Unwanted pigmented hair is a common problem for many patientsin many cultures. Hirsutism, excess hairgrowth in androgen-dependent areas, and hypertrichosis,greater hair density at any body site, mayaffect psychologic health by causing depression andanxiety.
Traditional methods of hair removal have included shaving, bleaching, plucking, waxing, use of chemical depilatories, and electrolysis.These techniques have been limited by their pain, inconvenience, and poor long-term efficacy. Only electrolysis has offered the potential for permanent hair removal. However, the technique is tedious, highly operator-dependent, and impractical for the treatment of large numbers of hairs. A number of lasers and other light sources have been developed specifically to target hair follicles. These include ruby, alexandrite, diode, and Nd:YAG lasers and an intense pulsed light source. These devices offer the potential for rapid treatment of large areas and long-lasting hair removal.
Photothermolysis/Phototricholysis/Photoepilation/ Laser Hair Reduction
Laser hair reduction for unwanted hair has become one of the most common cosmetic procedures performed. Laser hair removal utilizes beams of highly concentrated light designed to selectively penetrate into the hair follicles, to be absorbed by the pigment in the hair follicles and to destroy the hair within that hair follicle.
A variety of lasers and light sources have been developed that may be employed in laser hair removal. The procedure was originally described to be performed on dark hairs on light skin; newer technologies have made the procedure safer for patients with darker skin and those of color.
Various types of lasers are utilized with laser hair removal – the most common of which are alexandrite, diode, Neodymium YAG and intense pulsed light sources intense pulsed light sources
Biophysics of photothermolysis/ Laser hair reduction
The primary principle behind laser hair removal is selective photothermolysis (SPTL), the matching of a specific wavelength of light and pulse duration to obtain optimal effect on a targeted tissue with minimal effect on surrounding tissue. Lasers can cause localized damage by selectively heating dark target matter, melanin, in the area that causes hair growth, the follicle, while not heating the rest of the skin. Light is absorbed by dark objects, so laser energy can be absorbed by dark material in the skin, but with much more speed and intensity. This dark target matter, or chromophore, can be naturally occurring or artificially introduced.
Melanin is considered the primary chromophore for all hair removal lasers currently on the market. Melanin occurs naturally in the skin and gives skin and hair their color. There are two types of melanin in hair. Eumelanin gives hair brown or black color, while pheomelanin gives hair blonde or red color. Because of the selective absorption of photons of laser light, only black or brown hair can be removed. Laser works best with dark coarse hair. Light skin and dark hair are an ideal combination, being most effective and producing the best results, but new lasers are now able to target black hair in patients with dark skin with some success.
Lasers can cause localized damage by selectively heating dark target matter, melanin, in the area that causes hair growth, the follicle, while not heating the rest of the skin.
Hair removal lasers have been in use since 1997 and have been approved for “permanent hair reduction” in the United States by the Food and Drug Administration (FDA). Under the FDA’s definition, “permanent” hair reduction is the long-term, stable reduction in the number of hairs regrowing after a treatment regime. Indeed, many patients experience complete regrowth of hair on their treated areas in the years following their last treatment. This means that although laser treatments with these devices will permanently reduce the total number of body hairs, they will not result in a permanent removal of all hair.
Laser hair removal has become popular because of its speed and efficacy, although some of the efficacy is dependent upon the skill and experience of the laser operator, and the choice and availability of different laser technologies used for the procedure. Some will need touch-up treatments, especially on large areas, after the initial set of 3-8 treatments.
Why choose laser hair removal?
Laser hair removal is a noninvasive technique that uses highly concentrated light to penetrate hair follicles. The laser light is absorbed by the pigment in the hair shaft in the follicle-generating heat which damages the follicle to inhibit future hair growth. Therefore, plucking hair before treatment reduces the efficacy of the laser treatment as the target is absent.
Because laser hair removal only affects actively growing hair follicles, it may take several laser hair removal treatments to provide significant hair reduction. Additionally, while laser hair removal effectively slows hair growth, it doesn’t guarantee permanent hair removal. Periodic maintenance treatments may be needed.
Laser hair removal can remove unwanted hair, be it from a condition that causes excess hair growth or just the desire for a new look. Most individuals will require a series of treatments over time which will result in the removal of the unwanted hair. Most of the lasers and light sources are FDA cleared for permanent hair reduction, which means reduction over time. Some individuals will see very long term hair removal which may last for many years. Others may require maintenance treatments over time to maintain their degree of hair loss. It is truly impossible to determine in advance who will require how many treatments and how long the hair will remain gone. As stated above, laser hair removal works best in those with dark hairs on lighter skin; however newer technologies and newer lasers and light sources have made the procedure safe and effective in those with darker skin and those individuals of color.
Are you a good candidate for a laser hair removal?
The following are some common reasons why you may want to consider laser hair removal:
You have unwanted facial or body hair that makes you feel self-conscious
You are looking for an alternative to waxing, electrolysis, shaving and bleaching
You have dark hair and light skin
Darker hairs will absorb more of the laser light and lighter skin allows more transmission of the laser light into the hair follicle. Age, ethnicity, medication, hormone levels and body area affect the length, coarseness and color of body hair, which in turn will influence the results of any cosmetic laser treatment.
The following are the most important pros and cons to weigh when considering laser hair removal. If you want to focus on what is unique to you, please consult with your doctor.
- Both large and small areas of the body are effectively treated
- May make skin color and complexion more uniform
- Most patients have permanent hair loss after an average of 3 to 8 sessions
- Multiple treatments are usually required to produce satisfactory results
- Patients with darker skin may not respond well due to inadequate discrepancy between skin and hair colors
- Blonde or gray/white hair is less responsive due to lack of ample pigment in the hair
Comparisons with other removal techniques
Comparison with Intense Pulsed Light (IPL)
A 2006 review article in the journal “Lasers in Medical Science” compared intense pulsed light (IPL) epilators and both alexandrite and diode lasers. The review found no statistical difference in short term effectiveness, but a higher incidence of side effects with diode laser based treatment. Hair reduction after 6 months was reported as 68.75% for alexandrite lasers, 71.71% for diode lasers, and 66.96% for IPL. Side effects were reported as 9.5% for alexandrite lasers, 28.9% for diode lasers, and 15.3% for IPL. All side effects were found to be temporary and even pigmentation changes returned to normal within 6 months (Toosi, Parviz (2006-04-01). “A comparison study of the efficacy and side effects of different light sources in hair removal”. Lasers in medical science.)
IPL, though technically not containing a laser, are sometimes incorrectly referred to as “laser hair removal”. IPL-based methods, sometimes called “phototricholysis”, or “photoepilation”, use xenon flash lamps that emit full spectrum light. IPL systems typically output wavelengths between 400 nm and 1200 nm. Filters are applied to block shorter wavelengths, thereby only utilizing the longer, “redder” wavelengths for clinical applications. IPLs offer certain advantages over laser, principally in the pulse duration. While lasers may output trains of short pulses to simulate a longer pulse, IPL systems can generate pulse widths up to 250ms which is useful for larger diameter targets. Some current IPL systems have proven to be more successful in the removal of hair and blood vessels than many lasers.
IPL can be used to treat unwanted hair in a variety of anatomic locations. The large spot size makes it easy to treat larger surface areas, such as the back, chest, or legs, which would otherwise be cumbersome to treat with smaller spot-sized devices.
Treatment with the IPL device is generally well tolerated by most people when using standard energy settings. Priming the skin with topical anesthetic creams for an hour prior to treatment will further help alleviate some of the discomfort, but is not always necessary.
Although rarely observed in the hands of an experienced user, potential complications from IPL hair removal with excessive energy or improper technique. As with any treatment, there are risks associated with it, though they are minimized in the hands of a qualified and experienced doctor.
Possible laser hair removal side effects include:
- Mild swelling around the hair follicles
- Pigment changes may occur, especially in those with darker skin. These changes are usually temporary
- Slight redness of the skin
- Temporary irritation resulting in blistering, crusting, scarring or other changes in skin texture
- Folliculitis, and paradoxical hypertrichosis
Special care must be taken for those with darker skin. A less intensive laser should be used to avoid damaging the outer skin.
Anyone who has tanned, used a spray tan or gone to a tanning booth should wait until the tan has faded as the pigment in the skin absorbs the laser light and reduces the effectiveness of the treatment.
These risks and others will be fully discussed prior to your consent. It’s important that you address all your questions directly with your laser hair reduction provider.
Procedure of laser hair reduction
Laser hair removal is performed on an outpatient basis. A topical anesthetic gel may be applied before treatment, and skin cooling during the procedure will help keep you comfortable. In most cases, you should experience minimal pain and may feel a slight stinging sensation during the procedure. Most laser hair removal procedures take fifteen to thirty minutes; however, a longer time period may be required, depending on the area being treated.
Before the procedure, your doctor will usually review your medical history and conduct a physical exam. This is the time for the doctor and patient to discuss expectations, potential risks and outcomes of the procedure.
Patients also should:
- Avoid sunbathing, tanning beds, waxing, chemical peels or collagen injections for two weeks prior to the procedure.
- Avoid perfumes, deodorants or any potential irritants in the treatment area before and after treatment.
- Avoid aspirin, anti-inflammatory drugs and herbal supplements due to increased risk of bleeding.
Just before the procedure, your hair that will be undergoing treatment will be trimmed to a few millimeters above the skin surface. The laser equipment will be adjusted according to the color, thickness, and location of your hair being treated as well as your skin color.
Depending on the laser or light source used, you and the technician will need to wear appropriate eye protection. It will also be necessary to protect the outer layers of your skin with a cold gel or special cooling device. This will help the laser light penetrate the skin.
Next, the technician will give a pulse of light to the treatment area and watch the area for several minutes to make sure the best settings were used and to check for bad reactions.
When the procedure is completed, you may be given ice packs, anti-inflammatory creams or lotions, or cold water to ease any discomfort. You may schedule your next treatment four to six weeks later. You’ll get treatments until hair stops growing.
What to expect after the procedure
Following treatment, patients should expect:
- For a day or two afterward, the treated area of your skin will look and feel like it’s sunburned, there will be redness and swelling of the hair follicle. This is normal. Cool compresses and moisturizers may help. If your face was treated, you can wear makeup the next day unless your skin is blistering.
- Pain and discomfort, which can be easily treated with over-the-counter pain medicines.
- To be given a prescription for a topical antiseptic cream and/or sunscreen to be applied after treatment.
- To avoid direct sun exposure for at least one month (use sunscreen) following all laser hair removal procedures.