By Alex R. Thiersch, JD, Founder/Director of the American Med Spa Association (AmSpa)

Originally posted October 10, 2017
UPDATED October 8, 2020

The issue of who can and cannot legally operate cosmetic lasers troubles many medical spa and medical aesthetic facility owners and operators. After all, there is no universally accepted licensing procedure for cosmetic laser technicians, and most state medical boards have not taken the time to rule on the subject. However, the Georgia Composite Medical Board has been proactive in addressing the idea that cosmetic lasers are something of a hybrid of medical and non-medical treatment, and it offers cosmetic laser practitioner licenses that permit aestheticians, registered nurses and cosmetologists to legally fire lasers under certain circumstances.

Peachy Keen

It is difficult for some medical spa owners and operators to come to terms with the fact that some non-invasive laser treatments are considered medical treatments, and therefore require a physician, nurse practitioner (APRN) or physician assistant (PA) to not only perform an initial consultation, but also fire or supervise the firing of the laser. To many, this seems like an unnecessary use of these medical professionals' time and resources.

The Georgia Composite Medical Board decided to address this issue by creating a state licensure procedure to clarify who can legally fire certain types of cosmetic lasers, and what procedures need to occur in advance of these treatments.

First of all, it is important to clarify that this licensure covers only a few types of cosmetic laser treatments: laser hair removal, intense pulsed-light devices and non-ablative light-based devices. All other cosmetic laser treatments are beyond the scope of this licensure and must be treated as medical procedures, with accompanying initial exams and proper supervision. However, the simple, relatively inexpensive cosmetic treatments this licensure does cover account for a large percentage of the laser treatments administered in the U.S., so the impact of this licensure can be significant.

Georgia's law creates two levels of cosmetic laser practitioner licenses:

• Assistant laser practitioner: This license allows people who hold current licenses as PAs, licensed practical nurses (LPNs), APRNs, registered nurses (RNs), aestheticians and master cosmetologists, or people previously licensed as physicians, APRNs, PAs or RNs to conduct the cosmetic laser treatments mentioned above without a physician seeing the patient first or even being on site. Instead, they can be supervised by the senior laser practitioner licensee in addition to a physician. In order to earn this license, a candidate must complete three certain laser training certificate courses taught by physicians or Accreditation Council for Continuing Medical Education (ACCME)-approved educators. A licensed assistant laser practitioner does not require direct onsite supervision of either the senior laser practitioner or physician when performing laser hair removal or IPL treatments, which helps improve a medical spa's flexibility. Having a physician on site to supervise basic treatments such as these is a major hurdle that these businesses have to clear in order to improve their profitability, and Georgia has provided the mechanism to make that possible. For all other cosmetic laser treatments, the patient must be examined by a physician, PA or APRN, and the assistant laser practitioner will need onsite supervision by either a physician or the senior laser practitioner.
• Senior laser practitioner: This license permits PAs, RNs and APRNs to supervise assistant laser practitioners. If an LPN or aesthetician, say, does not have an assistant laser practitioner license, a physician would need to be on site to supervise. But with the assistant laser practitioner license, a person holding the senior laser practitioner license can provide that onsite supervision. As mentioned above, onsite supervision is not needed for laser hair removal or IPL treatments, but a patient exam and onsite supervision is needed for other cosmetic laser treatments. Again, this gives the practice the ability to treat a patient without needing a physician to be on site, instead using the senior laser practitioner, which could potentially save it a great deal of money. As with the assistant laser practitioner license, someone seeking a senior laser practitioner license must hold two laser training certificates from courses taught by either a physician or an ACCME-certified educator. In addition, he or she must have at least three years of experience in clinical or medical technological areas, not including clinical rotations in nursing or PA school.

The Laser's Edge

From AmSpa's perspective, the availability of these licenses is a major positive, because it provides some clarity in an area of medical aesthetics where, often, there is none. It's something we in the legal profession always seek—a definitive statement that illustrates exactly what one must do to be compliant. We're always supportive of efforts by a legislature or medical board to clarify things that need it.

Also, this law creates the potential for medical spas and laser centers in Georgia to see more patients, as well as potentially open more locations with a higher patient flow, because they don't need to circulate the patients in to see a doctor. However, this still only addresses a small number of laser services, so if you operate in Georgia and have questions about remaining compliant while administering other laser treatments, consult your local health care attorney or work with AmSpa's national law firm, ByrdAdatto. AmSpa members can view the Georgia legal summary to get an overview on the state's medical aesthetic laws.