanting to. Not that you can't stay natural with filler. It's just a way to help prevent from towing that line a little bit more.

What are some of the things that med spas need to focus on regarding laser safety?

Alex R. Thiersch, JD: Yeah, I think it's a great point. I think people really need to focus on that. Which is, you can't just go in and fix fine lines from forehead wrinkles, and then expect everything to be fine, because there's other things going on. Okay, when it comes to safety and training and things like that from my perspective, as kind of an outsider to providing the treatments, I think one of the things that makes me nervous about energy devices is that they seem kind of in practice, very, very easy to operate. You know, you're doing a setting, you're pressing a button kind of and it fires it. Whereas, you know, with injectables anybody can see that there is obviously, there's anatomy involved. There's a lot of safety involved because you're injecting something into somebody's face. With lasers, it just seems like you just, you know, point and press, and it kind of makes it easier. But I'm curious when it comes to safety and making sure that you have the right protocols in place, and that you're doing things safely. Why is that incorrect like, what are some of the things that we need to really focus on when it comes to safety? What are some of the things that can go wrong? And so, we can get into what that should look like as far as safety.

Taylor Siemens, NP-C: Yeah. So, I always try to relate it back to injectors in a very similar way. I mean, as you mentioned, there's anatomy that you're thinking about with injectables, and how the tissue is going to fit. A good laser clinician is actually thinking about all of those same types of things, right? The layers of the skin, and where the damage is sitting, and how we can use specific wavelengths to target those things, and what we expect the skin to do and how to pivot when it doesn't. It shouldn't be a plug and play, and I think that is a misconception that allows people not to get the advanced training. And it kind of has some of the things we were starting the podcast with is because people are not yet critically thinking about it in the same way that we do injectables.

They both require a lot of anatomy and learning and selecting the right treatment parameters. And so, I compare to injectors all the time. Yes, we learn 20 units of neurotoxin to the glabella, and that's the dose, right? Yes, but a good injector and clinician is going to assess that patient and determine is that really their dose based on their movement? Maybe we need less or more or a different product because of whatever reason. It's the same type of thought process with laser. And when people don't understand that, and they just plug and play, we get suboptimal results, or we overtreat, and those lead to things like burns, and scarring and hyperpigmentation, all of those just things that everyone is afraid about when we think about lasers.

How much training is enough to fire a laser?

Alex R. Thiersch, JD: How much, and this obviously depends very much on the type of treatment and many things, but how much training is enough? And this is also an unanswerable question, because I get this question, too, from folks, and I'm always like, well, the training, you have to be trained as much as you think that as a provider that you're able to do the treatment within the standard of care and safely. But are there any generalities, rules of thumb we can talk about when you're looking to bring one of these devices in? How much should you be investing in training? How long does it take to get trained on these devices that you can start doing the things that they can really increase the outlook of the patient.

Taylor Siemens, NP-C: Yeah, it really depends on the type of modality you're purchasing. So when we think about lasers in general, there's really three categories. So there's light-based devices. So these are things like [intense pulsed light] IPL or [broadband light] BBL photofacials versus non-ablative lasers, which are typically very safe, just for anybody new to kind of this conversation. Non-ablative means that it's bypassing the epidermis, the top layer of the skin. And so, your results are not as dramatic. It takes multiple sessions to get things there, but it's generally much safer than anything else. And then your ablative lasers. I always say those are like the big boys, right, where we're ablating tissue. There's a heavy downtime and a recovery associated. 

So the photofacial devices and the ablative devices typically do require much more training than a non-ablative laser, because they're very low risk. They are much more plug and play. It will take, you know, maybe a course treating a few different models to really understand the nuances and how you can adjust parameters, but non-ablative lasers are generally very, very safe and easy to learn, and are very safe and easy for your patients. So they require a lot less training than your photo facials and your ablative lasers. And so we've seen kind of a trend in the industry. When people are looking to invest in devices for the first time, they're tending to purchase non-ablative lasers for that reason, because they understand my team will be very safe with this. My patients won't have some huge downtime to adjust to us adding this new category of treatment, and we can generally feel very safe with whomever is providing the treatment and results there.

Understanding laser types and terminology: Can we put energy devices into ablative vs. non-ablative categories?

Alex R. Thiersch, JD: So you mentioned ablative and non-ablative, and that's, you know, something that we've struggled with as an industry, I think, to an extent. Several years ago, when we were talking about you know, how do we come up with some standards? The ablative versus non-ablative terminology was triggering for some people. And I heard from some of the manufacturers I heard from some providers, saying that in some ways that that delineation, ablative and non-ablative, is not as applicable, maybe, as it once was when, you know, 20 years ago, when these were kind of starting, or even 15, 10 years ago, when we were developing some of these technologies. Because there's, you know, some of the quote unquote, "non-ablative" lasers, or some of the quote, "ablative" lasers tend to be a little different, a little safer, a little less invasive. And so there were some questions as to whether or not that's still applicable, and whether you could put energy devices into those two buckets. What do you think about that? Is that something we should be talking about?

Taylor Siemens, NP-C: Yeah, you know, in my opinion, it's more of a, it's like a physics question, right? The definition of ablative and non-ablative remain the same. However, yes, technology is advancing, and so there are some ablative devices that are not as risky or as scary or hard to learn as in the past. But the fact of the matter is, they are still ablative, and so the same risks apply, right? If overtreatment happens, you still have the same adverse events that are there. And so I think we still need to, you know, weigh that very heavily in our conversations with training and scope of practice just to ensure that we're not being flippant with the devices that we're using. But yeah, certainly technology has gotten better. Devices, you know, I think of an ablative laser that I use almost on a daily basis. The recovery and the downtime is nothing like technology I was using 10 years ago. I mean, those patients were leaving oozing and red, and you know their skin was red for months at a time. You're not playing around as much with those aggressive ablative devices depending on the setting that you're in, but they are still ablative, so that still has to be part of the conversation, in my opinion.

What are some common safety risks of med spa laser treatments?

Alex R. Thiersch, JD: And again, ablative versus non-ablative, photofacial, it's different I realize. What are some of the risks that we need to train for? By way of an example, when I first came into the industry as a lawyer, I was very interested in the types of lawsuits that were being filed. I did some research—I figured there would be a lot more medical malpractice claims in this industry than I actually found, which I think was a pleasant surprise. But what I did find, and in my time actually litigating in this industry, almost probably 90% to 95%, if not more of the claims were laser burns. There were burns. It wasn't necessarily infections or anything like that. There were burns done by, you know whether it's someone who wasn't trained or a device that wasn't the proper thing. With that in mind, what are some of the risks here that we need to be concerned about to make it serious enough where we need to focus on training, what that training should be?

Taylor Siemens, NP-C: Yeah. So what you're referring to there is something that I found pretty shocking a few years ago when I started looking into it. So those burns that you were saying there with lasers, most of them, from what I've seen—maybe you'll disagree on what you've seen—were from light-based devices. So specifically, laser hair removal, the IPL, the photofacials. And I think that is the biggest takeaway for people is a lot of clinicians assume 'Oh, there's no downtime with a light-based device.' You know, patients are a little pink for a couple hours after treatment. Browns get darker, but there's no pause in lifestyle for your patient, and so they assume this is very safe. But I tell people all the time: Your photofacial device is the most dangerous device in your practice. I don't need to know what else you have in your practice to know if that's true or not. It just is. If your clinician doesn't understand things like wavelength and pulse duration, and how the light interacts with certain colors of skin, it is very dangerous. So that is the one that takes me personally, the longest to train my team on is really understanding that. And so it's a personal thing for us. We actually, before they graduate to learning any of our safer lasers, they have to master photofacial. Because I know if they can master the hardest thing, the others are going to be a breeze. But we use them in conjunction on most patients, and so they know how to use those. 

But burns yes, a lot of times it's really understanding how to skin type your patients. I mean, these devices are not always safe for all skin types or all indications. And so, just a few months ago I saw a lawsuit coming in here in the part of Texas where I live, where it was a Fitzpatrick Type 6, which is your darkest skin type, who was treated with an IPL device. Well, that's not even a 'Oh, we, she was over treated,' or anything like that. She, point blank, was not a candidate for the treatment. And so, it's making sure that clinicians really understand who can be treated and who we should not be treating with certain modalities.

How are different states handling legal requirements for laser operators?

Alex R. Thiersch, JD: Yeah, and that's one of the things that makes me nervous is that you know, some of these devices are again it goes back, they're easy, they're kind of easy to operate. You start throwing these things around and it doesn't take much. And what's interesting I found about what you said, and I think this is true and I've read this before, is many states have legislated laser hair removal kind of as if it is safer and better and therefore, because it's been around longer, the safety aspect is almost dismissed a little bit. The state of New York, for instance, kind of famously doesn't have really anything with respect to laser hair removal and kind of says, it's nothing. It's no big deal. But I've also heard from many folks, you included, that that can be one of the most dangerous devices to use. And so that just kind of shows you the level of the playing field that we're playing on. We've got to figure out these things, and we've got to educate not only the public, but the medical boards, the investigators, so that they know what's what.

Taylor Siemens, NP-C: Yeah, it's a really tricky thing. You know, you mentioned New York, Oklahoma is one. About three months ago they changed their legislation for light-based devices specifically and took it away from aestheticians, essentially. And they said, no longer they can do that. So I think certain states are swinging the opposite way, and realizing this is very dangerous. But I think the bigger conversation is yes, knowing who can and can't, and your laws and making a standard. But more importantly, okay, what about all of the other clinicians left in Oklahoma who legally, the state says they are safe to do it? What does their training look like, you know, beyond their licensure? What training and experience do they have? What experience do their medical directors have, and helping them triage some adverse events that they come. And so I know you and I talk about this, and yes, legalities are important, but scope of practice is also important, and part of that scope of practice is, what kind of education and training do you have with whatever service that you're providing to ensure that you are providing competent care within your state laws.

Does your med spa have the scope of practice to fire lasers?

Alex R. Thiersch, JD: Well, I'm glad you brought that up. And it's a very interesting point that most—and it's not even just med spa owners, who maybe aren't clinicians, but even most providers, including a lot of physicians that I've talked to—don't know the real, or recognize the distinction between legality and scope of practice. And it really is kind of the backbone of what we do. I mean everything that you do as a provider has to be within your scope of practice, irrespective of whether it's quote unquote, "legal" under your state. Can you just like describe a little bit what you mean by that, and why it's important? And what are maybe some of the things that confuse people about that, as we get into specific treatments?

Taylor Siemens, NP-C: Yeah, exactly. So when I say scope of practice, I'm just referring to 'Does your training and clinical experience back up what you were doing with your patients?' And I'll give myself as an example in our practices, I would love to have like female hormones. I'm passionate about how women want to age, and we treat their skin and their injectables, and we have some devices to help them tighten their skin, or, you know, tighten their pelvic floor after babies. We're really passionate about serving moms and their confidence in the way they age. And so, a really natural progression to that for me and our practice would be 'Let's do hormones.' I know as a clinician how that impacts a woman's aging process and her confidence. However, I don't have any background in OB. I don't have the diagnostic abilities in my clinic to monitor if any adverse events came about, and neither does my medical director. And so it's not something that we can bring on, because it's outside of our scope of practice, because we don't have the training in it. That doesn't mean that we couldn't go get training or find collab docs to collaborate with that, have the training that could help us grow in that and serve our patients. But because we haven't done that yet, I believe it's out of our scope of practice. And so it's not the best thing for our patients to offer. Does that make sense through there?

Alex R. Thiersch, JD: No, it does. When I am talking to folks I sometimes go to I usually use RNs because RNs tend to be, they have to work under the supervision of a physician or NP, PA, depending on your state. And so an RN can legally inject Botox, for example, in most states. But if number one, they don't have the training or number two, if their medical director, who is making the diagnosis and the treatment plan and overseeing it, the potential complications, doesn't have the training or experience to do it, that means that the physician is not within his or her scope to do it, and therefore the RN kind of beneath him or her is not within their scope. What you're saying, I think, is really poignant, because NPs, for instance, or PAs can go get the training. Doctors, MDs DOs can go get the training. Can go become educated, and then perform those treatments within the standard of care and within their scope of practice. I think we have to really be sure that it's not just 'Okay. This is what's legal in your state. Here's what you can do.' It's never that black and white. There's not going to be an answer to that. It has to be based upon your experience, your training, your physician's training and experience. All of that. Does that make sense. Am I right?

Taylor Siemens, NP-C: Yeah. And I, 100% agree with that. You know, we've got six locations, a team of 53 now, half of those are clinicians. And I'm in Texas, so any clinician can do anything, right? So in regards to laser. Yes, I have some aestheticians that fire lasers, I have some that don't. I have some nurses that do, some that don't. Some PAs and NPs that do, and some that don't. And it all comes down to their scope of practice. The ones who are not providing it yet, yeah, maybe it's not something they're interested in, they love to inject or whatever they specialize in. But the others who are interested, we take time to train them and make sure they understand the implications of each laser beam they're firing, and how we select the right candidates. All of those things. And until they're done with that training, it's not part their scope of practice. So they're not signed off on treating those people by my medical director's standard operating policies and procedures. We will get them there, right? In fact, I've got a laser training tomorrow. Three of my clinicians will be there as part of them training and working to earn that privilege to say 'I am competent and responsible for these treatments.' We're ready to sign off.

What level of training do med spa clinicians need to safely perform laser treatments?

Alex R. Thiersch, JD: So, how much—and again, unanswerable question I realize—how much training is enough? And what I mean by that is, you can go to a course right, there's courses you can go to that are weekend courses. You can have your manufacturer provide some training. But when it comes to say like you mentioned photofacials and light-based devices. I take it that a weekend training course is probably not enough. And what are some of the things that you need to learn? You mentioned wavelengths and the physics of lasers, skin types, all those types of things. I mean, how deep do you have to get before you can be safe using some of these devices?

Taylor Siemens, NP-C: Yeah, it is a tough question, and I think it depends on the person, too, with how quickly they're adapting to things. I will be completely honest with you. When I learned light-based devices, granted I didn't have someone teaching me. It really took me a solid year and a half to be like. 'Ooh, I am good at this.' It took me a long time. People can get there much faster now, because there are training programs. The companies are getting better at providing that education. But it's really about making sure that you have the didactic portion where you understand how the technology works tied with hands on experience. And that's where I find most people lacking. Either their company is getting them 10 models to treat to practice, so their technique is good, or they're sending them to laser physics courses, where really there has to be the marriage of the two. 

And so for us, that's really all I can speak to with that. But with our photofacial, our team comes to an eight-hour course training where we dive into all of the didactic things. They watch me treat about three different models, and then we start bringing their models in, and it's their hands-on. And so, our team has to treat really like 10 people before we even say, 'Okay, are we feeling confident with this?' And it's not 'hey, me giving you settings, and you try.' No, I need to see them critically think through all of the different things, and provide 10 effective and safe treatments before they're even ready to get their hands on a patient without me. If that makes sense.

Do laser trainers still experience complications from laser treatments?

Alex R. Thiersch, JD: Yeah, no, it does. And I think that that's great. But for me it's always, I always tell folks the more training the better. But people want that definitive answer, right? They want to know how much like, 'when am I safe?' And it's like, well, that's not an easy question to answer. You know, one of the things that we've talked about and that you're helping with is dealing with adverse events. Having the tools in place to be able to operate a laser practice safely. I think we're working on a toolkit that you're helping us put together. That helps practices deal with all of these things from 'What are the consents' to 'How do you deal with adverse events?' When it comes to adverse events, is this practice like injectables where you'll talk to some of the most experienced anatomists, injectors in the world, and they'll say 'It's not a matter of if you have a complication, it's when. Things will happen at some point. You will get an occlusion, whatever that might be.' Is that the same thing with laser practice, where it's like you're going to have some sort of a burn or some sort of an adverse reaction, or can you control it more with preparation, training, patient safety, education, all that kind of stuff.

Taylor Siemens, NP-C: Yeah, you know, I think it probably is a numbers game. But when we say, you know, a negative event or something like that, typically with injectables we're talking about one thing. It's your vascular occlusion, right? Tt's a numbers game. Where with lasers, it's a little bit more nuanced with that. Maybe not a burn right? I think my days of burning people are over. Fingers crossed like. I hope that I never do that again, because I have the skill set to avoid it.

The clinical skills needed to handle negative outcomes from laser skin treatments

Alex R. Thiersch, JD: And I guess that's what I'm asking. That's kind of what I'm asking. You have the ability with your training and experience. You don't think, obviously you never say never, but you're confident that you can avoid burning somebody at this point with your education.

Taylor Siemens, NP-C: Yes, but the follow up to that is skin is complicated. Right? So even if I don't burn someone that doesn't mean that that's the only adverse event. Maybe they get some type of infection because they were not caring for their skin appropriately right? Or maybe they didn't stop their retinol like I thought they did, and their skin was much more sensitive. And so we get some type of crazy breakout or prolonged redness that I was not anticipating. It's just the adverse event, the things we're scared of, it's not one thing. It's, okay, patient pre-education. Did they follow everything to get to the treatment appropriately? Now the treatment itself is relied on my skill set and knowledge. But then now we've got a recovery process that we have to educate the patient and make sure they understand they know what to do for the next several weeks, so that way, that doesn't cause some type of adverse event. And so constantly, we're dealing with, you know, healing not going like we think. Or maybe you know, one time I had a patient healing from a laser, she let her dog like all over her, so she got the infection. Like that had nothing to do with my skill set, but that is still a negative outcome that I had to be prepared to treat. Does that make sense? Like it's not just, 'Oh, we're afraid of this one thing.' It's we need to be knowledgeable of all of the nuances of skin and what can happen when things don't go as planned.

Is there a training standard for med spa providers to safely perform laser treatments?

Alex R. Thiersch, JD: Yeah, no, that makes sense. But again, it almost puts more emphasis on the training and experience. Because you're right, those things that you mentioned, though, are things that are in many ways beyond your control. There are things that the patient has done. The patient has either disclosed or not disclosed right, or the patient has maybe allowed to happen or not followed instructions. Again, like your training, your experience and doing these devices, you can safely say—and I guess it's kind of what my point is—there is a certain amount of training and experience where you can make these devices safe for the patient, taking aside obviously the patient, him or herself, because you just don't know kind of what everything is. In my mind, that's maybe not as true with injectables, because you're right. It's just, it is a numbers game. Sometimes things happen to the best plastic surgeons in the world. I've talked to them and they've had [an occlusion], and it just happens. There's just some times you can't do anything about it. So it gives me like maybe some hope that there is a standard that we as an industry could come up with to say, 'This is how much training you should have in order to make this safe.'

Taylor Siemens, NP-C: Yeah, yeah, or at least some measure of competency, right? To be able to say you're safe on this. And a lot of that I think the challenging part of lasers, and why it's a little bit more difficult to learn. Is it all depends on the device you purchase, right? Then we have different manufacturers of filler products, but at the end of the day you use most of them the same. Traditionally, any [hyaluronic acid] HA filler you use, your technique is going to be very comparable, regardless of if its Brand A or Brand B. Where lasers are not the same, one is not like the other. And so just because you had photofacial device from Company B at your last practice, does not automatically mean that you're competent in photofacial device number 2 at this other practice. And so that's where a lot of confusion comes from, too. You know, even with our practices we have all the same devices at most of our practices. But my practice that opened last year has a much newer device than a practice that opened four years ago. And so, even though they are both photofacial, you don't use them the same. The technology is different. And so, it's important for our team to understand those nuances, because if they work a shift at the other location they don't get to just use the same—it's the same skill set, but it's not the same technology that they use at their home location. So there's, it's so evolving that it really requires effort on behalf of the clinician to keep up with the technology that they have in their treatment room.

Building a community of aesthetic laser experts as a safety net and educational resource

Alex R. Thiersch, JD: Yeah, have you treated patients from other clinics? Obviously, we're not naming them. Who have had burns or adverse events that come into your clinic? And if so, I'm assuming you have, and if you have, can you usually tell kind of right away what the issue was with, I mean, is it easy to diagnose? Probably what happened is they didn't you know, compare your skin type, or that you were, you know, too strong a setting, whatever that is. Can you figure that out by kind of the way that these adverse reactions look and feel?

Taylor Siemens, NP-C: Yeah, very easily. And usually, it's not just by looking at the skin and diagnosing, it's usually much more of a conversation. But you know I get DMs, multiple every single day from people all over the country like, 'Help me, what did I do with my patient here? This is kind of their story. This is how it looks. What do we do next?' And yeah, it's very, it's usually a very simple thing like, 'Oh, you missed this. This means this wasn't applicable, or we shouldn't have done this wavelength because of this.' And so those are the types of things that only experience teaches you, right? You can't learn all of those nuances in a training. There are things, I'm sure, in my career that I haven't seen all of the negative events I'm gonna have. And thank goodness, I have a community to call and say, 'Have you seen this? Help me, what do I do?' 

And that's really part of that scope of practice, too, that I'm saying is just who is your network? If you don't have somebody to call that has more experience than you to help you navigate these things, you gotta start building those because we need friends to help us see. Most of my trainings, I start off by telling everyone, 'Oh, these are my worst case scenarios.' These are patients from 8 years ago, 9 years ago, like, 'look at the scar I made. My gosh, look at this burn!' She's permanently changed, and I cry almost every weekend when I present that, because I still feel the shame of not understanding, of firing a laser that I didn't understand how to use yet. But the hope is that when I tell these people. 'This is how this happened, and this is how I walked them through it,' that that clinician won't make that mistake. And then I always tell them. 'You're gonna have your own mistakes. Please call and educate me because I don't wanna. Let's just make different mistakes.' If we're all more open sharing the negative mistakes that we've made, then it's gonna make the industry safer, because we'll have the context of how to avoid those things.

What laser safety guidelines do aesthetic practices and providers need?

Alex R. Thiersch, JD: Yeah, you know, I'm sitting here thinking just things that we can do, AmSpa can do as a community and association. I mean, I think of like pilots. Pilots have checklists for everything, right? So everything they, no matter what it is, they have a procedure and a checklist they go off of that makes sure that they don't forget to check certain things. I don't know if that would, would that be helpful if we could develop some sort of kind of more as comprehensive as possible? Or I suppose the downside to that is that you're gonna you're not gonna be able to cover everything. So that's one question. And then before I forget, because I'll forget. The other thing I'm thinking of that we could always do is create a real database of these mistakes and lessons that people have, specific to devices. Right? So you can catalog it. This device, this type of skin, this type of patient, this setting. Here's kind of what. So that there is a way to at least research some of this stuff to get a better understanding of what you should or shouldn't do. Do either of those make sense? Is that possible do you think?

Taylor Siemens, NP-C: Yeah, I think it's a good idea. It just, it doesn't account for the nuance and all of the things. So I'll give you a good example. So for those listening, I know you can't see me, so I'm half Black, I'm half Latina, so I am a skin type 5, which can be very risky for lasers. That's also why I got good at lasers, because my family, my friends, they look like me. Patients who look like me are attracted to my treatment chair, and so I had to get good at firing lasers on these high risk laser candidates, right? So I'm a big believer in photofacial. I photofacial every single month, because I know the data, and I'm convinced it's going to keep me looking young forever. Okay, so I know that there are times. I'm a skin type 5, there's no arguing that. There are times that when I do my photofacial, I can push my treatment settings to that of a skin type 3, which is much lighter than me. I can give a really heavy treatment, and my skin responds beautifully. There are other times, the next month or 2 months later that I fire my test spot, and my skin behaves so differently in a way where I'm like. Oof, my skin's behaving like a skin type 6 today. I'm not a candidate for treatment. I'll burn if I try to treat myself, I'll overdo it. And so I cancel my treatment. 

Because there are so many other things like hormones right, depending on where they are in their cycle, if they traveled to a different topography a week before, and their skin is more sensitive. There are all of these things in nuance. That is why you really have to have the assessment skills to read what the skin is doing to be able to respond appropriately. And I think that's the challenge is, how do you put that on a piece of paper? You know, I think you can put the very hard and fast rules but there's still so much more nuance that goes into reading the skin appropriately with lasers.

Alex R. Thiersch, JD: Yeah, it's like as a lawyer, you get questions and it's like, well, it depends. It depends on the factual circumstances. And the skin is a living, breathing thing, so it's impossible to just make generalizations.

What to ask your energy device reps when purchasing a new laser for your med spa

Taylor Siemens, NP-C: One of the things, real quick, Alex, I'll say. So, if people are looking to add on laser devices. Those are also important things to be asking the reps when they're deciding on the best technology for them is: What does continuing education and training look like? What are my resources? If you're the medical director who doesn't have laser experience, and you're like 'Who, what are my resources on when my team has a complication, if I've never seen that? Who can I call? How will you help me?' Because some devices will not have answers to that, or they don't have a system in place. Others, there's a whole network of people who are literally ready and eager to spend 8 p.m. on a Tuesday night talking with other clinicians to help them get out of a mess. And that's, I owe so much of my growth to that. You think about people like Dr. A. Jay Burns, Dr. Chris Robb, Dr. Patrick Bitter, you know. Brilliant laser minds. I have, I had access to them, and so, if I made a mistake, they were the ones who taught me how to get out of it. And you know, they can't be the resource for the entire industry. But there are so many people who have, generations who have come from their knowledge that are ready and eager to help. But we only know how to help on our specific, you know, the devices we use. So, you need to make sure that the device you're purchasing has a network of people who are ready to give back to their community and help keep people safe.

Alex R. Thiersch, JD: Yeah. And that's so hard, because there's so many! There's just so many devices. And there's new ones popping up every day, and then you've got acquisitions, and so they're changing names. And ugh!

Taylor Siemens, NP-C: It's challenging. The laser world is a little more confusing than the other things that we have in our industry, for sure.

Defining laser safety protocols for your medical aesthetic practice

Alex R. Thiersch, JD: Yeah, but you know what I was just telling somebody—and we're bumping up against time here. So, people think of medical aesthetics, and they automatically go to injectables, particularly Botox. Almost all, because that's what people know, right? That's kind of the, that's the buzzword. But really, I've seen so many folks who have used energy devices and skincare, right? So skincare as well. But those two, in combination, or also adding in injectables where the results you can get are just, I mean, they're transformative. And they're really, really impressive. Changing people's lives, and to the point where it's like, you can just kind of see—whether it's acne, fine lines, whether it's spots, freckles, whatever it might be—you just see how much of a difference they can make. So, I think we need to talk about this more. We need to figure out kind of how we're gonna address this because it's such a valuable part of what we do. And my fear is that if we don't get around this issue, someone's gonna do it for us. And we might not like the result that comes from that.

Taylor Siemens, NP-C: Yeah, you know. And I think just an important thing of that, too, is if you are the practice owner, the medical director. Regardless of what your state laws are. I tell medical directors all the time, it's still your responsibility to define who can do what in your practices, right? So how deep can that specific team member ablate if you allow them to ablate? Putting those type of not restrictions, but expectations around it, and then making sure that your training and education for that team member backs up what's in your policy. And so again.

Alex R. Thiersch, JD: Protocols, too, right? What should be done and XYZ?

Taylor Siemens, NP-C: Exactly. How I mean, as part of your good faith exams even of, you know, being able to flag those things ahead of time. There are still a lot of things I think that we can do as practice owners within our own practice to really help protect our patients and protect our team members, too. You know, I meet clinicians all the time, and they show me this adverse event, and they'll tell me 'I knew I shouldn't have treated this patient. I felt it in my gut.' But they didn't know why they shouldn't have treated them. They're like 'I regret it. I knew I shouldn't have done it.' Well when we broke it down we're able to diagnose why they shouldn't have done it. Well that should have been in your standard operating policies and procedures. You should have known from the beginning, based on what your medical director has said, that that was not, they weren't a candidate for those things. And so, really, you know, I tell clinicians all the time. If you don't know what your SOPs say, go to your owner, go to your medical director and ask to see what the standards are. If they don't know, or they don't have one, really put some onus and responsibility on them to provide that for you, to help keep your license and your patient safe.

Final words

Alex R. Thiersch, JD: Good advice, Taylor. Thank you, as always. I'll give you the last word. Anything you want to get out there, but otherwise let folks know where—I know you do a ton of training, not only in energy devices, but also in injectables—so let folks know where they can find you. And then any last words regarding laser safety training. Well, this is something we're going to be talking about ongoing. So this is not the last word, but we're out of time for now. So yeah, let people know what the deal is.

Taylor Siemens, NP-C: Yeah, I think if we could summarize all of this topic, it's really three things: 

  1. You need the right education and training;
  2. You need to know how to select your patients appropriately; and 
  3. You need to know your laser-specific protocols in your practices. 

That's really what it boils down to. But I talk about this all the time on my Instagram. It's taylorsiemens.np. And MSS is coming up, Alex. I'm not specifically in the pre-education show for lasers, but I helped with it last year. I know the team who's doing it this year. They do a phenomenal job, and they are experts in this field and what they are doing. So I think that's a great next step for anyone who is interested in learning more. They try really hard to be brand agnostic there in teaching and educating, so that way people really get a good understanding. So I would encourage people to check that out even, and go there to ask more questions.

Find Taylor and laser energy device education at Medical Spa Show 2025

Alex R. Thiersch, JD: I appreciate you bringing that up. And you've been involved in that from the beginning. We're trying to, you know, make sure that we get all sorts of perspectives in there. But that's the kind of advanced energy device training course that we do on Thursday, which is April 10th and we bring in some of the best trainers, and we try to get different devices, different manufacturers. So it is agnostic. And so to really teach people the stuff that you're talking about. And you will be around MSS, though, so if anyone wants to come and meet Taylor and chat with her, please make it out there. Otherwise, thank you for joining me again, and we'll talk to you again soon.

Taylor Siemens, NP-C: Perfect. Thanks, Alex.

Taylor Siemens, NP-C, a board-certified nurse practitioner recognized by the American Association of Nurse Practitioners and clinical advisor for the American Med Spa Association, is a dynamic force in the world of aesthetic medicine. As the vice president of operations at Vitalyc Medspa and the founder of My Aesthetic Training, she seamlessly marries the expertise of a practitioner of medicine with that of a multi-site business operator. Siemens’s journey into aesthetic medicine commenced as an operating room nurse specializing in facial plastic surgery. Through her diverse patient interactions, Taylor has honed a profound understanding of the aging process, fueling her skillset in crafting comprehensive, multi-modality treatment solutions that align seamlessly with patients’ aesthetic objectives.

Sign up for Turning Your Practice Up to 11: Energy Device Master Class on Thursday, April 10, 2025 at Medical Spa Show.

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