If you're thinking about cosmetic or dermatological procedures, be careful. What you see isn't always what you get. A number of people have harmed, disfigured or scarred from what should have been relatively risk-free dermatological work.
Procedures like chemical peels, Botox wrinkle injections, tattoo and wart removals, complex laser skin resurfacing or hair removal techniques can cause injuries ranging from severe burns, to disfiguring scars and significant skin discoloration.
The biggest mistake to make is having these procedures performed by a technician with no medical training.
"Patients are being enticed into glamorous day spas, skin clinics, beauty salons, and even some unscrupulous doctors' offices with promises of qualified medical care. What they are too often ending up with is untrained technicians and damage that can take years to repair," says Dr Harold Brody, president of the American Society for Dermatologic Surgery.
So how do you tell the good guys from the bad guys in a world where beauty can be bought and is often an illusion? Ironically, the first rule of thumb is: never let looks deceive you.
"No matter how plush a salon, no matter how sophisticated or costly the advertising, no matter if technicians carry stethoscopes and wear white coats, don't assume anything and ask everything before accepting treatment," says Dr Jeffrey Dover, an associate professor of dermatology at Dartmouth Medical School.
Among the questions you should ask: How many procedures does the centre regularly perform; how long has it been in business; what's the specific training of the person doing your treatment; and has that person previously performed the procedure on the part of the body where you're having it done.
Among the answers you should expect: The centre should be performing at least several treatments a day; the technician should have at least several years' experience, and that training should include not only some medical schooling, but specific apprenticeships with board-certified dermatologists or plastic surgeons, Dover says.
Also important: Get a patch test for any procedure that involves a chemical solution on your skin. Doing so can help prevent an allergic or sensitivity reaction, which may also help reduce the risk of burns.
"If the centre refuses, don't accept treatment there," says Dover.
Additionally, if lasers are involved, ask if the system has been specifically approved for someone with your skin type, hair colour and complexion and for use on the area of your body where you're seeking treatment. And ask to see photos of previous patients who share your physical traits, says Brody.
If your questions aren't welcomed, Brody adds, that's a red flag you shouldn't ignore.
Equally important, never trust a centre that lets you choose the treatment. Although you may have a good idea of the kind of result you are seeking, such as wrinkle reductions or scar removals, only a physician is qualified to tell you the best way to achieve it.
"Never accept any treatment that doesn't start with a one-on-one consultation with a board-certified dermatologist or plastic surgeon," says Dr Roy Geronemus, a clinical professor of dermatology at New York University School of Medicine.
Although a well-trained physician's assistant or nurse may sometimes perform the treatment, be sure a qualified physician is on hand - no farther than one room away.
"Many spas and salons use the guise of a 'medical director,' often a physician who serves as an umbrella for multiple centres who is not on the premises and may not even be a skin specialist," says Dr Steven Mandy, president-elect of the American Society for Dermatologic Surgery.
Studies show the bulk of botched procedures occur at the hands of non-physicians. But bad results aren't limited to spas and salons. Sometimes, problems occur when the doctor who is advising or even treating you has a medical degree but no dermatology training.
"One of the fastest growing markets for cosmetic laser equipment are obstetrician/gynaecologists and primary-care doctors," says Dover.
You wouldn't want your dermatologist to deliver your baby, Geronemus says. So think twice about having aesthetic procedures performed by someone without specific aesthetic training, even if she is an MD, he adds.
"It takes years of dermatology training to do these procedures correctly," he says.
What to do
Regardless of who does your treatment, or where it's performed, if you experience any significant pain, discomfort or discoloration, or sense that something feels or looks worse than common sense tells you it should, don't wait - seek medical attention immediately.
A guide to skin treatments
Although treatment for skin cancer remains the most requested procedure, the following treatments are also among the most popular:
Dermabrasion: This involves the use of an abrasive instrument to mechanically "sand" or resurface the skin, achieving a rejuvenated, more youthful appearance. It is often used to treat substantial scarring, sun damage and pigmentation problems.
Laser resurfacing: Using laser light energy, this procedure heats and removes the top layer of skin cells, allowing new, unblemished skin to grow. Often used to remove scars, pigmentation problems, precancerous skin growths, even small tumors, and to diminish lines and wrinkles.
Non-ablative laser treatment: Penetrates below the skin surface to stimulate the production of collagen, a natural substance that helps plump skin, creating a more youthful appearance. Also helps to tighten underlying loose skin.
Chemical peel: A chemical solution is applied to remove outer layers of aged, discoloured or irregular skin, allowing fresh, new skin cells to grow. Most often used for wrinkles around the eyes and mouth, skin discoloration, age spots, dull skin texture or mild acne scars.
Botox injections: A derivative of the Botulism bacteria, this treatment, when injected into the skin in tiny amounts, paralyses small facial muscles causing the surrounding skin to relax, thereby diminishing lines and wrinkles.
Laser hair removal: Short pulses of energy generated from a laser light source help to injure the hair follicle, eliminating active hair growth and stunting re-growth. Skin type, skin colour and hair colour all respond differently to this treatment.
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