An indulgent afternoon at the spa may seem like the perfect reward after a stressful week. But under unhygienic conditions, or if left in the wrong hands, your beauty treatment could leave you in a worse state than when you stepped in.

In 2002, the American Society for Dermatologic Surgery reported an increase in the number of complications arising from laser procedures performed by spa aestheticians. In 2004, more than 115 customers at nail salons in the United States got serious skin boils from contaminated footbaths and, earlier this year, an Australian woman with type-1 diabetes almost died from an infection contracted after a Brazilian wax.

Industry players that Shape spoke to say that as long as one seeks out qualified and experienced therapists and visits spas and salons with good hygiene standards, problems should not arise. But things can go awry, especially if the people taking care of you do not know what they're doing. A check with the Consumer Association of Singapore found that complaints lodged against local spas were mostly about post-treatment bleeding, facial burns and allergies.

Dr Terrence Yap, a chiropractor at the Atlas Chiropractic Clinic, tells of a patient whose back condition worsened after getting a massage.

"My patient had a slipped disc and told the masseuse to refrain from applying unnecessary pressure to the lower back, where the injury area was located."

However, the masseuse ignored her request, and the customer ended up with inflammation on her lower back and more pain down her legs.

So how do you reduce the risk of an unpleasant post-pampering experience? Find out about the potential risks and how to play it safe.

Risk #1: Blistering Brazilians

Burns and rashes are certainly not what you'd want to flaunt after a "Brazilian". But they can happen if too-hot wax is applied or if you get an allergic reaction to certain ingredients or fragrances contained in the creams or oils applied.

According to Dr Eileen Tan, consultant dermatologist at Mount Elizabeth Hospital, skin irritation and the infection of hair follicles can be treated with topical antibiotics. Burnt skin takes a week to heal with steroid cream and antihistamines.

PLAY IT SAFE: Choose a reputable salon with good hygiene practices: disposable tools, latex gloves and paper towels laid on the bed.

Product information should be offered before the procedure, says Dr Tan. If you experience itching or excessive pain, alert the therapist immediately so the wax can be removed quickly and safely.

While there will definitely be some pain, it shouldn't last for more than a split second if the therapist is experienced, says Ms Yvonne Chow, a senior therapist at Visage The Salon, which has been providing "Brazilians" for the last 10 years.

The wax should be warm, not scalding hot. Observe the therapist. Does she explain the procedure in detail? Are you relaxed under her care? Does she do a patch test if you tell her you have sensitive skin? If so, you're probably in good hands.

Risk #2: Too-painful massages

Going for a back rub is a great way to relieve cramped muscles and stimulate blood circulation, but it is not a one-size-fits-all treatment, especially if you are pregnant or have back problems.

For back-pain sufferers, massaging the area with too much pressure will aggravate the pain as well as result in fainting spells, dizziness and muscle spasms, says Dr Yap. For pregnant women, an inappropriate massage could result in strong contractions and even induce early delivery for women in the last trimester.

PLAY IT SAFE: A good masseuse should listen to your concerns and know your health and medical background before she begins. She should adjust the pressure, rhythm and rate to suit your needs and also work around, not on, any affected areas.

If you feel stiff or uncomfortable in the middle of the session, the massage is probably too hard. If you're suffering from back pain, try a gentle lymphatic or Swedish massage to promote circulation and provide relief.

If you're pregnant, seek therapy from a qualified pre-natal masseuse. Ms Kethie Lim, a pre-natal masseuse, says: "The masseuse must understand the human anatomy well and know which pressure points to target."

Risk #3: Mangled nails

When the area under the nails is cleaned the nail plate may be lifted up from the skin, causing bacteria and fungus to enter. The same happens when a gap is created between the nail fold and nail plate when your cuticles are being
pushed back, says Dr Joyce Lim, consultant dermatologist at the Joyce Lim Skin and Laser Clinic. If instruments are not properly sterilised, infection can pass between people.

For diabetics, the risk is multiplied because they have reduced sensation in their feet or toes. "The absence of pain leads to unnoticed wounds and cuts. Poor blood supply due to diabetes then hinders the wound's healing process,"
says Dr Kevin Tan, consultant in diabetes, endocrinology and internal medicine at Mount Alvernia Hospital.

PLAY IT SAFE: Ensure the salon has high hygiene standards. The manicurist should be wearing disposable gloves, instruments sterilised and footstools cleaned after each customer leaves.

Diabetics must inform the salon of their condition so that an experienced pedicurist can take charge. They are advised to visit a podiatrist for a manicure or pedicure instead.

Risk #4: Unhygienic spa equipment

Towels, beds, slippers, massage stones, pimple extractors - many of the tools at spas are non-disposable and reused by countless customers.

If not sanitised properly, they can spread germs. The risk is especially high for equipment that comes into direct contact with bodily fluids, says Dr Chua Sze Hon, senior consultant at the National Skin Centre.

If the customer before you has an infection or a virus, you risk catching it if equipment is not properly sterilised.

PLAY IT SAFE: Ask the therapist if equipment and tools have been sterilised. Bring your own towels and pimple extractors if possible. Observe the general hygiene and housekeeping standards when you enter. Try to postpone your treatment if you are suffering from cuts or scratches, as broken skin means easier entry for germs.

Risk #5: Burning lasers

It's common to find general practitioners and beauty salons offering laser treatments these days. However, instead of a flawless complexion, you could end up with skin burns, uneven pigmentation or scars.

Lasers are directed onto light-absorbing tissues to rectify skin problems. People with dark skin, however, risk burns when non-selective broadband light, like Intense Pulsed Light (IPL), is over-absorbed by skin surrounding the
treated spot.

More aggressive procedures, like ablative laser skin resurfacing, are not recommended because of the tendency for dark skin to get more pigmented after inflammation from the laser, says Dr Chua.

PLAY IT SAFE: "All forms of laser treatments carry an inherent risk of skin injury," says Dr Chua. Ensure that the person treating you is qualified and licensed. Only dermatologists and plastic surgeons have undergone training in
laser procedures during their academic programmes, so it's better that you seek treatment from these specialists, he says. Seeing a qualified doctor also means that you will be able to reduce the damage if any complications arise.

Those with dark skin should stay away from IPL and consider gentler procedures such as hair removal with the Nd: YAG laser or facial treatments with chemical peels, microdermabrasion or creams.

Risk #6: Too-hot saunas

Sitting in saunas and steam rooms can help open pores, induce sweating and flush out toxins. They can promote a sense of well-being and are generally safe for everyone to use, unless you suffer from asthma or have heart problems. Asthmatics are sensitive to sudden changes in humidity and temperature.

Stepping into an extremely hot, dry or humid climate may trigger further inflammation of the airways, causing bronchoconstriction - constriction of the airways in the lungs that results in tightness of the chest, wheezing and
coughing, says Dr Yeo Chor Tzien, consultant physician in respiratory and internal medicine at the Gleneagles Medical Centre. Steam rooms can be as warm as 60 degrees while saunas run up to about 90 degrees.

For those with heart conditions, Dr Yeo says: "The heat will speed up one's heart rate, increasing its work load, and in severe cases, the heart may fail."

PLAY IT SAFE: If you suffer from respiratory tract problems, you need to acclimatise to the change in humidity and temperature. For example, you may want to leave the door open for a while to get used to the environment. Do not stay in the sauna or steam room for more than 15 minutes or you may end up dehydrated. If you have been diagnosed with a heart problem, it's best to consult your doctor before you visit a sauna or steam room.

Risk #7: Germy floors

Think twice the next time you walk about barefoot in changing rooms, saunas and treatment rooms. If you ditch the slippers, you pick up bacteria, viruses or fungi left behind by other people with foot infections. The chances of getting an infection are higher if you have a cut or broken skin on the soles of your feet, says Dr Joyce Lim. When the sole is moist, the skin is even more vulnerable because moisture promotes rapid multiplication of germs.

PLAY IT SAFE: Wear slippers when walking in damp areas of the changing room. Wash your feet thoroughly before putting on your own shoes. If you find broken skin, swab it with antiseptic lotion. If there is pus, or if the wound gets itchy, painful, red or swollen, get it treated by a dermatologist.

The article is from the September issue of Shape Singapore. Find out more from the complete mind & body guide for women, available now at newsstands for $5.