Consequences of laser hair removal: is there a health hazard?


From this article you will learn:

  • What is laser hair removal
  • Stages and number of laser hair removal sessions
  • Contraindications for laser hair removal
  • Possible negative consequences of laser hair removal
  • Myths about the health consequences of laser hair removal
  • Skin care before and after laser hair removal, as well as during procedures

What are the consequences of laser hair removal is not an idle question. This method of removing excess hair has become increasingly popular lately, because it is an excellent opportunity to “make yourself beautiful” without any problems and get rid of the daily routine. But isn't this dangerous? And will the result meet expectations?

No, it's not dangerous. Yes, it will. But only if you first study all the contraindications to the procedure, become familiar with the existing risks and protect yourself as much as possible from possible negative consequences.

What is laser hair removal

This method was first discovered in the late 1970s. During one of the experiments, a certain physicist accidentally exposed his hand to the laser light for a few seconds and noticed that the hair in the illuminated area had disappeared. The incident had no consequences for the researcher’s health and was soon forgotten, but several months later the hair on the affected skin had not recovered. After numerous repetitions of the experiment, the method received FDA approval, and it entered cosmetic practice as laser hair removal.

The essence of the procedure is to destroy the hair follicle, as a result of which it simply stops growing in the treated area. Since a person also has dormant hair follicles, laser hair removal must be repeated. The first procedure will get rid of (again, depending on the location) 15–40% of hair on the face, legs, arms, bikini area and armpits. Using laser treatment, you can remove not only unwanted body hair, but also age spots, freckles, wrinkles, acne, and spider veins.

The procedure is performed with a special device, which is characterized by the possibility of flexible settings for each patient in accordance with his phototype, thickness and direction of hair growth, as well as skin sensitivity and its condition.

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Modern devices are equipped with intelligent systems for cooling the impact surface, so that at the moment the pulse is applied, the epidermis is well protected from burns.

Late complications

If we consider the group of late complications of laser and photoepilation, we can distinguish hypo- and hyperpigmentation, scars, paradoxical hypertrichosis, leukotrichia, bromhidrosis, hyperhidrosis, malignancy or dysplasia of nevi in ​​the area of ​​the procedure.

1. Hypo- and hyperpigmentation are mainly a consequence of skin burns that occur during laser hair removal. They are most often found in tanned patients and people with skin phototypes III-VI. It has been noted that hypopigmentation often occurs with stage I thermal damage to the skin, when the crust formed after a burn disappears. Hyperpigmentation occurs in patients who do not follow the rules of post-procedure care and begin to tan in the first 2 weeks after hair removal or do not use sunscreen on exposed areas of laser-treated skin. Hypo- and hyperpigmentation often appear in the area of ​​post-burn scars.

To prevent these complications, it is recommended to perform laser hair removal in patients with skin phototypes III-VI using long-pulse Nd:YAG lasers. In addition, these patients can use whitening creams 2 weeks before the procedure.

During the procedure, it is important to choose the right radiation parameters and use reliable and effective methods of cooling the epidermis to prevent thermal injury.

In most cases, hypo- and hyperpigmentation are reversible phenomena, but if they persist for a long time, medications are used. To correct hyperpigmentation, whitening agents containing hydroquinone, azelaic acid, hydroxy acids, and glucocorticoids are prescribed. To correct hypopigmentation, copper-based preparations are used, but if they do not have the desired effect, you can resort to cosmetic tattooing.

2. Scars are the result of thermal damage to the skin below the basement membrane. If a burn wound becomes infected during the rehabilitation process, then in almost 100% of cases gross hypertrophic scar changes occur. It has been noticed that post-burn scars most often form on the neck and mandibular region. Depending on the anatomical location and genetic predisposition, atrophic, normotrophic, hypertrophic and keloid scars can occur.

Thus, Kluger et al. reported a case of development of a keloid scar in the tattoo area in a 41-year-old patient with skin phototype IIIB after laser hair removal of hair in the chest area. He had a history of keloid scars, which were successfully treated with triamcinolone injections. When analyzing this case, it turned out that the tattoo pigments acted as a chromophore that competed with the melanin of the hair follicle. As a result of the absorption of laser energy, the tattoo pigment heated up, which led to a burn of the skin and then the formation of a keloid scar.

Today, atrophic and normotrophic scars are treated with conservative methods, but with rather low effectiveness; their surgical treatment is possible. Laser ablative and non-ablative fractional photothermolysis is used quite actively and with a high degree of efficiency to smooth the skin surface in the scar area.

Pathological scars , which include hypertrophic and keloid scars, are treated with intradermal injections into the scar area of ​​prolonged forms of glucocorticoids (Kenalog, Diprospan). Russian scientists have recently proposed a new and quite effective method for treating pathological scars - the use of a copper vapor laser.

3. Paradoxical hypertrichosis - increased hair growth after laser and photoepilation procedures. According to data from various sources, stimulation of hair growth occurs in women with skin phototypes III-VI, mainly on the face and neck, on the border between the treated and untreated zones. Several mechanisms may be involved in the development of this complication:

  • Treatment using low (subthreshold) energy flux density, which does not destroy the hair follicle, but has a stimulating effect on hair growth.
  • Thermal-inflammatory effect - activation of “dormant” follicles and stimulation of telogen phase hair growth in areas bordering epilation.

Prevention of this complication is to use an energy flux density sufficient to remove hair. To correct paradoxical hypertrichosis, long-pulse Nd:YAG lasers are used.

4. Leukotrichia, bromhidrosis, hyperhidrosis. One interesting retrospective study was conducted in 2009. According to the data obtained, with laser hair removal in the armpit area, complications such as hyperhidrosis, bromhidrosis and leukotrichia may develop. Hyperhidrosis was observed in 11% of patients, mainly with skin phototypes II and V, when a combination of two lasers was used during the procedure - diode and alexandrite. The development of bromhidrosis (4% of cases) and leukotrichia (2%) did not have any significant correlation with age, skin phototype and type of laser radiation.

5. Dysplasia and malignancy of nevi in ​​the area of ​​laser hair removal. Do not forget about the possibility of degeneration of melanocytic nevi in ​​the hair removal area. Nevus melanin is a competing chromophore and absorbs laser radiation along with hair follicle melanin. As a result of repeated exposure to laser radiation or pulsed light (IPL system), thermal damage to melanocytic formations occurs, their growth is activated, and atypical cells appear, which can ultimately lead to the development of melanoma.

Prevention of this complication is not to subject skin areas with any neoplasms to laser hair removal. If there are nevi in ​​the affected area, and hair removal is still carried out, then the nevi must be covered with special protective devices.

So, avoiding complications and minimizing side effects is one of the main tasks of a doctor in aesthetic medicine. When performing laser hair removal, there is not only the risk of choosing high radiation parameters, leading to overheating of the skin and associated complications, but also the risk of playing it safe - choosing parameters that are insufficient to solve the problem for a given patient and, as a result, ineffective, which can lead not only to the absence of desired effect, but to the appearance of the exact opposite. Laser hair removal, which seems like such a simple procedure, can cause serious complications if performed incorrectly. In order to avoid this, you should be thoughtful about the appointment of procedures and carefully collect anamnesis. When choosing the type and parameters of exposure, the individual characteristics of the patient should be taken into account, especially the presence of tanning, skin phototype and its condition in the area of ​​influence. And of course, it is very important to have professional knowledge of the equipment that you use in your work, to know the specifics of each laser and each photosystem.

Literature

  1. Klyuchareva S. V., Selivanova O. D. Correction of side effects of laser therapy and pulsed light sources in dermatology and aesthetic medicine. Russian Journal of Skin and Venereal Diseases 2009; No. 4:36-40.
  2. Pozdeeva E. V. Acceleration of hair growth during hair removal procedures using light methods: an incident or a pattern? Cosmetics and Medicine 2009; No. 6:44-47.
  3. Alster TS Complications of phototherapy using laser and intense pulsed light // Laser and light therapy. - M.: Reed Elsiver, 2010. T. 2, p. 135-137.
  4. Carter JJ, Lanigan SW Incidence of acneform reactions a. er laser hair removal. Lasers Med Sci 2006; 21:82-85.
  5. Chan HHL, Kono T. Laser therapy in patients with dark skin // Laser and light therapy. - M.: Reed Elsiver, 2010. T. 2, p. 88-103.
  6. Choi CM, Dover JS Laser hair removal // Laser and light therapy. - M.: Reed Elsiver, 2010. T. 1, p. 134-153.
  7. Goldman MP, Fitzpatrick RE Laser resurfacing of the neck with the erbium laser. Dermatol Surg 1999; 25:164-167.
  8. Greve B., Raulin C. Professional errors caused by lasers and intense pulsed light technology in dermatology and aesthetic medicine: preventive strategies and case studies. Dermatol Surg 2002; 28:156–161.
  9. Helou J., Soutou B., Jamous R., Tomb R. Novel adverse effects of laser-assisted axillary hair removal. Ann Dermatol Venereol 2009; 136:495–500.
  10. Kluger N., Hakimi S., Del Giudice P. Keloid occurring in a tattoo a. er laser hair removal. Acta Derm Venereol 2009; 89:334–335.
  11. Lim SP, Lanigan SW A review of the adverse effects of laser hair removal. Lasers Med Sci 2006; 21:121-125.
  12. Rasheeed Al. Uncommonly reported side effect ects of hair removal. J Cosmet Dermatol 2009; 8:267–274.
  13. Shulman S., Bichler I. Ocular complications of laser-assisted eyebrow epilation. Eye 2009; 23:982–983.

Stages and number of laser hair removal sessions

This method includes several stages: preparatory, the hair removal procedure itself and the subsequent period of skin care.

At the first stage, in order not to damage the outer skin, the specialist treats it with anesthetic compounds.

Both the patient and the master who works with the laser wear protective glasses during the session - they cannot be removed until the end of the procedure. Its duration varies in different treated areas and is adjusted in accordance with the individual characteristics of the patient’s body. On average, a session lasts from 3 to 60 minutes.

After the procedure, a restorative soothing agent is applied to the irradiated part of the body.

There is a possibility that inflammation will remain on the skin. If it is not sensitive, then slight redness persists for about a day. If there are problems with sensitivity, inflammation may last longer. Crust formation is also possible. In order not to aggravate the consequences, cosmetologists recommend applying sprays, ointments or cream to it until it dries out.

The final result depends on the phototype of the dermis. Before starting the procedure, a test is performed on a small area of ​​skin to determine sensitivity to the laser. If the patient has a high pain sensitivity threshold, he is offered an anesthetic cream.

The hair removal session is carried out on clean and dry skin. There may be a tingling sensation that causes mild discomfort, but not pain.

In between several sessions, it is prohibited to use other hair removal methods. Otherwise, you can injure the hair follicles and provoke their increased growth. Subsequent laser therapy procedures are carried out as the hair growth increases, which was in the initial stage of growth.

Experts recommend extending the rest interval after each session by 1 week. It also matters where laser therapy was performed.

The number of sessions depends on the skin type, hair color and structure, and the area of ​​the body being treated. For the face you need from 3 to 8 procedures. The armpits and bikini area require laser treatment 5 to 9 times. There must be a certain time interval between procedures. Cosmetologists insist on increasing the interval by two weeks after each.

If the patient has hormonal disorders, even a full course of laser hair removal does not guarantee that unwanted hair will disappear completely. Hair growth may resume. In this case, experts recommend examination in medical institutions for the presence of endocrine diseases.

Classic bikini

Laser hair removal of a classic bikini is considered quite popular. It involves removing hair along the extreme line of underwear. Approximately the removal occurs on 2 cm of the thigh and 3 cm on the inside of the pubis. The average procedure time is 20 minutes.

Deep bikini

This type involves removing hair from the pubic area, outside the labia and on the inside of the thigh. The laser also affects the buttocks area. A deep bikini takes at least 40 minutes. Since the procedure is accompanied by discomfort, the use of local painkillers is necessary.

Total bikini

Total hair removal involves complete removal of vegetation in the intimate area. The hair on the inside of the labia is also laser-treated. Duration is at least an hour. Since the manipulation is painful, anesthesia is needed.

Contraindications for laser hair removal

It must be taken into account that in certain cases laser hair removal has contraindications and undesirable consequences. It is not recommended to do this:

  • During pregnancy and lactation. Although there is currently no scientific evidence that the consequences of laser hair removal during pregnancy can be negative, doctors still do not recommend resorting to this method of hair removal.

    A number of hormonal changes occur in the body of pregnant women, and what previously did not cause complications can turn into trouble during this period.

  • In the presence of diseases. The consequences of laser hair removal can be negative in the following cases:

    herpes in the acute stage;

  • severe reactions to histamine;
  • varicose veins at the treatment site;
  • skin diseases in acute or chronic form (dermatosis, psoriasis, eczema, etc.);
  • vitiligo;
  • extensive purulent rashes;
  • oncological diseases;
  • diabetes;
  • HIV.
  • In the presence of moles and skin lesions. Moles existing on the body or face can, as a result of laser exposure, begin to degenerate into benign or malignant neoplasms.
  • If your skin is dark or tanned. The consequences of laser hair removal of the armpits for those with dark skin are pigmentation. In areas where laser treatment is performed, the skin will darken or lighten.
  • Many women are interested in contraindications for laser hair removal in the bikini area, upper lip, armpits and the consequences if the prohibitions are not taken into account.

    Laser hair removal should not be performed in case of any inflammatory or infectious processes on the skin in the armpit area. Also, there should be no moles, warts, or age spots in this area. Laser hair removal of the armpits can cause harm to people suffering from cancer, diabetes, and thyroid diseases.

    Treatment in the bikini area also has its limitations. The procedure should not be performed if the patient has sexual disorders of an infectious nature, abnormalities in the functioning of the immune system, fungal diseases (such as thrush), during surgical procedures in the treated area (3 months before the procedure and after 3 months after them). The procedure is contraindicated during menstruation, taking potent hormonal drugs, and in patients under the age of 18 years.

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    Laser depilation of the upper lip is not performed during pregnancy and breastfeeding, if there are scratches or wounds on the skin, or neoplasms of various types. Other contraindications are cardiac and vascular, as well as acute infectious and inflammatory diseases, allergic reactions, high blood sugar. If you neglect the risks, various kinds of complications cannot be ruled out.

    How is the procedure performed?

    Before laser treatment of the face, the patient must wear protective glasses over his eyes to prevent damage to the cornea and retina. In the area where the treatment will take place, the hair is trimmed a few millimeters above the surface of the skin (this can be done at home with a razor in advance). A cold gel or special cooling agent is used to protect the outer layers. With its help, laser light penetrates the epidermis more easily. The device sets parameters that take into account the patient's skin tone, color, thickness, hair location and the amount of energy required for the procedure to be effective.

    The laser emits pulses of energy that travel through the hair follicle. It absorbs this energy and is destroyed. The laser targets the pigment that gives skin, eyes and hair their color – melanin. It protects against the sun's dangerous rays by absorbing harmful UV rays before they penetrate deeper into the body.

    The laser contains single wavelengths, creating a very narrow beam of light that can be focused onto a tiny area. The result is a very concentrated and powerful form of energy. When the melanin in the hair absorbs the rays, it heats up to 100 degrees Celsius. As the water evaporates, it burns and creates an explosion with a plume of smoke. Is it harmful to the skin? Although it seems counterintuitive to bombard your body with intense radiation, laser hair removal is safe as long as it is performed correctly.

    Do not take a “laser bath” of the whole body in one procedure. The goal of hair removal is to ultimately stop hair growth. To achieve this, the procedure must not cause damage. Typically six pulses are delivered at a time, each lasting 1.5 milliseconds. The process of working laser beams on your hair produces a brief flash of pain, like someone snapping a rubber band on your skin. It is necessary to consider all the pros and cons before making a decision.

    Possible negative consequences of laser hair removal

    Undesirable reactions of the body to laser are most often associated with the following reasons:

    1. The patient has contraindications.
    2. The client did not properly follow the rules for preparing the skin for laser exposure.
    3. The cosmetologist mistakenly diagnosed the patient's phototype.
    4. Incorrect device settings.
    5. Individual intolerance.

    Burns

    Possible consequences of laser hair removal of the upper lip are burns. Overheating of the skin is the most common cause of their appearance after a laser hair removal session. During the procedure, laser beams penetrate the skin to a depth of only 1–4 mm. The affected area heats up for a few fractions of a second. However, there are a number of circumstances that can prevent rapid natural cooling of the skin:

    • hair length is higher than required;
    • carrying out the procedure after sunbathing;
    • inappropriate radiation readings;
    • unsatisfactory treatment of the skin with refrigerant.

    Black dots

    This is nothing more than burnt hairs. Their appearance indicates the effectiveness of the procedure. Blackheads disappear gradually within 2 weeks after hair removal. They appear in clients with hard stubble or excessive hair growth. In these cases, the hair is more resistant to external influences. To remove black specks, you can carry out another procedure or make a mask based on badyagi.

    Pimples

    The appearance of acne is due to the following reasons:

    • Ingrown hairs are a classic consequence of many hair removal methods.
    • Infection of the hair follicle - it is almost impossible to introduce a virus or harmful bacteria with the laser method. However, this happens if there are wounds and cuts on the skin.

    A likely cause of acne and rashes may also be a hormonal imbalance in the patient's body.

    Itching and irritation

    There may be a slight feeling of discomfort during and immediately after the procedure. But if the itching does not go away within 2-3 days and red spots appear, the person may have a negative reaction to light exposure. In this situation, you should avoid aggressive cleansers and scrubs and use pharmaceutical shower gels without parabens and dyes. These side effects are the most common consequences of laser hair removal in the bikini area. The good news is that they disappear on their own within two or three days.

    Pigmentation

    Pigment spots form when the client is not thoroughly examined or due to incorrect laser adjustment.

    Bruises

    Subcutaneous bruises that do not cause pain when pressed indicate that hair removal was performed on tanned skin. There is no need to treat such bruises; you need to wait until they lighten naturally.

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    Folliculitis

    Folliculitis is a possible consequence of laser hair removal of a deep bikini. This is nothing more than inflammation of the hair follicles. It can develop in patients suffering from excessive sweating, or when the ban on moisturizing the skin after a session is violated. How to avoid this? Keep treated areas clean. Refrain from visiting the gym and swimming pool for two days.

    What should you not do after the procedure?

    1. Avoid using cosmetics and creams on the treated area as this may cause irritation.
    2. If there is swelling or redness on the skin, it is recommended to treat the surface with aloe vera gel for 2-4 weeks.
    3. People with dark skin may experience more discomfort, so it is better for them to use the gel for a longer time.
    4. If the treatment area remains hot even after 24 hours, applying ice will reduce swelling, reduce tenderness and promote healing.
    5. Avoid scratching, rubbing, internal and external heat (saunas, hot tubs, hot stoves, steam, strenuous exercise that causes sweat) as it stimulates melanocytes leading to hyperpigmentation.
    6. At first, tanning is contraindicated; take care of your skin especially when you go for a walk. Always use a good sunscreen with the highest SPF.

    Myths about the health consequences of laser hair removal

    Some stereotypes regarding laser hair removal have arisen due to the fact that in the past the equipment used had a number of disadvantages. As devices are modernized, they become safer, which expands their capabilities and reduces the risk of negative consequences.

    Myth 1: Laser work can cause cancer

    The consequence of laser hair removal is cancer. This is the most popular myth. From the point of view of the risk of developing cancer, the most dangerous is high-frequency ionizing radiation - X-rays and gamma rays. Laser radiation used in hair removal procedures is non-ionizing.

    Myth 2: After the procedure, scars will remain and hair will begin to grow in

    Scarring occurs during electrolysis, when needles are used that damage the surface of the skin and are inserted into the upper layer of the dermis.

    Laser hair removal does not violate the integrity of the skin, so scarring is simply impossible.

    And ingrown hairs are a consequence of unprofessional waxing. When a thinning hair does not have the strength to break through the skin, it simply grows under it. The laser is precisely aimed at eliminating such manifestations.

    Myth 3: After the procedure, a large amount of coarse hair will appear.

    After each treatment, the hair grows back finer, there is less of it and it appears more and more slowly. The paradoxical effect can be observed only once - after the second session. This is called synchronization and indicates the effectiveness of the procedure. In the third session, all this vegetation is removed, and after that the hair grows slowly, becoming softer.

    Myth 4: Laser hair removal is a rather painful procedure

    The cause of pain during procedures is the effect on the nerve fibers that are located in the skin. Each person has these fibers configured differently, so we all experience pain differently. Cosmetologists note that the sensations during the procedure are comparable to a click on the skin and are usually tolerated normally. In addition, at the client’s request, the cosmetologist, of course, can apply an anesthetic cream.

    Myth 5: Laser hair removal cannot be done in the summer

    The time of year cannot be an obstacle to removing excess hair on the body. Moreover, this is especially important in the summer. In fact, procedures can be planned during the holiday season, the main thing is to know some of the nuances.

    If you need to treat areas hidden under clothing, for example, the bikini area, there are no problems here. The procedure can be performed at any time. Laser hair removal should not be performed on tanned or dark skin. This will cause burns.

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    Read more And one more myth – rather one of the false positives. No additional care is needed after the procedure. This is wrong. The skin has experienced serious stress during laser hair removal and needs additional protection.

    Types of lasers for hair removal

    The main difference in laser systems used in cosmetology is the wavelength. It is the wavelength that determines the final result and the desired effect.

    1. Epilation with diode laser (diode laser hair removal). The wavelength of the diode laser is 810 nm. It is used not only for hair removal with any skin type, but also for the treatment of hirsutism (coarse hair) and hypertrichosis (excessive hair growth). At the same time, coarse hair becomes soft and invisible, and soft hair disappears.
    2. Laser hair removal with neodymium laser. The wavelength of this laser is 1063 nm, and the laser beam contains infrared light. Area of ​​application: hair removal of dark hair on dark or tanned skin, as well as removal of rosacea (network of capillaries), treatment of acne and correction of scars.

    For consultation, please contact the dermatology department of Medical

    tel: +7 (495)-745-65-03 +7 (495)-745-65-06 +7 (495)-745-65-07

    Skin care before and after laser hair removal, as well as during procedures

    Although laser hair removal is a gentle and safe method of hair removal, after it the skin should receive the necessary care:

    1. For 6 weeks before and after, it is important to avoid sunbathing and tanning in a solarium.
    2. Preparation for laser hair removal also includes avoiding taking medications that have a reflective effect and blood thinning medications.
    3. For 6 weeks before the procedure, you cannot resort to other types of hair removal: sugaring, waxing, use an epilator or tweezers, as they remove hair from the root. Otherwise, the laser will not be able to recognize the hair follicle.
    4. For three days after epilation, massage and rubbing should not be done in the area where hair was removed. You should also avoid taking hot baths and visiting the sauna. This slows down recovery, and high temperatures have a negative effect on irritated skin.
    5. 3 days before hair removal, you should not use cosmetics that contain irritants, such as alcohol.
    6. During the period of laser hair removal, you cannot visit a solarium or use self-tanning cosmetics.

    So, the procedure should be approached more responsibly by both cosmetologists and patients. And then laser hair removal, the consequences of which will be insignificant, will delight you with its high efficiency and will make you want to leave only the best reviews.

    Nowadays, you no longer have to spend a lot of time performing complex and unpleasant procedures at home. It is much easier to seek help from real professionals - the Veronika Herba beauty and health center, equipped with effective and modern equipment.

    Why clients choose Veronika Herba Beauty and Health Center:

    • This is a beauty center where you can get laser hair removal at a reasonable cost, and you will be treated not by an ordinary cosmetologist, but by one of the best specialists in Moscow. This is a completely different, higher level of service!
    • You can receive qualified help at any time convenient for you. The beauty center is open from 9:00 to 21:00, seven days a week. The main thing is to agree with your doctor in advance on the date and time of your appointment.

    Sign up for a consultation with a specialist by phone +7 (495) 085-15-13, and you will see for yourself!

    And yet there are contraindications

    After reading the entire list, you will understand that we are simply talking about a reasonable attitude towards your health. It is not recommended to do the procedure in the following cases:

    • The presence of chronic dermatitis and allergic skin reactions to light (photo dermatitis)
    • Hypertension and other heart and cardiovascular diseases
    • Diabetes
    • Herpes
    • Varicose veins
    • Glaucoma
    • Any neoplasms
    • Infectious diseases
    • Pregnancy and lactation period
    • Recent Botox or other hyaluronic acid treatments

    As for moles and papillomas, the master will simply “bypass” them during depilation, retreating the required few millimeters.

    It is not recommended to remove hair in close proximity to the eyes, on the upper eyelids and directly under the eyebrows. Women know that they should not make any sudden movements around the eyes, even during daily care, since the skin here is very thin and sensitive.

    Beauty salons should take great responsibility when it comes to the desire of teenage girls to undergo laser hair removal. And the point is not only that unstable hormonal levels can reduce the effect of the procedure to zero. We would like to remind you that parental consent is required to work with teenagers. Unfortunately, there are often negative reviews on the Internet about clinics that still violate basic ethical standards.

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