1. (1) The use of lasers/pulsed light devices, or other energy source, chemical, or modality that affects living tissue, for the purpose of treating a physical disease, disorder, deformity, injury, or other condition, including cosmetic, shall constitute the practice of medicine pursuant to the Code of Ala. 1975, §34-24-50.

2. (2) Categories of Procedures:

   1. (a) Ablative Laser Skin Resurfacing - These procedures include the use of fractional (partially ablative) and non-fractional (fully ablative) CO2 lasers, fractional and non-fractional Erbium-type lasers (2940nm) used deeper than 100 microns, plasma, and any other laser/device that vaporizes or removes skin beyond the dermal-epidermal junction, both fractional and non-fractional types.
   2. (b) Non-Ablative Laser Photorejuvenation - These procedures include the use of LLBD for skin resurfacing and rejuvenation that involves targeting certain chromophores with no purposeful vaporization or removal of skin.
   3. (c) Intense Pulsed Light (IPL) and Broad Band Light (BBL) - These procedures include the use of devices with pulsed light instead of a laser beam to target chromophores (pigment, vascularity, water). IPL devices consist of different levels with a wide range of power/energy and variable settings.

   4. (d) Photoepilation/Laser Hair Removal, and Vascular Conditions and Lesions, and Pigmentary Conditions or Lesions.

      1. 1. Photoepilation/Laser Hair Removal procedures include the use of Ruby (694 nm), Alexandrite (755nm), Diode (800nm-810nm), ND:YAG (1064nm) lasers that target chromophore melanin, and IPL/BBL devices (when used solely for hair reduction in appropriate, fair-skinned patients).
      2. 2. Vascular Conditions and Lesions, and Pigmentary Conditions or Lesions procedures include the use of LLBDs that target a specific individual colored target and are used to treat spider veins, telangiectasias, small non-varicose vessels, rosacea, pigmented spots/lesions such as freckles, lentigines (sun/age spots), melasma, and hyperpigmentation, and benign colored lesions (Seborrheic Keratosis, Actinic Keratosis).  LLBDs include ND:YAG, IPL, BBL, Pulsed Dye Laser, KTP, Alexandrite, radiofrequency probe procedure and LLBD categories (a) and (b) listed above.
   5. (e) Tattoo Removal - These procedures involve the treatment of all colors of tattoos with Q-switch ND:YAG, Q-switch Ruby, Q-switch Alexandrite, or other nano/picosecond devices used specifically for tattoo removal. These procedures carry a significant risk of complications, burns, and ulcerations.
   6. (f) Non-Laser Skin Rejuvenation - These procedures use energy sources such as radiofrequency, ultrasound, infrared, and Class III lasers that work on heat-based targeting of skin and collagen. These procedures include any ultrasonic treatments, treatments for skin tightening/fat removal (including cryolipolysis and cryotherapy), and radiofrequency micro-needling.
   7. (g) Endovascular Radiofrequency and Laser Ablation (EVLA) - These are surgical procedures that may only be performed by physicians.
   8. (h) Laser-Assisted Liposuction (LAL) and Power-Assisted Liposuction - These procedures involve laser or energy-assisted invasive liposuction with the use of 1064nm, 1320nm, 1440nm, 1444nm, 924/975nm, 1319nm, and ultrasounds. These procedures include VaserLipo, Smart Lipo, Cellulaze, Cool Lipo, Tickle Lipo, Accusculpt, Slim Lipo, ProLipo, CelluSmooth, BodyJet (water-assisted), and variations thereof, and may only be performed by physicians.
   9. (i) Laser-Assisted Surgery - These procedures involve the use of lasers to assist surgeons with cutting, coagulation, tissue removal and ablation, and other surgical procedures, and may only be performed by physicians.

Author: Alabama Board of Medical Examiners

Statutory Authority: Code of Ala. 1975, §§34-24-50, 34-24-51, 34-24-53.

History: New Rule: Filed August 16, 2007; effective September 20, 2007. Amended: Published May 31, 2023; effective July 15, 2023.