Laser Hair Removal

Laser hair removal is a medical procedure that uses a focused beam of light, known as the laser, to eliminate unwanted bodily hair. During the process of laser hair removal, a laser emits light that is absorbed by the pigment (melanin) in the hair. This light energy is then consequently transformed into heat, which then damages the tube-shaped sacs (hair follicles) responsible for hair production within the skin. This process disrupts and postpones future hair growth. While laser hair removal manages to effectively delay hair growth for prolonged periods, it generally does not achieve permanent hair loss. Multiple laser hair removal sessions are often necessary for the initial removal of hair, with ongoing maintenance sessions as needed. 

Typical sites for treatment with laser hair removal include the legs, armpits, upper lip, chin and bikini line. However, virtually any area with unwanted hair can be treated, excluding the eyelids and immediately surrounding regions. Furthermore, any skin that has been tattooed should also be excluded from treatment with lasers. The efficacy of this procedure is heavily influenced by hair color and skin type. The fundamental principle for laser hair removal states that the laser should be absorbed by the pigment of the hair, NOT by the pigment in the skin. The objective is to damage solely the hair follicle while safeguarding the skin from any harm. Therefore, optimal results from laser hair removal are achieved when there is a contrast between the color of the hair and skin. 

In terms of the technology that is used to complete this procedure, there are an array of different lasers and IPL (intense pulsed light) systems that are accessible and are generally the most effective choices for achieving long-term hair reduction. The mechanism of action of these machines is directing light specifically to the melanin in the hair shaft, follicular epithelium, and hair matrix, emitting wavelengths typically ranging between 600 to 1200 nm. This is because these particular wavelengths are selectively absorbed by the melanin found in the hair shaft, thus facilitating the desired results. The type of laser that is used on an individual patient should be decided based upon their Fitzpatrick skin types, ranging from level I to level VI: 

I: fair complexion, blue/green eyes, blond/red hair, prone to sunburn, lacks ability to tan

II: light skin, blue eyes, prone to sunburn, doesn’t tan well

III: fair skin that tans after initial sunburn

IV: light brown skin that experiences minimal burning and tans effortlessly

V: brown skin, seldom burns, readily tans to a darker shade 

VI: dark brown to black skin, never burns, always darkens when tanning 

The lasers available for different types of skin with varying wavelengths include the following: 

1. Ruby laser (694 mm): red light is delivered via synthetic red crystals , effective for individuals with light skin tones and dark hair (skin types I to III)

2. Alexandrite laser (755 nm): offers a deeper penetration than the Ruby laser, suitable for lighter hair (skin types I to III)

3. Diode laser (810 nm): penetrates more deeply, provides improved fluence, reduces epidermal damage, safer for darker skin tones (skin types I to V)

4. Neodymium-doped Yttrium-Aluminum-Garnet (Nd:YAG) laser (1064 nm): improved penetration, reduced epidermal damage, relatively lower melanin absorption, suitable for a wide range of skin types (types I to VI)

5. Intense pulse light (IPL) or Broadband light (BBL) (500-1200 nm): flash-lamp delivers high-intensity pulses of polychromatic, non-coherent light. Through the use of various filters, the emitted wavelength band can be narrowed. This method is appropriate for darker skin tones and covers larger areas at once due to its larger spot size. 

Aftercare post-laser hair removal often includes ice packs or cooling agents may be applied after the procedure to reduce discomfort and swelling. In the event of accidental skin injuries, topical antibiotics may be prescribed as needed. Stringent sun protection and the application of sunscreen are also highly recommended for post-procedure care. The most common side effects of laser hair removal are blisters, burns, hyper- or hypopigmentation and scarring. 

Resources: 

Vaidya T, Hohman MH, Kumar D D. Laser Hair Removal. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507861/

Laser Hair Removal. Mayo Clinic. March 13, 2024. Accessed May 2, 2024. https://www.mayoclinic.org/tests-procedures/laser-hair-removal/about/pac-20394555. 

Laser hair removal: What is it, procedure, safety & side effects. Cleveland Clinic. September 1, 2021. Accessed May 2, 2024. https://my.clevelandclinic.org/health/treatments/21757-laser-hair-removal.

Unwanted hair growth has a variety of removal options: waxing, threading, shaving, electrolysis, and newly invented laser hair removal. FDA-approved in 1997, laser hair removal has become a dominating aesthetic procedure in the cosmetic industry. This long-term hair removal procedure emits a laser that is absorbed by the melanin in the hair. This light energy damages the hair follicles that produce hair, resulting in delayed hair growth. Although this delays hair growth, several sessions are required to produce such results, and maintenance treatments may be required. Many of the available lasers for this medical procedure are curated towards light skin and dark hair due to the contrast between hair and skin color, avoiding damage to the skin. With the advanced technology of this generation, laser hair removal has become accessible to all hair and skin types.

For many people, this aesthetic procedure is done to eliminate ingrown hairs and constant shaving every few weeks, improving both confidence and quality of life. With the expanding gender communities, transitioning members may undergo laser hair removal to aid in the transitioning process because of dysphoria. A condition such as polycystic ovarian syndrome (PCOS) causes hirsutism in women. Electrolysis can be considered due to its permanent removal of hair, unlike laser hair removal. Effective yet more painful, electrolysis involves the insertion of a tiny needle in each hair follicle to emit an electric current that permanently destroys the hair follicles. 

The most common side effects of laser hair removal are post-treatment erythema, slight burning, and pain. These can be countered with the use of numbing or cooling agents. It is even recommended to simply ice the location 30 minutes prior to treatment. Severe and rare side effects include blistering, crusting, scarring, and changes in the skin’s pigment. Oftentimes, the change in pigment is temporary and resolves on its own over a few days. To avoid such side effects, it is essential to use the appropriate lasers and parameters based on the skin and hair type. Patients and customers should conduct their research on licensed businesses and personnel before getting laser hair removal. Before any scheduled sessions, customers are required to participate in a consultation to discuss the treatment course. With such risks come several regulations that are regularly monitored by the FDA, allowing customers and patients to perform at-home laser hair removal. At-home hair removal devices have not undergone safety and efficacy trials, however, these devices are not at the same standard as professional devices. Laser hair removal was valued at 1.13 billion US dollars and is projected to grow 18.4% by 2030.

References

1. https://pubmed.ncbi.nlm.nih.gov/23332016/

2. https://pubmed.ncbi.nlm.nih.gov/29020474/

3. https://www.mayoclinic.org/tests-procedures/laser-hair-removal/about/pac-20394555#:~:text=During%20laser%20hair%20removal%2C%20a,or%20delays%20future%20hair%20growth.

4. https://pubmed.ncbi.nlm.nih.gov/31018716/

5. https://www.sciencedirect.com/topics/medicine-and-dentistry/laser-hair-removal

Laser hair removal is a popular cosmetic procedure that utilizes concentrated beams of light to remove unwanted hair. It is commonly used to treat areas such as the legs, underarms, upper lip, chin, and bikini line. The procedure works by targeting the melanin, or pigment, in the hair follicles, heating them up and damaging the follicles to inhibit future hair growth.

One of the main advantages of laser hair removal is its efficacy. Compared to traditional methods like shaving, waxing, and plucking, laser hair removal offers longer-lasting results, which is what most people want when it comes to hair removal. Most people experience a significant reduction in hair growth after a series of treatment sessions. Additionally, the procedure is relatively quick and can treat large areas of the body at once, making it a convenient option for many individuals. People may also use at home hair removal devices in the comfort of their own house.

Another benefit of laser hair removal is its precision. The laser can selectively target dark, coarse hairs while leaving the surrounding skin undamaged. This makes it a suitable option for individuals with darker skin tones who may be at risk of pigmentation changes with other hair removal methods.

Despite its efficacy, laser hair removal can have some adverse effects. Common side effects include temporary redness, swelling, and discomfort in the treated area. These common side effects are only temporary, and that is why it is recommended to test a patch of skin prior. Some people may also experience changes in skin pigmentation, particularly those with darker skin tones, although these effects are usually temporary. In rare cases, more severe side effects such as burns, blisters, and scarring can occur. These risks are higher when the procedure is performed by an inexperienced or unqualified practitioner. It is essential to choose a reputable clinic with trained professionals to minimize the risk of complications.

It is also important to note that laser hair removal is not suitable for everyone. The procedure works best on individuals with light skin and dark hair, as the laser targets the pigment in the hair follicles. People with blonde, red, or gray hair may not see significant results from laser hair removal.

Additionally, laser hair removal is not a one-time treatment. Most people require multiple sessions spaced several weeks apart to achieve the desired results. Maintenance sessions may also be needed to sustain the effects over time.

Laser hair removal is an effective option for reducing unwanted hair growth, offering long-lasting results and precision. However, it is essential to be aware of the potential adverse effects and risks associated with the procedure.

References:

Laser Hair Removal - StatPearls. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK507861/

Laser Hair Removal: Faqs. American Academy of Dermatology, https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-faqs.

The first FDA laser hair removal device was approved in 1995. While this marks only 29 years of laser hair removal being around, it has become even more intensely popular due to new societal trends. The new trend of being completely hair-free is an aesthetic many women (& men) pay for these days. However, there are common misconceptions about LHR. One misconception is that hair removal is permanent, but it is a permanent reduction in the number of hair follicles. Less viable follicles lead to less hair, but laser hair removal cannot zap all the follicles. Thus, there will always be a need for maintenance treatments after a full course of therapy is done. I will be delving below into the science behind LHR, the different lasers used, the complications behind LHR, and some unconventional ways LHR is used therapeutically. 

Laser hair removal works by selective photothermolysis. This means, “a site-specific, thermally mediated injury of microscopic tissue targets by the selective absorption of pulses of radiation by the targets and the chromophores” (1). The chromophore used is melanin. Melanin absorbs light in the range of 300 to 1200 nm, and most lasers can achieve this range of wavelengths for effective hair reduction. Absorption is not always uniform. “Melanin captures energy from the laser and distributes it to the surrounding follicular structures. This results in the destruction of the hair matrix and hair bulge stem cells” (1). This allows weakly absorbing parts to be destroyed by the heat from the highly absorbing parts. 

The most common known indication for LHR is for aesthetic purposes. It may also be used for those with Hirsutism and hypertrichosis. Currently, there are 5 different types of lasers on the market. They are Ruby Laser (694 nm), Alexandrite laser (755 nm), Diode laser (810 nm), Neodymium-doped Yttrium-Aluminium-Garnet (Nd: YAG) Laser (1064 nm), and Intense Pulse Light (IPL) or Broadband Light (BBL) (500-1200 nm). The ruby and alexandrite laser are better for those with lighter hair, and rank between I-III on the Fitzpatrick skin types. The diode and Nd:YAG laser are good for those with darker skin and less melanin absorption. IPL are high intensity pulses of polychromatic, non coherent light. It is not as effective as a true laser, although it is less expensive and can be used for larger areas more easily due to its larger spot size.  All of the lasers have different benefits and adequate research should be done by the patient to ensure the right laser is being used for the right skin type. 

“Common adverse effects of laser or IPL-based hair removal include post-treatment erythema, pain, and burning. More severe adverse effects include blistering, crusting, dyspigmentation, purpura, and sometimes scarring. Ocular complications due to accidental injury may be seen. Paradoxical hypertrichosis may rarely occur, more commonly in skin type III and with the use of IPL systems” (1). These common side effects can be treated with OTC analgesics and ice packs. More adverse effects like crusting can be treated with Neosporin and Aquaphor. 

One unconventional indication for LHR is for Pilondial sinus. Standard treatment involves complete surgical excision of the sinus tract but because of its association with excessive hair in the sacrococcygeal region, LHR has been reported to be beneficial to prevent recurrence. Another unconventional indication is for peristomal hair growth. For those with an ileostomy, peristomal hair growth poses a problem. While the hair can be shaved, it can lead to folliculitis. Thus, LHR is a safer and more convenient option for hair removal. 

In conclusion, laser hair removal stands out as a highly effective and increasingly popular method, offering the dual benefits of long-lasting hair reduction and smoother skin, providing individuals with a convenient and efficient solution to unwanted hair.

References:

1. Vaidya T, Hohman MH, Kumar D D. Laser Hair Removal. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507861/

2. Aleem, S., & Majid, I. (2019). Unconventional Uses of Laser Hair Removal: A Review. Journal of cutaneous and aesthetic surgery, 12(1), 8–16. https://doi.org/10.4103/JCAS.JCAS_97_18

Body hair on humans is natural and normal, it even serves a purpose. Body hair serves as a vessel for thermal regulation, friction reduction, insect detection, protection from the sun and protection from foreign objects. Humans have about 60 hairs per square centimeter on their skin, which can be almost equivalent to a similar sized ape. However, in today’s societal norms, body hair is seen as a taboo and unwanted in most people, especially women. Hair removal services range from an extensive variety like shaving, waxing, chemical peels, sugaring and laser hair removal. Laser hair removal has been one of the most popular ways to deal with hair removal due to its long-lasting effects.

Laser hair removal is a medical procedure that uses a concentrated beam light to remove unwanted hair. The light energy targets the melanin in the dark hair follicles. Laser hair removal slows and thins hair over time and can only temporarily reduce hair growth. This mean laser hair removal is not permanent, and treatments must be reoccurring. During laser hair removal, a laser emits a light that is absorbed by the pigments in the hair. The light energy is converted to heart, which then damages the tube-shapes sacs within the skin, which is the hair follicles that produce hair. When this becomes damage, it stops or delays future hair growth. Laser hair removal is said to be most effective for clients with light skin and dark hair.

Laser hair removal should always be performed by someone who is certified in a specialty such as dermatology or cosmetic surgery and has experience on laser hair removal based on the client’s skin type. There is usually a set of special instructions to prepare for the procedure. Staying out of the sun is one of them, and always applying SPF to the area that is going to be treated. Trimming and shaving is recommended that day before laser treatment. It removes the hair above the skin that can result in surface skin damage from burnt hairs, but it still leaves the skin shaft intact below the surface. It is also important to note that hair removal should not be performed on damage or open skin.

Side effects of laser hair removal tend to be dismal. The most common side effects tend to be minor and only last 1 to 3 days post procedure. These side effects include, swelling and redness. However, side effects that are less common but possibly include, blistering, infections, scarring, and skin lightening or darkening. It is important to follow after care instructions promptly to ensure the least amount of side effects and the most effective results of the procedure.

Laser hair removal continues to be one of the most common and effective ways to get rid of unwanted hair. Its longevity makes it more desirable to other hair removal methods. It is not a permanent solution to hair removal, but it does come close, as the maintenance is minimal. A permanent solution to hair growth is a procedure called electrolysis. It is not as popular as laser hair removal, but in time may overtake laser hair removal, as it is a permanent solution.

References:

Yesudian, Patrick. “Human hair - an evolutionary relic?.” International journal of trichology vol. 3,2 (2011): 69. doi:10.4103/0974-7753.90799

“To Shave or Not to Shave: An OB-GYN’s Guide to Pubic Hair Care.” ACOG, www.acog.org/womens-health/experts-and-stories/the-latest/to-shave-or-not-to-shave-an-ob-gyns-guide-to-pubic-hair-care#:~:text=The%20purpose%20of%20pubic%20hair,the%20vagina%20to%20prevent%20infection. Accessed 25 Jan. 2024.

Natural hair growth on our bodies has become undesired in certain areas due to beauty standards and personal preference. Laser hair removal is a cosmetic procedure that can remove unwanted hair growth as a non-permanent solution. This procedure can reduce shaving and waxing time and with proper maintenance, the results leave behind hairless skin. Laser hair treatments can be done on any area of the body besides the eyes and surrounding area, as well as tattooed skin. The success rate of the laser treatment depends on the skin type and hair color. The basic principle of this procedure is that a contrast between the skin and hair color is required for the hair to absorb the heat. For example, dark hair and light skin will absorb more and reduce the hair follicle effectively. Risks occur when there is less of a contrast between the hair and the skin type. Hair colors that are gray, red, white, or blond do not absorb the light as well compared to darker hair types.

Some patients who are on certain medications or have other conditions may benefit from this treatment. Those who have been taking anabolic steroids or birth controls might have unwanted hair growth and can consider laser hair removal treatment. One condition called, hirsutism, is when a woman grows dark coarse hair in areas where men usually have hair. This includes the chin area, above the lip, the chest abdomen and back. Another condition called, hypertrichosis, is where men and women have excess hair anywhere on their bodies and they may not be able to maintain it on their own. Laser hair treatment should be avoided in patients who are pregnant, have skin cancer and keloid scars. It should also be avoided if patients are taking acne medications such as isotretinoin and antibiotics because they can increase the skins sensitivity to light and risk skin injury.

Typically, two to six appointments are necessary to see optimal results and then maintenance appointments can be scheduled. For hair that grows fast such as the upper lip, a session can be scheduled every four to six weeks. Hair that grows in slower areas such as the back can have a longer interval, every twelve to fourteen weeks, between sessions. Laser hair removal is generally safe and the equipment used are FDA approved. There are machines where a cooling air is released and the heat targeted on the skin prevents scarring. Some side effects include hyperpigmentation, burns, blisters, irritation and infections. These are based on the sensitivity of the skin and how much heat is applied from the machine.

Other types of hair removal besides waxing are discouraged because the heat will not target the root of each hair. Waxing and plucking remove the hair from the follicle and shaving only cuts what is exposed on the surface of the skin. For effective treatment, heat from the machine needs to shrink the follicle during each session to minimize the next growth of the hair cycle. Overall, laser hair treatment is effective choice for hair removal for some patients looking for a semi-permanent solution.

References:

Cleveland Clinic medical. “Laser Hair Removal: What Is It, Procedure, Safety & Side Effects.” Cleveland Clinic, my.clevelandclinic.org/health/treatments/21757-laser-hair-removal.

“Laser Hair Removal.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 May 2022, www.mayoclinic.org/tests-procedures/laser-hair-removal/about/pac-20394555#:~:text=During%20laser%20hair%20removal%2C%20a,or%20delays%20future%20hair%20growth.

Yu Feng Lin & Fawziya Twam

The demand for safe, long-lasting, and effective hair reduction for aesthetic as well as medical indications is on the rise. A variety of options for hair removal are available, such as epilation by plucking or waxing, depilation by shaving, chemical depilatories, electrolysis, eflornithine cream, and laser and intense pulsed light (IPL) systems. A variety of lasers and IPL systems are available and are the best option for long-term hair reduction. Laser hair removal is gaining popularity as an effective and long-lasting method for reducing unwanted body hair. This procedure has become the third most commonly performed laser therapy in the United States, with over a million treatments administered in 2016. 

Lasers used for skin treatment work based on a concept called "selective photothermolysis." In simple terms, this means using laser light to target and damage tiny structures in the skin by making them absorb specific light pulses. These structures, known as chromophores, can be natural or artificial. In the case of laser hair removal, the chromophore we're interested in is melanin, the pigment that gives color to hair and skin. Melanin can absorb light in a specific range of wavelengths, which is typically between 300 to 1200 nanometers (nm). Lasers that emit light in this range can effectively be used to reduce hair. However, it's important to note that sometimes not all parts of the target absorb the laser energy equally. In such cases, the parts that don't absorb the energy well may still be affected by heat that spreads from the highly absorbing areas. This idea is called the "extended theory of selective photothermolysis" and is applied in laser treatments. Melanin is found in higher amounts in structures like the hair shaft and matrix cells compared to the hair follicle itself. So, when we use lasers for hair removal, melanin captures the laser's energy and transfers it to the nearby follicular structures, which eventually leads to the destruction of the hair matrix and hair bulge stem cells. This process effectively reduces hair growth.

To assess long-term efficacy and safety, a retrospective study was conducted using a 755 nm alexandrite laser equipped with an epidermal cooling device. The study spanned from 1997 to 2005, with follow-up assessments until 2013. The study included 948 patients with Fitzpatrick skin types I-IV, primarily females (95.1%). A total of 3,606 laser treatments were administered to these patients across various body regions, such as the axilla, back, bikini area, breast, abdomen, face, lower extremity, and upper extremity. Patients received an average of 5.31 treatments, with a minimum of three.

The results of the study revealed significant insights into the long-term outcomes of laser hair removal. The first follow-up assessment was conducted approximately 3.9 years after the final laser treatment. According to physician assessments, 74% of patients achieved 75-100% hair clearance, while patient self-assessments reported 48% clearance. Additionally, 52% of patients reported slower hair growth, and 42% experienced changes in hair texture. Specific body regions showed varying rates of clearance, with the axilla, bikini area, and lower extremities achieving 75% or more clearance after three treatments. In contrast, the face, breast, and abdomen required additional sessions to reach similar clearance levels (66%, 62%, and 79%, respectively). Unfortunately, there were insufficient physician ratings for upper extremity and back treatments to draw conclusions.

Laser and IPL-based hair removal can have common side effects, including post-treatment erythema, which causes the skin to become red. Some people may also experience pain and a burning sensation during or after the procedure. However, there are more severe side effects, although they occur less frequently. These include blistering, which results in the formation of blisters on the treated skin, as well as crusting, where a hard layer forms on the skin. Dyspigmentation, or changes in skin color, and purpura, the appearance of purple or red spots on the skin, are also possible. In rare cases, scarring can occur as a result of laser treatments.

Additionally, there can be complications related to the eyes if there is accidental exposure to the laser. Furthermore, there is a rare phenomenon known as "paradoxical hypertrichosis" where, instead of reducing hair, more hair grows back after treatment. This is more likely to happen in individuals with skin type III and when IPL systems are used. Long-term adverse events were minimal, with all reported adverse events occurring on the face, including one case of scarring and four cases of herpes infection. A second follow-up was conducted approximately 11.5 years later, with 87.9% of patients reporting that their hair reduction improvements had been sustained.

In conclusion, the study found that the 755 nm alexandrite laser is a safe and highly effective treatment option for reducing unwanted body hair. It offers permanent results and is associated with high patient satisfaction. Moreover, long-term adverse events are infrequent, with minimal risks. However, the number of treatments required and the rate of clearance can vary depending on the treated body region, highlighting the importance of individualized treatment plans.

Despite the success of laser hair removal, there is a growing emphasis on the need for adequate training and regulation in this field. The increasing demand for laser hair removal has led to more stringent oversight in some countries. Regulatory boards and mandatory training hours ensure that laser operators meet minimum safety and competency standards. However, in some regions, like South Africa, the lack of regulatory boards and training requirements poses a risk to the public. Without proper oversight, individuals with minimal qualifications may perform laser hair removal treatments, potentially endangering patient safety.

To enhance patient outcomes and safety, it is crucial to select the appropriate laser parameters and cooling methods, especially for patients with darker skin tones. Although laser hair removal can provide long-lasting results, it is essential to manage patient expectations, as touch-up maintenance treatments are often necessary in the long term. While laser hair removal is generally a safe and effective option for hair reduction, it may not provide a permanent cure for hair growth, making ongoing maintenance treatments a part of the process.

References:

Russe E, Purschke M, Herold M, Sakamoto FH, Wechselberger G, Russe-Wilflingseder K. Evaluation of Safety and Efficacy of Laser Hair Removal With the Long-Pulsed 755 nm Wavelength Laser: A Two-Center Study With 948 Patients. Lasers Surg Med. 2020;52(1):77-83. doi:10.1002/lsm.23160

Thomas MM, Houreld NN. The "in's and outs" of laser hair removal: a mini review. J Cosmet Laser Ther. 2019;21(6):316-322. doi:10.1080/14764172.2019.1605449

Vaidya T, Hohman MH, Kumar D D. Laser Hair Removal. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507861/

Hair is a common part of the human body, however, many women decide to remove it. Different methods commonly used are shaving, waxing, and plucking. Laser Hair removal has become a more popular removal of hair in the last few years. Laser hair removal uses concentrated light beams to inhibit hair growth. The laser is absorbed into the melanin if the hair follicle. The light is absorbed as heat, which damages the hair follicles without damages the surrounding skin. Different wavelengths of the lasers include long pulse ruby (694 nm), long pulse alexandrite (755 nm), long pulse diode (810 nm), and long pulse Neodymium-doped Yttrium- Aluminium- Garnet also known as Nd:YAG (1064 nm). Common locations treated with lasers are legs, armpits, chin, and bikini lines. However, all places can be treated except around the eyes and eyebrows, open skin, and skin with the tattoos. In areas that grow back fast, the sessions should take place every four to eight weeks. In areas that have slow hair growth, the sessions should take place every twelve to sixteen weeks. The sessions do reduce hair growth, however, it does not permanently remove hair. There will have to be follow ups and continuous sessions to maintain hairlessness.The area should be clean and patient should be wearing eye protection. Some side effects include skin irritation, pigment changes of the skin, and rarely can cause blistering, crusting, or scarring. Side effect that patient should be warned about is perifollicular edema and erythema. To reduce irritation such as swelling, redness, and discomfort, one can apply ice. After sessions, apply sunshine and avoid tanning beds due to skin sensitivity. Laser hair removals can be performed by nurses, dermatologists, plastic surgeons, primary care providers and cosmetic surgeons.

Since the laser targets melanin in the hair, different skin and hair colors affect the results. People with similar skin and hair color will have less effect than those who have dark hair and lighter skin. The sessions will have to be individualized based on the person's complexion. A study was done with 30 subjects, 14 of those subjects had Fitzpatrick skin types I–IV, and 16 had Fitzpatrick skin types V–VI. Type 1 being fair skin and blue eyes that tans poorly and Type 4 being dark skin that tans easily. They received four sessions of laser and returned for a 3 month follow up visit The wavelengths of the lasers were a combination of 755, 810, and 1064 nm. The results showed, "mean hair reduction in skin type I–IV was 45.5 ± 16.9% (range 5.4–77.9), p < 0.0001, and in skin type V–VI 40.3 ± 17.2% (range 36.5–63.8), p < 0.0005" (Gold). There is a slight difference between mean hair reduction in a patients with different skin. There was no serious side effects to the patients. In a 5 point scale of satisfaction, the mean satisfaction rate varied from 3.75 to 3.88.

Gold, Michael H et al. “Novel laser hair removal in all skin types.” Journal of cosmetic dermatology vol. 22,4 (2023): 1261-1265. doi:10.1111/jocd.15674

Laser Hair Removal - Statpearls - NCBI Bookshelf, www.ncbi.nlm.nih.gov/books/NBK507861/. Accessed 17 Aug. 2023.

Laser Hair Removal

Unwanted hair growth is a common aesthetic problem as the demand for safe, long-lasting, and effective hair reduction is on the rise. There are a variety of options for hair removal including plucking, waxing, shaving, chemical depilatories, electrolysis, and laser and intense pulsed light systems. Laser hair removal has emerged as a leading treatment option for long-term depilation. A variety of lasers and IPL systems are available and are the best option for long-term hair reduction Lasers for skin treatment work on the theory of “selective photo thermolysis” which implies a site specific, thermally mediated injury of microscopic tissue targets by the selective absorption of pulses of radiation by the targets and the melanin chromophores. Melanin absorbs light in the range of 300 to 1200 nm, and lasers in this range of wavelengths can be effectively used for hair reduction. Laser hair therapy can be used for hirsutism, hypertrichosis, aesthetic purposes, and medical indications like psuedofolliculitis barbae, and pilonidal sinus.

  There are different types of lasers which differ based on the skin type. Skin types can be graded based on the Fitzpatrick skin type scale which ranges from one to six. The scale ranges based on skin tone and ability to tan. A one on the Fitzpatrick scale is pale white skin, blue/green eyes, and blond/red hair that always burn and do not tan. A two is fair skin with blue eyes that burns easily and tans poorly. Skin type 3 is darker white that tans after initial burn and four is light brown skin that burns minimally and tans easily. A five is brown skin that rarely burns and tans darkly easily and lastly six being dark brown or black skin that never burns and tans darkly. The lasers include ruby laser, which is more effective for light skin with dark hair, alexandrite laser which is good for lighter hair. The diode laser is safer in darker skin, and the IPL laser can be used on darker skin.

The hair matrix is inly sensitive to laser treatment during the anagen phase of the hair growth cycle; therefore, multiple treatments will be necessary in order to address all hair follicles when they are most sensitive to treatment. In the initial phase of hair removal therapy, 4-6 sessions spaced 4-6 weeks apart are the minimum required to achieve adequate results. Various factors may affect the outcome of laser therapy. Hair location is a major factor as axillary and pubic hair respond better than hair on the extremities and chest. Skin and hair color also affect how effective lasers are. The hair growth stage, laser type, hormonal status and treatment plan all affect how effective laser therapy is.

The common side effects from laser therapy include post-treatment erythema, pain, and burning, more severe side effects include blistering, crusting, dyspigmentation, purpura, and sometimes scarring. Wearing appropriate eye wear is also important as ocular complication due to accidental injury may be seen. Selecting the correct lasers with the appropriate parameters, individualized to each patient, is vert important, particularly in patients with intrinsically dark skin. Most complications are preventable when adequate precautions are taken with adjustments of the fluence, spot size, wavelength, and the use of appropriate cooling, Overall, laser therapy can be an effective way for long term hair removal as long as it’s down by trained personnel with thorough knowledge of the mechanisms, techniques, and complications.

References

Vaidya T, Hohman MH, Kumar D D. Laser Hair Removal. [Updated 2023 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507861/

Casey, A. S., & Goldberg, D. (2008). Guidelines for laser hair removal. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology, 10(1), 24–33. https://doi.org/10.1080/14764170701817049

Laser hair removal has become increasingly popular as a long-term solution for unwanted body hair. Laser hair removal is a non-invasive cosmetic procedure that uses concentrated beams of light to target hair follicles. The laser's heat is absorbed by the pigment (melanin) in the hair follicles, effectively damaging them and inhibiting future hair growth. The procedure can be performed on various body areas, including the face, legs, underarms, bikini line, and back.

One of the key advantages of laser hair removal is its ability to provide long-term hair reduction. While results can vary depending on factors such as hair color and skin type, multiple treatment sessions can lead to a significant reduction in hair growth. Many individuals experience a noticeable decrease in hair thickness and density, allowing for smoother and more manageable skin. Laser hair removal targets specific hair follicles, leaving surrounding skin unharmed. The procedure's precision allows for effective hair removal without causing damage to the skin or adjacent tissues. Moreover, lasers can treat multiple hair follicles simultaneously, making the process efficient and time-saving for large areas like the back or legs. Unlike traditional hair removal methods such as shaving or waxing, laser hair removal provides a long-lasting solution. This eliminates the need for frequent hair removal maintenance, saving both time and effort in the long run. Over time, individuals may find themselves spending significantly less time on hair removal routines. Laser hair removal typically requires multiple treatment sessions to achieve optimal results. Hair grows in cycles, and the laser can only target hair follicles in the active growth phase. Therefore, several sessions are necessary to treat all the hair follicles effectively. The number of sessions varies depending on individual factors, including hair color, skin type, and the treated area. The effectiveness of laser hair removal can be influenced by the contrast between the hair color and the skin tone. Lasers target the melanin pigment in the hair follicles, so individuals with dark hair and light skin tend to achieve the best results. However, advancements in laser technology have made it possible to treat a wider range of skin tones and hair colors with greater precision. Although laser hair removal is generally well-tolerated, some individuals may experience mild discomfort during the procedure. Sensations often compare to the snapping of a rubber band against the skin. However, most professionals use cooling techniques or topical anesthetics to minimize discomfort and ensure a more comfortable experience.

Temporary redness, swelling, or slight skin irritation may occur immediately after laser hair removal. These side effects typically subside within a few hours to a day. Following proper aftercare instructions, such as avoiding sun exposure and applying soothing creams, can help minimize these effects. In rare cases, laser hair removal may cause temporary or permanent changes in skin pigmentation. Lightening or darkening of the treated area may occur, particularly in individuals with darker skin tones. Adhering to proper sun protection measures before and after the procedure can help reduce the risk of pigmentation changes. While rare, laser hair removal can carry potential risks such as blistering, scarring, or infection. These complications are more likely to occur when the procedure is performed by inexperienced practitioners or when post-treatment care guidelines are not followed properly. Therefore, it is crucial to seek treatment from qualified professionals who have expertise in laser hair removal.

Laser hair removal offers a convenient and effective long-term solution for unwanted body hair. Its benefits include long-lasting hair reduction, precision, and time savings. However, considering factors such as the number of sessions required, skin and hair color, and potential risks is essential. By consulting with experienced professionals, adhering to pre- and post-treatment care instructions, and understanding individual needs, individuals can make informed decisions about laser hair removal to achieve smoother, hair-free skin.

Resources

Laser Hair Removal - StatPearls. (2023, March 1). NCBI. from https://www.ncbi.nlm.nih.gov/books/NBK507861/

Laser Hair Removal

Laser hair removal is a procedure to remove hair for the long term. In comparison to shaving, tweezing, threading, or waxing, laser hair removal can be more permanent. Shaving leaves blunt tips which can cause ingrown hairs. Tweezing can have a slower regrowth period, but it is not practical for larger areas of the body. Threading is also impractical for larger areas and requires one to learn the skill. Waxing has a slower regrowth period than shaving, but still not as permanent as laser hair removal.

Lasers remove hair by selective photothermolysis. The target of this treatment is melanin located in the hair shaft, follicular epithelium, and hair matrix. Light is emitted at a specific wavelength between 600 to 1200 nanometers which is absorbed by melanin. The extended theory of selective photothermolysis is that melanin in the shaft and matrix absorbs the energy from the laser and distributes it to the follicle. There is thermal injury from absorption of the light by melanin without damage to the skin. Lasers are best for those with thick, dark hairs, and light, pale skin. Lasers do not work well for thin, white, gray, or red hairs. Adverse events are more common in those with darker skin types and include erythema, edema, burns, folliculitis, skin damage, pigmentation changes, blisters, and crust formation (Kang, C. et al.). It is recommended to shave before treatment to allow for stubble to develop, instead of waxing or plucking. Complications arise when the laser energy is absorbed by pigment in the epidermis causing epithelial damage.

Caution needs to be taken in patients with dark skin types. There is an increased amount of melanin in the epidermis which competes for absorption of the laser. To avoid damaging the skin, less fluence can be used but this will reduce the efficacy of the procedure (Arsiwala, S. Z. & Majid, I. M.). For those with dark skin and dark hair, it is recommended to use: average fluence, long wavelength, and long pulse duration.

Laser hair removal works best in patients with normal hormonal status. Patients with polycystic ovarian syndrome, thyroid dysfunctions, adrenal hyperplasias, and hyperprolactinemia can influence the regrowth of hair after laser hair removal. Before starting laser hair removal, tests measuring FSH, LH, thyroid function tests, insulin, sugar, hormones, and serum prolactin should be performed (Arsiwala, S. Z. & Majid, I. M.).

The skin has a flora that protects the body from the external environment. The axillary skin is mostly populated by staphylococci, corynebacteria, or propionibacteria. The axilla produces odorless fluids to keep the environment moist. The interaction of this fluid with the microbiome in the axillae produces the smell of sweat. A study was conducted to measure whether there was an improvement in the smell of sweat after laser hair removal. There was a significant increase in S. epidermis after laser treatment and a decrease in S. aureus and M. luteus. In 63.3% of cases in the study, there was improved sweat odor. The effect on each bacterial strain is dependent on the amount of energy, wavelength, the area of skin, and the structural membrane of the microorganism (Fazel, Z. et al.). Further research is required to determine the effect of lasers on bacteria. It is not clear whether the laser increases the growth of certain bacteria or if the inhibition of other bacteria allows for another to flourish. It is still not fully established, but it seems that laser hair removal can improve the smell accompanied by sweat.

Laser hair removal is the most long lasting strategy for removal of hair. It allows for a reduction in the time of regrowth of hair. It is dependent on many properties of the patients to be successful. Studies must be conducted to investigate techniques to avoid adverse effects in those with darker skin types and whether there is an effect on axillary microorganisms after laser hair removal.

Resources

Arsiwala, S. Z., & Majid, I. M. (2019). Methods to overcome poor responses and challenges of laser hair removal in dark skin. Indian journal of dermatology, venereology and leprology, 85(1), 3–9. https://doi.org/10.4103/ijdvl.IJDVL_1103_16

Fazel, Z., Majidpour, A., Behrangi, E., Fathizadeh, S., Nokandeh, M., Atefi, N., & Ghassemi, M. R. (2020). Using the Hair Removal Laser in the Axillary Region and its Effect on Normal Microbial Flora. Journal of lasers in medical sciences, 11(3), 255–261. https://doi.org/10.34172/jlms.2020.43

Kang, C. N., Shah, M., Lynde, C., & Fleming, P. (2021). Hair Removal Practices: A Literature Review. Skin therapy letter, 26(5), 6–11.

Vaidya, T., Hohman, M. H., & Kumar D, D. (2023). Laser Hair Removal. In StatPearls. StatPearls Publishing.

Laser hair removal is a noninvasive procedure to remove unwanted body hair by destroying the hair follicle. Results are permanent, but results require about six treatments or more. Laser treatment affects hair in the active growth phase. The laser beam is made up of controlled pulses of energy that are absorbed by melanin or pigment in the hair, reaching the active hair follicle that lies beneath the skin. The energy heats up the hair, right down to the root, and destroys it without damaging the surrounding tissue or skin, the process is also called photo thermal destruction.

When used as hair-removal methods, there are laser and intense pulsed light (IPL) therapy that use light to heat hair follicles and prevent regrowth. IPL technology is actually not a laser treatment. It uses a broad spectrum of light and multiple wavelengths, meaning there is more unfocused energy around the hair and skin area. So, IPL uses multi-spectrum lights whereas laser use single spectrum light, meaning IPL energy is more scattered and much weaker than laser, which has a densified light, and all energy is focused on this single light. In IPL, spectrum lights are measured as wavelength, for example 755 wavelength means that spectrum light can penetrate 755 nm deep beneath the skin. 755 nm wavelength light is best attracted to melanin, so it’s best used for hair removal.

The use of IPL for hair removal dates back to over 15 years and the first IPL for hair removal was researched and the findings published on its safety and efficacy following a single treatment, as well as long-term safety and efficacy with one- and two-year results. These studies proved that an IPL is a legitimate and useful light source for effective hair removal. Clinical results of IPL for hair removal on darker skin types were also published, showing appropriate cut-off filters, the IPL can be used successfully in all skin types.

In a clinical trial evaluating hair removal with Silk’N device, a IPL treatment, subjects were getting treatments biweekly and followed up. Two week hair reduction was noted to be 74%, then two weeks later, the hair reduction was noted to be 84%. At the three-month follow-up period, 95% of all the patients noted improvement with an average reduction of 64%. Milk, transient, perifollicular erythema was noted in 25% of the patients. A second published trial by Alster and Tanzi was evaluated for the same device. As in the previous study, three treatments were given and subjects were followed for one, three, and six months following the last treatment session. All the subjects in the clinical trial showed a response and the hair reduction was noted to be from 37.8% to 53.6% six months after three treatments. Side effects were also minimal at 25% of the subjects noting mild erythema following the treatment session. Overall patient satisfaction scores were high.

IPL will typically be cheaper than laser given that the results are less effective and in the long run would require more treatments. However, it is a good at-home hair removal option.

References:

• Gold, M. H., Foster, A., & Biron, J. A. (2010, February). Low-energy intense pulsed light for hair removal at home. The Journal of clinical and aesthetic dermatology. Retrieved March 23, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921762/

• Schroeder, B. M. and R. (2021, April 7). IPL vs laser hair removal: What's right for you. Harper's BAZAAR. Retrieved March 23, 2022, from https://www.harpersbazaar.com/uk/beauty/skincare/a30794701/ipl-vs-laser-hair-removal/

Laser Hair Removal

There are many forms of hair removal such as epilating, plucking, waxing, shaving, using chemical depilatories, electrolysis and eflornithine cream, and lasering and intense pulsed light (IPL) systems. Lasers and IPL systems are the best for long-term hair reduction. It works by emitting light with wavelengths ranging from 600 to 1200 nanometers to target melanin in the hair shaft, follicular epithelium, and hair matrix.

There are different types of lasers used such as ruby laser, alexandrite laser, diode laser, Neodymium-doped Yttrium-Aluminium-Garnet (Nd: YAG) laser, and Intense Pulse Light (IPL) or Broadband Light (BBL). Ruby laser is a red light from synthetic ruby crystals that is more effective for lighter skin types with dark hair. Alexandrite laser has greater penetration and is also good for lighter skin types. Diode laser goes even deeper and is safer in darker skin types. Neodymium-doped Yttrium-Aluminium-Garnet (Nd: YAG) laser penetrates even deeper and is also safe for darker skin types. Intense Pulse Light (IPL) and Broadband Light (BBL) are not true lasers and is not as effective. A flash lamp is used to deliver high-intensity pulses of polychromatic, non-coherent light. This is also safe to use in darker skin types.

At first, it takes around 4 to 6 sessions spaced 4 to 6 weeks apart to see noticeable difference and achieve adequate results. After that, a session every 6 to 12 months may be necessary to maintain the results. However, this is dependent on many factors such as hair location, skin and hair color, hair growth stage, laser type, hormonal status and treatment plan.

Before the treatment, the skin is cleaned and then a numbing gel may be applied to the area. Then, protective eyewear is used to cover the eyes from the lights. A laser removes hair by vaporizing it causing smoke that have a sulfur-like smell. After hair removal, it is necessary to avoid the sun as much as possible and to apply sunscreen daily.

Some common side effects of laser hair removal are post-treatment erythema, pain, and burning. Therefore, ice packs may be used to minimize pain and swelling. Topical steroid creams may also be used to minimize erythema and swelling. Topical antibiotics can also be used if there is an inadvertent epidermal injury. Some more severe side effects include blistering, crusting, dyspigmentation, purpura, and scarring. This may leave a permanent change in your skin, so it is best to choose a board-certified dermatologist to perform laser treatment. It is of utmost importance to take precautions such as adjusting fluence, spot size, wavelength and the use of appropriate cooling to prevent complications.

References

1. “Laser Hair Removal: Faqs.” American Academy of Dermatology, https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-faqs.

2. Vaidya T, Hohman MH, Kumar D D. Laser Hair Removal. [Updated 2021 Aug 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

Thank you for sharing the information. I have always been wondering if modern technologies might harm hair texture. The laser hair removal actually does affect skin!

Natalie Eshaghian & Donna Salib

Laser Hair Removal

Waxing, shaving, and plucking have been major forms of hair removal for centuries. Laser hair removal is the new aesthetic treatment that is rising in popularity. Laser hair removal began in the mid to late 1900s. Its efficacy has been rising throughout the years, especially into the early 2000s. Unfortunately, where our hair grows is up to genetics, however, where we can keep our hair is up to us in the long term. Laser hair removal is a treatment option to remove unwanted hair on certain parts of your body using a heated laser to burn the hair follicles to inhibit hair growth within that follicle. Although it may be painful, newer techniques have been developed, such as a cooling laser, to make the treatment more bearable and tolerable.

A study was done to see the effectiveness of laser hair removal in patients receiving treatment of 755nm alexandrite laser, and was found to be safe and effective in the treatment. (3) Over 500 patients were included in this study, and treatment sights included areas such as the back, arms, legs, bikini, breast, face, and abdomen. About 50% of the patients studied were seen to have a decrease in hair growth after about 4 years after their last treatment. In addition, over 75% of the patients studied were found to have a full clearance of hair removal in the area they received treatment.

A common side effect of laser hair removal is perifollicular edema, which is swelling of the hair follicle. This is normal since it indicates that the energy was sufficiently absorbed into the skin by the hair follicle and the hair follicle will slowly be disabled and shrink to thin out the hair. This is important to be noted to the patient prior to and post receiving treatment since it may be a concern when seen. Its characteristics are bumpy bubble like blisters that should go away shortly after treatment. (1) If this swelling does not go down within a day or two of treatment, it is important for the patient to receive medical attention. Other side effects include redness, itching, and stinging of the skin. It is important for the patient to apply sufficient moisturizer after treatment to keep the epidermis hydrated after being exposed to the high heat of the laser. In addition, the patient should avoid the sunlight and avoid tanning at least 2 weeks before and after laser hair removal treatment. Many of the laser’s have cooling agents to decrease the pain and swelling that may be experienced during the laser treatment.

Another major side effect of laser hair removal is folliculitis, which is an infection of the hair follicle. It has been seen to be common amongst patients who have curly and/or coarse hair to develop folliculitis more easily. Many times patient’s may avoid getting laser hair removal treatment due to the fear of developing folliculitis. Patients who are found to develop the infection more easily or who develop folliculitis from the laser effects can take prophylactic methods to treat folliculitis, such as doxycycline and topical steroids in addition to gentle washing techniques to help in hair removal. (2)

It is important for medical professionals, including pharmacists, to be aware of the treatment options for hair removal, especially laser hair removal since it is growing in popularity. Its popularity makes it important to understand what the laser treatment entails, as well as how to treat and care for possible side effects, such as the itching, redness, and swelling that occurs. In addition, many patients may use creams such as silver sulfadiazine cream to treat possible burns that occur as negative side effects of the laser. Many patients may experience negative adverse effects from laser, such as skin burns, that can sometimes be severe and cause infections, such as folliculitis. If the patient does not have an infection, silver sulfadiazine cream may be used. For things like itching and swelling, creams and ointments such as hydrocortisone could be used to ease the symptoms. If infection is seen to be present, the patient can use doxycycline to decrease and minimize the length and severity of the infection, as discussed above. Overall, laser hair removal is growing in its usage throughout the years, and it could be associated with many adverse effects that require treatment. It is important for the patient to take the proper precautions and to receive medical attention, as well as the pharmacist to know which treatment options could be used to help alleviate the adverse event.

References:

1. Vaidya T, Hohman MH, Kumar D D. Laser Hair Removal. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 17, 2021.

https://www-ncbi-nlm-nih-gov.jerome.stjohns.edu/books/NBK507861/

1. Schuler A, Veenstra J, Tisack A. Folliculitis Induced by Laser Hair Removal: Proposed Mechanism and Treatment. J Clin Aesthet Dermatol. 2020;13(5):34-36.

https://www-ncbi-nlm-nih-gov.jerome.stjohns.edu/pmc/articles/PMC7380697/

1. Russe E, Purschke M, Herold M, Sakamoto FH, Wechselberger G, Russe-Wilflingseder K. Evaluation of Safety and Efficacy of Laser Hair Removal With the Long-Pulsed 755 nm Wavelength Laser: A Two-Center Study With 948 Patients. Lasers Surg Med. 2020;52(1):77-83. doi:10.1002/lsm.23160

https://onlinelibrary.wiley.com/doi/10.1002/lsm.23160