Download Laser Hair Removal

Laser Hair Removal
Summary

Laser Hair Removal works best in patients with light skin and dark hair.

Laser Hair Removal will not work for gray or blonde hair that has no pigment.

There are no scientifically validated treatment protocols for laser hair removal to date.

"Permanent” hair removal may be possible with multiple treatments over time.
Since the technology of lasers for removal of unwanted hair is still very new, there are no long-term,
scientifically validated studies documenting the most effective treatment protocols for laser hair
removal, nor agreement on what would even qualify as “permanent” hair removal. Consequently, there
is still much discussion about what part of the hair follicle needs to be targeted, at what stage in the hair
growth cycle treatment should be given, the best interval between treatments, the best way to prevent
associated skin damage, and the ultimate fate of treated hair follicles. Nevertheless, the newer
technology for hair removal can produce acceptable long-term results. The following discussion will
outline the basic principles of laser hair removal and provide some essential background information.
What You Should Know About Hair: Vellus hairs are fine, colorless hairs ("peach fuzz") covering most of
the body, except those areas covered with Terminal hairs, which are coarse pigmented hairs found, for
example, on the scalp and eyebrows. Vellus hairs can transform into terminal hairs when stimulated by
androgens (male sex hormones), especially those on the face, back, chest, abdomen, axillae (armpits)
and genitalia at puberty. Vellus hairs can transform into terminal hairs with aging. The number of hair
follicles present in the skin is fixed at birth.
The hair shaft is composed of the protein keratin and is produced in the bulb, the deepest part of the
follicle. The middle part of the follicle contains a thickened area called the "bulge", which is believed to
contain cells important for regeneration of the hair follicle. Current research suggests that this is the
area affected most by the laser. Melanin is the pigment giving hair and skin its color. Melanin is more
concentrated in hair than in skin, a property that allows relatively more absorption of laser light energy
in hair than in skin.
Hair Growth Cycles: Active hair growth is called Anagen, and the length of the anagen phase determines
the length of the hair. Scalp hairs may remain in anagen for up to 3 years. Hair follicles then enter
Catagen, a phase of regression which lasts a few weeks. The Telogen, or resting phase, can last for
months, depending inversely on the number of actively growing hairs in the area, i.e. the scalp has a
shorter telogen phase than the chest. As anagen resumes, the hair follicle lengthens, the (now
superficial) bulb descends deeper into the skin, and the old hair shaft is gradually shed. (In contrast to
most animals, individual human hair follicles grow more or less independently of each other, with most
hairs in anagen phase at any given time.)
Physical Basis for Laser Hair Removal: Laser Hair Removal is based on the principle of selective
photothermolysis, in which the laser light energy is delivered to the to the target area, hair, while
sparing the skin and surrounding tissue. Melanin pigment attracts the laser energy and is the primary
target for the laser beam. Melanin pigment is less concentrated in epidermis (most superficial portion of
the skin) than in the hair shaft, allowing greater absorption of the laser energy into hair, even in dark
individuals.
Commercial lasers have different physical properties, all of which have some effect on the eventual
outcome of the treatment. Since it is clinically desirable to selectively treat the hair follicle without
producing any injury to the surrounding skin, laser energy is always delivered in single, short pulses.
This, however, does create heat in the tissue under treatment. The target tissue, in this case, hair,
approaches its maximum temperature once the laser light has been absorbed. It then cools by
transferring the heat to the adjacent tissue. The time required for the target tissue temperature to
decrease by 50% is called the thermal relaxation time (TRT). In order to destroy the target tissue, the
duration of the laser pulse should approximate its TRT. If the skin is cooled, heat dissipates away from
the epidermis, leaving the deeper hair follicles vulnerable to the longer pulses of laser energy. In our
office, we use the newest technology in Lasers which utilizes a cooling device as described above during
treatment, and is FDA cleared for laser hair removal with all skin types.
Laser surgeons currently do not know exactly which portion of the hair follicle unit to target for the most
successful laser hair removal. It's believed that stem cells in the bulge are most important for
regeneration of the hair follicle. Both the hair bulb and the bulge are targeted during laser hair removal.
Early anagen hairs are most vulnerable to laser treatment because of their small size and more
superficial location. The cyclical nature of hair growth, therefore, affects treatment schedules.
Clinically, and with skin biopsies, two basic responses have been observed after laser treatment:

Complete follicle destruction

Prolonged dormancy (catagen and telogen phase) after non-lethal bulb injury suggesting
recurrence of hair growth over time.
While the hair may return, the characteristics of that hair may be changed, such as becoming finer, or
perhaps blonde in color.
Preoperative Evaluation: All patients need to be evaluated for the possibility of any underlying medical
condition, which may cause excess hair prior to any hair removal treatment. Such conditions may be
intrinsic or iatrogenic (produced by medication). Of utmost importance is the patient's hair color and
skin type, which needs to be ascertained before laser treatment can be performed. The ideal candidate
has fair skin and dark hair.
Contraindications: Laser hair removal treatments are not recommended for patients...

With white or gray hair.

Who are tanned. Laser treatments to tanned skin can result in areas of pigment loss.

With a history of abnormal scar formation, especially after other forms of laser therapy.

Who are prone to skin discoloration.

Who are taking photosensitizing medication such as tetracycline or retinoids. When possible,
these medications should be discontinued 3-4 weeks prior to laser treatment.
Accutane patients should discontinue treatment a minimum of 3 months prior to treatment.
Preoperative Instructions:

Do not pluck, wax or bleach hair before treatment for at least one month. Shaving is permitted
and recommended.

Avoid all cosmetics, moisturizers and other skin preparations the day of treatment.

You will be given a prescription for topical anesthetics when applicable and instructions on how
to apply them, usually 2-3 hours prior to treatment.
Treatment: During treatment you will be given protective eyewear, and a gel coolant will be applied to
control the heat in the treatment area prior to activating the laser. The duration of the treatment
depends upon the technique required to effectively treat the anatomical area and skin type, as well as
patient comfort. Most treatments are from 5 to 60 minutes.
The treatment itself causes a stinging sensation similar to a snapping rubber band or insect sting. Using
topical anesthetic creams, which we will arrange prior to your treatment, can minimize the discomfort.
Most importantly, be aware that the area treated will still have hair at the end of the treatment.
It will not look any different than it did before the treatment. During the weeks after treatment,
damaged hair follicles and hair shafts are shed. During this time, the hair may be shaved, you do not
want to pluck or waxed.
To achieve acceptable results in most patients, a total of 3-6 treatments are required, but results cannot
be guaranteed. You should see, however, a dramatic reduction in numbers or hairs and/or a softer
texture to the hair itself which may also be a lighter color. In addition, a topical cream may be
prescribed which will slow hair regrowth.
Rarely, blistering occurs. If this happens, we will give you topical preparations to facilitate
recovery. Temporary pigment changes can occur in these circumstances.
Post-Operative Care: Little specific postoperative care is necessary in most cases. If burning sensations
and/or redness occurs, ice packs are helpful. Oral pain medication is rarely needed. Sun exposure
should be avoided for at least 4 weeks. Use a sunscreen with an SPF of 30, or greater. You can resume
cosmetics and moisturizers in 24 hours.
Side Effects and Complications: When used properly, laser devices are safe and effective for laser hair
reduction. Redness and swelling are not uncommon following laser hair removal, especially at high
energies, and usually resolve within a few hours. If blisters occur, there is a low risk of infection and/or
scarring. To minimize this, meticulous hygiene is indicated.
Pigmented lesions (lentigines), and freckles may be lightened or disappear. Reactivation of fever blisters
is also possible, so be sure to tell the laser operator if you have herpes, so appropriate preventions can
be instituted. People with light skin and dark hair will have a more noticeable, longer-lasting response
than people with blond or red hair or people with darker skin, and will; therefore, require fewer
treatments for long-term hair reduction.
Efficacy of Laser Hair Removal: Current technology does not assure permanent hair removal. To date,
no laser destroys all of the hair follicles. Some are destroyed; others are miniaturized. Multiple
treatments will yield best results, and the best interval for treatment is when new hair regrowth is
observed, usually 6 weeks to 3 months after the first treatment, and 3 to 6 months after the second
treatment. In most cases there should be visible improvement within 7-14 days after the first treatment.
Despite the fact that no “perfect” laser exists which will totally eliminate all unwanted hair, long-term
reduction of visible hair is a certainty.