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Safe Use of Lasers and Intense Pulsed Light Equipment

HABIAHairdressing And Beauty Industry Authority

Consumer Services Industry Authority 2003Fraser House, Nether Hall Road, Doncaster DN1 2PHTel: 01302 380000Fax: 01302 [email protected]

All rights reserved by the Consumer Services Industry Authority 2003. The text of this publication, or any partthereof, may not be reproduced or transmitted in any form or by any means, electronic or mechanical, includingphotocopying, recording, storage, in an information retrieval system, or otherwise, without the prior permissionof the publisher.

Those who choose not to abide by the law leave themselves open to prosecution. If convicted of copyright theftthe Consumer Services Industry Authority will seek maximum costs and maximum publicity in every case.

DisclaimerThe Consumer Services Industry Authority has used every effort to avoid errors and to ensure that the contentsof this booklet are accurate and complete. However, the Consumer Services Industry Authority gives no warrantyand accepts no liability for errors or omissions. Readers should not use this booklet as a substitute for expertadvice in appropriate circumstances.


Hairdressing And BeautyIndustry Authority is a tradingname of Consumer Services

Industry Authority

HABIA Spain, OMAT (Organización Mundial de Artes y Técnicas)Evaristo San Miguel 18. 28008 Madrid, Spain Tel> 3491 547 3292 Fax> 3491 547 8402email> [email protected] website> www.omat.net

HABIA Italy, A.E.S S.r.l.Via G. Vittorio, 2/D - 42100 Reggio Emilia. Italy Tel> 0522 616506 Fax> 0522 922002email> [email protected] website> www.aessrl.it

HABIA East, Kanagawa PrefectureYokohama City. Nakaku Honmoku, Osato-cho 10-8-4 B Tel> 045 661 1214 Fax> 045 661 1214email> [email protected] website> www.habia-east.org

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1. Contents1. CONTENTS...................................................................................................P1

Foreword ........................................................................................................P3Acknowledgements .........................................................................................P4

2. INTRODUCTION..........................................................................................P5Regulations ......................................................................................................P8

3. GUIDANCE ON TREATMENTS .................................................................P10

3.1. How does laser and intense pulsed light hair removal work?.................P10

3.2. Is the treatment suitable for everyone? .................................................P11

3.3. How many treatments are needed? .....................................................P12

3.4. Is it permanent?....................................................................................P13

3.5. Which areas can be treated?.................................................................P14

3.6. How long does a treatment take?.........................................................P14

3.7. Is treatment painful?..............................................................................P15

3.8. Can my client remove hair between treatments? ..................................P15

3.9. What are protocols and who should write them? .................................P16

3.10. Why do I need to carry out a test patch before starting treatment? .......P18

3.11. Should I take photographs of my treatments?........................................P20

3.12. Why do some hair removal systems use gel? ........................................P22

3.13. What does a typical treatment involve? .................................................P22

3.14. How should the skin look after treatment?............................................P24

3.15. What aftercare advice should I give my client?.......................................P26

3.16. What is an adverse reaction to treatment? ............................................P27

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4. CONTRA-INDICATIONS.............................................................................P30

4.1. Are there any contra-indications for laser and intense pulsed light hairremoval? ..............................................................................................P30

5. EQUIPMENT AND LEGAL ISSUES ..............................................................P36

5.1. What should I look for when buying a hair removal system? .................P36

5.2. What is the difference between a laser and an intense pulsed light system? .........................................................................................P38

5.3. Why is there so much ‘jargon’ around lasers and intense pulsed light equipment? ...................................................................................P39

5.4. Are lasers and intense pulsed light systems dangerous and can I use them anywhere in my salon or clinic? ...........................................P40

5.5. Are there any legal requirements for providing a laser or intense pulsed light hair removal service? ..............................................P42

5.6. How can I show that I am meeting the National Minimum Standards? ..............................................................P48

5.7. What training do I need to carry out treatments? ..................................P50

5.8. Do I need a medically qualified person working with me? .....................P52

6. FUTURE DEVELOPMENTS ..........................................................................P54

6.1. What new or future treatments might I be able to offer?.......................P54

7. GLOSSARY OF LASER & INTENSE PULSED LIGHT TERMS........................P56

8. NATIONAL OCCUPATIONAL STANDARDS (NOS) ...................................P64

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There has been an enormous growth in demand for intense pulsed lightand laser treatments in the past few years, and employers had expressed tous their desire for better guidance on their correct use.

HABIA’s first response was to ensure that the use of intense pulsed lightand laser treatments became part of the National Occupational Standards,the basis for all vocational beauty qualifications.

As a result, techniques in intense pulsed light and lasers are due to be a partof the new Beauty Level 4 Standards (from February 2004).

HABIA’s next response was to develop this booklet, designed specifically togive you no-nonsense, straightforward guidance on the new standards, aswell as advice on the application of the Care Standards Act to beauty salons.

Together, this booklet and the new standards will help ensure that beautysalons have the competent and knowledgeable staff needed to tap into thisgrowth market and perform intense pulsed light and laser treatments withsafety and confidence.

John GrayDirector, Oxford Hair Foundation

Foreword

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We would like to thank Dr Elizabeth Raymond who has written thisbooklet in collaboration with HABIA. Elizabeth has a background in laserscience and laser safety and has been involved with European wideprojects in laser training and education.

Elizabeth acts in an advisory capacity to a number of companies and was akey member of the team who wrote the National Occupational Standardsfor HABIA.

Whilst Head of Lasers at The Laser Centre, Loughborough College,Elizabeth was responsible for the development and delivery of the firstnationally recognised qualifications in skin laser therapies, laser and intensepulsed light hair removal and laser safety.

Elizabeth continues to develop and offer qualifications and courses in laserand intense pulsed light therapies from The Laser Training and EducationCentre at The Mapperley Park Clinic, Nottingham. The Centre providestheoretical and practical training within a clinical environment for thebeauty and medical sectors.

In addition HABIA would like to thank the many companies who providedthe illustrative photographs used within the booklet. Each of thephotographs is credited individually.

Acknowledgements

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If you look through any beauty publication, women’s magazine, healthmagazine or medical journal, the chances are that you will find an articleabout laser or intense pulsed light treatments. The number of newtreatments and procedures using lasers or intense pulsed light technologyis increasing rapidly and crosses both the beauty therapy and medicalsectors. For example – vision and eyesight correction, removingbirthmarks and tattoos, treating red veins and skin lesions, surgicalprocedures, treating cancers and tumours, wound healing and treatingsports injuries, improving the appearance of skin, treating active acne orimproving acne scarring and, of course, hair removal.

Overleaf are some of the treatments currently using laser or intensepulsed light equipment.

2. Introduction

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Here are some of the treatments currently using laser or intense pulsedlight equipment:

TREATMENT

Vascular treatmentsport wine stains, telangectasia,thread veins, leg veins

Pigmented treatmentstattoo removal, pigmentedlesions such as café au laitmacules, lentignes, photo-ageing

Ablative treatment removal of epidermal layers toreduce wrinkles and facial lines,treatment of acne scarring, wartremoval, benign lesions

Photo-rejuvenationphoto-ageing, roscea, largepores, mottled pigmentation

Hair removalbody and facial hair, hairmanagement for hirsutism

TECHNOLOGY

• Dye lasers, Frequencydoubled Nd:YAG lasers,intense pulsed light

• Q switched ruby, Nd:YAG or Alexandrite lasers

• Carbon dioxide laser, Er:YAG laser

• Intense pulsed light

• Intense pulsed light, diodelasers, Nd:YAG lasers,Alexandrite lasers

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SKILLS SECTOR

• Medical training, identification of lesions. Full or topical anaesthesia,repeated treatments, high level of aftercare

• Medical training, identification of lesions. Topical anaesthesia,repeated treatments, aftercare

• Medical training. Full or topical anaesthesia, high level of aftercare,issue of antibiotics

• Some medical training or working knowledge of hair and skinbiology, knowledge of contra-indications and when to refer, noanaesthesia, repeat treatments, limited aftercare

• Some medical training or working knowledge of hair and skinbiology, knowledge of contra-indications and when to refer, noanaesthesia, repeat treatments, limited aftercare

Vasculartreatmentbefore and 5 weeks afterone treatment

Pigmentedtreatmentsinclude theremoval oftattoos andpigmentedlesions

Ablativetreatmentbefore and 6months aftertreatment

Photo-rejuvenationimproves pigmentedlesions, mottledpigmentation anddiffused facialredness

Hair removalbefore and 10 weeks after one treatment

Courtesy of DonG

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Courtesy of FranklynCos m

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CourtesyofEllipsePulse

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In April 2002 a new law came intoeffect – the Care StandardsAct 2000. This law and itssupporting Regulations includesignificant legal requirements forthe safe and correct use of laserand intense pulsed lightequipment. Lasers and intensepulsed light systems are powerfuldevices and in the wrong hands,or used in the wrong way, arecapable of serious injury to oureyes, our skin and our tissues.Because of this potential for harm,it is important that we recogniseand distinguish between invasiveand non-invasive, cosmetic-typeprocedures. Beauty therapistsshould be very clear as to where,how and by whom particulartreatments should be carried out.The Hairdressing And BeautyIndustry Authority (HABIA)take this responsibility seriously and

has developed NationalOccupational Standards andguidance for qualified beautytherapists for hair removal andphoto-rejuvenation treatments.Only these non-invasivetreatments are consideredappropriate in the beauty sectorand HABIA recommends that onlybeauty therapists who havequalified in electrolysis shouldprogress to become laser andintense pulsed light practitioners.The most important criteria foroffering a laser or intense pulsedlight hair removal service is thatyour facility is registered with theNational Care StandardsCommission (NCSC) in England(or equivalent body in Scotland,Wales or Northern Ireland) andthat it meets the NationalMinimum Standards (NMS).

As a quick guide –if a word or phrase

appears in bold textyou will find its

definition in theGlossary!

Regulations

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Although laser and intense pulsedlight hair removal is seen as apotentially lucrative market, youmust do your research thoroughlyto ensure you have the correctfacilities, staff, equipment, safetyand training for the job –otherwise, at best you maydamage your business or sufferfinancial loss – at worst, you maydamage a client. Because the rangeof treatments and equipment isconstantly being increased andimproved, make sure you stay up-to-date and knowledgeable byjoining professional organisations,subscribing to trade journals andnewsletters, attending training orstudy days and exhibitions.

This booklet is designed to helpyou with your research. The aim isto introduce the use of lasers andintense pulsed light systems for hairremoval in a clinic or salonenvironment. It stresses the needto understand and comply with the

legal and safety requirements andthe need to follow best practice. Itshould give you a goodintroduction to the subject andhopefully answer many of thequestions that salon owners havewhen they are thinking of investingin this technology or expandingtheir treatments to include laser orintense pulsed light hair removal. Itwill not make you an expertpractitioner – that takes time,training and practice – but it willgive you the information you needto make informed choices anddecisions if you plan to undertakethese rewarding and worthwhiletreatments.

The new NationalOccupational Standardsdeveloped by HABIA setout the recommendedbest practice for the useof lasers and intensepulsed light treatmentsfor hair removaltreatments and photo-rejuvenation.

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Lasers and intense pulsed lightsystems can both provide veryeffective treatments for hair removalif you use them in the right way onclients with appropriate hair andskin types. An essential referencefor current best practice for beautytherapists wanting to learn to uselaser and intense pulsed lightsystems are the NationalOccupational Standards developedby The Hairdressing AndBeauty Industry Authority(HABIA).

The laser or intense pulsed lightdelivers a pulse or several pulses oflight energy into the skin whereit is absorbed by the pigment inthe hair follicle and, to a lesserextent, by the surrounding tissues.The light energy is converted toheat energy and if the temperature

of the hair follicle is raised toaround 70ºC for the correct lengthof time, the follicle will bedamaged and its ability to re-growa hair significantly reduced.

The most effective time fortreatment is thought to be whenthe hair is in the active growing, or‘anagen’ phase. Anagen haircontains the most melanin and isbetter at absorbing light energythan hair in the resting (catagen) orshedding (telogen) phase. Thisexplains why laser and intensepulsed light hair removal is not aone-off treatment. Hair folliclesthat are resting or shedding will notbe significantly affected by the lightenergy and will re-grow in time.

To provide safe and effectivetreatments the light energy mustbe delivered to the skin in the rightway. You will need to learn how toadjust the settings on your systemto suit your client’s skin type andskin and hair colour. If you do notdeliver the light in the right waythere is a risk of blistering orburning the skin or causingpigmentation changes, resulting inlighter or darker patches of skinwhich can take many months toclear.

3.1 How does laser and intense pulsed light hair removal work?

3. Guidance on treatmentsLight energy is absorbedby the hair pigment and

converted to heat energy.The follicle will be

damaged if it is heatedsufficiently which reducesits ability to re-grow hair.

It is essential that thesurrounding tissues are

not also damaged by thelight energy and coolingdevices or gels may be

necessary - especially fordarker skin types.

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The general rule is that the haircolour should be darker than theskin colour. Treatment is mosteffective when there is goodcontrast between the hair colourand skin colour – making black hairin pale skin the ideal combinationto treat.

Blonde, red or grey hair respondsless well so you may need tosuggest alternative therapies, suchas electrolysis, for these hair types.

Some newer laser and intensepulsed light systems claim to workon blonde or grey hair. As thetechnology develops this maybecome possible but you shouldalways ask your supplier for clinicalstudies or pictures to support theirequipment claims. If you includestatements that you can treat allskin types or all hair colours in

your client information leaflets oradvertising materials you may beasked to defend this by theNational Care StandardsCommission (NCSC) inspectors.

Clients with darker skin typesmay absorb too much lightenergy in the skin and are moreat risk of burns or pigmentationchanges. You will need veryeffective skin cooling and the righttype of system to treat very darkskin types.

Clients with a suntan in thetreatment area should not betreated until their tan has faded.

Clients taking certain medicationsmay not be suitable for treatment.Your clinic should have treatmentprotocols which list themedications or conditions thatwould contra-indicate treatment.

Clients who are pregnant are notideal for treatment because of thehormonal and pigmentary changesthat can occur during pregnancy.

3.2 Is the treatment suitable for everyone?

More information aboutadverse reactions can befound in Section 4.16.For contra-indications totreatment see Section5.1

Female test client.After four treatments she was so satisfiedthat she declinedfurther treatments. The majority of theremaining hairs arewhite and cannot betreated.

Upper lip on a skin typeV after four treatments.Laser and intense pulsedlight treatment of darkerskin types is possiblewith appropriateequipment settings andeffective skin cooling.

Courtesy of Ellipse PulsedLight &

Danish

Derm

atologicDevelopment

Courtesy of Seema Health

&Beauty

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You will need to offer your client acourse of treatments becauseindividual hairs go through a cycle ofgrowth. Most salons and clinicsrecommend a course of 4 - 6treatments for the best, longer-termresults. But the hair growth cyclevaries in different areas of the bodyand is affected by ethnic origin, ageand hormones. Depending onthese factors some clients mayneed more or less treatmentsbecause each individual will responddifferently to treatment. Your clientconsultation and informedconsent must explain why acourse of treatments is necessaryand set realistic expectations andoutcomes.

Hair removal is thought to be mosteffective when the hair is activelygrowing, so on the first treatmentthe light energy will damage thegrowing hairs but not those that are

resting or shedding. When yourclient visits again, typically 4 - 6weeks after the first treatment,different hairs will have moved intothe growing phase and will respondwell to treatment. So over thecourse of the 4 - 6 treatments youwill target hairs as they come intothe growing phase and significantlyreduce their ability to re-grow.

Your client information leafletsshould include this sort ofinformation to make it clear that it isnot a one-off treatment and thatresults can vary from person toperson.

3.3 How many treatments are needed?

You will need to offeryour client a course of

treatments becauseindividual hairs go

through a growth cycle.

ANAGEN

CATAGEN

TELOGEN

Treatment is thought to be most effectivein the anagen, or growing phase. Eachsuccessive treatment will result in longterm hair reduction. Many clients find thatremaining hair becomes finer and lesspigmented as treatment progresses.

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This is always a difficult question toanswer! Clinical and researchstudies have proved that laser andintense pulsed light treatments cansignificantly reduce the rate of hairgrowth compared to otherremoval methods such as waxingand shaving. It has also beenshown that re-growth in thetreatment area is finer and softer asa result of treatment.

Hair removal by laser and intenselight is a relatively new treatmentso it might be too early to talkabout ‘permanence’. Treatmentsuccess varies from person toperson and relies upon carefulclient selection, setting realisticclient expectations and clientcompliance. Because of the hairgrowth cycle you need to offer acourse of treatments and you mayfind that some clients require anoccasional ‘top-up’ treatment once

the initial course of treatments iscomplete. Equally, if your client istaking certain medications or has amedical condition that affects hairgrowth, the treatment may be lesssuccessful.

These factors can make it difficultto describe the treatment as‘permanent’ so it is wiser to talkabout hair management or hairreduction as this will give yourclient a more realistic picture ofwhat laser and intense pulsed lighttreatments can achieve.

3.4 Is it permanent?

Remember that if you usethe word ‘permanent’ inyour advertising material oroffer guarantees on hairremoval, you may have todefend this if a client is nothappy with your service.

Long term hair reductionis possible with laser andintense pulsed lighttreatments.

Courtesy of David McDaniel MD, Laser Center ofVirginia,picturesprovidedbyCynosureUKLtd

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Most areas can be treated if thehair and skin type are suitable butyou should not treat very close tothe eyes or over the mucousmembranes such as in the nose or ears.

The most common areas fortreatment are legs, back,underarms, bikini area, chin, top lip,beard area, chest and abdomen.

The National OccupationalStandards developed by HABIAare a useful reference for currentbest practice for beauty therapistswanting to work with laser andintense pulsed light systems.

3.5 Which areas can be treated?

This depends on which area youare treating and on the spot sizeof the treatment beam. A small areasuch as a top lip can be as quick as15 minutes whilst a full back mighttake up to two hours to treatdepending upon the laser orintense pulsed light systemyou have.

Most lasers and intense pulsed lightsystems can operate at differentspeeds (pulse repetition rates).

For example, a system that firestwo pulses a second is twice as fastas one pulse every second. Forlarge treatment areas such as backsand legs this can significantly reduceyour treatment time and help tomaximise your income.

Ask your equipment manufactureror supplier about treatment speedand treatment area for theirparticular equipment – this will helpyou plan your treatment times andfees when comparing systems.

3.6 How long does a treatment take?

Most parts of the body canbe treated if the skin and

hair are appropriate.

Courtesy of The Laser Centre

Courtesy of Aculight

Courtesy of Lynton Lasers

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Most clients say they experience atingling, ‘hot’ sensation. Somedescribe it as a sharp, briefpinprick, or an elastic band flickingagainst the skin. However, mostclients say it is less painful thanwaxing or electrolysis.

Once the light energy has done itsjob it is important to remove theheat from the skin. This isabsolutely essential if you treatdarker skin types which retain heat

longer than pale skin types. Youmay need to use cooling gels orcold compresses to soothe andprotect the skin after treatment.

Areas that have a greater hairdensity, eg, the beard area, can bemore uncomfortable than othertreatment areas because the heatcan build up and be retained forlonger. Offer cooling gels oradditional cooling to soothe the skin.

Many laser and intense pulsedlight systems have built-incooling on the treatmenthandpiece to reduce discomfortand reduce the chances of skindamage during and after treatment.This is a useful feature to look forwhen choosing equipment foryour salon or clinic.

3.7 Is treatment painful?

You must advise your client not topluck or wax between treatmentsbecause these methods pull thehair from the follicle – and this isthought to make treatment lesseffective. Your clients can shave ortrim hairs between treatments.

Some salons allow clients to usebleach or depilatory creams butnot immediately prior to atreatment.

After the first or second treatmentsome salons ask their clients toshave in readiness for theirtreatment to keep theappointment time to a minimumand maximise their fees.

3.8 Can my client remove hair between treatments?

Many laser and intensepulsed light treatmentshave in-built cooling toreduce discomfort andhelp protect theepidermis duringtreatment. This pictureshows a cooled lasertip used in contactwith clear gel.

Courtesy of Dr E Raymond

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The National Care StandardsCommission (NCSC) recognisethat lasers and intense pulsedlight systems are used in avariety of settings for a variety ofpurposes, including beauty salonsand clinics offering minimally ornon-invasive services (such as hairremoval) which do not require theoperator to be medically qualified.However, because laser andintense pulsed light equipment hasthe potential to cause seriousinjury, the NCSC insist uponregulation and inspection to ensuresafety. This includes therequirement that laser and intensepulsed light practitioners followprotocols that are supported bywritten procedures.

A protocol is a precise and detailedplan that is followed whenundertaking a treatment. Inpractice this means you will need

to have a formal written statementthat describes exactly what you dowhen you carry out a treatment.Standard P1 of the NationalMinimum Standards states that:

“A protocol produced by an expertmedical or dental practitioner isfollowed which sets out thenecessary pre-treatment checksand tests, the manner in which theprocedure is to be applied, theacceptable variations in the settingsused, and when to abort atreatment.”

Many of the equipmentmanufacturers and suppliersprovide outline treatment settingsor guides on how to use theirequipment correctly and safely andmany salons and clinics use theseas their protocols. Other clinicsmay appoint a medical adviser orconsultant to help them developprotocols.

To comply with the legalrequirements ensure that yourprotocol includes information on:

� Contra-indications� Technique� Pre-treatment tests� Post-treatment care� Recognition of treatment-

related problems� Procedure if anything goes

wrong with treatment� Permitted variation on machine

variables� Procedure in the event of

equipment failure.

3.9 What are protocols and who should write them?

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Once you have the protocol youwill need to develop some writtenprocedures for how you use thelaser or intense pulsed lightequipment. These writtenprocedures must cover:

� The potential hazards fromlasers and intense pulsed lightsystems

� Details of the controlled areaand access procedures

� Methods of safe working� Safety checks� Normal operating procedures� Personal protective

equipment� Prevention of use by

unauthorised persons and� Adverse incident procedures.

Most of these details are normallyincluded within the ‘Local Rules’for each controlled area. Localrules are exactly what the namesuggests – the rules or procedures

that everyone must follow whenworking with laser or intensepulsed light equipment in the salonor clinic. They tell you who canuse the equipment, what to do ifyou have an accident, how to startup and close down equipment,how to check and maintainequipment, what the hazards areand who is responsible for safety.

Accurate and detailed protocolsand procedures are an essentialelement of your hair removalservice. Take time to develop themand check them and get peopleless familiar with the procedures toread through them to see if theyare clear and easy to follow.

Remember – the mostimportant thing aboutprotocols or proceduresis that they set outexactly what you do –and that you do exactlywhat they say! So makesure you get them right.

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You will need to carry out a testpatch to determine the righttreatment parameters and to judgehow the skin (and client!) mightreact to full treatment.

A test patch is a small trial in anarea with similar hair and skin tothe treatment site. Typically a fewdiscrete pulses are delivered to theskin – with careful recording of thesettings – which allows thepractitioner to assess how well thelight energy is being absorbedand whether the skin is respondingas would be expected. A ‘normal’skin response could includefollicular erythema (redness) andlocalised swelling (oedema) aroundthe follicles. Darker skin typescan take longer to show aresponse than paler skin types, soalways give the test patch time todevelop before rushing into

treatment. Your protocols shouldset out exactly how the test patchis performed, including: whichareas to test, the laser or intensepulsed light settings, how long towait to judge skin response, howto spot adverse reactions.

You must record the equipmentsettings accurately and carefully butthe most important factor is to testin an area that has similar hair andskin as the treatment area. Thetest patch is also a good way foryour clients to experience the‘pricking’ sensation and it lets youjudge their tolerance to treatment.

3.10 Why do I need to carry out a test patch before startingtreatment?

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Many salons and clinics test patchduring the initial consultation(which you can only do aftergaining informed consent) andarrange for the client to returnwithin a given time after the testpatch. For the paler skin types adelay of one week is typical,whereas darker skin types may beasked to wait for two weeksbefore returning for assessmentand treatment. This delay betweentest patch and full treatment is animportant opportunity to assessthe longer-term reaction of theskin to the light and the clientshould make a note of any rednessor swelling and how long it takesto reduce, whether the skinblistered or felt excessively hot andfor how long. It is also anopportunity for the client to besure they want to proceed withtreatment. When the client returnsand before you start the first

treatment, you should record theclient’s reaction to the test patchand if necessary adjust yourtreatment settings accordingly.

If you are treating more than onearea on a client you must testpatch each different treatmentarea. An armpit might show a verydifferent reaction from an upper lipbecause of the difference in skintype and hair density.

Remember – eventhough a test patch maynot show an adversereaction this does notguarantee that a fulltreatment will always bewithout complications.

A test patch is anessential part of yourprotocols as it allows youto assess how the skinresponds to the lightenergy. The test patchcan be in a discrete areabut it must haverepresentative hair andskin to the actualtreatment area.


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Close-up photographs of thetreatment area are an essential partof your client records andtreatment plans.

It is best practice to takephotographs of the treatment areabefore the hair is shaved ortrimmed and before the clientstarts a course of treatments. Thisis a very valuable record for youand your client to see howtreatment is progressing. You willneed to use a good quality camerawith a flash. Choose one with alens that can take normal andclose-up pictures, eg, of smalltreatment areas such as the chin orupper lip. Use good quality filmand processing and always use theflash.

Good quality photographs willshow:

� The condition of skin and hairprior to treatment – andwhether it was suitable to treat

� Patches or areas of skin in thetreatment that should beavoided, eg, skin tags, moles,tattoos

� The expected ‘normal’ skinreaction to treatment – eg, some redness, localisedswelling around the follicle orsome dark hair ‘splatters’ onthe surface of the skin

� Immediate after-effects oftreatment if you think the skinhas reacted badly – eg, blistering, excessive swellingor redness, skin whitening orgreying

� Whether the course oftreatments has been effectiveand achieved a hair growthreduction.

If your client returns complaining ofpigmentation changes, blisters orskin damage you shouldphotograph the area and takecareful notes. In extreme casesyou may need to refer your clienton for further advice – yourprotocols should include this sortof detail so that you know exactlywhat to do and how to proceed ifa client shows an adverse reaction.

3.11 Should I take photographs of my treatments?

A good quality photograph withaccurate labelling is a very valuablerecord of your treatmentoutcomes andsuccess.


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Your client might be concernedabout having their photographtaken. You should reassure themabout confidentiality, security andanonymity:

� Take ‘close-up’ photographs ofjust the treatment area so thatthe client cannot be easilyidentified

� Use numbers or codes on thephotograph label and not theclient name

� Keep photographs with theclient record, stored safely andsecurely in accordance with theData Protection Act 1998 andthe National MinimumStandards.

The client records that you takemust be kept and made availableto the National CareStandards Commission(NCSC). One of the NationalMinimum Standards (C29)requires that your salon or clinichas a policy for creating, managing,handling, storing and destroyingrecords to meet the legalrequirements and professionalpractice recommendations. Themost important thing is to makesure your records are clear andaccurate and that they are dated,timed, signed and legible.

The HABIA website has useful linksand information about clientrecords and the Data ProtectionAct 1998.

You will have to keep your clientrecords for up to eight yearsdepending upon the age of theclient when they finish theirtreatment – so it might be worthconsidering storage space if youare planning a new laser or intensepulsed light facility.

You should refer to the CareStandards Act 2000 and thesupporting regulations to makesure you meet the legalrequirements for which documentsyou must keep and for how longyou must keep them.

Remember, you mayneed to use yourphotographic records toshow that you haveacted with integrity andcompetence if a clientcomplains about yourservice or yourtreatments.

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A layer of gel is often used to help‘direct’ the light energy into theskin. Gel can also give a coolingeffect if the system does not havebuilt-in cooling.

For treating large areas such as theback, gel allows the user to ‘glide’the treatment handpiece which canreduce treatment times – but you

must be an experienced user forthis technique.

The gels you use must becompletely clear and colourless.You must ask your client about anyallergies – including use of gels –before you start treatment.

3.12 Why do some hair removal systems use gel?

Your clinic or salon must havewritten protocols that set outexactly how treatment is deliveredincluding the laser or intensepulsed light settings for differentskin types. You must follow theseprotocols.

If your protocols need to bechanged because you develop abetter or safer way of working, orbecause your treatments areineffective or harmful, you shouldconsult with your medical adviser

or equipment supplier. If you dochange your treatment protocolsyou must make a careful record foryour NCSC evidence and makesure that all the users know aboutthe changes.

Before you can begin anytreatments you must be certainthat the client is suitable fortreatment. You should have taken amedical history, discussed thetreatment, its benefits and risks,identified skin type, answered any

questions or concerns and gainedInformed Consent from theclient.

The National OccupationalStandards developed by HABIAare produced by consultation withindustry experts and are reviewedregularly to provide a usefulreference for current best practicefor beauty therapists wanting tolearn to use laser and intensepulsed light systems.

3.13 What does a typical treatment involve?Many laser and

intense pulsed lightsystems use gel to

direct the lightenergy into the skin

and provide acooling effect.


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A typical treatment routine mightinclude:

� Checking medical history andthat informed consent is stillvalid, for example: that yourclient has not started certainmedications, has recent sunexposure, or is likely to bepregnant

� Preparing the client fortreatment

� Cleaning or removing make-upfrom the treatment area andmarking-out or pre-coolingthe area for treatment ifnecessary

� Labelling and photographing thearea

� Shaving or trimming the hair inthe area

� Issuing appropriate protectiveequipment such as eyewear

� Setting treatment parametersaccording to skin type, hairtype, test patch results,previous treatment settings

� Applying gels to the treatmentarea if appropriate

� Delivering the laser or intensepulsed light beam according totreatment protocols

� Cleaning and soothing thetreatment area

� Photographing the area� Providing aftercare advice� Writing up client records and

treatment plans

� Scheduling the nextappointment.

Remember that record keepingand documentation is an essentialpart of your service. Only bycarefully documenting yourtreatment settings and outcomeswill you be able to judge thequality and effectiveness of yourservice. You can then identify anyproblem areas or complicationsthat arise and by doing this yourtreatments will become safer,more reliable, more effective ormore repeatable. All of whichleads to better client satisfaction!

Consultation, pre-treatment proceduresand aftercare are allpart of a good treatment protocol.

Courtesy of Mapperley ParkCli nic





P24

This depends upon the client skintype and the equipment you usefor treatment. A goodmanufacturer or supplier shouldprovide equipment manuals andreference pictures that tell youwhat to expect from treatment –but everyone reacts differently totreatment and you must adviseyour clients of this. The mostimportant thing is to advise yourclients of what to expect fromtreatment and how they shouldcare for their skin in order tominimise possible complications.

Clients may experience thefollowing reactions to treatment:

� Skin redness – which can lastfor several hours or a few days

� Localised swelling around thefollicles – which can last forseveral hours or a few days

� An urticarial or ‘goose bump’appearance of the skin – whichcan last for several hours or afew days

� ‘Frazzled’ hairs adhering to thesurface of the skin – which willbe shed naturally – clientsshould not pick or pluck thesefrom the skin

� Bruising, most typically seen inthe axilla and bikini area –which can last for several days

� Occasional blistering – thismight indicate that subsequenttreatment settings requiremodification.

3.14 How should the skin look after a treatment?

After treatment the area may appear red with localised swellingaround the follicle, there may be burnt stubble or temporarycrusting – although treatment endpoints can vary betweendifferent laser and intense pulsed light systems.

Courtesy of Godfrey Town, FranklynCosm

eticLaserCentre


Danish

Der m

atologicD

evelopment

Normal erythema in two half-axillatreated areas produced by twodifferent 810nm diode lasers at thesame fluence, both using contacttransmission and contact coolingand roughly similar spot sizes,same time post treatment.

P25

Not every client will show all ofthese reactions but this does notnecessarily mean that treatmenthas not worked. You might find ituseful to build up a collection ofpost-treatment photographs ofnormal and adverse reactions sothat you can begin to identifytypical treatment reactions.

Unlike electrolysis, the hairs thathave been exposed to the lightremain in the follicles aftertreatment. You should advise yourclient that these hairs will move tothe surface and be shed over aone or two week period. Clientsthat are not warned about thisoften believe the treatment hasincreased their hair growth so willbe unhappy with your service.

A good aftercare advice leaflet canhelp to answer your clients’questions and reduce any anxietiesthey might have about what toexpect after a treatment.

Stop immediately if yousee significant skin

changes such as greying orwhitening of the skin as

this may lead to blisteringor pigmentation changes.

P26

You must stress to your client theimportance of post-treatment careand ideally you will have anaftercare leaflet that your client cantake away with them.

Because the treatment puts lightenergy into the skin it is importantto advise your client not to doanything that will add to thesensation of heat or irritate thearea, so most clinics and salonsoffer the following post-treatmentadvice to their clients:

� To cool the area with soothinggels, damp cotton pads or aloevera if the hot sensation orfeeling of warmth remains aftertreatment

� To avoid sun exposure in thetreatment area and to alwayswear a high factor sunprotection cream (SPF 15 orhigher) after and betweentreatments

� To stop using sun beds and faketanning products in thetreatment area

� To stop waxing or plucking hairsin the treatment area

� To avoid hot baths, strongdeodorants, heavily chlorinatedswimming pools or vigorousexercise for 12 – 24 hours andnot to use make-up in thetreatment area for as long ascan be avoided. After atreatment these things canirritate the skin and increase thesensation of heat anddiscomfort

� To contact the clinic or salon ifthey experience excessiveblistering, crusting or swelling inthe treatment area.

3.15 What aftercare advice should I give my client?

The most important post-treatment advice you cangive is sun avoidance. Not

only will a tan increasethe risk of pigmentation

changes and adversereactions but you will not

be able to treat a clientwith a suntan. The

consultation and post-treatment advice shouldstress this to your client.

P27

It is well proven that lasers andintense pulsed light systemscan both provide very effective hairremoval treatments on clients withthe appropriate hair and skintype when used in conjunctionwith the correct settings andprotocols. But with any treatmentthere is always the potential for anadverse reaction and this is equallytrue for laser and intense pulsedlight hair removal. This is whycareful client selection and a goodunderstanding of the principles andpractice of hair removal are vital.

Complications following treatmentare rare, but they can occur and aknowledge of how laser andintense pulsed light hair removalworks tells us why adversereactions are possible.

The target for treatment ismelanin, which is found in the hair follicles and in the epidermis – making the skin sensitive toexposure from lasers and intensepulsed light systems. Successfultreatment relies upon raising thetemperature of the hair follicle high enough and for long enoughto disrupt the hair growth cycle.This means we need a balancebetween the heat in the treatedhair follicles and in the absorbingskin layers. This explains why theideal combination for treatment isdark hair in a pale skin – the hairwill strongly absorb the lightcompared with the skin – makingthe skin less susceptible to heatdamage.

Adverse reactions to treatment caninclude:

� Excessive redness of the skin(erythema)

� Excessive localised swelling(perifollicular oedema)

� Excessive urticarial reactions� Blistering – which may only be

temporary but which indicatestreatment settings are notappropriate

� Long term complications suchas hyper or hypo pigmentation– tanned skin being at greaterrisk of pigmentary changes

� Scarring – which is rare – butclients must still be warned ofthe risks.

3.16 What is an adverse reaction to treatment?

P28

In the majority of cases, adversereactions are short lived and doresolve – but time spent on clientconsultation and informedconsent can be time well spent asit may help you spot potentialproblems before treatment begins.You can help to reduce thechances of an adverse reaction bytaking a medical history to checkfor known contra-indications totreatment such as existing skinpigmentation disorders, a history ofkeloid scarring, use of photo-sensitising drugs such as St. John’sWort, suntanned skin.

Even when correct treatmentparameters are chosen, adversereactions can still occur but thereare ways that you can reduce thechances of this happening. Inparticular:

Do not treat recently suntannedskin. A tanned client is likely tohave a higher level of melanin inthe skin and this may increase thechance of pigmentary changes orscarring. This is why your clientinformation must stress the needto avoid sun exposure prior to andduring a course of treatments.

Advise against post-treatment sunexposure. This can lead to anincreased chance of adverseinflammatory and pigmentarychanges.

Adjust the laser or intense pulsedlight equipment settings to suit thetreatment area. Areas that have ahigher density of hair, eg, a densebeard area, will strongly absorblight energy which can createand retain significant heat in theskin. Appropriate settings and

active cooling can lessen post-treatment inflammation anddiscomfort.

Advise the client to avoid activitiesor substances that might increasepost-treatment discomfort orirritation, for example: hot bathsand deodorants.

You must know what to do if youhave an adverse reaction duringtreatment – your protocols,policies or procedures mustinclude these details. In particularyou should have clear instructionsabout:

� How to recognise treatment-related problems

� What to do if anything goeswrong with treatment.

P29

If your client does experience anadverse reaction it is important torespond quickly to any complaint.You may need to ask the client toreturn to the salon or clinic forassessment or to photograph thearea, or you may need to refer theclient on for further assessment,perhaps to a GP or dermatologist.If your client wants to complainabout your service you must havea complaints leaflet or procedurethat is readily available to them. Ifyou receive a complaint you mustacknowledge and respond to it asset out in the NCSC NationalMinimum Standards. Yourclient is also entitled to complaindirectly to the NCSC and yourcomplaints leaflet or form mustinclude their contact details.

Appropriate training on the laser orintense pulsed light system and aknowledge of equipmentspecifications and variableswill help you understand whydifferent settings must be used fordifferent hair and skin types.Keeping careful and accuraterecords, including records ofadverse reactions, is a requirementof the National MinimumStandards. An audit of yourrecords may help you spot reasonsor trends for adverse reactions andby taking appropriate measures –such as staff training, revisingtreatment protocols, havingequipment maintained orserviced – you may reduce thelikelihood of adverse reactions totreatment.

No one wants to harm a client –so make sure that your laser andintense pulsed light hair removalservice includes:

� Careful client selection� Suitable pre- and post-

treatment advice� Appropriate equipment� Correct protocols, policies

and procedures � Accurate record keeping.

These things will help to reducethe chances of an adverse reactionto treatment and are thefoundation for a safe and crediblehair removal service.

P30

We know that treatments are mostsuccessful when there is a goodcontrast between the hair and skincolour, eg, dark coloured hairagainst a pale skin. But even aclient with this ideal combination ofhair and skin contrast may not besuitable for treatment. Experiencedbeauty therapists – even thosewithout laser or intense pulsedlight experience – will know thatcareful client selection is the key tosuccessful treatment. In practicethis means taking a full andaccurate client history to identifyfactors that could be a contra-indication for laser and intensepulsed light hair removaltreatment.

Essentially a ‘contra-indication’means something that is opposedto, or working against, a particulartreatment. Your salon or clinic

protocols will need to include theconditions, drugs or circumstancesthat will contra-indicate treatment.You will need to be able to identifycontra-indications, whether referralto a GP is necessary or whenalternative treatments areappropriate. This is why workingwith a medical practitioner can beextremely valuable and helpful. Ifyou have developed your protocolsin conjunction with a medicalpractitioner you may be able toconsult them if you encountercontra-indications, particular drugsor medical conditions that are notknown to you.

For the majority of salons andclinics, the following conditions,drugs or circumstances are typicallycontra-indicated:

4. Guidance on contra-indications

4.1 Are there any contra-indications for laser and intense pulsed light hair removal?

Good contrast between hair andskin colour is the ideal combination.

Darker skin types have a highermelanin content which absorbs the

light energy and can increase therisks of side effects.

P31

• Although treatment is not proven to be harmful to pregnant women itis better to advise your client to wait until after the baby is born beforestarting treatment.

• Do not treat suntanned skin as the increased level of melanin in theskin can cause unpredictable results including long term pigmentationchanges.

• Clients with artificial tans should not be treated until the product hascompletely faded from the skin.

Many drugs are known to be photo-sensitisers but usually at differentwavelengths than those used for laser and intense light hair removal – even so you should still be very cautious if a client is taking drugs ormedications you are not familiar with. Seek advice from your medicaladviser or pharmacologist. • Some drugs, including herbal remedies such as St. John’s Wort, can

react to light and cause unpredictable response to treatment. Knownphoto-sensitisers include certain antibacterials and antibiotics,antifungals, non steroidal anti inflammatories, cardiovascular drugs,diuretics and drugs containing retinoids.

• Clients with a history of melasma or vitiligo should not be treated. • Skin containing moles or pigmented nevaii should be avoided or

covered during treatment.

• Clients with a history of keloid scarring are more at risk fromdisfiguring scars in the event of a treatment producing skin damage.

Pregnancy

Suntanned skin

Drugs or medications that causephoto-sensitisation

Skin pigmentary conditions

Keloid scars

Guidance on contra-indications

P32

A number of conditions may be contra-indicated, even if the conditionsare being treated: • Active eczema, psoriasis or acne. In fact, do not treat any areas where

the skin is broken. • Clients who are receiving steroid based treatments or oral retinoids

should not be treated due to skin thinning effects and increased risk ofpost-treatment infection.

• Clients who are suffering from connective tissue disorders such asscleroderma are contra-indicated.

• Clients undergoing any form of photo therapy should not be treated asthe laser or intense pulsed light treatment may cause pigmentationchanges or interfere with the effectiveness of the photo therapytreatment.

• Although treatment is not proven to trigger an epileptic attack youshould check with the client as to how well their epilepsy is controlledbefore you offer treatment.

• Clients with diabetes that is well controlled and managed may besuitable for treatment. You should emphasise to the client theimportance of them being prepared for treatment and having theirmedication or appropriate food available.

• Heat and light are known triggers for the herpes virus. Clients whoregularly suffer from cold sores are recommended to have anti-viralproducts available should treatment trigger an outbreak. You should nottreat any areas with active herpes infection.

Dermatological conditions

Epilepsy

Diabetes

Herpes


P33

• Some clients get very anxious about treatment and may experience anincrease in blood pressure. Clients suffering from coronary conditionsshould not be treated.

• Clients who suffer from fainting or giddiness are not necessarily contra-indicated, but you should monitor them closely, especially whenthey sit up after treatment or leave the treatment couch.

• Always check with your client as to whether they suffer from allergicreactions to the products or materials you may use, eg, latex or rubberbased gloves, creams and gels.

• If your client is suffering from underlying conditions, such as PolycysticOvarian Syndrome (PCOS) or Hirsutism, that affect hair growth you mustset realistic expectations of treatment. ‘Hair management’ is a better wayof describing treatment for those with hair growth related problems.

• You must always be aware of the risks of infection from blood relatedconditions especially since treatment typically involves shaving the area tobe treated and nicks and cuts are a possibility. It is recommended practiceto wear gloves during treatment (refer to the National OccupationalStandards).

Coronary and blood pressureconditions

Allergies

Hair growth related problem

Blood related conditions


P34

Remember – the safest treatment isNO treatment. If ever

you are in any doubtabout providing a

treatment seek adviceor a second opinion.

• Do not treat over areas that have heavy or dark pigmentation as it maycause adverse skin reactions. Piercings/body jewellery – whereverpossible remove piercings or body jewellery. Do not fire a laser orintense pulsed light beam on to reflective jewellery.

• It is generally accepted that implants, such as silicone implants, heart pace-makers, and artificial joints will not be affected by treatment but do ensurethat your client is in good general health and fully recovered from anysurgical procedures before offering treatment.

Permanent make-up and tattoos

Implants

Herpes Dermatological conditions Skin pigmentary conditions Keloid scars

Courtesy of Dr John Gray



Courtesy of Dr John GrayGuidance on contra-indications

Illustrations of contra-indications

P35

Suntanned skin is one of the mostcommon contra-indications andshould not be treated. But don’tforget that you must also adviseyour client to avoid the sun aftertreatments as well. The skin canbecome extremely sensitive tolight and heat after treatment andcases of pigmentary changes havebeen recorded in clients whosunbathed after treatment. Thissensitivity can last for as long as sixmonths. Your aftercare leafletshould stress the need for highfactor sun protection before,during and after a course oftreatments.

Remember that consultation andinformed consent are theopportunity to identify your client’shistory of medical or hair growthrelated problems, reasons forseeking treatment, their generalhealth and wellbeing and whetherthey are appropriate and suitablefor treatment. It is also essentialthat you use the consultation to setrealistic expectations of what thetreatment will, or will not, achieve– and checking for known contra-indications is an essentialpart of this process.


P36

Buying a system could be a verybig investment and it is easy to feeloverwhelmed with the amount ofinformation you need to know.Even if you lease a system youmust make sure you can cover thecost of the financial package fromyour treatments. The mostimportant question is whether youfeel you can trust your supplier andare confident doing business withthem. You should think of it as along term relationship and look fora manufacturer or supplier that willbe there to support you – not justin the early days, but once yourbusiness is established and set togrow.

Make sure you do your researchby contacting severalmanufacturers and suppliers,

visiting trade shows and exhibitionsor other clinics that offer thisservice, identifying your customerneeds and reading trade journalsand magazines on the subject.Here are the type of questions youshould be asking:

� What treatments can theequipment achieve?

� Are there any reported sideeffects or complications fromusing the equipment?

� How reliable is the equipment?� Does the equipment meet the

legal requirements and safetystandards for laser and intensepulsed light equipment, eg, CE marking?

� Where is the equipment madeand are spare parts readilyavailable?

� What are the on-goingequipment service ormaintenance costs?

� Is an equipment loan available ifmy equipment fails?

� Will I be able to get software orequipment upgrades if they areavailable?

� Are finance options availableand are they affordable?

� Will the supplier providemarketing or advertisingmaterials to help you attractcustomers and build yourbusiness?

� Who else is using theequipment and what is theirexperience of the supplier andequipment?

5. Guidance on equipment and legal issues

5.1 What should I look for when buying a hair removal system?

P37

� How do I look after theequipment and keep it runningcorrectly?

� What clinical trials or researchstudies are available for thisequipment?

� Does the equipment have theright specifications andvariables or settings to treatdifferent skin types?

� Does the system have built-inskin cooling on the handpieceor beam delivery system?

� How quickly (pulserepetition rate) can thepulses of light be delivered tooptimise my treatment times?

� Are gels or creams needed tocarry out a treatment?

� What are typical treatment feesand will I be able to generatesufficient income?

� How easily could theequipment be returned or soldif I decided not to continue withmy hair removal service?

� How many treatments arerecommended using theequipment?

� Is the system portable or easyto move and store within myclinic or salon?

� What training and support willthe supplier provide?

� Are there any safety issues Ineed to know about eg,wearing Personal ProtectiveEquipment (PPE) such aseyewear?

Courtesy of Jenifer R Lloyd, pictures providedby

CynosureUK

Ltd

Courtesy of Jenifer R Lloyd, pictures providedby

CynosureUK

Ltd

Laser and intensepulsed light treatmentsoffer fast and effective

long term hairreduction and hair

management.

P38

The beam of light from a laser hassome unique properties that makeit different from other types of lightsources such as the sun or a flashlight. The differences are illustratedin the picture below.

Even though intense pulsedlight systems are not lasers, theycan do serious eye or skin damage.You must be trained to use theequipment properly and follow thesafety rules and treatmentprotocols for your particularsystem.

The National MinimumStandards (NMS) as set out bythe Care Standards Act 2000, andthe National OccupationalStandards developed by HABIAare essential reading for thoseworking with lasers and intensepulsed light systems. The NationalOccupational Standards developedby HABIA are produced byconsultation with industry expertsand are reviewed regularly toprovide a useful reference forcurrent best practice for beautytherapists wanting to learn to uselaser and intense pulsed lightsystems. HABIA recommends thatonly beauty therapists who havequalified in electrolysis shouldprogress to become laser andintense pulsed light practitioners forhair removal.

5.2 What is the difference between a laser and an intense pulsed light system?

White light or intense pulsed light:- emits a beam of many colours- spreads out as it travels

Laser light:- emits a beam of a single colour- travels in a narrow beam

White light or intense pulsed light:- emits a non coherent beam

Laser light:- emits a coherent beam of waves

that travel in step or in phase

P39

Lasers and intense pulsed lightsystems are technical pieces ofequipment so the language used todescribe them and the treatmentsthey offer can appear full of‘jargon’. But it is important that youunderstand some of the technicalaspects of the equipment in orderto select or use it correctly.

Manufacturers and suppliers ofequipment should include thetechnical details andspecifications of their products intheir literature. If you canunderstand the specifications youwill be able to make directcomparisons between equipmentand not just rely upon the salesliterature claims – essential if youintend to buy your own system.

For example, you should be ableto recognise:

� What wavelength of light itemits

� How fast or how often thepulse is delivered (pulserepetition rate)

� How long the pulse of lightenergy lasts (pulse duration)

� How much light energy isdelivered – the fluence

� The size(s) of the treatmentbeam or spot size.

These things are just as importantas comparing reports or pictures oftreatments using differentequipment and getting tounderstand the terms can help youmake objective comparisonsbetween systems and treatments.

Your equipment supplier should beable to explain these terms to youin plain and simple language, andmore importantly tell you why thedifferent features are important.

There are also training providersthat offer ‘Core of Knowledge’training or study days andqualifications and these can be auseful way to learn the jargon andtechnical terms of laser and intensepulsed light hair removal.

You may also need to seek advicefrom specialists in laser and intensepulsed light safety (Laser SafetyAdvisers). These people shouldalso be able to help you interpretthat jargon and the technicalspecifications.

The National OccupationalStandards developed by HABIAare an essential reference forbeauty therapists wanting to learnto use laser and intense pulsedlight systems and for salon ownerswanting to specify competencerequirements in, eg, protocols andjob descriptions.

5.3 Why is there so much ‘jargon’ around lasers and intense pulsed light equipment?

You will find a veryhelpful glossary at theend of this booklet – use it for a quickdefinition of many ofthe technical terms andjargon that go alongwith laser and intensepulsed light systems!

P40

Many people think of lasers aspowerful weapons that can cutthrough metal and flesh! Whilstsome lasers can do these things, inreality they are used in many otherways: in supermarket barcodescanners, in CD players, for makingthe holograms on credit cards, forindustrial machines and in lasersurgery and eyesight correction.

Lasers are ‘classified’ (LaserClassification is from Class 1through to Class 4) according to thepotential harm that the laser beamcan cause. The highest is Class 4and these are the type typicallyused for medical and therapeutictreatments. The lasers used for hairremoval are powerful devices andcan cause skin burns and eyesightdamage or set fire to materials ifyou do not use the equipmentcorrectly. Class 4 lasers must beused carefully and this is whytraining and protocols are soimportant.

Intense pulsed light systemsare not lasers because they emit adifferent type of light energycalled broad spectrum. But theycan still damage the skin and eyes ifmisused. So it is sensible that youapply the same safety precautionswith an intense pulsed light as youdo for a laser.

The Care Standards Act 2000and the National MinimumStandards (NMS) regard lasersand intense pulsed light systems asidentical in their safety and trainingrequirements.

This is why your clinic or salonmust have a ‘controlled area’ for the laser or intense pulsed lightsystem. Only those authorised toenter this area and trained to usethe equipment will be allowed tocarry out treatments.

The controlled area:

� Will have clear and detailedsafety rules which describe howto use the area correctly, anyhazards you might be exposedto, who is authorised to use theequipment, what to do in theevent of an accident

� Must have clear signs or warninglights showing when it is safe toenter or when the laser/intensepulsed light is on

5.4 Are lasers and intense pulsed light systems dangerous and can I use them anywhere in mysalon or clinic?

Cou

rtesy

ofM

appe

rley Pa

rkClinic, Nottingham

Your laser or intensepulsed light controlled

area must be a safeplace for your staff

and clients.

P41

� Will have appropriate safetyequipment such as protectiveeyewear as specified by yourLaser Protection Adviser(LPA) or equipment supplier

� Should be well lit, well ventilatedand a comfortable temperatureto work in

� Should have suitable door locksor keypads so that no one canwalk in during treatment

� Should avoid unnecessaryreflective surfaces or objectsaround the treatment area

� Might require blinds or shuttersover windows during treatments

� Should be well laid out withclear floor areas, workspace andsuitable storage, eg, forprotective eyewear, camera,cleaning materials

� Should allow easy access aroundthe equipment formaintenance and service

� Should not be used to storeflammable materials near thelaser or intense pulsed lightequipment

� Must meet fire and generalhealth and safety requirementsand provide a safe environmentfor all who enter.

HABIA produces an excellentHealth & Safety ImplementationPack for Beauty Therapists. Thisprovides many example forms forrisk assessments, accident reportingand other safety checklists. Thesecan easily be adapted to meet thecriteria for the National MinimumStandards (NMS).

To help you plan and develop theprotocols for your controlled areayou may need to seek advice fromspecialists in laser and intensepulsed light treatments and safety.For safety advice you use theservices of a Laser ProtectionAdviser (LPA) to:

� Identify potential hazards andsafety issues

� Undertake a risk assessment� Suggest safe ways of working to

reduce any hazards or dangers � Develop local rules for your

controlled area(s)� Select safety equipment such as

interlocks, illuminated signs andeyewear

� Carry out regular safety auditsand reviews of your workingpractices.

If you run a number of systems(including intense pulsed lightequipment) or treatment roomsyou may want to appoint a suitablyqualified or competent member ofstaff to act as a Laser ProtectionSupervisor (LPS). The LPS cantake the day-to-day responsibilityfor safety in the controlled area byensuring that users follow localrules, procedures and protocols andremember to work safely.

P42

We all have a legal obligation toprotect our health and safety whilstworking and especially when usinglasers or intense pulsed lightsystems. This is true whether weare an employer or an employee.Using lasers or intense pulsed lightsystems brings some additionalrequirements to the broadknowledge of applicable legislationand hygiene procedures youshould already have from yourdaily practices.

The first step for providing hairremoval treatments in England is toregister with the National CareStandards Commission(NCSC) (or with the equivalentbody in Scotland, Wales orNorthern Ireland). It is a legalrequirement, under the CareStandards Act 2000, for clinicsor salons using lasers or intense

pulsed light systems, to be formallyapproved and registered to carryon the service they offer. If you donot have a Certificate ofRegistration from the NCSC youare operating illegally and liable toheavy penalties and fines.

‘Registration’ describes the processof formally approving persons andorganisations to run a clinic orsalon. Registration can be a lengthyand time-consuming process soyou need careful planning andpreparation of statements anddocuments relating to the servicesyou provide. The NCSC willrequire ‘evidence’ which maytake the form of policies,procedures, certificates of training,or any other such documents thatcan show that:

� The staff and directors in yourorganisation are ‘fit to practise’

� The establishment is financiallysecure with sound financialaccounts and business plans

� The premises comply withHealth & Safety requirementsand those required for workingsafely with lasers and intensepulsed light systems.

The NCSC Inspectors will use thisevidence to check that your facilityand services comply with thePrivate & Voluntary Health Care(England) Regulations 2001 (PVHCRegulations) and meet the newNational Minimum Standards(NMS).

5.5 Are there any legal requirements for providing a laser or intense pulsed light hair removalservice?

To find out more aboutregistration and the work of

the NCSC contact:

The National CareStandards Commission

St. Nicholas BuildingSt. Nicholas Street

Newcastle Upon TyneNE1 1NB

Tel: 0191 233 3600Fax: 0191 233 3569

E-mail:[email protected]

Web: www.ncsc.gov.uk

Scotland

The Regulation of Care(Scotland) Act 2001 appliesto the use of lasers and IPL.

Care Standards andSponsorship Branch

2 ESSt Andrew’s House

Regent RoadEdinburghEH1 3DG

www.scotland.gov.uk/health/standardsandsponsorship/

The Scottish Commissionfor the Regulation of Care

(‘the Care Commission’) is responsible for

monitoring specialist clinics in Scotland.

P43

The documents you will need tobe aware of for laser and intensepulsed light use are listed below.The first three documents can bedownloaded free fromwww.ncsc.gov.uk

Care Standards Act 2000(CSA2000)A very comprehensive documentcovering all aspects of care fromnursing homes to fertility clinics butalso making reference to the use oflasers and intense pulsed lightsystems.

The Private & VoluntaryHealth Care (England)Regulations 2001 These Regulations give meaningsand definition of various terms andrequirements set out in theCSA2000. The Regulations give fulldetails about the records you mustkeep, information you must givethe NCSC and include the

‘schedules’ that tell you what toinclude in the ‘Statement ofPurpose’ and ‘The Patients’ Guide’.

Independent Health CareNational Minimum Standards(NMS) These are the statements orcriteria your clinic or salon mustmeet and against which yourservice is graded. They covereverything from client informationleaflets through to the use of namebadges.

The National OccupationalStandards developed by HABIAare produced by consultation withindustry experts and are reviewedregularly to provide a usefulreference for current best practicefor beauty therapists wanting tolearn to use laser and intensepulsed light systems. HABIArecommends that only beautytherapists who have qualified in

electrolysis should progress tobecome laser and intense pulsedlight practitioners.

The main British Standardapplicable to salon and clinic lasersafety is: BS EN60825-1:1994.Safety of Laser Products Part 1.Equipment classification,requirements and user’s guide.

Useful Documents

Wales 2000

The Care Standards Act(2000) applies to Wales and gives the Assemblypowers to implement itsrequirements under theCare Standards Act 2000(Commencement No 9)(Wales) Order 2002.

Care Standards Inspectorate for WalesNational Assembly for Wales4-5 Chain Wood CourtHeol BillingsleyNant GarwCardiffCF15 7QZwww.wales.gov.uk/subisocialpolicycarestandards/index.htm

Northern Ireland

There is currently noequivalent of the NationalCare Standards Commissionin Northern Ireland. HABIArecommends that salonowners should considerworking to the NationalMinimum Standards set by the CSA and use theNational OccupationalStandards as the basis fortraining and operation.

P44

A number of other Standards arealso relevant as summarised below:

BS IEC 60825-8:1999Technical Report. Safety of LaserProducts – Part 8: Guidelines forthe safe use of medical laserequipment.

BS EN 60601-2-22: 1996This Standard is a section of theMedical Electrical EquipmentStandards – Part 2, ParticularRequirements for Safety, Section2.122: Specification for Diagnosticand Therapeutic Laser Equipment.

BS EN 207:1994 Specification for Filters andEquipment Used for Personal Eye-Protection Against Laser Radiation– normal use safety eyewear

British and European Standards areavailable on line fromwww.bsonline.techindex.co.uk ormay be available to order fromyour local library.

Guidance NotesThere are a few guidancedocuments produced for particularindustries but only one relevant tolaser/intense pulsed lightapplications:

Medical Applications‘Guidance on the Safe Use ofLasers in Medical and DentalPractice’ produced by the MedicalDevices Agency.

As well as registering with the NCSCand meeting the National MinimumStandards you will need to meetgeneral health and safetyrequirements and employment laws.

Remember that legislation changesregularly and whether you are anemployer or employee you shouldkeep abreast of these changes tosafeguard yourself. Belonging toprofessional organisations andsubscribing to trade journals andmagazines is a good way to keep

yourself up-to-date with legalrequirements.

Other Useful Documents

HABIA produces an excellentHealth & Safety ImplementationPack for Beauty Therapists. Thisexplains many of the regulationslisted below and provides exampleforms for risk assessments, accidentreporting and other safetychecklists. Here is a summary ofother laws and regulations that youshould be aware of and how theymight affect your clinic or salon:

The Health & Safety at Worketc Act 1974This Act sets out the responsibilitiesof the employer and employee.

The employer has a duty of care toprotect the health, safety andwelfare of everyone who might beaffected by the work of the clinic orsalon.

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Duties of an employee include:following safety rules andregulations, co-operating withhealth and safety matters, takingcare of themselves and others andnot misusing or abusing safetyequipment.

A number of Regulations havebeen issued under the Health &Safety at Work Act and the mainregulations that could be appliedare listed below:

Control of SubstancesHazardous to HealthRegulations 1998 (COSHH)The main requirement of theseRegulations is that you must carryout an assessment of the risk tohealth from substances you use inthe clinic or salon. This will includeany particular materials for cleaninglaser or intense pulsed lightequipment.

Reporting of Injuries,Diseases and DangerousOccurrences Regulations1995 (RIDDOR)Requires you to record accidentsthat might occur. Certain eventssuch as a death, serious injury,specific diseases etc, must bereported to the Health & SafetyExecutive.

Electricity at WorkRegulations 1989All electrical equipment used in theclinic or salon must be safe andmaintained to prevent danger. Thisregulation also applies to lasers andintense pulsed light systems. Keepyour equipment regularly servicedand well maintained.

Management of Health &Safety at Work Regulations1999These Regulations overlap withmuch other safety legislation. Theirbasic purpose is to ensure thatemployers assess the risks to theiremployees (and to others) and,where appropriate, take steps toreduce or eliminate those risks.

Health & Safety (DisplayScreen Equipment)Regulations 1992If a computer is an integral part ofa laser or intense pulsed lightsystem these Regulations mightapply depending upon how muchtime is spent at the keyboard.However, the Regulations can alsobe considered to represent ‘goodpractice’.

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Provision and Use of WorkEquipment Regulations 1998(PUWER)‘Work equipment’ is broadly takento mean everything from handtools to lasers and intense pulsedlight systems. Every employer mustensure that work equipment issuitable for its purpose and usedfor that purpose. When installingnew equipment you must alsothink about any health and safetyrisks it might have. Equipmentmust be properly maintained andequipment maintenance logs keptup-to-date.

If any equipment involves a specificrisk or risks then its use, service orrepair must be restricted tosuitably trained and authorisedpersons – which does includelasers and intense pulsed lightsystems. If you supervise or usethis equipment you must havehealth and safety information andwritten instructions such as safe

operating instructions, and ahazard and risk assessment.

Workplace (Health, Safetyand Welfare) Regulations1992These Regulations apply to theworkplace. It must be clean,maintained, have safety equipmentsuch as emergency lighting, fireprotection, etc. There should begood lighting, adequate workingspace, appropriate seating if you sitdown at work.

Manual Handling OperationsRegulations 1992More than a quarter of theaccidents reported each year tothe enforcing authorities areassociated with manual handling.This Regulation requires employersto carry out an assessment of eachemployee’s ability to carry ormove equipment. They shouldalso provide training on safetyworking practice.

Protective eyewear isspecifically designedfor a particular type

of laser or intensepulsed light system. If you have different

systems in your clinicyou must have the

correct eyewear foreach system. Make

sure your eyewear isclearly labelled and

ready for use.

You should be able to get advice on

protective eyewearfrom your Laser

Protection Adviser oryour equipment

supplier.

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Visit the HABIA websitefor more informationabout Health & Safety in the Salon Environmentand details about theHealth & SafetyInformation Pack forBeauty Therapy.

The Regulations also deal withdomestic things such as toilet orchanging facilities, rest areas andfacilities where employees can eat.

Personal ProtectiveEquipment at WorkRegulations 1992Personal protective equipment(PPE) is needed for both lasers andintense pulsed light systems. Underthe PPE regulations it must beprovided free of charge, must fitproperly and give adequateprotection.

PPE must be maintained, cleanedand replaced as necessary. Whenyou are not using the PPE it mustbe properly stored away. Staffmust be given proper informationabout PPE, the risks the PPE isdesigned to avoid and how to useit and look after it.

Duties are placed on both theemployer and the employee toensure that any PPE is actuallyused and in the correct manner.Any loss or breakage of PPE mustbe reported immediately to theemployer.


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The National MinimumStandards (NMS) issued by theNCSC are the statements or‘criteria’ that your clinic or salonmust meet and against which yourservice is graded. The PVHCRegulations which support theCare Standards Act 2000 givefull details of all the requirementsyou must meet to be grantedregistration – and withoutregistration you will be workingoutside the law.

You will need to take a careful lookat everything you do in your clinicor salon, you will need to thinkabout health and safety, about howyou recruit people, about theservices you offer, the informationyou give your clients, the trainingfor your staff, and the facilities youhave available.

The best way for you todemonstrate compliance is to keepvery thorough and careful recordsof your procedures and policies.This is your ‘evidence’ in supportof the way the clinic is run and theservice it provides. Evidence caninclude: written policies,protocols, client records, clientinformation leaflets, equipmentmaintenance logs, trainingcertificates, records of meetings,etc.

You will have to keep certainrecords and documents for theNCSC inspectors to see at anytime. In particular:

� Client records that includename and address, date ofbirth, marital status and othergeneral details.

� A laser or intense pulsed lightregister or book that must becompleted each time you usethe equipment. This registermust show: the client name,the date and nature of thetreatment, the name of thelaser or intense pulsed lightpractitioner and any accidentsor adverse incidents.

� A register of any mechanical or technical equipment you use along with the treatment – this could include a smokeevacuator or a skin coolingdevice. This register must showthe date of purchase andinstallation of the equipmentand any maintenance schedulesyou have for it.

5.6 How can I show that I am meeting the National Minimum Standards?

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� Reports or records such as: anyserious injury or death of aclient, outbreak of infectiousdiseases, allegations ofmisconduct that cause actualharm to a client or staff in theclinic or salon.

� A record of any shift work andthe actual hours worked bystaff.

� A record of any person whouses a laser or intense pulsedlight system in the clinic orsalon, including medicalpractitioner’s grantedpermission to use theequipment.

� Client records – which need tobe kept for up to eight yearsdepending upon the age of theclient when they received theirlast treatment.

If you collect your evidencetogether and cross reference it to

the National Minimum Standardsyou will be able to see whetheryour existing policies andprocedures meet the criteria. Insome cases you might just need torecord what you are already doing,but for other areas you may haveto develop new policies orworking practices.

This is how the National MinimumStandards are set out; each‘Standard’ has an ‘Outcome’ and‘Assessment Criteria’. For example,Core Standard C2 is all aboutPatient Centred Care and it makesreference to staff identificationbadges:

OUTCOME – The treatment andcare provided are patient-centred.

CRITERIA 2.9 – Staff wearidentification badges showing nameand position held.

Your clinic or salon might alreadyhave staff name badges and staffare expected to wear them – butyou probably won’t have anythingwritten down about name badges.A simple statement, or ‘policy’ thatall staff must wear badges showingname and position will provide theevidence of compliance against thisparticular National MinimumStandard – obviously you mustthen make sure that staff weartheir badges.

The National OccupationalStandards developed by HABIAare an excellent reference to checkthat your current working practicesare up-to-date and correct. Thesehave been developed with theNational Minimum Standards inmind, so you can be sure theyrepresent recommended practice.

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Anyone who uses a laser orintense pulsed light systemwill need to show evidence thatthey meet the NationalMinimum Standards (NMS) ofcaring for clients and usingequipment correctly. You do notneed to be a registered health careprofessional to provide treatmentbut you must be appropriatelytrained and able to follow writtenprotocols.

HABIA has produced NationalOccupational Standards forbeauty therapists using laser andintense pulsed light systems forhair removal and these standardsrepresent current best practice.The skills and knowledge of abeauty therapist qualified inelectrolysis provide an excellentbasis for learning to use laser andintense pulsed light systems forhair removal. HABIA recommendsthat only beauty therapists who

have qualified in electrolysis shouldprogress to become laser andintense pulsed light practitioners.

Clinics and salons in Englandwanting to offer laser and intensepulsed light hair removal must beregistered with the NationalCare Standards Commission(NCSC) who inspect the premises,equipment and those using theequipment.

You will have to prove that:

� Clients receive treatment usinglasers and intense pulsed lightsfrom competent operators andin accordance with appropriateprocedures.

� Clients receive treatment fromappropriately trained operators.

� The environment in whichlasers and intense pulsed lightsystems are used is safe.

5.7 What training do I need to carry out treatments?

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Inspectors will want to know whattraining you have received for theequipment you are using. They willexpect to see evidence of yourtraining, that it was delivered by areputable provider, that it was atan appropriate level and that itincluded:

� The characteristic features oflight from lasers and intensepulsed light sources.

� Hazards or dangers fromequipment that goes wrong.

� How to maintain and look afterequipment.

� The effects of light on the eye,skin and body tissues.

� How to work safely, includingunderstanding local rules andworking in a controlled area.

� How to minimise risks in yourworkplace.

� What to do in the event of anadverse incident.

You can ask your equipmentsupplier or other reputable trainingproviders for training. Ideally itshould include some form ofassessment or test – this can beuseful to identify your staff trainingneeds and help you plan futuretraining sessions.

Remember that you may also need to attendor facilitate updatetraining or study days.These could be heldregularly or when newtechniques, protocols or equipment areintroduced. If you changeanything of significancein your working practiceyou should document itand make sure thateveryone involved knowsabout and understandsthe changes.

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Clinics and salons using a laser orintense pulsed light system mustbe registered with the NationalCare Standards Commission(NCSC). The NCSC inspectorswill assess your service and facilityagainst the National MinimumStandards (NMS) and against thePrivate and Voluntary Health Care(England) Regulations 2001(PVHC Regulations).

One requirement from the PVHCRegulations is that the facility musthave in place;

“…a professional protocol drawnup by a trained and experiencedmedical practitioner or dentistfrom the relevant discipline inaccordance with which treatmentis to be provided, and is soprovided.” (Regulation 42)

This does not necessarily meanthat you must have a medically

qualified person working in yoursalon or clinic, but you will beexpected to show that you arefollowing appropriate protocolsand procedures. More importantlyis that these protocols have beendeveloped by people withappropriate knowledge, skills andexperience in laser and intensepulsed light hair removal.

Many equipment manufacturersand suppliers provide training orinstruction manuals that includetreatment parameters or treatmentprotocols – some even have built-in default treatment settings in thecomputer software of theequipment. These parameters areusually developed through clinicaltrials and studies when theequipment is being designed ortested.

5.8 Do I need a medically qualified person working with me?

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The reason why it is useful toestablish a good workingrelationship with a medicallyqualified person is in the event ofan adverse reaction to treatmentthat might require medicalattention. Ideally you would beable to refer your client to themedical practitioner that hasdeveloped your protocols andtherefore is aware and familiar with your practice and procedures.

Some hair removal salons andclinics appoint a medical adviser orconsultant to oversee theirprotocols and procedures, forwhich they may expect a fee. Thisis an ideal way to ensure that yourservice has medical support and islikely to meet the legalrequirements of the CareStandards Act and supportingPVHC Regulations. Such medicaladvisers or consultants may

provide advice and guidance ontreatment parameters, identifydermatological conditions orcontra-indications, take clientreferrals, treat adverse reactionsand generally oversee clinicalpractice. This might be throughregular meetings or visits from themedically qualified person or via atelephone service to answerdermatological or medical historyqueries.

Whether you have the support ofa medical practitioner or not, it is alegal requirement that any personwho delivers the treatment isappropriately trained and thattreatments are given in a safeenvironment. The NationalMinimum Standards set out thecriteria for this.

If you followprotocols providedby the equipmentmanufacturer orsupplier you mustcheck that theymeet the NationalMinimum Standardsrequirements for aprotocol (seeSection 4.9)

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This is an exciting time for beautytherapy related laser and intensepulsed light treatments – withnew equipment, techniques andtherapies being continuallydeveloped. The NationalOccupational Standardsdeveloped by HABIA currently setout the best practice for qualifiedbeauty therapists wishing tobecome laser and intense pulsedlight practitioners for hair removaltreatments and photo-rejuvenation.

Photo-rejuvenation is an innovativenew procedure for face and bodyclaimed to improve theappearance of photo-aged skin,remove age spots (sun-inducedfreckles), most benign brownpigments, and redness caused bybroken capillaries. The treatmentstypically use broad spectrumlight to treat the face, chest, neckand hands – virtually anywherethat sun damage shows. The lightis delivered through a smooth, flatglass handpiece which is placedover a layer of gel spread on tothe skin. A course of treatmenttypically consists of four to sixtreatments administered to thewhole face, chest, neck or hands,spaced at three week intervals.

It is described as a ‘non-invasive’technique that also claims to reachdeep into the skin to stimulatecollagen to provide a rejuvenatedeffect on skin appearance andcomplexion. Manufacturers of theequipment claim the process isideal for clients with active lifestylesbecause the procedure requiresno downtime and produces fewside effects. Because the skinimprovement is subtle, the client’sskin does not appear obviouslytreated – hence the ‘no downtime’description of photo-rejuvenation.With many of these more ‘subtle’treatments it is necessary to setrealistic outcomes and advise yourclient that a course of treatmentswill be necessary and that therejuvenation effects may not bepermanent.

6. Future Developments6.1 What new or future treatments might I be able to offer?

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This is a relatively newdevelopment and dermatologicaland aesthetic studies are beingundertaken to clarify the properuse and expectations of photo-rejuvenation.

The legal and safety requirementsfor carrying out photo-rejuvenationare the same as for laser andintense pulsed light hair removaltreatments. Your facility will needto be registered with TheNational Care StandardsCommission (NCSC) and mustmeet the National MinimumStandards (NMS).

Because the range of treatmentsand equipment is constantly beingincreased and improved, makesure you stay up-to-date andknowledgeable by joiningprofessional organisations,subscribing to trade journals and newsletters, attending trainingor study days and exhibitions. As technology advances andprofessional standards aredeveloped to meet the currentand future training needs, you mayfind many new skin therapytreatments using lasers or intensepulsed light equipment that areperfectly suited to the knowledgeand skills of qualified beautytherapists!

Photo-rejuvenation is a new light therapyfor improving theappearance of sundamaged or photo-aged skin.


Danish

Derm

atologicDevelopment

Courtesy of David HM

cDaniel MD

, LaserCenterofVirginia,picturesprovidedbyCynosureUK

Ltd

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Absorbed/Absorption The ‘taking in’ of light energy. Absorption of light energy can produceheating effects in the tissues which can interrupt the hair growth cycle.

Beam delivery system Describes the way that the laser or light beam is ‘delivered’ to the client.Methods include fibre optics or an articulated arm with a ‘handpiece’ or lightguide.

Broad spectrum light Light that contains a wide range of ‘colours’ or wavelengths. The sun andintense pulsed light systems produce broad spectrum light.

Care Standards Act 2000 An Act of Parliament that came into effect in April 2002 (in England andWales). The CSA2000 replaced the Nursing Homes Act 1984 whichpreviously regulated the use of lasers. CSA2000 was introduced to improvethe old Act and to bring the management, interpretation and inspectionunder the authority of the National Care Standards Commission (NCSC).

Chromophore A ‘target’ such as melanin, water or haemoglobin that can absorb light of theappropriate wavelength. The chromophore for hair removal is melanin inthe hair follicle and possibly the stem cells in the bulge.

Coherent/Coherence A property of laser light that describes the way that the light waves travel ‘in phase’ or in step with each other.

Contra-indication ‘Contra’ – meaning opposed or against. ‘Indication’ – meaning the basis orrationale for using a particular treatment. Contra-indications for hair removaltreatments may include: pregnancy, certain skin disorders, use of certainmedications or drugs or certain medical conditions.

Criteria See National Minimum Standards (NMS).

7. Glossary of Laser & Intense Pulsed Light Terms

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Electromagnetic spectrum The range of energies or radiations that include gamma rays, X rays,ultraviolet, visible, infrared and radio waves. Lasers and intense pulsed lightsystems used for hair removal typically emit beams in the visible or infraredpart of this spectrum.

Evidence Information that you can present to an NCSC Inspector to demonstrateyour compliance with the National Minimum Standards. Evidence caninclude: written policies, medical protocols, client records, client informationleaflets, equipment maintenance logs, training certificates, or records ofmeetings.

Fluence (J/cm-2) The amount of light energy delivered over a given treatment area. Quotedas Joules per square metre (J/cm2 or J/cm-2). It may also be referred to asenergy density.

Hairdressing And Beauty The Government recognised body for standards setting within the Industry Authority (HABIA) hairdressing and beauty therapy industries. HABIA develops National

Occupational Standards in consultation with industry experts to meetcurrent and developing employer requirements. Contact HABIA via: email: [email protected] or visit their website: www.habia.org.uk

Informed consent Voluntary consent given by a person (or responsible proxy) for participationin a treatment regime after being informed of the purpose, methods,procedures, benefits and risks of the treatment.

Intense Pulsed Light (IPL) A system that uses a powerful flash of ‘light’ of broad spectrum, nonSystem coherent light. Filters are used in front of the flashlamp to remove unwanted

wavelengths of light and pass through only those needed for treatment.Light from an intense pulsed light system can be used to target a range ofchromophores in the skin making them suitable for hair removal and/or skinphoto-rejuvenation.

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Interlock connector A socket on a laser/intense pulsed light system that allows a switch(interlock) to be connected to a door/entrance. Opening the door willpause the laser/intense pulsed light system.

Laser An acronym that describes the way that laser light is produced: LightAmplification by the Stimulated Emission of Radiation. A device whichamplifies light and usually produces an extremely narrow beam of a singlewavelength (one colour).

Laser Classification The ‘class’ allocated to a laser (not intense pulsed light systems) fromBSEN60825-1:1994. Medical laser devices are typically Class 4 (the highestclassification) carrying the greatest risk of eye and skin injury.

Laser Protection Adviser A competent person able to evaluate, monitor and enforce the control of(LPA) laser safety hazards.

Laser Protection Supervisor A competent person to help with local supervision in the controlled area to (LPS) ensure that local rules, policies or procedures are implemented. Often the

LPS is the practitioner responsible for the use of the laser or intense pulsedlight equipment or a member of staff closely involved in the work.

Laser/Intense Pulsed Light An area where laser/intense pulsed light safety controls must be applied.Controlled Area The controlled area is often the treatment room and this should not be

readily accessible to unauthorised staff/clients.

Light Energy With a laser or intense pulsed light system this refers to the emitted beamof light and its capacity to do work. Light is radiation that causes thesensation of vision. Even though some lasers and intense pulsed lights emitinvisible radiation it is generally still referred to as light or light energy. Energyis expressed in Joules (J). Energy is the product of power (W) multiplied bypulse duration (typically milliseconds). See also Fluence.

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Light Guide The glass or quartz block used to deliver the light energy to the treatmentsite. Light guides are most commonly used on intense pulsed light systems.

Local Rules Local Rules should be written for each specific application of a laser orintense pulsed light equipment. They should include details about the actualequipment in use, hazards or risks from the equipment, details ofauthorised users, methods of safe working and normal operatingprocedures, contact details of the LPA or LPS, accident procedures, safetychecks and use of any safety equipment. Your LPA should be able tosupport you in writing and implementing local rules.

Maintenance (of equipment) Tasks undertaken by the practitioner to maintain the correct performanceof the system. This can include handpiece cleaning, cooling water top-up,cleaning display screens, checking filters.

Marking-out The use of coloured pens or inks touched lightly on the skin to show theregion or limits of the treatment area. Care must be taken to choose thecorrect inks/colours so that the beam does not react with the inks and causeskin damage.

Maximum Permissible The level of radiation (light) to which, under normal circumstances, aExposure (MPE) person may be exposed without suffering adverse effects, eg, how much

laser light can be withstood by the eye or skin before tissue damageoccurs.

Monochromatic Light that contains a single wavelength or ‘colour’. Laser light is described as monochromatic.

National Care Standards The NCSC is the body responsible for the regulation and inspection ofCare Commission (NCSC) social services and the private and voluntary health care sector in England.

Equivalent bodies will be created in Scotland, Wales and Northern Ireland.The NCSC will inspect against the National Minimum Standards to makesure the clinic or salon delivers the service they claim to offer.

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National Minimum These are the statements or criteria that your clinic or salon must meet andStandards (NMS) – against which your service is graded. There are 32 Core (‘C’) Standards: Independent Health Care ‘C’ standards

C1 Information ProvisionC2 – C7 Quality of Treatment & CareC8 – C13 Management & PersonnelC14 – C16 Complaints ManagementC17 – C19 Premises, Facilities & EquipmentC20 – C28 Risk Management ProceduresC29 – C31 Records & Information ManagementC32 ResearchThere are also ‘Service-Specific Standards’ which include the use of laser and intense pulsed light systems: P1-3 Prescribed Techniques & TechnologiesEach ‘Standard’ has an ‘Outcome’ and ‘Assessment Criteria’. For example:Standard C1 OUTCOME – Patients receive clear and accurate information about theirtreatment and its likely costs. C1.1 The establishment or agency has available for prospective patients andtheir families a patients’ guide expressed in clear, relevant language……….etcAll of the Core and Laser/Intense Pulsed Light Standards must be met inorder to comply with the regulations. Criteria are the individual elements of the NMS against which your service isjudged and graded.

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National Occupational The Hairdressing And Beauty Industry Authority (HABIA) is recognised byStandards Government as the standards setting body for the hairdressing and beauty therapy

industries. National Occupational Standards are developed by consultation withindustry experts and are reviewed regularly to ensure they meet current anddeveloping employer requirements. These standards have various uses:Awarding bodies add assessment mechanisms to create qualifications;Employers incorporate them in appraisal systems, job descriptions and trainingprogrammes; Training providers develop learning materials and programmes tomeet them; Manufacturers and suppliers base manuals and instructions on them.

Personal Protective Safety equipment designed to protect the client, practitioner and others from Equipment (PPE) laser or light beams and other hazards in the controlled area. It may include

protective eyewear, gloves, laser masks, overalls, etc.

Photo-rejuvenation A non-ablative procedure using low level light energy to rejuvenate and improvethe appearance of photo-aged skin, remove age spots (sun induced freckles), most benign brown pigments and redness caused by broken capillaries. Lightbased treatments may be combined with chemical peels or micro-dermabrasionto increase the effectiveness of treatment. Treatments typically use broad spectrumlight to treat the face, chest, neck and hands – or anywhere that sun damageshows. A course of treatments typically consists of four to six treatmentsadministered at approximately four week intervals. May also be known as photo facial or skin rejuvenation.

Protocol A precise and detailed plan that is followed when undertaking a treatment. It must set out the necessary pre-treatment checks and tests, the manner in which the procedure is to be applied, the acceptable variations in the equipmentsettings used and when to abort a treatment.

Protective eyewear/goggles Glass or plastic goggles designed to protect the eyes against accidental exposure to light energy. They must be specifically matched to the wavelength and output of the laser/light system in order to provide effective protection.

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Pulse delay A short delay, often variable, between the emitted pulses of light. Typically quoted in milliseconds (ms).

Pulse duration The duration or ‘length’ of the pulse of light energy. Hair removal typicallyuses pulses that last for milliseconds (ms). The pulse duration determineshow the tissues of the skin and hair react to the light – ranging from heatdamage through to total destruction of cells.

Pulse repetition frequency The rate or ‘frequency’ at which pulses of light energy are emitted. (PRF) or pulse repetition Measured in Hertz (Hz).rate

Private & Voluntary Health These Regulations give meanings and definition of various terms and careCare (England) Regulations requirements set out in the CSA2000. The Regulations give full details 2001 – (PVHC Regulations) about the records you must keep, information you must give the NCSC

and include the ‘schedules’ that tell you what to include in the ‘Statementof Purpose’ and ‘The Patients’ Guide’.

Radiation The process of emitting energy as waves or particles. Radiation is the correctterm for invisible wavelengths that do not cause the sensation of vision.

Selective Photothermolysis A theory used to describe the selective absorption of light energy by a targetchromophore without damaging the surrounding tissue.

Service (of equipment) Tasks normally undertaken by a specialist or service engineer to ensureproduct performance. This can include: flashlamp replacement, calibration,realignment, changing or cleaning optical parts.

Skin Types and Skin The Fitzpatrick skin classification was developed to predict a person’s lifetimeClassification risk of developing skin cancer. This used a scale (typically I – VI) to judge how

skin reacts to light, in particular whether it is likely to burn or tan. Mostpractitioners use a combination of hair and skin colour, eye colour andburn/tan response to determine the initial test patch and treatment settings.The HABIA website contains links for information about skin typing(www.habia.org.uk).

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Specifications & variables The controls or settings on a laser or light system that might be varied bythe practitioner in order to deliver the correct amount of light energy in theright quantity and speed to bring about an effective treatment. Variables caninclude the size of the treatment spot, the pulse duration, pulse delay, thestrength of cooling, pulse repetition frequency.

Spot size The size of the beam used for treatment. Typically quoted in millimetres(mm). Circular beams refer to the diameter of the spot in mm, whereasintense pulsed light systems often have rectangular or square shapedbeams. Some systems offer different spot sizes for treating larger or smallerareas. Larger spot sizes also allow deeper penetration of light energy intothe skin. The area of the spot size is used in the calculation of fluence.

Test patch A test or trial exposure of a small area of representative skin and hair. Usedto determine optimum treatment settings and gauge the response of theskin (and client) to the light energy.

Thermal Relaxation Time A theory used to describe the time taken for a target chromophore to lose (TRT) a given percentage of the heat caused by the absorption of light energy.

Many systems allow the user to vary pulse duration to ‘match’ the TRT ofdifferent hair types and thickness for optimum treatment outcomes.

Wavelength A term to describe the ‘length’ of a light wave measured betweensuccessive peaks or crests of the wave. Typically quoted in nanometers(nm) or micrometers (µ). Certain ‘targets’ within the skin are known toabsorb energy of particular wavelengths – the basis of selectivephotothermolysis. The wavelength determines the ‘colour’ of the beamand the type of interaction with different materials.

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UNIT OVERVIEWThis unit is about removing hair using light and laser systems. It stresses the importance of safe working practice and placesemphasis on identifying and controlling hazards in the workplace.You will need to be able to identify hair and skin conditions andthose clients suitable for light and laser system treatments.The main outcomes of the unit are:1. Select and maintain the light and laser controlled area for

treatments2. Consult with the client and prepare a treatment plan3. Prepare for the treatment4. Carry out hair removal treatments using light or laser systems5. Provide aftercare and post treatment advice to clients.

PERFORMANCE CRITERIAIn order to perform this unit successfully you must:1. Select and maintain the light and laser controlled

area for treatments by:a) ensuring the selection of appropriate equipment meets

treatment requirement and outcomesb) checking that equipment selection, specifications and variables

are correct to carry out treatmentsc) checking the light/laser controlled area is set up to meet legal

and safety requirementsd) following manufacturers’ and organisational instructions for the

start up and shut down of equipmente) ensuring that systems are in place to prevent accidental

exposure to yourself, the client and others within thecontrolled area

f) confirming that equipment is safe and working correctly, faultsare accurately identified and the necessary action is taken.

8. National Occupational StandardsINTRODUCTIONThe National Occupational Standards have been written by experts from the Laser and Light industry including trainers, manufacturers andpractitioners. They have been written to reflect the skills and knowledge required for a Laser/Light practitioner in the workplace.The National Occupational Standards have undergone consultation with industry to gain feedback and approval. Prior to their launch inFebruary 2004 the standards will require final approval from government. Consequently, they are still in draft form and may be subject tominor changes leading up to their launch. Any such changes will be notified through the trade press, the HABIA website and emailnewsletter. You can register for this free by visiting www.habia.org.ukThere are two units - one for hair removal and one for photo-rejuvenation using light and laser systems.

Hair Removal Using Light or Laser Systems

National Occupational Standards - Hair Removal Using Light or Laser Systems

2. Consult with the client and prepare a treatment plan by:

a) ensuring that the consultation procedure is conducted in asensitive and supportive manner

b) using assessment techniques which accurately identify theclient’s medical history, contra-indications, emotional andphysical condition and expectations relevant to the treatment

c) actively encouraging the client to ask questions and clarify anypoints of which they are unsure

d) tactfully advising achievable outcomes of the treatment whereclients have unrealistic expectations or hair colour and typesthat are unsuitable for treatment

e) using assessment techniques which identify the condition andskin classification of the client

f) explaining the physical sensation created by the equipmentbeing used

g) referring clients with contra-indications which are suspected ofrequiring medical treatment to their General Practitioner, priorto any treatment and without reference to a specific condition

h) clearly and tactfully explaining to the client recognised contra-indications which prevent treatment

i) recommending alternative treatments which are suitable forthe client’s condition and needs if contra-indicated forlight/laser treatments

j) clearly explaining and agreeing with the client, the projectedcost, likely duration and frequency of treatment and recoverytime

k) ensuring that the treatment plan is discussed and agreed, aninformed consent form is signed by the client and practitionerand where necessary a medical expert

l) ensuring client consultation records are up-to-date, accurateand complete.

3. Prepare for the treatment by:a) preparing the light/laser controlled area to meet safety, legal,

hygiene and treatment requirements, ensuring equipment isswitched on and in stand by/safe mode

b) ensuring your personal appearance meets accepted industryand organisational requirements

c) wearing personal protective equipment (PPE) to avoid cross-infection and prevent accidental exposure to light/laser foryourself, the client and others within the controlled area

d) making sure that environmental conditions are suitable for thetreatment, the client and practitioner

e) ensuring the positioning of the client and equipment permitseffective access and minimises the risk to practitioner anddiscomfort to the client

f) managing resources within the limits of the practitioner’sauthority

g) preparing the client to meet the agreed treatment plan andsafety requirements.


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4. Carry out hair removal treatments using light orlaser systems by:

a) sanitising hands and wearing suitable gloves prior to treatmentb) maintaining hygiene and safety throughout the hair removal

treatmentc) cleansing, photographing and preparing the area to be treated

to ensure it is clean and shaven according to treatmentprotocols

d) marking out the treatment area accurately using the correctmethods and equipment according to organisationalrequirements

e) providing cooling methods according to skin classification andtreatment protocols

f) setting the light/laser variables according to organisationalrequirements

g) switching and enabling equipment to ready/enable mode inorder to carry out test patch/treatment after ensuringprotective eyewear and other safety procedures are in place

h) carrying out the test patch ensuring safety procedures are inplace

i) assessing the outcome of the test patch, as necessary, todetermine the suitability for treatment

j) ensuring the hand piece/scanner are used at the correct angleand pressure according to treatment protocols

k) stretching and manipulating the skin where necessary,according to treatment protocols

l) delivering the light/laser pulse or beam according tomanufacturers’ instructions and treatment protocols

m) assessing the skin and client response to determine suitablereactions and avoiding adverse reactions

n) adjusting variables as necessary, whilst monitoring skin andclient response and discontinuing treatment where adversereactions occur

o) checking the client’s wellbeing and giving on-going reassurancewhere necessary

p) ensuring position and posture whilst working minimises fatigueand risk of injury to yourself and the client

q) checking light/laser variables throughout treatment and makingany necessary adjustments

r) ensuring the treatment is carried out within a commerciallyacceptable time

s) concluding treatment by returning the light/laser system backinto stand by/safe mode

t) disposing of sharps and waste to meet legal and organisationalrequirements.

5. Provide aftercare and post treatment advice to clients by:

a) ensuring the treated area is cooled and soothed using suitablecooling methods

b) taking post treatment photographs according to organisationalrequirements

c) ensuring aftercare advice and recommendations are accurate,constructive and based upon up-to-date knowledge of thetreatment and products available

d) ensuring client and equipment records are accurate, legible andcomplete

e) ensuring the light/laser controlled area is left in a clean, safe andtidy condition

f) giving the client accurate information on complementaryservices, home care products and the recovery process andlikely duration.


RANGE1. Equipment includes:a) laser, eg, laser diode, Alexandrite, Nd:YAG, Rubyb) broadband spectrum systems, eg, intense pulsed light.2. Specifications and variables are:a) wavelength(s)b) energyc) powerd) fluencee) pulse duration/widthf) pulse delayg) pulse repetition frequency (PRF)h) spot sizei) cooling devicesj) hand pieces/beam delivery systems/scannersk) electrical requirementsl) environmental requirements.3. Light/laser controlled areas have:a) minimum reflective surfacesb) enclosed areac) suitable entry and exit pointsd) adequate fire precautions and suitable services, eg, provision

for hand sanitisation.4. Legal and safety requirements include:a) lightingb) ventilationc) waste management, eg, sharpsd) room size and layout.5. Systems are:a) engineering controls, eg, key switches, foot pedals, interlocks etc.b) administrative controls, eg, local rules, training, signage, issue of

keys etc.c) personal protective equipment (PPE) eg, gloves, masks, eye wear.

6. Clients are:a) maleb) female.7. Assessment techniques are:a) questioningb) observingc) touching.8. Hair colour and type include:a) colour, eg, dark, medium, pale b) type, eg, vellus, terminal, ingrown.9. Skin classifications include:a) Fitzpatrick or ethnic skin classification systems b) Skin condition, eg, healthy/normal, combination, dry, oily.10. Consultation records (including treatment plan and

record cards) cover:a) informed consent form, eg, previous hair removal treatment

history, medical history, emotional and physical condition, etcb) treatment recordc) photographic evidence, eg, pre and post treatment including

correct labelling.11. Environmental conditions are:a) lightingb) heatingc) ventilationd) general comfort.12. Resources are:a) tools and equipmentb) products and consumablesc) timed) people/staffing.


P68

13. Areas to be treated are:a) axilla (under arms)b) face – chin, upper lipc) bikini lined) backe) legsf) chest/breastg) abdomenh) other areas, eg, fingers, toes, neck, ear lobes, buttocks, arms.14. Treatment protocols must cover:a) techniqueb) pre and post treatmentc) recognition of treatment-related problemsd) procedure if anything goes wrong during and after the treatmente) permitted variation on machine variablesf) procedure in the event of equipment failure.15. Reactions include:a) client b) smellc) erythemad) oedemae) frazzled hair.16. Cooling methods are:a) cooling gelb) water soaked gauzec) cold aird) ice packse) laser/light cooling heads.17. Aftercare advice includes:a) avoidance of sunlight, sunbeds and fake tanning products,

touching the treated area, exposure to heat treatments,wearing of restrictive clothing, perfumed and chemical basedproducts

b) use of aftercare products including high factor sun creams c) hair management, eg, avoidance of waxing, plucking, bleaching

etc. between subsequent treatments.

KNOWLEDGE AND UNDERSTANDINGTo perform this unit successfully, you will need to know andunderstand:Organisational and legal requirements1. your responsibilities under current relevant health and safety

legislation, standards and guidance, eg, the Care Standards Act,the Health & Safety at Work Act (and any other relevantlegislation)

2. the importance of the guidance and detail listed in the MDAdocument (Guidance in the safe use of lasers or medical anddental practice) and subsequent amendments, eg, signage,training requirements

3. the importance and reasons for sanitising your hands andwearing personal protective equipment (PPE)

4. why it is important to maintain standards of hygiene and theprinciples for avoiding cross-infection

5. the importance of correct client positioning to minimisepotential discomfort and injury to yourself

6. the importance of avoiding work-related injury, eg, repetitivestrain injury (RSI), back injury, contact with chemicals

7. the importance and reasons for keeping records of treatments8. the importance of the correct storage of client records in

relation to the Data Protection Act9. the importance of producing high quality photographic

evidence (before and after treatment) in line with organisationalpractices and emerging industry trends

10. how to minimise and dispose of waste from treatments11. why it is important to complete services in the given time12. principles of quality assurance13. the light/laser controlled area practices and policies14. the importance and reasons for adhering to organisational and

treatment protocols for treatment procedure, clinicmanagement, client consultation, record keeping, wastemanagement, light/laser safety, aftercare procedures, etc.


Client consultation15. how to use effective communication and consultation

techniques16. the contra-indications that may affect treatment, including;

suntanned skin, pregnancy, some herbal remedies, activeherpes simplex, active impetigo, active eczema, active acne,photo-sensitive medication, keloid scars, tattoos in thetreatment area, psoriasis in the treatment area, certaincirculatory conditions, inappropriate hair type and colour

17. the conditions that may require medical approval for treatment(eg, moles and pigmented lesions, insulin controlled diabetes,epilepsy, haemophilia)

18. the importance of, and reasons for, not naming specific contra-indications when referring clients to a general practitioner

19. why it is important to maintain clients’ modesty and privacy20. the importance of understanding the factors that make certain

clients less suitable for light/laser treatment21. the importance of considering the client’s physical and

emotional conditions, previous treatment, sun exposure,reaction and medical history

22. the importance of identifying the client’s skin classification usingthe Fitzpatrick and ethnic colour scales to predict how a clientmay react to light

23. the importance of and gaining informed consent24. the importance of using test patches and how to carry them

out to determine client suitability for treatment25. how to recognise an adverse reaction following a test

patch/treatment, ie, skin greying or whitening, excesserythema, blistering, pigmentary changes, excessive discomfort

26. the knowledge of treatments that could be given in conjunctionwith/after light/laser treatment.

Preparation for treatment27. how to prepare consultation records covering: a) informed

consent form (ie, previous hair removal treatment history,medical history, emotional and physical condition, suntanninghistory, skin classification, pigmentation, client signature,practitioner’s signature, client expectations); b) treatmentrecord (ie, area treated, practitioner’s name, treatmentmethod, time and duration, equipment settings, treatmentoutcome)

28. how to prepare yourself for carrying out the treatment29. how to prepare the client for the treatment30. how to position clients for treatments31. the necessary conditions for a light/laser controlled area32. how to produce and the significance of, photographic images

pre and post treatment.


P70

Anatomy and physiology33. the principles of the endocrine system, the major endocrine

glands, the hormone secreted and their actions (ie, pituitary,thyroid, para-thyroid, pancreas, adrenal, gonads)

34. the effect of malfunctions of the endocrine system on hairgrowth (ie, Polycystic Ovarian Syndrome [PCOS])

35. the structure and function of the skin (ie, epidermis, dermisand its appendages and subcutaneous layer)

36. how to identify common skin lesions and disorders(ie, eczema, acne, psoriasis)

37. the effects of UV light on skin (ie, tanning)38. the structure of the hair and its follicle39. the growth pattern of the hair and how this influences present

and future treatments40. the hair growth cycle (ie, anagen, catagen, telogen)41. the causes of hair growth (ie, topical, congenital, systemic)42. the definition of hair growth (ie, superfluous, hirsutism,

hypertrichosis)43. the principles of the circulatory and lymphatic system44. previous hair removal methods and their effects on hair

growth.

Treatment specific knowledge45. the principles of light energy and how it interacts with skin

and hair46. differing types of light/laser equipment and their recommended

use and application47. why it is important to understand the variables and

terminology of light/lasers in relation to treatment practice48. the causes and hazards of accidental exposure to light/laser

light49. features and properties of light and light/laser beams 50. basic light/laser operation, eg, types of active media,

production of laser beams51. light-tissue interaction including effects of light/laser light on the

eye and skin52. the importance of questioning/assessing the client to gain

information on their skin healing ability and rate53. the knowledge of post treatment effects and the importance of

clients avoiding sun exposure, heat treatments and vigorousphysical activity

54. the importance of advising clients on effective hair managementtechniques.

Equipment and materials55. how to prepare and use the equipment and materials for the

treatment56. methods of sanitising equipment57. how to maintain equipment and materials in a clean and

hygienic condition58. procedural and associated hazards relating to light/laser use59. the principles of MPE (Maximum Permissible Exposure) and

the selection of protective eye wear.National Occupational Standards - Hair Removal Using Light or Laser Systems

UNIT OVERVIEWThis unit is about using light and laser systems for photo-rejuvenation. It stresses the importance of safe working practiceand places emphasis on identifying and controlling hazards in theworkplace. You will need to be able to identify skin conditions andthose clients suitable for light and laser system treatments.The main outcomes of the unit are:1. Select and maintain the light and laser controlled area for

treatments2. Consult with the client and prepare a treatment plan3. Prepare for the treatment4. Carry out photo-rejuvenation using light or laser systems5. Provide aftercare and post treatment advice to clients

PERFORMANCE CRITERIAIn order to perform this unit successfully you must:1. Select and maintain the light and laser controlled

area for treatments by:a) ensuring the selection of appropriate equipment meets

treatment requirements and outcomesb) checking that equipment selection, specifications and variables

are correct to carry out treatmentsc) checking the light/laser controlled area is set up to meet legal

and safety requirements

d) following manufacturer’s and organisational instructions for thestart up and shut down of equipment

e) ensuring that systems are in place to prevent accidentalexposure to yourself, the client and others within thecontrolled area

f) confirming that equipment is safe and working correctly, faultsare accurately identified and the necessary action is taken.

National Occupational StandardsCarry Out Photo-rejuvenation Using Light or Laser Systems

National Occupational Standards - Photo-rejuvenation Using Light or Laser Systems

P72

2. Consult with the client and prepare a treatment plan by:

a) ensuring that the consultation procedure is conducted in asensitive and supportive manner

b) using assessment techniques which accurately identify theclient’s medical history, contra-indications, emotional andphysical condition and treatment aims

c) actively encouraging the client to ask questions and clarify anypoints of which they are unsure

d) tactfully advising clients of achievable outcomes of photo-rejuvenation where they have unrealistic expectations or thepresenting condition is unsuitable for treatment

e) using assessment techniques which identify the condition andskin classification of the client

f) explaining the physical sensation created by the equipmentbeing used

g) referring clients with contra-indications which are suspected ofrequiring medical treatment, to their general practitioner priorto any treatment and without references to a specific condition

h) clearly and tactfully explaining to the client recognised contra-indications which prevent treatment

i) recommending complementary treatments which are suitablefor the client’s condition and needs

j) clearly explaining and agreeing with the client, the projectedcost, likely duration, frequency of treatment and likely recoverytime

k) ensuring that the treatment plan is discussed and agreed, aninformed consent form is signed by the client and practitionerand, where necessary, a medical expert

l) ensuring client consultation records are up-to-date, accurateand complete.

3. Prepare for the treatment by:a) preparing the light/laser controlled area to meet safety, legal,

hygiene and treatment requirements, ensuring equipment isswitched on and in stand by/safe mode

b) ensuring your personal appearance meets accepted industryand organisational requirements

c) wearing personal protective equipment (PPE) to avoid cross-infection and prevent accidental exposure to light/laser foryourself, the client and others within the controlled area

d) making sure that environmental conditions are suitable for thetreatment, the client and practitioner

e) ensuring the positioning of the client and equipment permitseffective access and minimises the risk to practitioner anddiscomfort to the client

f) managing resources within the limits of the practitioner’sauthority

g) preparing the client to meet the agreed treatment plan andsafety requirements.


4. Carry out photo-rejuvenation using light or lasersystems by:

a) sanitising hands and wearing suitable gloves prior to treatmentb) maintaining hygiene and safety throughout the treatmentc) cleansing, photographing and preparing the area to be treated

to ensure it is clean according to treatment protocolsd) marking out the treatment area accurately using the correct

methods and equipment according to treatment protocolse) providing cooling methods according to skin classification and

treatment protocolsf) setting the light/laser variables according to organisational

requirementsg) applying gel to treatment area according to treatment

protocolsh) switching and enabling equipment to ready/enable mode in

order to carry out a test patch after ensuring protective eyewear and other safety procedures are in place

i) assessing the outcome of the test patch, as necessary, todetermine the suitability for treatment

j) ensuring the hand piece/scanner are used at the correct angleand pressure according to treatment protocols

k) stretching and manipulating the skin where necessary,according to treatment protocols

l) delivering the light/laser pulse or beam according tomanufacturer’s instructions and treatment protocols

m) assessing the skin and client response to determine suitablereactions and avoiding adverse reactions

n) adjusting variables as necessary, whilst monitoring skin andclient response and discontinuing treatment where adversereactions occur

o) checking the client’s wellbeing and giving on-going reassurancewhere necessary

p) ensuring position and posture whilst working minimises fatigueand risk of injury

q) checking light/laser variables throughout treatment and makingany necessary adjustments

r) ensuring the treatment is carried out within a commerciallyacceptable time

s) concluding treatment by returning light/laser system back intostand by/safe mode

t) disposing of sharps and waste to meet legal and organisationalrequirements.

5. Provide aftercare and post treatment advice toclients by:

a) removing gel from treatment area as necessary b) ensuring the treated area is cooled and soothed using suitable

cooling methodsc) taking post treatment photographs according to organisational

requirementsd) ensuring aftercare advice and recommendations are accurate,

constructive and based upon up-to-date knowledge of thetreatment and products available

e) ensuring client and equipment records are accurate, legible andcomplete

f) ensuring the light/laser controlled area is left in a clean, safe andtidy condition

g) giving the client accurate information on possible visual skinchanges and recovery process and duration

h) giving the client accurate information on complementaryservices and homecare products.


P74

RANGE1. Equipment includes:a) laser systems, eg, copper bromide, dye laserb) broadband spectrum systems, eg, intense pulse light. 2. Specifications and variables are:a) wavelength(s)b) energyc) powerd) fluencee) pulse duration/widthf) pulse delayg) pulse repetition frequency (PRF)h) spot sizei) cooling devicesj) hand pieces/beam delivery systems/scannersk) electrical requirementsl) environmental requirements.3. Light/laser controlled areas have:a) minimum reflective surfacesb) enclosed areac) suitable entry and exit pointsd) adequate fire precautions and suitable services,

eg, provision for hand sanitisation.4. Legal and safety requirements include:a) lightingb) ventilationc) waste management, eg, sharpsd) room size and layout.

5. Systems are:a) engineering controls, eg, key switches, foot pedals,

interlocks etc.b) administrative controls, eg, local rules, training, signage,

issue of keys etc.c) personal protective equipment (PPE),

eg, gloves, masks, eye wear.6. Clients are:a) maleb) female.7. Assessment techniques are:a) questioningb) observingc) touching.8. Treatment aims include:a) reduction of fine lines b) evening out of pigmentation, colour tone and texturec) reduction of superficial Telangiectasia, Spider Naevi and

Campbell DeMorgan spots (blood spots)d) improving the appearance of photo aged skine) improving the appearance of Rosaceaf) stimulating the production of collagen.


9. Skin classifications include:a) Fitzpatrick or ethnic skin classification systems b) Skin condition, eg, healthy/normal, combination, dry, oily.10. Consultation records (including treatment plan and

record cards) cover:a) informed consent form, eg, previous light/laser treatment

history, medical history, emotional and physical condition, etcb) treatment recordc) photographic evidence, eg, pre and post treatment.11. Environmental conditions are:a) lightingb) heatingc) ventilationd) general comfort.12. Resources are:a) tools and equipmentb) products and consumablesc) timed) people/staffing.13. Areas to be treated are:a) face b) neckc) chestd) handse) other body areas that include suitable lesions for treatment.

14. Treatment protocols must cover:a) techniqueb) pre and post treatmentc) recognition of treatment-related problemsd) procedure if anything goes wrong during and after the

treatmente) permitted variation on machine variablesf) procedure in the event of equipment failure.15. Reactions include:a) client reactionb) erythemac) oedemad) pigmentation changese) crusting.16. Cooling methods are:a) cooling gelb) water soaked gauzec) cold aird) ice packse) laser/light cooling heads.17. Aftercare advice includes:a) avoidance of sunlight, sunbeds and fake tanning products,

touching the treated area, exposure to heat treatments,wearing of restrictive clothing, perfumed and chemical basedproducts

b) use of aftercare products including high factor sun creams,hydrating treatments and creams

c) recovery time and subsequent treatments.


P76

KNOWLEDGE AND UNDERSTANDINGTo perform this unit successfully, you will need to know andunderstand:Organisational and legal requirements1. your responsibilities under current relevant health and safety

legislation, standards and guidance, eg, the Care Standards Act,the Health & Safety at Work Act (and any other relevantlegislation)

2. the importance of the guidance and detail listed in the MDAdocument (Guidance in the safe use of lasers or medical anddental practice) and subsequent amendments, eg, signage,training requirements

3. the importance and reasons for sanitising your hands andwearing personal protective equipment (PPE)

4. why it is important to maintain standards of hygiene and theprinciples for avoiding cross-infection

5. the importance of correct client positioning to minimisepotential discomfort and injury to yourself

6. the importance of avoiding work-related injury, eg, repetitivestrain injury (RSI), back injury, contact with chemicals

7. the importance and reasons for keeping records of treatmentsand equipment use

8. the importance of the correct storage of client records inrelation to the Data Protection Act

9. the importance of producing high quality photographicevidence (before and after treatment) in line with organisationalpractices and emerging industry trends

10. how to minimise and dispose of waste and clinical waste (ie, items contaminated with body fluids) from treatments

11. why it is important to complete services in the given time12. principles of quality assurance13. the light/laser controlled area practices and policies14. the importance and reasons for adhering to organisational and

treatment protocols for treatment procedure, clinicmanagement, client consultation, record keeping, wastemanagement, light/laser safety, aftercare procedures, etc.


Client consultation15. how to use effective communication and consultation

techniques16. the contra-indications that may affect treatment, including; sun-

tanned skin, pregnancy, some herbal remedies, active herpessimplex, active impetigo, active eczema, active acne, photo-sensitive medication, keloid scars, tattoos in the treatmentarea, psoriasis in the treatment area, certain circulatoryconditions, inappropriate hair type and colour

17. the conditions that may require medical approval for treatment(eg. moles and pigmented lesions, insulin controlled diabetes,epilepsy, haemophilia)

18. the importance of, and reasons for, not naming specific contra-indications when referring clients to a general practitioner

19. why it is important to maintain client’s modesty and privacy20. the importance of understanding the factors that make certain

clients less suitable for light/laser treatment21. the importance of considering the client’s physical and

emotional conditions, previous treatment, sun exposure,reaction and medical history

22. the importance of identifying the client’s skin classification usingthe Fitzpatrick and ethnic colour scales to predict how a clientmay react to light

23. the importance of and gaining informed consent24. the importance of using test patches and how to carry them

out to determine client suitability for treatment25. how to recognise an adverse reaction following a test

patch/treatment, ie, skin greying or whitening, excesserythema, blistering, pigmentary changes, excessive discomfort

26. the knowledge of treatments that could be given in conjunctionwith/after light/laser treatment

27. the importance of recognising presenting conditions that willrestrict treatment, ie, deep wrinkles, vascular malformationsuch as port wine stains, excessively dry or dehydrated skin.

Preparation for treatment28. how to prepare consultation records covering: a) informed consent form (ie, previous light/laser treatment

history, medical history, emotional and physical condition,suntanning history, skin classification, pigmentation, clientsignature, practitioner’s signature, client expectations)

b) treatment record (ie, area treated, practitioner’s name,treatment method, time and duration, equipment settings,treatment outcome)

29. how to prepare yourself for carrying out the treatment30. how to prepare the client for the treatment31. how to position clients for treatments32. the necessary conditions for a light/laser controlled area33. how to produce and the significance of, photographic images

pre and post treatment.


P78

Anatomy and physiology34. the structure and function of the skin (ie, epidermis, dermis

and its appendages and subcutaneous layer)35. how to identify common skin lesions and disorders,

(ie, eczema, acne, psoriasis)36. how to identify common vascular lesions and disorders,

(ie, Telangiectasia, Spider Naevi, Campbell DeMorgan spots,port wine stains, Haemangiomas, Cherry angiomas)

37. how to identify common pigmented lesions and disorders, (ie, pigmented naevi, café au lait macules, lentigines)

38. the ageing process of skin, including the effects of UV light (ie, tanning)

39. the principles of the circulatory and lymphatic system40. previous treatments and skin care methods and their effects on

skin condition.Treatment specific knowledge41. the principles of light energy and how it interacts with skin and

hair42. differing types of light/laser equipment and their recommended

use and application, including equipment not appropriate forphoto rejuvenation, eg, CO2, Er:YAG

43. why it is important to understand the variables andterminology of light/lasers in relation to photo rejuvenationtreatment practice

44. the causes and hazards of accidental exposure to light/laserlight

45. features and properties of light and light/laser beams 46. basic light/laser operation, eg, types of active media,

production of laser beams47. light-tissue interaction including effects of light/laser light on the

eye and skin

48. the importance of questioning/assessing the client to gaininformation on their skin healing ability and rate

49. the knowledge of post treatment effects and the importance ofclients avoiding sun exposure, heat treatments and vigorousphysical activity

50. the importance of advising clients on effective skin caremanagement following treatment including soothing andhydrating products

51. the importance of advising clients of the likely recovery timeincluding the pigmentary and other visible changes followingtreatment .

Equipment and materials52. how to prepare and use the equipment and materials for the

treatment53. methods of sanitising equipment54. how to maintain equipment and materials in a clean and

hygienic condition55. procedural and associated hazards relating to light/laser use56. the principles of MPE (Maximum Permissible Exposure) and

the selection of protective eye wear57. the use and application of gels for photo-rejuvenation with

particular reference to type and thickness.


The Hairdressing And Beauty Industry Authority would like to thank the following companies for their support in the production of this booklet.

Aculight UK Limited5th Floor, Merit House, The Hyde, Colindale, London, NW9 5ABTelephone: 0870 902 1615 Fax: 020 8732 7482Email: [email protected] Website: www.aculight.co.uk

Energis International Limited2 Park Pavilions, Off Valley Way, Enterprise Park, Swansea, SA6 8QYTelephone: 01792 798768 Fax: 01792 762099Email: [email protected] Website: www.energisint.com

Lynton Lasers LimitedLynton House, Manor Lane, Holmes Chapel, Cheshire, CW4 8AFTelephone: 01477 536977 Fax: 01477 536978Email: [email protected] Website: www.lynton.co.uk

HABIA, Fraser House, Nether Hall Road, Doncaster DN1 2PH Tel> 01302 380013 Fax> 01302 380028

email> [email protected] website> www.habia.org.uk

Hairdressing And Beauty Industry Authority is a trading name of Consumer Services Industry Authority

© Consumer Services Industry Authority 2002 – all rights reserved


L A S E R S

M A K I N G L I G H T W O R K F O R Y O U

Tel: +44 (0) 1477 536977 E-mail: [email protected]

MEDICAL QUALITYAND KNOW-HOWWITH BEAUTY IN MIND

Laser and intensepulsed light systemsfor beauty andcosmetic treatments

� Hair removal� Photo rejuvenation� Pigmentation� Vascular

P83

Client Care for Salons £44.50 + VATThis pack shows you how to build your business and keep your clients by increasing client attraction and retention, building customer loyalty and improving profitability.

Security in the Salon £44.50 + VAT Crime costs you money! Crime costs companies on average £5,000 a year. Protect your staff, protect your business and protect yourself!

Employment Law for Salons £44.50 + VAT How much money can you afford to throw at your staff? Avoid costly mistakes, get the most from your staff and protect your business. This pack includes example contracts of employment, disciplinary procedures plus much, much more.

The Official Illustrated Guide to Health & Safety £9.95Ideal for individual therapists and students – this guide simplifies the relevant Health & Safety Acts and Regulations using checklists and illustrations providing guidance and understanding.

Health & Safety Implementation Pack £44.50Ideal for salon owners and managers and specially tailored for Hairdressing or Beauty Therapy, this pack relates to your industry and aims to save you time to spend on running your business. Including: A comprehensive guideto how Health & Safety Regulations relate to your business; Leaflets and signs; An accident record book; Colour poster and window sticker; COSHH regulations and record forms.

Shopping with HABIAWith over 200 hairdressing and beauty therapy mail order titles featuring many exclusive products, make HABIA your number one choice for learning.

Online shop Telephone sales By fax By Postwww.habia.org.uk 01302 380013 01302 380028 CSIA, FREEPOST DC643,

Doncaster, South Yorkshire DN1 2BR

HABIA, Fraser House, Nether Hall Road, Doncaster DN1 2PH Tel> 01302 380013 Fax> 01302 380028

email> [email protected] website> www.habia.org.uk

Hairdressing And Beauty Industry Authority is a trading name of Consumer Services Industry Authority

© Consumer Services Industry Authority 2002 – all rights reservedHABIAHairdressing And Beauty Industry Authority

L A S E R S