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.     

Laser therapy for hair removal on grafts and flaps

The diversity and utility of laser procedures have increased over the recent years and nowadays, applications for medical and cosmetic reasons have increased considerably. Problematic intraoral and cutaneous hirsutisms have been described as a consequence of complex reconstruction usually after oncology surgery. We present three patients in whom hair removal laser was performed on grafts and flaps in different compromised anatomical areas: oral cavity, penis, and auricular pavilion. All three patients were men; in two of them the hairy graft was a consequence after oncologic surgery reconstruction whereas the third patient presented hair in his auricular pavilion after cochlear implant due to a congenital ear malformation. In all the patients, neodymium:yttrium, aluminum, garnet laser (Nd:YAG) (1,064 nm) laser was performed with excellent aesthetic and functional outcomes with only three sessions. Hair removal laser is a well‐accepted and effective method of achieving permanent decrease in hair density. Several lasers have been used successfully, including the long‐pulse Alexandrite (755 nm), the long‐pulse diode (810 nm), and the Nd:YAG laser (1,064 nm). There is currently no standard protocol for laser use on hairy grafts or flaps and there is limited published data regarding skin graft revision to enhance aesthetics and function.     

Paradoxical effects of hair removal systems: a review

Although a variety of lasers have proven to be clinically effective for long-term hair removal, the use of these lasers has also been associated with undesirable side effects, such as hyper- and hypopigmentation, crusting, erythema, and edema. One notable side effect that seems to be underreported in the literature is the growth of fine dark hair in untreated areas close to the treated ones. This contradictory hypertrichosis is known as the paradoxical effect. In this paper, we review the published reports of the paradoxical effect and offer some possible explanations for this effect. The paradoxical effect has been documented most commonly after the use of induced pulse light and alexandrite lasers. One possible explanation is the activation of dormant hair follicles by suboptimal fluences. Another mechanism may be the synchronization of hair growth cycles by direct light stimulation.     

Effective epilation of white and blond hair using combined radiofrequency and optical energy

OBJECTIVE: The present study examined the long‐term photoepilatory effect on blond and white hair of a combined intense pulsed light (680–980?nm) device with a bipolar radiofrequency component producing electrical current at a depth of 4?mm.

MATERIALS AND METHODS: Thirty‐six adult women with white and blond hair (skin phenotypes I–V) were included in the study. The chin and upper lip were treated with four treatment sessions over 9–12 months with long‐term follow‐up performed at month 18 (6 months after the last treatment). The level of RF energy was 20?J/cm³, while optical fluences varied from 24 to 30?J/cm². Hair counts and photographic evaluation of some sites were obtained at baseline, months 1, 3 and 5 and the final treatment session.

RESULTS: An average hair removal of 48% was observed at month 18 (6 months following the final treatment session). A slightly higher photoepilatory efficiency was noted for blond hair (52%) versus white hair (44%) treatment sites.

CONCLUSION: Combined radiofrequency and optical energy technology may produce effective photoepilation of blond and white hair phenotypes.     

Pili bigemini complicating diode laser hair removal

After two diode laser treatments for hair removal, a 39-year-old woman was noted to have pili bigemini within the treated areas. It resolved after a third treatment. Pili bigemini, the appearance of two hairs coming from the same follicular opening, can be induced by intermediate doses of laser energy. It follows sublethal damage to the hair follicule apparatus.     

From flint razors to lasers: a timeline of hair removal methods

Today, most do not go a day without practicing or hearing about new hair removal methods. However, little is discussed about the history of hair removal and the development of most hair removal methods since the period of cavemen. Avoiding decapitation and fitting in with society are two of many reasons for the development of this now normative practice. Knowledge of the hair growth cycle is vital in understanding the efficacy of various hair removal methods as well as the difference between epilation and depilation. While laser hair removal (LHR) is one of the most common cosmetic procedures practiced in the world, according to the FDA, the only current permanent form of hair removal is electrolysis. These two methods as well as various other ones are discussed in this article. Further developments are being made every day to better treat the removal of blonde and white hair as well as to diminish the pain of hair removal. With these developments, dermatologists will better understand the advancement of hair removal methods and the reasons why patients may seek treatment.     

Long-pulsed ruby laser-assisted hair removal in male-to-female transsexuals

Background Unwanted male‐pattern pilosity is a heavy psychological burden and can cause distress for male‐to‐female transsexuals. Orchidectomy and oestrogen supplementation combined with antiandrogens fail to make hair disappear. Aims To study the effect of long‐pulsed ruby laser treatment. Results Hair density was successfully abated on the beard and chest of three male‐to‐female transsexuals. A lingering effect over 6 months with a 50–90% hair density reduction was obtained. Conclusion Photothermolysis using the long‐pulsed ruby laser is a promising, well‐tolerated method of hair removal in male‐to‐female transsexuals under oestrogen supplementation and antiandrogens.     

Laser-assisted hair removal for darker skin types

Before the advent of longer wavelengths, longer pulse durations and more efficient cooling devices, laser-assisted hair removal was best suited for phototypes I-III with dark terminal hairs. Now, laser-assisted hair removal can be performed safely and efficaciously on darker skin types. The long-pulsed diode and Nd:YAG-wavelength-based laser systems are best suited to safely and effectively treat patients with darker skin types. By using conservative fluences, longer pulse durations and multiple treatments, safe and effective laser-assisted hair removal is possible for darker skin types. Patients with darker skin who suffer from hirsutism, hypertrichosis, and pseudofolliculitis barbae can finally be treated safely and effectively.     

Novel laser hair removal in all skin types

Background

Laser has been long accepted as a solution for excess or unwanted hair growth yet traditional lasers are not always ideal for safe and effective outcome for all skin types and hair characteristics. A diode laser module combining three wavelengths (755, 810, and 1064 nm) in a single pulse was developed to provide a fast and long-term solution for subjects with various profiles.

Aims

To evaluate the safety and efficacy of a Triple wavelength diode laser module for hair removal treatment in all skin types (Fitzpatrick I–VI).

Subjects and methods

This was a prospective, dual centered, single-arm study. Subjects were treated with a novel diode laser module. Thirty-six subjects were enrolled, sixteen with Fitzpatrick skin types I–IV (46%) and twenty with Fitzpatrick skin types V–VI (54%). Treatment areas were axilla and bikini lines. Subjects underwent 4 treatment sessions at 6 weeks ± 5 days intervals and attended a follow-up visit 3 months after the last treatment session. 2D digital photographs were taken at baseline and at the follow-up visit, and a hair count was conducted by three blinded evaluators.

Results

A significant reduction in hair count between baseline and the 3-month follow-up visit was observed in both axilla and bikini lines for all skin types. The mean hair reduction was 41.5 ± 19.4% and 48.1 ± 20.9% in the axilla and bikini line, respectively. A significant hair reduction was also observed within skin type groups; mean hair reduction 45.5 ± 16.9% and 40.3 ± 17.2% in skin types I–IV and V–VI, respectively, indicating similar efficacy for both light and dark skin types. No serious adverse events were reported.

Conclusions

This study demonstrates that the Soprano Titanium laser platform is safe and effective for hair removal treatment in all skin types.     

Effect of hair removal by Nd:YAG laser on the recurrence of pilonidal sinus

Background  Pilonidal sinus (PNS) is chronic inflammatory process of the skin in the natal cleft. Management of PNS is mainly surgical. Although different types of surgery have been performed, the recurrence rate is still high.
Objective  To evaluate the effectiveness of laser hair removal (LHR) in the natal cleft area on the recurrence rate of PNS as an adjuvant therapy after surgical treatment.
Methods  Twenty five patients with PNS were included in this study. Fifteen patients underwent LHR treatment using Nd:YAG laser after surgical excision of PNS (Patients group) while ten subjects with PNS did not do LHR and served as a control group.
Results  All of the patients were male patients. Their age ranged from 17 to 29 years with a mean of 21.60 ± 3.13 years. They had Fitzpatrick skin type III, IV and V. The patients have got 3 to 8 sessions of LHR (mean 4.87 ± 1.64). Follow up period lasted between 12 to 23 months. None of the patients, who underwent LHR, has required further surgical treatment to date. Seven patients out of ten in the control group have developed recurrent PNS. Pain was the most frequent side effect and it was seen in 6 patients (40%).
Conclusion  LHR can prevent the recurrence of PNS. LHR should be advised as an essential adjuvant treatment after surgical excision of PNS. In non-complicated recurrent PNS, LHR is strongly advocated to be started before and continued after doing surgical treatment.     

A 12-month follow-up of hypopigmentation after laser hair removal

Abstract

Introduction: Laser hair removal is becoming an increasingly popular alternative to traditional methods such as shaving, waxing, among other methods. Semiconductor diode lasers are considered the most efficient light sources available and are especially well suited for clinical applications including hair reduction. The effectiveness of laser hair reduction depends on many variables, including the skin type of the patient. Material and Methods: A patient with Fitzpatrick Skin Type IV was submitted to laser hair removal of the arms with a high-power diode laser system with long pulses with a wavelength of 800 nm, a fluence of 40 J/cm² and a pulse width of 20 ms. A 12-month follow-up assessment was performed and included photography and questionnaire. Results: Hypopigmentation was observed after a single laser hair removal section. After 6 months with the area totally covered, a gradual suntan with a sun screen lotion with an SPF of 15 was prescribed by the dermatologist. After 12 months of the initial treatment, a complete recovery of the hypopigmentation was achieved. Conclusion: Although a safe procedure, lasers for hair removal may be associated with adverse side effects including undesired pigment alterations. Before starting a laser hair removal treatment, patients seeking the eradication of hair should be informed that temporary, and possibly permanent, pigmentary changes may occur.     

Laser hair removal

The theory behind laser hair removal and pulsed flashlamps is briefly reviewed, as are the devices currently available for this indication. Today, the treatment procedure has been firmly established so that clear and precise information can be provided to patient on the results obtained with these techniques, both for medical and esthetic indications. The potential complications are discussed with respect to the treatment procedures and a thorough understanding of the theoretical foundations.     

Laser hair removal in a patient with polycystic ovarian syndrome and vitiligo

It is well recognized that vitiligo displays the Koebner phenomenon. However, the impact of this phenomenon on hair removal in these patients has little been considered. This is a challenging case of a woman with hirsutism and vitiligo who opted to have laser hair removal treatment.     

Laser hair removal

Laser hair removal created controversy when it was first described over 5 years ago. It has now become an accepted modality for long-term hair reduction. It rivals electrolysis in the successful treatment of small hair-bearing areas. It surpasses any modality in the treatment of larger hair-bearing anatomic areas.     

Laser hair removal

The presence of unwanted hair continues to plague many individuals for whom traditional methods of hair removal remain unsatisfactory. Laser and flashlamp technology now offers the potential for rapid, safe, and effective treatment of unwanted hair. An ever-increasing number of published studies have confirmed the long-term efficacy of laser and flashlamp treatment. For the most part, however, the benefits of this technology have been limited to individuals with dark hair and relatively fair skin. The remaining challenge is to develop the means to eliminate light-colored hair as well as the capability to safely treat individuals with darker skin. The rapid pace of technological advancement as well as continued studies of hair follicle biology promise to improve this field over the years to come.     

Effects of ambient room temperature on cold air cooling during laser hair removal

Forced air cooling is a well-established technique that protects the epidermis during laser heating of deeper structures, thereby allowing for increased laser fluences. The goal of this prospective study was to identify whether an elevation in ambient room temperature influences the efficacy of forced air cooling. Skin surface temperatures were measured on 24 sites (12 subjects) during cold air exposure in examination rooms with ambient temperatures of 72 degrees F (22.2 degrees C) and 82 degrees F (27.8 degrees C), respectively. Before cooling, mean skin surface temperature was 9 degrees F (5 degrees C) higher in the warmer room (P < 0.01). Immediately after exposure to forced air cooling (within 1 s), the skin surface temperature remained considerably higher (10.75 degrees F, or 5.8 degrees C, P < 0.01) in the warmer room. We conclude that forced air cooling in a room with an ambient temperature of 82 degrees F (27.8 degrees C) is not as effective as in a room that is at 72 degrees F (22.2 degrees C).     

Second‐degree burn within a tattoo after intense‐pulsed‐light epilation

The use of high energy light sources [laser, intense pulsed light (IPL)] is booming in aesthetic surgery. A trend, especially concerning usage of photoepilation in cosmetic institutes, is detectable. Photoepilation works through selective photothermolysis, by heating the chromophore melanin within the hair follicles. We present a case impressionably demonstrating that high‐energy light demands profound knowledge of its mechanism of action, and can cause severe harm in absence of basic knowledge. Photoepilation is a balancing act between maximal therapeutic effect and minimal side effect risk. Nevertheless, complications have to be clearly distinguished from professional errors. The latter are rising especially with IPL devices, mainly because its use depicts a legal grey area in most of the countries and is not bound to physicians' supervision. Due to its worse risk–benefit profile as compared with that of laser therapy, we advise against the use of IPL devices and claim for stricter regulation of its use, similar to laser devices.     

Silk'n™ – A novel device using Home Pulsed Light™ for hair removal at home

A small, light-weight, low-energy, and low-cost IPL system designed for home use (Silk'n?; HomeSkinovations, Kfar, Saba, Israel) was tested for efficacy and safety on 34 test individuals and 92 sites. Each of the patients underwent informed consent and performed self-treatment at the clinic supervised by an experienced laser hair removal nurse. The pre- and post-treatment hair counts were performed and the reduction counts were analyzed by a blinded observer.     

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.