Lasers for reduction of unwanted hair in skin of colour: a systematic review and meta-analysis

Light-based therapies are one of the most effective and widely used strategies for removal of undesired hair, with a broadly favourable safety profile. However, subjects with pigmented skin are found to be more prone to laser-related adverse events. While prolonged pulse-width and longer treatment duration were proposed to minimize adverse events, the optimal treatment option among available phototherapy modalities – long-pulsed (Nd:YAG), pulsed diode and alexandrite lasers as well as intense pulsed light (IPL) – remains unclear, particularly for skin of colour. To determine superiority in terms of effectiveness and tolerability, we conducted a systematic review of literature on different types of in-office laser and IPL for hair removal in subjects with Fitzpatrick skin types III–VI. The meta-analysis was performed using Review Manager (RevMan) version 5.3 and included 12 eligible comparative trials (nine randomized controlled trials and three quasi-randomized). In terms of hair count reduction, pooled effect estimates for long-pulsed ND:YAG laser [OR: 0.26, 95% CI (0.1, 0.78)] and diode laser [standardized mean difference (SMD): −0.11, 95% CI (−0.62, 0.39)] were not statistically significant from those of IPL; in contrast, alexandrite laser was found to be superior to IPL in reducing hair count [SMD: −1.7, 95% CI (−2.6, −0.78)]. In terms of adverse events, the pooled effect estimates favoured long-pulsed Nd:YAG laser to IPL with respect to postinflammatory hyperpigmentation [OR: 0.26, 95% CI: (0.1, 0.78)]. However, both pulsed diode and alexandrite lasers exhibited a comparable safety profile to IPL, despite higher pain scores with lasers. In conclusion, this systematic review suggests that treatment outcomes for different in-office laser devices and IPL in subjects with skin type III–VI are broadly similar; nevertheless, we observed a trend towards greater hair reduction following laser therapy compared with IPL.     

Laser hair removal

Since 1996, there have been numerous advances in hair laser removal that utilize melanin as a chromophore. All of the devices on the market may be used in patients with light skin (phototypes I-III) and yield hair reduction near 75%. The ruby (694 nm) laser, alexandrite (755 nm) laser, and diode (810 nm) laser, as well as intense pulsed light are commonly used devices for hair laser removal. The long-pulsed Nd:YAG (1064 nm) laser represents the safest device for hair removal in dark-skinned patients because of its long wavelength, although the diode laser, alexandrite laser, and intense pulse light may be used. For treatment of light hair, combination radiofrequency and optical devices as well as photodynamic therapy are under investigation.     

Treatment of trichostasis spinulosa with a 755‐nm long‐pulsed alexandrite laser

Background Trichostasis spinulosa (TS) is a common disorder of hair follicle, characterized by spinous plugs. Topical treatments offer temporary relief but permanent removal of the abnormal follicles using hair removal lasers may result in a definite cure. Objective To evaluate the safety and efficacy of 755‐nm alexandrite laser for the treatment of TS lesions. Patients and methods Two consecutive 755‐nm alexandrite laser treatments were performed one month apart. The clinical response and adverse effects were assessed four weeks after the first and second treatments and 20 weeks after the second treatment. Results Thirty one patients with skin phototypes II to IV completed the study. At the last follow up visit, a decrease in dark‐plug density of greater than 50% was noted in 16 patients (51.3%), while only three patients (9.7%) had an improvement of greater than 75%. Ten of the 21 patients (47.6%) with skin type III and six of the seven patients (85.7%) with skin type IV achieved at least 50% improvement in lesions at the last follow up visit (P = 0.1). Conclusion The 755‐nm alexandrite laser can safely and effectively reduce TS lesions lasting for a relatively long time in patients with skin types III–IV.     

Photorejuvenation using long-pulsed alexandrite and long-pulsed neodymium:yttrium-aluminum-garnet lasers: a pilot study of clinical outcome and patients' satisfaction in Koreans

Long-pulsed 755-nm alexandrite and long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers have been used for photorejuvenation of the face. The aim of this study was to investigate the safety and efficacy of long-pulsed alexandrite and long-pulsed Nd:YAG lasers for photorejuvenation in Korea. One hundred and sixteen Korean patients with photo-aged facial skin were enrolled. Sixty-two patients with facial pigmentation underwent long-pulsed alexandrite laser treatment. Eleven patients that wanted to improve facial pigmentation with minimal pain had quasi-long-pulsed alexandrite laser treatment. Forty three patients had long-pulsed Nd:YAG laser therapy. Outcome assessments included standard photographs and global evaluation by blinded investigators. The self-assessment grade was provided in questionnaires. Forty-four percent of patients reported excellent or good improvement of their pigmentary lesions (>50% improvement) using a long-pulsed alexandrite laser. Of patients who underwent long-pulsed Nd:YAG laser treatment, 36% reported excellent or good improvement in skin tightening, 50% in facial flushing and 45% in pigmentary lesions. We conclude that long-pulsed alexandrite and long-pulsed Nd:YAG lasers are safe and effective for facial photorejuvenation in Koreans.     

Clinical comparison of four hair removal lasers and light sources

Background and objective: There are few clinical studies directly comparing the efficacy of multiple hair removal systems in the same individual. This study evaluates the efficacy of four highly popular systems for laser hair removal. Methods: In this prospective comparison study, 10 subjects underwent treatment of unwanted hair on the back or thigh. Subjects were skin types I–III, aged 18–55 years. All were treated twice with (1) an intense pulsed light with a red filter; (2) an intense pulsed light with a yellow filter; (3) an 810?nm diode laser; and (4) a 755?nm alexandrite laser. Four treatment areas, using commonly accepted parameters for permanent hair reduction, as well as a control non‐treated area were selected. Each treatment area was evaluated with a camera system specifically designed for hair counts at 1, 3, and 6 months after the second treatment by a blinded non‐treating physician. Clinical results and adverse events were also noted. Results: Evaluation of photographs at 1, 3, and 6 months revealed a significant decrease in hair counts (～50%) and hair coverage (～55%). In the hairs that remained after two treatments, no statistical difference was noted in hair length or diameter. There was no statistical difference in efficacy between the four different light devices. Minimal transient adverse effects were noted from all systems. The cryogen spray‐based alexandrite laser showed the highest pain scores. Conclusion: Although hair removal with commonly used systems is, as expected, highly effective, treatment with light‐based devices can cause less pain, yet show efficacy similar to laser systems.     

Long-pulsed Nd:YAG laser-assisted hair removal in pigmented skin: a clinical and histological evaluation.

OBJECTIVE: To determine the safety and effectiveness of a long-pulsed Nd:YAG laser at 1064 nm in effecting long-term hair reduction in patients with darkly pigmented skin. DESIGN: Nonrandomized before-after clinical and histological trial. SETTING: Private practice, ambulatory care facility. PATIENTS: Twenty women with skin phototypes IV through VI and dark brown to black terminal hair on the face, axillae, or legs. INTERVENTION: A series of 3 long-pulsed (50-millisecond) 1064-nm Nd:YAG laser treatments at fluences ranging from 40 to 50 J/cm(2) were delivered to the identified treatment areas on a monthly basis by a single operator. MAIN OUTCOME MEASURES: Global clinical grading scores of comparable before-after treatment photographs were determined by 2 independent medical assessors during each laser session and 1, 3, 6, and 12 months postoperatively. A dermatopathologist reviewed unmarked histological specimens obtained at baseline, immediately after the initial laser treatment, and at 1 and 6 months after the final laser session. RESULTS: Substantial hair reduction was seen after each of the 3 treatment sessions. Prolonged hair loss was observed 12 months after the final laser treatment (70%-90% hair reduction). Axillary hair was substantially more responsive to laser irradiation than was hair located on the legs and face. Adverse effects included mild to moderate treatment pain and rare occurrences of vesiculation and transient pigmentary alteration without fibrosis or scarring. Histological tissue changes mirrored clinical response rates, with evidence of selective follicular injury without epidermal disruption. CONCLUSION: The long-pulsed 1064-nm Nd:YAG laser is a safe and effective method of long-term hair reduction in patients with darkly pigmented skin.     

Novel 755-nm diode laser vs. conventional 755-nm scanned alexandrite laser: Side-by-side comparison pilot study for thorax and axillary hair removal

Background: Alexandrite (755 nm) and diode lasers (800–810 nm) are commonly used for hair removal. The alexandrite laser technology is somewhat cumbersome whereas new diode lasers are more robust. Recently, alexandrite-like 755 nm wavelength diodes became available. Objectives: To compare the efficacy, tolerability, and subject satisfaction of a 755 nm diode laser operated in conventional (HR) and non-conventional in-motion (SHR) modes with a conventional scanned alexandrite 755 nm laser for chest and axillary hair removal. Materials and methods: A prospective, single-center, proof of principle study was designed to evaluate the safety, efficacy and handling of a 755 nm diode laser system in comparison to a standard alexandrite 755 nm scanning hair removal laser. Results: The new 755 nm diode is suitable to be used in SHR and HR mode and has been tested for its safety, efficacy and handling in a volunteer with success. Overall, both systems showed a high efficacy in hair reduction (88.8% 755 nm diode laser vs. 77.7% 755 nm alexandrite laser). Also, during the study period, no severe adverse effects were reported. Conclusion: The new 755 nm diode laser is as effective and safe as the traditional 755 nm alexandrite laser. Additionally, treatment with the 755 nm diode laser with HR and SHR modes was found to be less painful.     

A case of generalized bromhidrosis following whole-body depilatory laser

Background: Laser treatment is a widespread method for hair removal. Despite its very common use, side effects remain relatively rare and transient. Objective: Axillary hyperhidrosis and bromhidrosis have already been reported in the literature after depilatory lasers. We report here a novel side effect of total body bromhidrosis following hair removal laser. Results: A 27-year-old man, phototype 3 underwent four sessions of total body depilatory laser, combining pulsed alexandrite and pulsed diode lasers. A few days afterwards, a generalized foul odor was noted and was resistant to regular deodorants and Aluminum chloride based antiperspirants. Possible mechanisms include the activation of dormant bacteria in the skin flora, sweat gland dysfunction, altered skin flora, sweat gland hormone receptor disturbances, and genetic factors. Conclusion: Total body bromhidrosis and hyperhidrosis are potential complications of total body laser hair removal.     

Hair removal on dark‐skinned patients with pneumatic skin flattening (PSF) and a high‐energy Nd:YAG laser

Background: Permanent laser hair removal is normally performed with high‐energy densities and associated with acute pain. Pneumatic skin flattening (PSF) is a new technology, which helps to control the pain during laser aesthetic treatments. Based on the gate theory of pain transmission, it activates tactile and pressure skin receptors just before the laser shot to naturally block the transmission of pain to the brain while the laser is activated. Objective: To test the safety, pain reduction, as well as the efficacy of PSF in hair removal on patients with dark skin (mainly skin types IV, V and VI) with a high‐energy Nd:YAG laser and without skin chilling. Methods: Patients were treated for hair removal with a 1064‐nm laser (GentleYAG, Candela) at energy densities of 40–44 J/cm². Each patient was treated on both axillae: PSF on one side and without PSF (but with a chiller) on control sites. Pain was evaluated on a 1–10 scale. Hair re‐growth was counted after 12 weeks. A second treatment was delivered at that time for additional evaluation of pain and further efficacy evaluation. Post‐treatment erythema and adverse effects were also noted. Results: Pain reduction was demonstrated in all 28 patients: the average was 2.6 with PSF and 4.5 without PSF. Hair removal efficacy with and without PSF was identical: 78–79% hair reduction after 12 weeks (standard deviation 14% and 10% respectively, t‐test: 0.78). There were no cases of adverse effects and post‐treatment erythema was consistently lower with PSF. All patients preferred PSF over non‐PSF treatment. Conclusion: The PSF technology considerably reduces pain in hair removal with high‐energy Nd:YAG lasers on dark skins without side effects, while preserving efficacy. Analgesic creams and skin chilling are not required.     

Ein neuer Ansatz in der Laser-Haarreduktion

Background

Photoepilation has been an essential field of application of dermatologic laser therapy for many years. The present article evaluates whether the use of a new operation mode of a long-pulsed diode laser can be effective, nearly painless, with few side effects and independent of the skin type. To this aim, its use has been compared to an established method of photoepilation.

Material and methods

In a controlled prospective study with 18 (♀=12, ♂=6) patients aged between 22 and 58 years, the effects of photoepilation with the long-pulsed alexandrite laser and the long-pulsed diode laser, operated in the Super Hair Removal mode (SHR), were compared.

Results

The alexandrite laser is slightly more effective with fair skin types; the SHR mode is clearly more effective with dark skin types. Regarding painfulness, the SHR mode is clearly superior. In terms of speed, the two systems are comparable. The alexandrite laser is more user-friendly because of its light and small handpiece.

Conclusion

The major advantages of the SHR mode are its effectiveness in dark skin types and its lack of pain. The alexandrite laser is slightly more effective with fair skin types, slightly faster and its handling is considerably more comfortable. None of the two systems has yet brought about a breakthrough with fair hair.     

Hair removal utilizing the LightSheer Duet HS hand piece and the LightSheer ET: A comparative study of two diode laser systems in Chinese women

Abstract

Objective: To compare the clinical efficacy, safety and pain associated with the use of the LightSheer Duet HS as compared to the original LightSheer ET diode Laser for axillae hair removal in Chinese women. Methods: Thirty-six Chinese women received three axillae laser hair removal treatments using the LightSheer Duet HS on one side and the LightSheer ET on the other side. Subjects were evaluated for hair removal efficiency. The immediate pain associated with the treatments was noted. Results: At 1 month following the final laser treatment, hair reduction on the LightSheer Duet HS side and on the LightSheer ET side was 81 ± 13% and 85 ± 9% respectively. There was no statistical difference. Immediate pain scores at the first session on the LightSheer Duet HS sites and LightSheer ET sites was 5.71 ± 1.74 and 6.86 ± 1.80 respectively, which was statistically significant (p < 0.05). Following the second and third sessions, immediate pain scores of the LightSheer Duet HS sites were both less than those of the LightSheer ET sites, but the differences were not statistically significant. Conclusions: The LightSheer Duet HS laser is a safe and effective method of hair removal in Chinese women. Treatment with the LightSheer Duet HS causes less pain.     

Histological hair removal study by ruby or alexandrite laser with comparative study on the effects of wavelength and fluence

BACKGROUND: Several different laser systems are currently used to remove unwanted hairs. In this study, we studied follicular changes following hair removal with ruby or alexandrite lasers at different fluences.

METHODS: Unwanted hairs were treated with a ruby laser (Chromos 694, ICN PhotonIcs, UK) at 10, 14 or 18?J/cm² or with an alexandrite laser (LPIR, Cynosure, USA) at 11, 14 or 17?J/cm². A 3?mm skin punch biopsy was taken immediately after each laser exposure and also 1 month later. Specimens were stained for histological observation. They were observed using immunohistochemistry with antibodies recognizing factor VIII related antigen or PCNA, and also by the TUNEL method. Similarly, electron microscopic observation was examined.

RESULTS: Immediately after the laser exposure, moderate follicular damage was observed following treatment with either type of laser. One month later, cystic formation of hair follicles and foreign body giant cells were observed in skin treated with either type of laser. A similar fluence with either laser treatment resulted in similar histological changes.

CONCLUSION: In this study, the histological changes following treatment with a ruby or an alexandrite laser at the same fluence are similar.     

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.     

长脉宽755nm紫翠宝石激光治疗雀斑的疗效观察

目的观察长脉宽755nm紫翠宝石激光治疗雀斑的疗效及安全性。方法119例雀斑患者接受长脉宽755nm激光治疗,共治疗1～2次,治疗间隔4周。术后4周、1年和2年复诊或电话随访,观察疗效和不良反应。结果119例患者中1次治疗有效率为79．8％（95例）,2次治疗后有效率为98．3％（117例）。所有患者术后反应轻微,且均无永久色素改变、瘢痕、皮肤质地改变、创面感染及其他严重不良反应。结论长脉宽755nm激光治疗雀斑疗效肯定,且较为安全。     

A split-face comparison of facial hair removal with the long-pulsed alexandrite laser and intense pulsed light system

Background: Undesirable hair growth presents a significant problem for many patients. Photoepilation has become a very popular procedure in esthetic and cosmetic practice. Among the systems used are the long-pulsed alexandrite laser (755 nm) (ALX) and intense pulsed light (IPL). Objective: To compare the safety and efficacy of long-pulsed ALX and IPL for hair removal. Patients and methods: This comparative study was carried out in the outpatient Department of Dermatology and Venereology, Al-Sadir Teaching Hospital, Al Najaf City during the period from June 2009 to July 2010. Thirty-five patients were included; thirty of them completed the study. They received six treatment sessions with the ALX on the left side of the face and IPL on the right side of face with 4-week intervals between sessions. Response to treatment on both sides of the face was assessed at 1, 3, and 6 treatment sessions. Hair-free intervals and patient's satisfaction were recorded in each visit. Results: After six treatment sessions, IPL-treated sides showed longer median hair-free intervals compared with ALX-treated sides. Reduction in hair counts was significantly larger on the IPL compared with that on the ALX-treated sides at 1, 3, and 6 sessions. Three patients (10%) developed postinflammatory hyperpigmentation, one of them on the left side and the others on the right side. It was more severe on the right side and both the patients were of skin type IV. Slight stinging and burning sensation at time of the treatment were recorded in all patients. All reported side effects were transient and tolerated by the patients except postinflammatory hyperpigmentation which persisted and was decreasing gradually toward the end of the study. Conclusions: The results of this study suggested that IPL is more effective in reducing excessive facial hair growth, with longer hair-free intervals and greater patient satisfaction than the ALX.     

Hair Removal Using a New Intense Pulsed Light Source in Chinese Patients

Background: Unwanted hair is a widespread cosmetic problem. Several lasers and intense pulsed light (IPL) have been utilized for this purpose. A new IPL device (Lumenis One^?) with OPT is one of the newer modalities to be studied in Chinese patients. Objective: This study evaluates the short-term efficacy and side effects of the new IPL device for epilation in Chinese patients. Methods: Eighteen Chinese women with Fitzpatrick skin types III–V and black hair, were treated four times at 4 to 6-week intervals using IPL (Lumenis One^?) on the axillae (n=13) and the upper lip (n=5). The energy density for treatment ranged from 14 to 22 J/cm². Parameters utilized were 695-/755-nm filters, triple pulse for patients on the axillae, and 640-/695-nm filters, double pulse for patients on the upper lip (3.5- to 7-ms pulse, 30- to 90-ms pulse delay, 15×35 mm spot size). Hair reduction was assessed at baseline, immediately before each treatment session, and at 4 weeks after the fourth treatment. Patient's satisfaction on a 5-point scale was also evaluated. Results: The average hair reduction for all sites was 49.9% after one session, 58.6% after two sessions, 79.3% after three sessions, and 83.8% after four sessions (p=0.001). The hair reduction of 44.1%, 52.1%, 81.1%, and 86.0% were achieved after each treatment for axillae, with 65.1%, 75.7%, 74.6%, and 78.0% for upper lip. Patients got more satisfaction after four sessions (score 3.1) than that after two sessions (2.0) (p=0.001). In both the assessments, upper lip appeared to show a better response than axillae after two IPL treatments, which reversed after four treatments. No significant complications or adverse events were reported. Conclusion: The new IPL device provides a safe and effective means of hair removal for Chinese patients. Treatment efficacy varies with the anatomic location and number of treatments. However, further study is necessary to determine the long-term clinical efficacy in Chinese patients.     

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.     

Incidence of side effects after laser hair removal

BACKGROUND: Despite the widespread use of lasers for hair removal there are few data published on the incidence of side effects from this treatment. OBJECTIVE: The aim of this study was to generate data on a large number of patients receiving laser hair removal to obtain an accurate assessment of the incidence and type of side effects resulting from treatment. METHODS: A multicenter prospective study of patients presenting for laser hair removal was conducted to determine incidence of side effects in relation to skin type and laser or lasers used. RESULTS: Laser hair removal is associated with a low incidence of side effects that are self-limiting in the majority of cases. The highest incidence of side effects was seen in patients with darker skin treated with the long-pulsed ruby laser. CONCLUSIONS: Laser hair removal is inherently safe. For darker Fitzpatrick skin types the long-pulsed neodymium:yttrium-aluminum-garnet laser is preferred to the ruby laser.     

Temporary hair loss using the long-pulsed alexandrite laser at 20 milliseconds

Facial hypertrichosis presents an enormous psychological burden for women. Temporary hair removal (waxing, plucking, etc.) and electrolysis are prolonged and unsatisfactory methods of treatment. For a few years several laser systems with varying wavelengths, pulse durations and energy fluences have been used successfully in laser epilation. In the retrospective study on hand, we report on results of 30 female patients with hypertrichosis in the facial area treated with the long pulse alexandrite laser at 20 msec (Cynosure PhotoGenica LPIR/Apogee; 755 nm; 20 msec; up to 30 J/cm2; 10 or 12.5 mm beam diameter) over an 18 month treatment period. After an average of 8 treatments, an average clearance rate of 75% could be achieved. Fair hair (white/blond/red) only showed a clearance rate of 10%. Hypo- and hyperpigmentation did not appear. The most frequent adverse effects were the occasional appearance of scattered crusting (17%), which healed without consequences, and folliculitis (13%). The average post-treatment observation time lasted 3.25 months. The long-pulsed alexandrite laser at a pulse duration of 20 msec is an effective and safe method of treatment of hypertrichosis in the facial region of women. Black hair responds considerably better to the laser treatment than fair hair. A longer post-treatment observation time is necessary, though, in order to provide evidence for the permanence of the success of the method.     

Clinical comparison of four hair removal lasers and light sources.

BACKGROUND AND OBJECTIVE: There are few clinical studies directly comparing the efficacy of multiple hair removal systems in the same individual. This study evaluates the efficacy of four highly popular systems for laser hair removal. METHODS: In this prospective comparison study, 10 subjects underwent treatment of unwanted hair on the back or thigh. Subjects were skin types I-III, aged 18-55 years. All were treated twice with (1) an intense pulsed light with a red filter; (2) an intense pulsed light with a yellow filter; (3) an 810 nm diode laser; and (4) a 755 nm alexandrite laser. Four treatment areas, using commonly accepted parameters for permanent hair reduction, as well as a control non-treated area were selected. Each treatment area was evaluated with a camera system specifically designed for hair counts at 1, 3, and 6 months after the second treatment by a blinded non-treating physician. Clinical results and adverse events were also noted. RESULTS: Evaluation of photographs at 1, 3, and 6 months revealed a significant decrease in hair counts (approximately 50%) and hair coverage (approximately 55%). In the hairs that remained after two treatments, no statistical difference was noted in hair length or diameter. There was no statistical difference in efficacy between the four different light devices. Minimal transient adverse effects were noted from all systems. The cryogen spray-based alexandrite laser showed the highest pain scores. CONCLUSION: Although hair removal with commonly used systems is, as expected, highly effective, treatment with light-based devices can cause less pain, yet show efficacy similar to laser systems.