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Midvale • Amanda Reutlinger is training to be a master esthetician, but today she lies on an exam table experiencing how it feels to be "on the receiving end" of a facial peel.

Before the 23-year-old graduates of Cameo College of Essential Beauty, she'll also learn some chemistry, anatomy and how to decipher which patients are good candidates for treatments, based on their complexions and underlying health problems. She'll pay $17,000 for 1,200 hours of training — double the average number of hours required nationally, says the school's owner, Brenda Scharman.

"Utah holds the crown when it comes to esthetics training," Scharman says.

But the Utah Medical Association (UMA) isn't convinced. Citing accounts of botched procedures, the association wants to raise the bar.

At the group's behest, Sen. Peter Knudson, R-Brigham City, is sponsoring a bill that would require certain minimally invasive cosmetic procedures to be performed under the direct supervision of a licensed doctor, osteopath or advanced practice registered nurse.

Of concern to the UMA are beauty treatments such as laser hair removal and skin rejuvenation, wrinkle fillers and neurotoxins like Botox, chemical peels and microdermabrasion. These affordable alternatives to plastic surgery have been made popular by a booming medical spa industry.

Michelle McOmber, executive vice president of the UMA, says regulations haven't kept pace. "These are tissue-altering procedures that can seriously harm, burn and disfigure people for life," she says.

A medical degree may not be necessary to do laser hair removal, but even that could harm a patient with undiagnosed, cancerous skin lesions, she says. Some laser manufacturers will sell a machine to anyone who goes through their training, which might take a few days.

SB54 has twice been tabled in committee hearings to allow Knudson to seek broader consensus. McOmber said the UMA now plans to develop a new bill over the next year, hoping for buy-in from cosmetologists, some of whom bristle at what they perceive to be a land grab.

Chiropractors, too, oppose the bill, saying it would prevent them from using so-called "cold lasers" to treat soft tissue injuries. "This is a turf war. The MDs want control of everything," said Tim Apgood, executive director of the Utah Chiropractic Physicians Association.

Regulating beauty • In 2008, cosmetologists worked with the UMA to create a tiered licensing system for estheticians. "We were the first state to do this and now others are looking to mirror our legislation," Scharman said.

Basic estheticians are limited to procedures like massage, manicures and pedicures and require more direct supervision by a physician for other procedures. Master estheticians undergo more rigorous training and are free to do laser treatments and chemical peels under the "general" contractual supervision of a doctor who need not be on-site.

SB54 would require that cosmetic patients be evaluated by a doctor prior to treatment and that the doctor be available during the procedure, if only by phone.

But Scharman says in her 10 years on Utah's cosmetology licensing board, none of the state's 2,700 basic and master-level estheticians have been accused of injuring patients.

Indeed since 2009, only two have faced any sort of discipline, according to records at the state Division of Occupational and Professional Licensing (DOPL).

The real problem is with consumers being treated by untrained, unlicensed practitioners, Scharman says. McOmber agrees SB54 is imperfect, but says DOPL needs clearer definitions of who is allowed to perform what procedures in order to police the industry.

Patient safety • One allegation now attracting attention involves the owner of Hollywood Body and Laser Center in unincorporated Salt Lake County at 7430 S. Creek Road.

William Ricker Ferguson, also known as Richard, is facing 18 charges, including counts of aggravated assault and practicing medicine without a license.

A probable cause statement alleges that in 2009 and 2010 Ferguson performed cosmetic treatments without a license. One patient says she suffered third-degree burns on her face from a laser resurfacing treatment. Another alleges that a Smart Lipo procedure by Ferguson — which she halted, dizzy with drugs given by him — left her with third-degree burns that became infected and required skin grafts.

Ferguson's lawyer, Rudy Bautista, says all procedures at the spa are done by a medical doctor or by doctor-supervised staff.

"There are always going to be customers who aren't satisfied with what's rendered. None of this was unlawful. All of it was done with consent," Bautista said.

Salt Lake plastic surgeon Renato Saltz, former president of The American Society of Aesthetic Plastic Surgery, supports tougher rules — and more patient education.

Across the country, untrained professionals, some of them doctors, are doing injections, liposuction, even tummy tucks, he said. And the problem is getting worse, fueled by new technologies "and the recession, which is driving people to seek out quick cash with total disregard to patient safety," Saltz says.

"This isn't a turf battle. It's about patient safety. If one or two fewer Botox patients come here, it's not going to affect my bottom line."

Meanwhile, Reutlinger and scores of other cosmetology students press ahead with their training, lured by the promise of a steady income but with no guarantees.

Says Sabrina Weiss, the student working on Reutlinger, "The perception is we're just rubbing creams on your face. People don't realize all the schooling that happens behind the scenes."

Know before you go to the doc

O Utah's Division of Occupational & Professional Licensing keeps records on medical professionals who have run afoul of regulations, but they aren't easily searchable. The Salt Lake Tribune has a database which consumers can search for disciplinary records by profession, a professional's name and their place of work.

To file a complaint or request disciplinary records > or 801-530-6626.