With all cosmetic therapies, I strongly encourage the involvement of a dermatologist or plastic surgeon as this has relevance to underlying formal training. My state of Iowa has very lax regulations and minimal oversight. In Iowa, sadly, less training equals less oversight. Some laser centers and spas in Iowa have little to no physician oversight and even when they do, it often time is in name only. In some areas of Iowa, no physician oversees the operation of medical devices including lasers and radiofrequency devices. These devices have nothing to do with the training of dentists, family practice, pediatricians, gynecologists, or the general public without any medical training. Yet, all of these subgroups have operated Lasers, IPL, Radiofrequency Devices, Fillers, Botulinum Therapy, Kybella in the State of Iowa. I strongly recommend having medical procedures done in the office of a quality-trained dermatologist or plastic surgeon. Anyone (even a non-physician with NO MEDICAL TRAINING) can buy a laser or medical device. Most certifications for lasers and medical devices are NOT standardized and are designed to show a basic understanding of how to operate a device (think starting a car). This doesn't mean they understand the use of the device or how to handle complications. Using the car analogy, knowing how to start the car and run the accelerator and the brake doesn't mean you know how to drive safely or appropriately. Always make sure a Board Certified Dermatologist or Plastic Surgeon has an ACTIVE and VISBILE presence at the site you are having the procedure done.