Ruby laser-assisted hair removal – long-term results after repeated treatments

The long-pulsed ruby laser has been used to remove unwanted body hair with encouraging results. It is clear from various studies that complete removal of hair is unlikely after a single treatment and diverse response rates have been observed in various individuals. It was the aim of this study to examine the efficacy of ruby laser hair removal after repeated treatments and to assess the patients’ satisfaction with this method of hair removal. In all, 88 patients were treated with the Chromos 694 Depilation Ruby Laser (SLS/Biophile, Wales) at monthly intervals for 4 months and their hair density was measured at 7 and 12 months after the first treatment. The average reduction in hair density was 13.7% at 1 year, which was statistically significant. No adverse long-term side effects were seen. Although only 44.3% of patients had reduced hair count at 1 year, 79.5% patients were satisfied with their treatment. In conclusion, we have shown in this study that the long-pulsed ruby laser is only effective in permanently removing a small proportion of unwanted dark coloured body hair. This method of hair removal is, however, superior to other conventional types of hair removal according to the patients’ subjective observation, because it slows the hair growth, causes thinning of hair, and provides good temporary control of hair from most treatment sites. Received: 14 November 1998 / / Accepted: 4 December 1999     

The effect of ruby laser light on ex vivo hair follicles: clinical implications

Several clinical studies on the efficacy of ruby laser-assisted hair removal have reported that regrowth of hair after treatment is common. One of the reasons for the regrowth of hair is the incomplete destruction of germinative hair cells due to the insufficient penetration of the ruby laser in the skin. It was the aim of this study to estimate the extent of damage to the hair follicles after one ruby laser treatment and to determine whether the ruby laser destroyed the bulbs and the bulge regions of hair follicles. The extent of laser damage in hair shafts was determined by serial examination of six specimens of ex vivo scalp skin lasered with the Chromos 694 Depilation Ruby Laser at 14 J per square centimeter and 20 J per square centimeter. Another nine specimens of ex vivo scalp skin were similarly lasered, and monoclonal antibody LP2K was used to identify the bulge regions of the hair follicles using the immunoperoxidase technique. Damage to the bulge region was assessed from consecutive specimens, which were stained with hematoxylin-eosin stain. The mean depth of laser damage sustained by hair follicles was 1.34 mm (14 J per square centimeter) and 1.49 mm (20 J per square centimeter) underneath the skin surface. Most of the laser damage involved the bulge regions but fell short of the hair bulbs. The laser damage did not seem to extend far enough down the hair shafts to result in permanent hair destruction. The clinical implications of this finding are discussed.     

Hair removal with intense pulsed light

The use of light and laser for hair removal has evolved during the past few years. Laser systems such as the ruby laser (694 nm), alexandrite laser (755 nm), diode laser (810 nm) and neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1,064 nm) are commonly used in hair removal. However, permanent hair removal has been difficult to achieve using lasers owing to the long growth/rest cycle of normal human hair follicles. There is still an increasing demand for safer and more efficient hair removal techniques. The latest and most effective choice in the treatment of hair removal is non-coherent intense pulsed light (IPL), which is both efficient and safe for hair removal. A group of 210 patients with skin type III–V were treated for superfluous hair in different areas of the body (face, extremities, axillae, bikini line and back) for three to five sessions at 6-week intervals using IPL. There was a significant hair reduction of about 80% with no side effects and minimal complications. Follow-up was done 6 months after the last session. In conclusion, IPL is very effective and safe for hair removal.     

Ruby laser-assisted hair removal – correlation of efficacy with the growth cycle of human hair

There is great variation in response when ruby laser is used to remove unwanted body hair. Destruction of hair is often not possible after one laser treatment and the frequency and timing of repeated treatments required to achieve optimum treatment results are unknown. It was the aim of this study to determine whether the efficacy of ruby laser hair removal depended on the hair growth cycle. A prospective clinical study was carried out. The lower legs of 48 patients were treated with the Chromos 694 ruby laser at a standard fluence of 11 Jcm^–2. Treatment efficacy was determined as the percentage decrease in hair density at 3 and 7 months. The proportion of growing and resting hairs in the treatment site was assessed by examination of plucked hair roots harvested from areas adjacent to the treatment site. To determine whether examination of plucked hair roots microscopically was reliable in assessing the proportion of growing and resting hairs in a specific site, 7 ex-vivo scalp skins were examined histologically. Results showed that examination of plucked hair roots was a reliable method in assessing the proportion of growing and resting hair. There was no correlation between the treatment efficacy and the growth phases of hair (one way analysis of variance, P=0.116). In conclusion, growing hairs are not more susceptible than resting hairs to ruby laser injury. The clinical implications of this finding are discussed. Received: 14 November 1998 / Accepted: 4 December 1999     

Ruby laser hair removal: evaluation of long-term efficacy and side effects

BACKGROUND AND OBJECTIVE: Although several studies on laser-assisted hair removal have been published, data on long-term follow-up are few. The present study investigated the long-term efficacy and safety of normal-mode ruby laser pulses on hair removal. STUDY DESIGN/MATERIALS AND METHODS: The normal-mode ruby laser (Epilaser; 694 nm, 3 msec) was used to treat a wide range of body sites in 51 volunteers. The mean follow-up after the last treatment was 8.37 months. RESULTS: Sixty-three percent of the patients had sparse regrowth. The mean fluence used was 46.5 J/cm(2) in patients who had sparse hair regrowth and 39.3 J/cm(2) in patients who had moderate hair regrowth (P = 0.0127). Transient pigmentary changes occurred most frequently in patients with skin type 4. CONCLUSION: The normal-mode ruby laser is an efficient and safe method for long-term hair reduction, especially in fair-skinned individuals with dark hair. Higher fluences produce greater long-term efficacy. Adverse effects are minimal and transient.     

Meta-analysis of hair removal laser trials

Traditional hair-removal techniques have included shaving, waxing, chemical depilation, and electrolysis. All of these methods result in temporary hair removal. The theory of selective photo thermolysis led to the development of a variety of different laser systems. These lasers range from the short end of spectrum, with the 694-nm ruby laser, to the middle, with the 755-nm alexandrite and 810-nm diode lasers, and to the long end with the 1,064-nm Nd:YAG laser. We made a systematic review on the clinical trials with use of various laser sources for hair removal, so all clinical trials related to hair removal lasers in 1998–2003 were considered after elimination of heterogenite sources in data store. Trial results were synthetized on the basis of kind of laser. Our study clarified that hair reduction at least 6 months after the last treatment and hair reductions were 57.5, 42.3, 54.7, and 52.8% after three sessions for diode, Nd:YAG, alexandrite and ruby, respectively. We compared the result with use of analysis of variance method (Scheffes) and double comparison with use of Student’s t test. Our results clarified that diode laser is the most effective, and Nd:YAG has the least effect of hair removal.It seems that diode and alexandrite lasers are proper for hair removal, but as we need high fluence in the darker skin types and this is accompanied with higher complications, diode is advised for lighter skin, and we advised alexandrite laser for darker skin types.     

Ruby laser-assisted hair removal reduces the coarseness of regrowing hairs: fallacy or fact?

There have been anecdotal reports that hairs that regrow after ruby laser-assisted hair removal are finer in appearance. If true, this phenomenon adds to the improved aesthetic effect of laser treatment of unwanted hair. It is the aim of this study to determine whether this phenomenon indeed occurs, and if so, assess its permanence and its mode of action. In this prospective clinical study, 71 patients with 94 treatment sites were treated with the Chromos 694 Depilation Ruby Laser. Hair diameter was measured pre-treatment, and at 3 and 7 months post-treatment. In addition, ex vivo scalp skin was used to assess if the ruby laser selectively damaged coarser hairs. Laser-treated and matched untreated skin samples were histologically assessed and the diameters of hair shafts (normal or obviously damaged) were measured. Results of this study were analysed using Kruskal-Wallis one-way analysis. There was no statistically significant difference between the hair diameter of non-lasered specimens and the hair diameter of the normal hair in lasered specimens. However, a statistically significant difference was seen between the hair diameter of non-lasered specimens and diameters of damaged hair in lasered specimens (P < 0.05). There was a statistically significant difference (P < 0.05) between pre-treatment and 3 month hair diameters, but no statistically significant difference was found between pre-treatment and 7 month hair diameters. In conclusion, ruby laser-assisted hair removal results in a temporary reduction in hair diameter of regrowing hair. This is not due to the selective targeting of larger hair follicles.     

Evaluation of the ruby 694 Chromos for hair removal in various skin sites

Lasers have been established as effective treatment for hair removal, with possible long-term suppression of hair growth in treated areas. The purpose of this study was to assess long-term hair regrowth after treatment with the ruby laser. Volunteers recruited into the 1997–99 study were divided between three treatment groups, each having left and right treatment sides. Two treatments were given on both sides at monthly intervals. A third treatment was given randomly to one side. Hair counts of the experimental sites were made at monthly intervals for 1 year. The three patient groups were: top lip (25), axillae (25) and legs (19). Long-term hair reduction was achieved in all patients. A single treatment reduced hair counts by up to 75. Three treatments had an impact for 2 additional months, but not long term. Unexpected spontaneous hair reduction was found 5 months following treatment and lasted 2 months. This ruby laser produced a persistent two-thirds reduction in hair count over 8 months of follow-up. Extension of the follow-up to 12 months did not show significant regrowth. Existing experimental data, together with the results of this study, suggest that hair shaft damage is the key feature in achieving damage to the hair-producing mechanism. The correlation of treatment success and anagen growth phase is less likely.     

Ruby laser-assisted hair removal: an ultrastructural evaluation of cutaneous damage.

Ruby laser-assisted hair removal is thought to act via selective photothermolysis of melanin in the hair follicles. Although initial clinical trials of permanent hair removal using ruby lasers are promising, the exact mechanisms of hair destruction and the potential damage to other structures of skin are not known. The aim of this study was to evaluate the cutaneous ultrastructural changes following ruby laser hair removal.Nineteen healthy Caucasian patients with dark (brown/black) hair were treated with the ruby laser and biopsies taken after 0, 2, 3, 5, 7, 14 and 21 days. Specimens were examined by light and electron microscopy. Laser-treated specimens showed widespread coagulation and charring of subcutaneous hair shafts. These obviously damaged follicles were randomly dispersed amongst intact follicles within the same treatment sites. Microscopic changes were also seen in the basal epidermis where melanin was concentrated, irrespective of any obvious macroscopic damage. A low level of inflammatory response seen up to 2 weeks after treatment always followed laser treatment. Suprabasal epidermal necrosis was only seen in patients with blister formation after treatment.Ruby laser irradiation results in selective damage to the hair follicles, with microscopic changes to the basal epidermis. The damage is probably compounded by the inflammatory response to the damaged hair. The normal appearance and distribution of collagen in the dermal layer supported the clinical evidence that laser-assisted hair removal, if performed correctly, does not lead to scar formation.     

Ruby laser-assisted hair removal: a preliminary report of the correlation between efficacy of treatment and melanin content of hair and the growth phases of hair at a specific site

An unpredictable response, even in patients with dark hair, often undermines successful ruby laser hair removal. A prospective clinical study was carried out to evaluate the roles of melanin content and growth phases of hair in treatment efficacy. Thirty-six volunteers with white skin and dark hair were recruited for the study, and were all treated using the Chromos 694 Depilation Ruby Laser. The overall efficacy of treatment was assessed at the end of 3 months. The efficacy of laser treatment is not due solely to the proportion of hair in the growing or static phase of the hair cycle. There is a lack of correlation between the melanin content and the overall efficacy of laser hair removal in those treated once, but patients with darker hair responded better after repeated treatments. The proportion of hair in the growth phase and the melanin content of hair do not contribute solely to the efficacy of ruby laser hair removal.     

Hair Removal Using a 5-msec Long-Pulsed Ruby Laser

BACKGROUND: Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal exist, with laser hair removal rapidly becoming the most widely used modality. OBJECTIVES: Our objective was to evaluate the efficacy and side effects of a long-pulsed ruby laser for epilation in patients with varying skin types and hair color 6 weeks and 6 months after treatment. METHODS: Seventy-four patients received one to four treatments with a long-pulsed ruby laser (694 nm, 5-msec pulse length, 6 mm spot size, 17.5-32 J/cm2) in different body areas. RESULTS: After a mean number of treatments of 1.98 (range 1-4) the mean clearance was 51-75% after 6 weeks and less than 25% after 6 months. A lower percentage of hair regrowth was observed in the facial region than on the trunk or legs and in dark hair compared to blond hair. CONCLUSION: Laser epilation provides a quick and relatively comfortable, but nonpermanent modality for hair removal with few side effects.     

Recalcitrant Scarring Follicular Disorders Treated by Laser-Assisted Hair Removal: A Preliminary Report

Background. Recalcitrant scarring follicular disorders have been treated previously by removing hair follicles both surgically by scalp resection with skin grafting and with X-ray epilation. Laser-assisted hair removal may provide an alternate method of hair removal with less associated morbidity.
Objective. The goal is to determine whether laser-assisted hair removal can be used to treat follicular inflammatory disorders by destroying hair follicles.
Methods. Three patients with various scarring follicular disorders (dissecting cellulitis of the scalp, keratosis pilaris spinulosa decalvans, and pseudofolliculitis barbae) were treated with the long-pulse non-Q-switched ruby laser and followed clinically.
Results. The patients tolerated the treatments well without significant side effects and noted improvement of their condition along with decreased hair growth in the treated area.
Conclusion. Laser-assisted hair removal may provide a safe, effective means of treating recalcitrant follicular disorders.     

The removal of unwanted hair using a ruby laser.

A ruby laser has been developed to remove unwanted hair. Melanin within the hair is used as a natural chromophore. It is postulated that photothermal damage destroys the hair itself and also key cells surrounding the hair follicle to prevent regrowth. A prospective study of laser depilation in 116 patients or 175 sites was performed over a period of 18 months. All the patients had tried other methods of hair removal and found them to be unsatisfactory. Hair counts (follicles/cm2) were used to judge the outcome. The mean follow-up time was 23.25 weeks (range 12-76 weeks). After a mean number of treatments of 1.92 (range 1-20) there was a 56.4% reduction in hair density. Comparing pre- and post-treatment hair density, there was a highly significant reduction (paired t-test: P < 0.00001). Laser removal of hair is now a realistic treatment option.     

Long-pulsed ruby laser for permanent hair reduction: histological analysis after 3, 4 1/2, and 6 months

BACKGROUND AND OBJECTIVES: The histology of hair follicles in both animal and human skin treated with ruby lasers has been evaluated to a limited extent in previous studies. We have previously looked at such follicles up to 2 months after treatment. This study examines the longer-term effects at a microscopic level and attempts to further elucidate the mechanism of ruby laser hair reduction. STUDY DESIGN/MATERIALS AND METHODS: Thirty-six patients underwent 1, 2, or 3 treatments of their axillary or bikini area skin with a 3 milliseconds ruby laser at 10, 20, 30, or 40 J/cm(2). Biopsies were taken 3, 4(1/2), or 6 months after the last treatment and examined histologically. Nine control biopsies were taken from comparable bikini areas of untreated patients and similarly evaluated histologically. RESULTS: There was a significant increase in telogen compared to anagen follicles in treated skin, which was slightly increased by multiple compared to single treatments, but unaffected by different time intervals since the last treatment. There was also a significant increase in miniaturized compared to terminal hairs in treated compared to control skin, a finding that was further increased with higher energies used. Multiple treatments and time after treatment had a slight, but not statistically significant effect on follicle size. CONCLUSIONS: Induction of telogen in terminal follicles followed by miniaturization appears to be the main mechanism of ruby laser hair reduction.     

Effectiveness of the normal-mode ruby laser and the combined (normal-mode plus q-switched) ruby laser in the treatment of congenital melanocytic nevi: a comparative study

The effect of the normal-mode ruby laser (NMRL) and the combined (normal mode plus Q-switched) ruby laser on congenital melanocytic nevi (CMN) was evaluated, and the degree to which both laser treatment regimens remove melanocytes was compared in 15 patients. Each nevus was marked to designate half of the lesion for the NMRL treatment and half of the lesion for combined ruby laser treatment. The efficacy of each laser treatment was correlated with the degree of clinical improvement determined by photographic assessment, histological examination, and melanin reflectance spectrometry before and 3 months after laser treatment. A single treatment using the NMRL with energy fluences of both 20 J per square centimeter and 30 J per square centimeter resulted in a slight, but not significant, improvement in lightening of pigmentation (42.61% and 30.38%, respectively). A better clinical response (excellent to good) and higher percentage of lightening (64.45%-72.43%) was noted in the combined ruby laser-treated areas than the NMRL-treated areas. Histological results showed that the combined ruby laser provided a marked decrease in the number of the nevomelanocytic nests in both the junctional area and the papillary and reticular dermis, whereas the NMRL (with energy fluences of either 20 J per square centimeter or 30 J per square centimeter) caused a decrease in the junctional area and the papillary dermis. None of the nevi had complete clearance of the pigmentation after a single treatment. Therefore, multiple (four to five) treatment sessions are needed to cause complete removal of nevomelanocytic nests in CMN. In conclusion, the combined ruby laser is more effective than the NMRL alone in the treatment of CMN without scarring or textural change of the skin.     

Solar-Induced Postinflammatory Hyperpigmentation after Laser Hair Removal

BACKGROUND: Postinflammatory hyperpigmentation (PIHP) is a frequently encountered problem in many cosmetic procedures. The treatment of PIHP is difficult and remains a challenge. OBJECTIVE: To treat a patient who developed multiple hyperpigmented macules on her thighs due to sun exposure after treatment of unwanted hair using a normal-mode ruby pulse laser. METHODS: The patient was treated daily with tretinoin (Retin A) 0.1% cream, triamcinolone 0.1% cream, and hydroquinone 4% cream with sunscreen (Solaquin forte), and was to avoid sun exposure. Several sites received monthly treatment of 40% trichloroacetic acid (TCA). The degree of clinical improvement of the hyperpigmentation was assessed by both the physician and the patient. RESULTS: Cosmetic results were fair. The amount of hair in her thighs was reduced but the PIHP responded only slightly to therapy. CONCLUSION: To our knowledge this is the first case of solar-induced PIHP following laser hair removal. The treatment of PIHP is difficult because there are few therapeutic options that are consistently successful. Avoidance of exposure to ultraviolet light should be emphasized to all patients prior to laser therapy. We demonstrated that serial TCA peels provided an additional benefit compared to medical treatment.     

Histologic effects of ruby laser hair removal in Japanese patients

BACKGROUND AND OBJECTIVE: Hair removal by lasers has recently become a popular method to remove unwanted hair. However, histologic changes in human skin before and after exposure to lasers have not been thoroughly investigated. The aim of this study was to clarify the differences that occur immediately after laser exposure and 1 month after laser exposure. STUDY DESIGN/MATERIALS AND METHODS: Eight adult Japanese volunteers were recruited for this study. They were treated with a long pulsed ruby laser at 20 J/cm(2). A single 3-mm punch biopsy of the laser-treated sites was obtained immediately after laser irradiation and at the 1-month follow-up visit, and they were analyzed using hematoxylin and eosin, PAM, and immunohistological staining. RESULTS: Immediately after laser exposure, hair follicles were very damaged and had extensive eosinophilic degeneration. One month after laser therapy, one type of hair follicle showed cystlike formations with negative proliferating cell nuclear antigen reactions (PCNA). Another type of hair follicle showed follicular mitotic figures with cytoplasmic halos. Early anagen hair follicles were apparently not treated effectively by ruby laser. CONCLUSION: Ruby laser leads to extensive follicular damage, and hair follicles considered to be at early anagen phase were not effectively treated. This may be the reason several courses of laser therapy are required to obtain satisfactory results.     

Terminal hair growth after full thickness skin graft: Treatment with normal mode ruby laser

BACKGROUND AND OBJECTIVE: Treatment of hirsutism is often unsatisfactory with many of the currently used methods providing only temporary improvement. The use of lasers for hair removal has shown promising results and treatment by using the normal mode ruby laser has provided reduction in hair numbers sustained on follow-up. We report a woman who developed terminal hair growth at the site of a full thickness skin graft and describe her successful treatment with the normal mode ruby laser.     

Efficacy, Tolerability, and Safety of a Long-Pulsed Ruby Laser System in the Removal of Unwanted Hair

BACKGROUND: Unwanted hair growth is a common, usually physiologic phenomenon. OBJECTIVE: In this study the efficacy and tolerability of a long-pulsed ruby laser system was compared with needle electrolysis and hot wax on three parts of the body. METHODS: Thirty volunteers were treated three times on the forearm (n = 10), on the face (n = 10), or in the pubic area (n = 10) with 25 J/cm2 laser, 40 J/cm2 laser, needle electrolysis, and hot wax therapy. RESULTS: The 25 J/cm2 and 40 J/cm2 laser treated sites showed a statistically significant decrease (38% and 49%, respectively) in the number of hairs at the first visit after the last treatment compared to the pretreatment hair counts. No significant decrease was observed in the needle electrolysis and hot wax treated sites. Laser therapy yielded better results on the forearm than on the face or pubic area and was scored as the least painful. CONCLUSION: The long-pulsed ruby laser is a promising, well-tolerated method of epilation.     

Adverse effects reported in epilatory ruby laser treatment

A retrospective study was conducted to investigate the incidence of reported adverse responses after epilatory laser treatment to control the growth of facial hair in patients with polycystic ovary syndrome. Forty-eight patients received a median of 6 (range 2–11) treatments with an Aesculap ruby laser during a 704 day monitoring period at Salisbury District Hospital. Nine adverse skin responses such as blistering, scabbing, sustained localised erythematous reactions or hyperpigmentation were reported. The energy output of the laser was also recorded at the start of every clinical session during this period using an external energy meter. The measured energy output of the laser was plotted alongside incidents of adverse responses, although no statistically significant correlation was found. The question of whether or not some adverse effects in ruby laser treatment can be attributed to laser performance remains open.