KUALA LUMPUR, Nov 24 — Malaysia currently has fewer than 1,000 registered aesthetic doctors, but centres offering beautifying medical procedures are popping up all over the Klang Valley which makes one wonder how safe they are.

Instead, beauticians or "beauty therapists” — as some of them call themselves — are the ones performing invasive medical procedures at centres that are not equipped with proper medical facilities as required of clinics prescribed in the Private Healthcare Facilities and Services Act 1998.

Malay Mail checked on five aesthetic centres — big and small — around Kuala Lumpur and Selangor offering invasive medical procedures in the name of beauty, and discovered that doctors were not administering the treatments.

When asked, these beauty centres confidently claimed that their staff possess adequate skill to operate lasers on certain skin conditions, even though the Ministry of Health (MOH) considers them as medical procedures as listed in its latest Guidelines on Aesthetic Medical Practice published in 2020.

"For us, it’s clear: lasers and injectables are not allowed when done by beauticians," a senior official from the Health Ministry told Malay Mail when contacted.

President of Registered Aesthetic Doctors Malaysia Dr Ungku Mohd Shahrin Ungku Mohd Zaman also confirmed that lasers and injectables cannot be administered by beauticians or "beauty therapists” as they are considered medical procedures.

The Health Ministry has also never consented or authorised any surgical or invasive aesthetic procedures to be performed in beauty centres and such procedures must be done by a doctor who holds a Letter of Credentialing and Privileging (LCP) in aesthetic medicine in a registered clinic, Health Minister Datuk Seri Dzulkefly Ahmad said on November 4.

Nonetheless, notable treatments at beauty centres include High-Intensity Focused Ultrasound (HIFU) and "pico” and "carbon” lasers.

"Pico” and "carbon” lasers are a type of laser used to treat certain skin conditions and often advertised as treatments at beauty centres.

However, to Dr Ungku Mohd Shahrin, it’s just a brand that centres use to entice customers.

Some centres are transparent about using lasers but some deny using them. An establishment denied using "pico” lasers for their treatments when asked and instead shared a video of their "alternative” technology.

However, Dr Ungku Mohd Shahrin confirmed with Malay Mail that it was lasers. "HIFU, lasers, medium and deep chemical peel, injectables, surgical procedures... they can’t manage this. Beauticians cannot carry out the procedures that doctors carry out,” Dr Ungku Mohd Shahrin explained.

Lasers are powerful medical devices used to perform medical procedures that should only be operated by qualified doctors and carried out in registered clinics that are well-equipped to deal with medical emergencies, not mere beauty centres.

"If it is not done properly or the wrong setting is conducted, the power, the energy of the laser is not done well, it can burn the patient’s skin,” Dr Amelia Siah Siang Yee, founder of chain aesthetic clinic Aglow Clinic, explained.

As many beauticians or beauty therapists have used lasers on clients, it may seem easy enough to operate. However, even qualified doctors with years of experience can make mistakes, said Dr Ruban Nathan, former chairman of the Cosmetic Dermatology & Laser Medicine Board under the Malaysian Dermatological Association.

He called beauticians who administer medical procedures "very brave”. "I can teach a monkey how to do it, but can they handle the complications?” Dr Ruban asked.

Dr Ungku Mohd Shahrin said the human body is delicate and prone to unpredictable reactions arising from certain procedures.

He listed several examples such as post-inflammatory hyperpigmentation, which is the darkening of a certain spot; scarring and low-level laser therapy (LLLT) can also cause increased permeability of the skin cell that may result in other detrimental effects.

He added that mishandling lasers can cause blindness and errors from HIFU treatments can cause permanent nerve damage. "Unless they are trained, certified to manage complications – they are medical doctors to begin with, then only they can perform these procedures,” he said.

"Some of the devices that are there in medical and beauty centres are even much more expensive, have much higher specifications, more complex than what I have actually in my clinic,” he added.

Lasers are medical devices that must be registered with the Medical Device Authority.

However, a loophole in the rules allows non-medical practitioners to operate medical-grade lasers without a penalty as it is not a designated medical device under the Medical Device Act 2012.

Unless lasers are designated medical devices under Section 26 of the Act, anyone without a permit can operate lasers without any repercussions.

While there is no law that explicitly prohibits beauticians from administering lasers and similar treatments, it is possible for beauticians to be charged under Section 33 of the Medical Act 1971 which prohibits unqualified persons from practising medicine with a fine of not exceeding RM2,000 for a first-time offence, an MOH source said.

The ministry, however, has not utilised this law to act against errant aesthetic centres.

Although all the beauty centres Malay Mail contacted claimed to use medical-grade lasers, unbranded and unregistered lasers can also be purchased on e-commerce platforms for as low as RM1,600.

However, all three doctors said that the price of medical-grade lasers were above RM100,000.

Laser treatments are not the only procedure that is cause for concern; other procedures such as light chemical peels can also be dangerous as patients could develop anaphylactic shock, a severe allergic reaction, and difficulty in breathing, Dr Ungku Mohd Shahrin said.

"[At clinics] we have doctors who manage to inject with adrenaline, antihistamines, and the patient calms down.

"What are you going to do if you are not trained as a medical professional? How are you going to treat that?” he asked.

The legality of procedures and the status of registered clinics and doctors can be checked here.