Cosmetic Lasers in the US: Who's Using Them, the Latest Technology, and What Patients Need to Know.

BACKGROUND

The use of laser treatments for cosmetic and medical dermatologic conditions has increased significantly, yet provider training varies widely, raising concerns about patient safety and treatment efficacy. This study examines the availability and practice patterns of fellowship-trained laser dermatologists and compares them to medical spas and plastic surgeons offering laser services.

METHODS

In September 2024, an online search and telephone survey were conducted to identify board-certified dermatologists who completed an American Society for Dermatologic Surgery (ASDS) Cosmetics and Lasers Fellowship. Data on consultation availability, pricing, provider involvement, technology investment, and treatment customization were collected from dermatology, plastic surgery, and medical spa practices.

RESULTS

A total of 124 fellowship-trained dermatologists were identified. Compared to medical spas and plastic surgeons, these dermatologists had longer wait times for consultations (23 vs. 4 and 11 days), higher consultation fees ($153 vs. $30 and $78), and a greater number of laser devices per practice. Physician involvement in laser procedures was significantly higher among dermatologists (60%) compared to plastic surgeons (33%) and medical spas (9%). Medical spas relied heavily on nonphysician providers (26%) and laser technicians (56%), with only 41% providing direct on-site supervision. The majority (98%) of dermatologists and plastic surgeons customized laser treatments, compared to 63% of medical spas. Dermatologists dedicated more clinical time to laser procedures, with 19% spending over 50% of their practice on lasers, compared to none at medical spas and plastic surgery offices.

CONCLUSION

Fellowship-trained laser dermatologists provide more direct physician involvement, greater technological resources, and highly customized treatments compared to medical spas and plastic surgeons. While medical spas offer lower costs and shorter wait times, the lack of physician oversight and limited training among providers may represent substandard care. These findings highlight the importance of provider qualifications in ensuring optimal patient outcomes and underscore the value of specialized laser training in dermatology.