Who will be able to remove tattoos using lasers in the future?
We dispel myths surrounding the NiSV
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Within the legal questions surrounding laser tattoo removal, there is hardly an area that is discussed more than the NiSV. In order to clarify who is currently allowed to remove tattoos with a laser, we first have to look at what the aim of the respective treatment should be. Basically, two areas of application can be distinguished here: on the one hand, medical and on the other hand, cosmetic tattoo removal. During medical tattoo removal, physical suffering is healed or at least alleviated. This means that only appropriate groups of people (doctors and alternative practitioners) are allowed to carry out these applications. Why alternative practitioners are also allowed to remove tattoos in this case can be found in Section 1 Paragraph 2 of the Alternative Practitioners Act. The counterpart is cosmetic, non-medical tattoo removal. This application is specifically reserved for doctors in accordance with Sections 1 Paragraph 1 and 5 Paragraph 2 NiSV with appropriate further training. The following diagram illustrates what is shown here.
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However, if you are a naturopath, we strongly recommend that you seek legal advice before continuing to remove tattoos using laser. If you misjudge the scope of application of the NiSV, you could face high fines and much more.
| INITIAL CONSULTATION | FORMS | FULL SUPPORT | Deliverables |
|---|---|---|---|
| 0 € | 990 € | 3.490 € | |
| x | Tattoo removal contracts | Tattoo removal contracts | We provide you with legally secure contracts for tattoo removal. |
| x | further forms | further forms | We also provide you with many other forms such as patient questionnaires, declarations of consent and medical questionnaires for use in your practice. |
| x | Consulting | Detailed advice | We advise you on the legal problems related to tattoo removal. |
| x | x | Legal assistance | You take care of your work - we take care of the out-of-court representation before authorities and competitors. |
Are beauticians still allowed to remove tattoos?
The ordinance on protection from the harmful effects of non-ionizing radiation when used on humans, or NiSV for short, was introduced in 2018 adopted. Especially in the area of tattoo removal using lasers, this regulation has a massive impact on the professional practice of many tattoo removers.
As of January 01.01.2021st, 5, according to § 2 paragraph XNUMX NiSV, only licensed doctors with appropriate medical training or advanced training may remove tattoos or permanent make-up using a laser for cosmetic or other non-medical purposes. This means the inevitable end for many tattoo removers. Especially in the last few years, many cosmetic studios or even entire chains have built up a good foothold with the removal of tattoos using lasers.
What's next for these traders?
First of all, it is necessary to take a closer look at the regulation. It can be anticipated that the minimum requirement to be able to remove tattoos at all is training as a naturopath (or higher). All other groups of people are prohibited from performing the applications listed above. Section 5 (2) NiSV makes a clear statement on this. So it says here:
"Ablative laser applications or applications in which the integrity of the epidermis is violated as a protective barrier, the treatment of vascular changes and pigmented skin changes, the removal of tattoos or permanent makeup, and applications with optical radiation, the effects of which are not limited to the skin and its appendages are, like the fat tissue reduction, may only be carried out by licensed doctors with appropriate medical training or advanced training. "
Is there still a loophole for alternative practitioners?
Yes there is. This loophole can be found in Section 1 (1) NiSV. This says:
"This ordinance applies to the operation of systems for the application of non-ionizing radiation on people, which are too cosmetic or other non-medical purposes used commercially or in the context of other economic ventures. (...) "
The crux of the matter is that the The doctor's reservation only applies to cosmetic applications or other non-medical applications. Conversely, this means that laser applications, which for example alleviate physical or psychological suffering, are not covered by this regulation. Should such a condition be alleviated by the removal of the tattoo, the removal is for medical (and no longer cosmetic) purposes.
This is exactly why it is absolutely necessary to have at least completed training as a naturopath. Because according to Section 1 (2) of the Heilpraktikergesetz (Heilpraktikergesetz), alternative practitioners are allowed to cure or alleviate illnesses, ailments or physical injuries in humans. If the desired tattoo removal is absolutely necessary to cure or alleviate any physical ailments (e.g. allergies), this is not covered by the doctor's reservation according to the clear wording of the NiSV.
Can laser tattoo removal be delegated according to the NiSV?
Definitely no! The laser treatment may not be delegated to the staff.
The former ministerial draft for the NiSV of May 30.05.2018, 5 still provided for the possibility of delegation in Section 2 (3) No. XNUMX
(2) Ablative laser applications or applications in which the integrity of the epidermis is violated as a protective barrier, the treatment of vascular changes and pigmented skin changes, the removal of tattoos or permanent make-up as well as applications with optical radiation, their effects do not have on the skin and their appendages are limited, such as fat tissue reduction, may only be performed by
- a specialist in skin diseases,
- a specialist in plastic and aesthetic surgery or
- Personnel with specialist knowledge under the direct supervision and responsibility of a specialist in skin diseases or in plastic and aesthetic surgery.
If you compare the design with the now current and valid version the NiSV one recognizes that the Section 5 (2) No. 3 has been deleted without replacement. In its decision-making process, the legislator executes the deletion as follows:
In the case of high-frequency treatments, which are used to reduce thermal fat tissue or to treat vascular changes or pigmented skin changes, these are services “which the Doctor because of their difficulty, their dangerousness for the patient or because of the unpredictability of possible reactions with the use of their specific specialist knowledge and experience must provide personally"(See announcement BÄK / KBV" Personal service provision - possibilities and limits of the delegation of medical services ", p. 3).
This is only consistent, since the legislator recognized the massive hazard potential of lasers within the framework of the NiSV. In the context of the medical delegation law, however, only treatments are included that do not present a great risk potential for the patient. Conversely, it can be assumed that the regulatory authority wanted such a dangerous activity to be carried out only by licensed doctors. This consideration also supports the decisions of numerous courts, which saw the tattoo removal by laser as a dangerous procedure, which - as currently - may only be carried out by doctors or alternative practitioners (personally). At this point we refer to ours Article on the so-called picosecond laser. This has a different mode of action than the nanosecond laser and, in our opinion, offers significantly less hazard potential. A current court decision on our opinion is still pending - but is pending by our law firm at the Nuremberg Higher Regional Court. We will inform you on our website as soon as there are any innovations in this matter.
If you have any questions on the subject, please contact our office. For alternative practitioners in particular, the procedure outlined above is an opportunity to continue their work after December 31.12.2020, XNUMX. However, this should definitely be accompanied by a lawyer, as this still represents a loophole and can be changed at any time. In addition, the above is our legal opinion, which we present for our clients to authorities, competitors, etc. in any proceedings. In sum it can be said: the The opportunities for alternative practitioners are great - but they are also associated with a certain risk.
I am a non-medical practitioner and would like to do my own tattoo removal. Can you help me outside of legal advice? Kind regards
Hello Mr. Franke, we primarily “only” advise (as lawyers) legally. Of course, I would be happy to put you in touch with laser manufacturers or competitors. We have a large network of alternative practitioners who are currently joining together to form larger units. Talk to me personally about this.
The Federal Ministry for the Environment and Reactor Protection (BMU) may have imagined the right of delegation in the draft bill, but reality caught up with it. When the ordinance passed the Federal Council, there was massive headwind from the state health ministers and the German Medical Association. After the admonition to stay out of the doctors' work, 1. the ordinance was released from the specialist doctor's reservation and the BMU had to relativize the doctor's reservation on its side. "It should be noted that the responsibility for the application remains with the doctor even if a delegation to assistants is involved." Source BMU website FAQ.
This is a creative approach to classify people who want to remove a tattoo as a patient. I wholeheartedly wish you success.
Dear Mr. Freier,
Thanks for your comment. However, it should be added that - if our legislator wanted a possibility of delegation - this could simply have been included in the regulation. However, that did not happen. Rather, the possibility of a delegation (active) was seen by the legislator and deleted without replacement. Conversely, this does not mean that a delegation is not allowed. We consistently advise our clients against a delegation, as there is a risk of a warning from other doctors or professional sanctions from the medical associations.
With kind regards,
Attorney Stephan Hendel
Dear sir Hendel,
Do I understand correctly that a specialist (neither dermatologist nor aesthetic surgeon) with appropriate training is not allowed to instruct / delegate an assistant doctor without appropriate training?
Thank you for the answer.
Dear Mr. Yanisch,
at the moment this is still possible without any problems. However, that will change on January 01.01.2022st, XNUMX. Then it is actually as you write it. The assistant doctor then has to demonstrate appropriate advanced training.
For further information I am gladly at your disposal.
With kind regards,
Stephan Hendel
Lawyer
Dear sir Hendel,
Do I understand correctly that a specialist (neither dermatologist nor aesthetic surgeon) with appropriate training is not allowed to instruct / delegate an assistant doctor without appropriate training?
Thank you for the answer.