Guidance on Surgery Using Lasers, Pulsed Light, Radiofrequency Devices, or Other Techniques 1

Adopted by the SCBME May 7, 2024

Surgery is performed for the purpose of structurally altering the human body by the incision or destruction of tissues and is a part of the practice of medicine. Surgery is also the diagnostic or therapeutic treatment of conditions or disease processes by any instruments causing localized alteration or transposition of live human tissue, which include lasers, ultrasound, ionizing radiation, scalpels, probes, and needles. The tissue can be cut, burned, vaporized, frozen, sutured, probed, or manipulated by closed reduction for major dislocations and fractures, or otherwise altered by any mechanical, thermal, light-based, electromagnetic, or chemical means. All of these surgical procedures are considered to be invasive, including those that are performed with lasers, and the risks of any surgical intervention are not eliminated by using a light knife or laser in place of a metal knife or scalpel.

In recent years, technological advances have made it possible to perform cosmetic surgical procedures of the skin using a variety of devices and techniques. Lasers, pulsed light, and radiofrequency devices are often used for ablative and non-ablative treatments.2 Surgery using these techniques, or other similar means, constitutes the practice of medicine and are, therefore, medical acts similar to other standard forms of surgical intervention. It is subject to the same regulations that govern the performance of all medical acts or procedures, including those that are ablative or non-ablative, regardless of site of service (hospital, ambulatory surgery center, physician's office, or other locations).

As with many other medical acts or procedures, the South Carolina BME recognizes that the use of ablative and non-ablative lasers may be delegated to non-physician advanced health care practitioners (i.e. Physician Assistants and Nurse Practitioners) who are appropriately trained and licensed in South Carolina.3

Ablative treatments or procedures performed by advanced health care practitioners must fall within the statutory and/or regulatory scope of the practitioner's profession. This means that Physician Assistants ("PAs") performing light-based procedures must do so pursuant to physician supervision as set forth in South Carolina Code § 40-47-938, which includes having an appropriate supervising physician who is likewise educated and trained in the procedures being performed. Additionally, a PA must add any additional acts to the PA's scope of practice if they are not already included in a standard or modified scope.

Nurse Practitioners ("NPs") performing light-based procedures must do so pursuant to a written practice agreement as required by South Carlina Code § 40-33-20(45). The practice agreement must identify (i) medical conditions for which therapies may be initiated, continued, or modified; (ii) treatments that may be initiated, continued, or modified; (iii) drug therapies that may be prescribed; and (iv) situations that require direct evaluation by or referral to the physician. See S.C. Code Ann. § 40-33-34 (D)(1)(b). In order to perform these additional acts, an NP must have training, education, and experience, which should be confirmed by their collaborating physician. Their collaborating physician must also have sufficient training, education, and experience related to these acts.

Physicians, PAs, and NPs may also delegate the performance of non-ablative treatments to other individuals when permitted by state law. The Board of Nursing has held that Registered Nurses ("RNs") may perform laser hair removal under direct supervision of a physician, PA, or NP if they meet specific criteria. See the Board of Nursing's current guidance on laser hair removal.

In performing these procedures, practitioners must examine each patient prior to any initial treatment or prior to authorizing treatment by a non-physician. The patient should also be examined for any significant new problems. Practitioners must only perform procedures that are within the practitioner's scope of practice and based upon the practitioner's education and training. When performing or providing supervision for a cutaneous medical procedure, a practitioner must have adequate training in the procedure and the devices used for performing the procedure.

1 The Board is authorized by law to (1) publish advisory opinions and position statements relating to practice procedures to comply with acceptable standards of practice; (2) develop minimum standards for continued competency of licensees continuing in or returning to practice; and (5) use minimum standards as a basis for evaluating safe and effective medical practice. S.C. Code Ann. § 40-47-10(I)

2 Ablative treatments are those that are not intended or expected to excise, burn, or vaporize the skin below the dermo-epidermal junction. Non-ablative treatments are those that are not expected or intended to excise, burn, or vaporize the epidermal surface of the skin.

3 This position statement is consistent with the position of the American College of Surgeons