Laser and intense pulsed light hair removal technologies: from professional to home use

Light-based hair removal (LHR) is one of the fastest growing, nonsurgical aesthetic cosmetic procedures in the United States and Europe. A variety of light sources including lasers, e.g. alexandrite laser (755 nm), pulsed diode lasers (800, 810 nm), Nd:YAG laser (1064 nm) and broad-spectrum intense pulsed light (IPL, 590-1200 nm), are available and used widely for such procedures in dermatological/clinical settings under proper supervision. Patient selection and appropriate fluence settings are managed by professionals to maximize efficacy while minimizing adverse events. In the past 5 years, LHR devices have been sold directly to consumers for treatment in the home. In this review, we outline the principles underlying laser and IPL technologies and undertake an evidence-based assessment of the short- and long-term efficacy of the different devices available to the practising dermatologist and discuss the efficacy and human safety implications of home-use devices.     

Measurement of home‐use laser and intense pulsed light systems for hair removal: Preliminary report

Background: Laser and intense pulsed light (IPL) devices are used routinely by healthcare professionals for hair removal, but laser and light technology devices intended for home use have so far had little impact in the consumer market. However, as multinational companies enter this market, there will be an explosion in the use of such devices by the consumer. Objectives: This investigation focuses on the technical performance of the devices tested and although no clinical data are presented, the measured parameters are those that will directly impact efficacy in hair reduction, efficient coverage of skin, and safety in terms of unintentional eye exposure to the light source or incorrect settings for a given skin type. Consumers will consult healthcare professionals with experience of light‐based therapies for guidance and this study provides useful reference information on available home‐use devices. Methods: Previously published standard test methods were used to evaluate the devices tested. Results: Some of the devices measured in this study showed significant discrepancies between claims made by the manufacturers and the parameters measured. Conclusions: There is an urgent need for early ratification of the draft international IEC 60601‐1 intense light standard, which will encompass manufacturing standards for both professional and home‐use hair removal devices.     

A review of hair removal modalities in pediatric patients: Ethical and clinical considerations

Unwanted hair is a common concern among patients presenting to pediatric dermatology clinics, and parents and patients alike inquire about the safety of methods employed for elective removal. Various methods of hair removal exist with different levels of invasiveness and permanence, from simple mechanical depilation to light-based therapies. All methods of hair removal appear to be safe and generally well tolerated in children, and there are no age restrictions to any modality. In this review, we aim to address the available literature on the safety and efficacy of hair removal modalities in pediatric patients and propose guidance on how to manage requests for at-home and in-office therapies within an ethical framework.     

Laser hair removal pearls.

A number of lasers and light devices are now available for the treatment of unwanted hair. The goal of laser hair removal is to damage stem cells in the bulge of the follicle through the targeting of melanin, the endogenous chromophore for laser and light devices utilized to remove hair. The competing chromophores in the skin and hair, oxyhemoglobin and water, have a decreased absorption between 690 nm and 1000 nm, thus making this an ideal range for laser and light sources. Pearls of laser hair removal are presented in this review, focusing on four areas of recent development: 1 treatment of blond, white and gray hair; 2 paradoxical hypertrichosis; 3 laser hair removal in children; and 4 comparison of lasers and IPL. Laser and light-based technologies to remove hair represents one of the most exciting areas where discoveries by dermatologists have led to novel treatment approaches. It is likely that in the next decade, continued advancements in this field will bring us closer to the development of a more permanent and painless form of hair removal.     

Home-use laser and light devices for the skin: an update

Over the past several years, a number of home-use laser and light skin devices have been introduced for various indications, including photorejuvenation, hair growth, hair removal and acne treatment. Although these devices allow for privacy and a significant cost advantage, they are typically underpowered and afford lower efficacy than their in-office counterparts. A number of these devices have recently received FDA clearance. Although large clinical trials are lacking, dermatologists should familiarize themselves with the various options to help patients assess their clinical value.     

Photobiomodulation therapy for androgenetic alopecia: A clinician’s guide to home-use devices cleared by the Federal Drug Administration

The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code “OAP” to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, wavelength, light sources, technical features, price, and level of clinical evidence. To date, there are no head-to-head studies comparing the efficacy of these devices. Photobiomodulation therapy devices have an excellent safety profile and mounting evidence supporting their efficacy. However, long-term, high quality studies comparing these devices in diverse populations are lacking. As these devices become increasingly popular, dermatologists should be familiar with this treatment modality to add to their therapeutic armamentarium.

Abbreviations: AGA, androgenetic alopecia; FDA, Food and Drug Administration; IEC, International Electrotechnical Commission; LED, light-emitting diode; PBMT, photobiomodulation therapy.     

Laser hair removal

The extended theory of selective photothermolysis enables the laser surgeon to target and destroy hair follicles, thereby leading to hair removal. Today, laser hair removal (LHR) is the most commonly requested cosmetic procedure in the world and is routinely performed by dermatologists, other physicians, and non-physician personnel with variable efficacy. The ideal candidate for LHR is fair skinned with dark terminal hair; however, LHR can today be successfully performed in all skin types. Knowledge of hair follicle anatomy and physiology, proper patient selection and preoperative preparation, principles of laser safety, familiarity with the various laser/light devices, and a thorough understanding of laser-tissue interactions are vital to optimizing treatment efficacy while minimizing complications and side effects.     

Optical hair removal

Traditional methods of hair removal have proven unsatisfactory for many individuals with excessive or unwanted hair. In the last few years, several lasers and xenon flashlamps have been developed that promise to fulfill the need for a practical, safe, and long-lasting method of hair removal. Aggressive marketing of these has contributed to their popularity among patients and physicians. However, significant controversy and confusion surrounds this field. This article provides a detailed explanation of the scientific underpinnings for optical hair removal and explores the advantages and disadvantages of the various devices currently available (Nd:YAG, ruby, alexandrite, diode lasers, and xenon flashlamp). Treatment and safety guidelines are provided to assist the practitioner in the use of these devices. Although the field of optical hair removal is still in its infancy, initial reports of long-term efficacy are encouraging.     

The “in’s and outs” of laser hair removal: a mini review

Conventional treatments for excessive hair are tedious and time consuming. Laser hair removal has become the leading therapy option for long–term results. It works on the principle of selective photothermolysis, whereby photons destroy the hair follicle while sparing the surrounding tissue. As demand increases, there has been an increase in the regulation of these treatments. Laser hair removal is not risk-free and side effects are associated with the treatment. Adequate training is vital to minimise adverse side effects. Certain countries have regulatory boards that laser operators need to register with, as well as the completion of mandatory hours. Others require laser operators to register with a Care Quality Commission (CQC) to ensure that minimum training and safety standards are met. Currently, in South Africa, the lack of regulatory boards and mandatory hours poses a risk to the public as anyone with little or no qualification is allowed to perform laser hair removal treatments, placing patients at risk. This review looks at some of the devices used and basic mechanisms of action of laser hair removal, its associated risks, side effects and current regulation.     

Past, present, and future: vascular lasers/light devices.

Vascular lasers were among the first available cutaneous light-based technologies. The past 20 years has seen a variety of safe and effective laser and light-based vascular treatment devices. This article provides a review of the medical and scientific literature, which concludes that newer lasers have led to increasing success and safety in the treatment of cutaneous vascular lesions.     

Fotodepilación

Unwanted hair is a common problem for which different types of light therapy have been developed as the treatment of choice. Since 1996, when the American Food and Drug Administration approved the first laser therapy for depilation, much progress has been made in light-based technology and lasers. Lasers and intense pulsed light sources with red or near infrared wavelengths (600 to 1200 nm) are the most widely used for removing hair as they target the melanin of the hair shaft, hair follicle epithelium, and hair matrix. The aim of this review is to describe and compare the different photodepilation methods currently available.     

A systematic review of light-based home-use devices for hair removal and considerations on human safety

Background Hair removal with professional light‐based devices is established as an effective, mainstream treatment. The field of optical home‐based hair removal is evolving and movement from control by physicians into hands of consumers warrants understanding efficacy and human safety. Objectives To systematically review and evaluate the efficacy and human safety of currently available home‐based optical hair removal devices. Methods A comprehensive Pub Med literature search was conducted which systematically identified publications of relevance. Prospective clinical trials were included whether controlled, uncontrolled or randomized and with a sample size of at least 10 individuals. Results We identified a total of seven studies: one controlled (CT) and six uncontrolled trials (UCTs). No randomized controlled trials (RCT) were recognized. The best evidence was found for IPL (intense pulsed light) (three devices, one CT, five UCTs) and limited evidence for laser devices (one diode laser, one UCT). Most studies evaluated short‐term hair reduction up to 3 and 6 months following light exposure at different body sites. Hair reduction percentages ranged from 6% to 72% after repetitive treatments. The most frequently reported side‐effect was erythema, but oedema, blistering, crusting and pigment changes were also reported. Theoretical concerns about ocular damage and paradoxical hair growth have not been reported in any of the studies reviewed. Conclusions Available evidence from prospective, uncontrolled clinical trials indicates short‐term hair removal efficacy of currently available home‐use light‐based hair removal devices. Additional controlled trials will be helpful to substantiate the efficacy and to better predict the incidence of adverse events associated with optical home‐use hair removal.     

A review on laser and light-based therapies for alopecia areata

Alopecia areata is a form of non-scarring alopecia that results from a hyperactive immune response of T cells against hair follicles. Many patients with visible hair loss experience psychological and emotional distress, as a result of their cosmetic disfigurement, and frequently seek treatment. However, existing treatment methods, such as corticosteroids, topical irritants, sensitizing agents, immunosuppressants, and psoralen plus ultraviolet light A, may result in various adverse effects and often lack efficacy. Laser and light treatments offer a safe and effective alternative. This review aims to provide clinicians with a comprehensive summary of laser and light-based modalities used for the treatment of alopecia areata. Currently, the excimer laser is the most widely studied device and has shown positive results thus far. However, the development of future randomized controlled clinical trials will help determine the appropriate treatment protocols necessary, in order to achieve superior clinical outcomes.     

Complete regression of a melanocytic nevus under intense pulsed light therapy for axillary hair removal in a cosmetic center

Intense pulsed light (IPL) therapy using noncoherent broad-spectrum light has been reported to be effective for hair removal, and also for treating superficial pigmented lesions like ephelides and solar lentigines. We report complete regression of a pigmented melanocytic nevus, histologically confirmed, after hair removal treatment with IPL. The use of lasers and IPL is a common procedure used by dermatologists and even other professions for the treatment of cosmetically troubling skin conditions. The main advantage of such treatment is a reduction of surgical scars, thus producing a favorable cosmetic outcome, but a major limitation is that histopathologic diagnosis is not usually obtained prior to treatment. Such devices should be carefully used in patients with potentially dangerous melanocytic lesions. We also review the recent literature regarding inadequate treatment of melanocytic lesions with lasers.     

Laser-assisted hair removal for facial hirsutism in women: A review of evidence

Poly cystic ovarian syndrome (PCOS) has been described as the common diagnosis for hirsutism in women. Facial hirsutism is by far the most distressing symptom of hyperandrogenism in women with PCOS. A statistically significant improvement in psychological well-being has been reported in patients with PCOS allocated for laser-assisted hair removal. The theory of selective photothermolysis has revolutionized laser hair removal in that it is effective and safe, when operated by sufficiently trained and experienced professionals. Long-pulsed ruby (694 nm), long-pulsed alexandrite (755 nm), diode (800–980 nm), and long-pulsed Nd:YAG (1064 nm) are commercially available laser devices for hair removal most widely studied. This article will introduce the fundamentals and mechanism of action of lasers in hair removal, in a contemporary literature review looking at medium to long term efficacy and safety profiles of various laser hair removal modalities most widely commercially available to date.     

Hair removal with a novel,low fluence,home-use intense pulsed light device

Objective: To evaluate the reduction in unwanted body and facial hair at various body sites of Fitzpatrick skin types I–III and the efficacy, comfort and safety of this treatment intended for home-use by the general public. Methods: In this non-randomized study, 29 individuals were given three sequential weekly treatments on a total of 31 body and facial areas including the axilla, bikini area, abdomen, neck, chin and upper lip using a novel intense pulsed light device. All participants completed a simple self-assessment questionnaire, as well as an evaluation of pain/discomfort. Results: The mean reduction in terminal hair counts was 47% at 4 weeks' follow-up and 41% at 6 months' follow-up after completing three sequential weekly treatments. Overall, 84% of participants showed a significant percentage of hair reduction (p<0.01) at the 6-month follow-up, with a mean of 51% (range 25–86%). No treatment-related side effects were reported, with little or no discomfort reported during the treatment. Only mild erythema was noted immediately post-treatment. In total, 85% of the participants were either pleased or very pleased with the results 1 month after the third treatment. Conclusions: In simulated consumer use, this home-use IPL demonstrated a significant, quantifiable and sustainable reduction in unwanted body and facial hair with minimal side effects.     

Optical treatments for acne

Light-based treatments for acne are becoming increasingly commonplace in dermatology. This article reviews various light approaches in acne therapy. Methods are discussed from an anatomical and a functional perspective. The emphasis is on the practicality of treatment as well as the pros and cons of various devices. Also, a review of the recent literature is presented. The article is intended to give the reader a panoramic view of this still-young and developing area. Most likely, light-based acne treatment will receive more popularity as dermatologists learn how to integrate this type of therapy within the context of more established drug agents.     

Dermocosmetic aspects of hair and scalp

Hair cosmetic agents are preparations intended for placing in contact with the hair and scalp, with the purpose of cleansing, promoting attractiveness, altering appearance, and/or protecting them in order to maintain them in good condition. Current shampoo formulations and styling products are tailored to the variations associated with age, gender, hair quality, hair care habit, and specific problems relating to the superficial condition of the scalp. The great amount of variables to be accounted for, some of them contradictory and hard to bring into accord, makes adequate product formulation a challenge and requires continuous research. Recent hair cosmetic developments include topical hair growth stimulants, photoprotectors, and anti-aging compounds. The advances in molecular technology have opened the avenue to the study of the molecular basis of hair growth and its deviations, as well as of the aging process. The discovery of potential pharmacological targets and the development of selective and effective delivery systems following topical application indicate further strategies for maintenance of healthy hair and scalp in the young and old.     

Guidelines for laser hair removal

Requests for removal of unwanted body hair are common in dermatologic and surgical practices. Technology continues to improve the achievement of a more permanent reduction through the use of lasers. Despite the increased use of lasers, to date, few guidelines exist in terms of how to approach laser hair removal. Specifically, one must understand the mechanism of hair growth and how lasers work to target the hair follicle. There is significant variation among practitioners in pre‐and post‐laser recommendations to patients as well as intervals between treatment sessions. We performed a thorough review of the literature in order to determine evidence for the ideal interval between treatment sessions and the ideal number of sessions. We also sought to establish, based on published reports, the recommendations for shaving, plucking, waxing or other hair removal methods prior to laser hair removal and the guidelines for sun exposure before and after laser treatments. Finally, we searched the literature to find out whether there are areas that should not be treated with laser hair removal. The evidence and recommendations in this article aim to help guide practitioners in their approach to laser hair removal.