Evidence-based review of hair removal using lasers and light sources

BACKGROUND: Unwanted hair growth remains a therapeutic challenge and there is a considerable need for an effective and safe treatment modality. OBJECTIVE: From an evidence-based view to summarize efficacy and adverse effects from hair removal with ruby, alexandrite, diode, and Nd:YAG lasers and intense pulsed light (IPL). METHODS: Original publications of controlled clinical trials were identified in Medline and the Cochrane Library. RESULTS: A total of 9 randomized controlled (RCTs) and 21 controlled trials (CTs) were identified. The best available evidence was found for the alexandrite (three RCTs, eight CTs) and diode (three RCTs, four CTs) lasers, followed by the ruby (two RCTs, six CTs) and Nd:YAG (two RCTs, four CTs) lasers, whereas limited evidence was available for IPL sources (one RCT, one CT). Based on the present best available evidence we conclude that (i) epilation with lasers and light sources induces a partial short-term hair reduction up to 6 months postoperatively, (ii) efficacy is improved when repeated treatments are given, (iii) efficacy is superior to conventional treatments (shaving, wax epilation, electrolysis), (iv) evidence exists for a partial long-term hair removal efficacy beyond 6 months postoperatively after repetitive treatments with alexandrite and diode lasers and probably after treatment with ruby and Nd:YAG lasers, whereas evidence is lacking for long-term hair removal after IPL treatment, (v) today there is no evidence for a complete and persistent hair removal efficacy, (vi) the occurrence of postoperative side-effects is reported low for all the laser systems. CONCLUSION: The evidence from controlled clinical trials favours the use of lasers and light sources for removal of unwanted hair. We recommend that patients are pre-operatively informed of the expected treatment outcome.     

Pneumatic skin flattening (PSF): A novel technology for marked pain reduction in hair removal with high energy density lasers and IPLs

Background: Intense pulsed light (IPL) aesthetic treatment, such as hair removal from large areas, is often very painful. The problems of pain and discomfort can be divided into two different phases: immediate acute pain and the long‐term, milder, post‐treatment discomfort also associated with erythema. The immediate acute pain is felt during each treatment pulse and can accumulate to an intolerable sensation after a few shots, resulting in the necessity of either using topical analgesic creams which have several limitations or else to considerably slow down the process and/or apply less efficient low‐energy densities. The immediate pain is created by the stimulation of sensory nerves located near the basal layer of the epidermis and adjacent to the treated hair follicles. There is an interest in a technology which would significantly reduce acute pain and post‐treatment erythema, without the necessity of lowering the energy density or speed of treatments. Objectives: To examine the advantages of pneumatic skin flattening (PSF) with negative pressure: (i) for the reduction or elimination of pain, without chilling the skin, during hair removal with high energy density IPLs and pulsed lasers; (ii) for the reduction of post‐treatment erythema; and (iii) for the enhancement of hair removal. Materials and methods: We have removed hair from large areas such as legs and backs with a high‐energy (42?J/cm²) pulsed diode laser and an IPL (15–20?J/cm²). Room temperature gel was applied to the skin before treatment. In all cases but one, skin was not chilled by external cooling devices. We utilized a vacuum chamber and a transparent sapphire window to generate deep negative pressure in the treatment site and flatten the skin against the window. The level of applied vacuum was in the 200–600?mmHg range. We have compared the level of pain (I–V according to a modified McGill Pain Questionnaire) and the efficacy of hair removal on a total of 40 treatment sites The results of the vacuum‐assisted treatment sites were compared with the results on adjacent control areas, obtained without the application of vacuum. Post‐treatment erythema was also compared. Results and conclusions: PSF significantly reduces pain in all patients, even when higher (+30%) treatment energy levels are applied. Skin is well protected thermally by the conductive sapphire window. Post erythema and edema is considerably reduced, as well. Hair removal efficacy is preserved or enhanced. Treatment is faster and is uninterrupted by pain, without the necessity to apply topical anesthetic over a large area. Blood expulsion resulting from flattening the skin has also enabled the treatment of thin hair in light‐skinned patients, using yellow and green wavelengths (540?nm cut‐off filter) and short pulse durations with a higher efficacy than with the 650?nm cut‐off filter.     

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.     

Evaluation of the vacuum-assisted handpiece compared with the sapphire-cooled handpiece of the 800-nm diode laser system for the use of hair removal and reduction

Abstract

Background: A handpiece with a 35 × 22-mm treatment window that uses vacuum technology has been designed for the diode laser system. Vacuum suction stretches the skin and brings the hair follicle closer to the surface with the intent to damage the hair follicle at a lower surface fluence. The objective of this study was to compare the degree of follicular thermal damage between the sapphire-cooled smaller handpiece at a higher fluence versus the larger vacuum-assisted handpiece at a lower fluence. Methods: Five male patients with Fitzpatrick skin types I–IV were enrolled in the study. Three test spots on the right back were treated with the vacuum-assisted laser handpiece at a setting of 10–12 J/cm², and 61-ms pulse duration. Three test spots on the left back were treated with the sapphire-cooled handpiece with a setting of 30–34 J/cm² and a pulse duration of 14–16 ms. A punch biopsy was obtained from one treated area for each handpiece type. The biopsies were sectioned horizontally and examined for the degree of thermal damage to the hair follicle at the level of the isthmus and the bulb. Immediate treatment response, pain score, and total treatment time were recorded. Results: Biopsies from the skin treated with the sapphire-cooled handpiece and the vacuum-assisted handpiece showed the mean hair follicle diameter was 258.3 µm (SE [standard error] 41.7) and 225.1 µm (SE 17.1), respectively. The mean thermal damage diameter to hair diameter ratio was 0.91 (SE 0.10) and 0.72 (SE 0.12), respectively. The mean immediate treatment response, the mean pain severity, and the mean total treatment time were all lower for the vacuum-assisted handpiece. Conclusion: Treatment with the vacuum-assisted handpiece is faster and has a tendency to be more comfortable. Thermal damage to the hair follicle was greater with the sapphire-cooled handpiece.     

强脉冲光脱毛的疗效观察及分析

目的 观察强脉冲光脱毛的疗效和治疗时间，以及能量密度、毛发部位及皮肤类型对脱毛效果的影响。方法 574例患者，采用美国科医人公司生产的IPL Quantum HR仪器进行治疗。结果 574例患者中，57例患者自动放弃治疗（只治疗了1次未随访，未记入统计数据），517例患者取得了满意疗效，治疗毛发再生减少，再生时间延迟，再生毛发较前细小，色泽较前变淡。治疗早期，2例发生热损伤。结论 强脉冲光脱毛方便快捷，疗效满意，不良反应少．治疗效果在适当能量密度下与治疗次数呈正相关关系，亦与治疗部位有关。     

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.     

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.     

A novel explanation for the healing effect of the Er:YAG laser during skin rejuvenation

Abstract

The popularity of cutaneous laser resurfacing has soared in recent years. Ablative laser skin rejuvenation with carbon dioxide (CO₂) and erbium:yttrium-aluminum-garnet (Er:YAG) lasers has been popularized and their side effects individually reported. It has been suggested that initial collagen contraction and thermal damage modulate wound healing. Progress in laser technology permits precise tissue removal and minimal thermal damage. However, mechanisms for cosmetic improvement have not yet been completely determined. In the present short communication, we would like to suggest a possible mechanism for the healing effects exerted by the Er:YAG laser.     

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.     

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.     

Fractional ablative laser skin resurfacing: A review

Abstract

Ablative laser technology has been in use for many years now. The large side effect profile however has limited its use. Fractional ablative technology is a newer development which combines a lesser side effect profile along with similar efficacy. In this paper we review fractional ablative laser skin resurfacing.     

Fractional carbon dioxide laser for facial rejuvenation: A prospective study to evaluate the efficacy and the safety

Background: The aim of this study was to evaluate the efficacy and safety of the fractional ablative carbon dioxide laser for facial rejuvenation. Materials and Methods: Twenty-nine female who have the complaint of facial aging were recruited for the study. Participants received a maximum of three laser treatment sessions with one-month intervals and were scored using a 5-point scale on seven categories for facial aging before and after the treatment by the physicians. Self-assessments by participants were done at the last month of follow-up period and 3 years after the last session. Results: Mean facial aging score before the treatment was 11,24 ± 4,30 and after the treatment was 10,51 ± 3,86 (p = 0.003). The decrease in the score was mild in 18 (62,1%) participants, whereas it was moderate in only 1 (3,4%) participant. None of the participants had significant or perfect improvement. When the seven categories were analyzed seperately, the only statistically significant alteration in the score was found in the skin tone category (p = 0.0001). Conclusion: Results show that rejuvenation with the fractional ablative carbon dioxide laser decreases mildly the symptoms of facial aging in more than half of the patients.     

Erbium:yttrium aluminum garnet laser versus Q-switched neodymium:yttrium aluminum garnet laser for the treatment of xanthelasma palpebrarum

Background: Several lasers have been used for the treatment of xanthelasma palpebrarum (XP), such as Q-switched neodymium:yttrium aluminum garnet (QSNd:YAG) and erbium:yttrium aluminum garnet (Er:YAG) laser. Up to now, a comparative study among these laser options in the treatment of XP has not been reported. Objective: The aim of this study was to compare the clinical efficacy and response rates of QSNd:YAG and Er:YAG in the treatment of XP. Methods: Sixty patients with a total of 102 XP lesions were randomly and equally divided into two groups. The first group was treated with QSNd:YAG at a fluence of 10 joule/cm², 10 Hz and 2 mm spot size, and the second group was treated with Er:YAG at 200-300 millijoule, 4 Hz and 2 mm spot size. Results: In the Er:YAG group, the percentage of patients who required 3 or 4 sessions and wound healing time were higher compared to those of the QSNd:YAG group. Furthermore, the percentage of patients who had an improvement score of 4 was higher in the Er:YAG than that in the QSNd:YAG group. Conclusion: Er:YAG is an efficient, successful and minimally invasive method without long-lasting adverse effects.     

Picosecond alexandrite laser is superior to Q-switched Nd:YAG laser in treatment of minocycline-induced hyperpigmentation: A case study and review of the literature

Background: Minocycline is a commonly prescribed tetracycline antibiotic used for the treatment of a number of dermatological conditions including acne and rosacea. Long-term adverse effects of minocycline include cutaneous hyperpigmentation. Various treatment options have been suggested for the treatment of minocycline pigmentation. We report a case of a patient on long-term low-dose minocycline for the treatment of rosacea with type III minocycline hyperpigmentation. A comparison was made between Q-Switch Nd:YAG and picosecond laser over a nine 9-period with treatments spaced 1 month apart, with a clearance in the patient pigmentation after four treatments with picosecond laser.     

New clinical outcomes utilizing a 1064-nm Nd:YAG laser for lipolysis of the torso oblique region

Abstract

Objectives: The safety and efficacy of a 1064-nm Nd:YAG laser (Cynosure, Westford, USA) utilizing a 300-μm optical fiber and a 1-mm diameter micro-cannula were evaluated as a treatment for reduction in the appearance or elimination of unwanted fat in the lower back/flanks (‘love handles’). In addition, the use of the laser for tightening the skin and collagen regeneration in the area of lipolysis was assessed through biopsies. Methods: Ten subjects with unwanted flaccidity and fat deposits in the oblique region of the torso were enrolled in the study. Subjects underwent a single laser lipolysis treatment followed by aspiration of the treatment area. The total tumescence used, laser energy delivered, and tissue removed was recorded for each subject. All subjects had baseline photographs taken and their weight recorded prior to treatment. Pregnancy tests (if applicable) were performed prior to treatment as well. Three subjects had 4-mm biopsies taken at baseline and 6 months to evaluate collagen regeneration. Collagen and elastic tissue fibers were evaluated using special routine stains and histochemical stains designed to highlight these dermal components. Follow-up visits were conducted at 1 week, 1 month, 3 months and 6 months following treatment to evaluate side effects, weight loss and laxity. Additionally, patients kept an evaluation log for each of the first 7 days following treatment. At the 6-month conclusion, patient satisfaction was recorded. Results: Laser lipolysis procedures with subsequent aspiration were performed bilaterally on the flanks of 10 subjects. At 1-week post-treatment, 80% of the subjects demonstrated reduction in laxity. Similarly, 100% of patients showed visible skin improvement at 1 month, with 70% recording a score of 2 (good improvement). Three-month evaluations yielded one patient (10%) with a score of 3 (excellent improvement) and seven patients (70%) with a score of 2. Histology reports confirmed the visual clinical outcomes, describing thicker collagen bundles at 6 months, as well as coagulation of blood vessels and adipocytes. Side effects were mild and transient in nature, and the majority of discomfort, redness, bruising, swelling, and tingling experienced was resolved within 1 week post-procedure. The treatment was well tolerated and efficacious, with 90% of patients rating their results as good or excellent and 100% of patients reporting that they would recommend the procedure. Conclusion: The use of the 1064-nm Nd:YAG laser with a 300-μm fiber demonstrated the ability to treat adipose tissue in the highly vascular flank area with favorable efficacy and safety. Patients exhibited a quick recovery time and excellent tolerance, as well as visually improved skin.     

Efficacy and safety of mascara dyeing as an adjunct to Alexandrite and Nd:YAG laser applications for removing thin and white-colored facial and axillary hair

Introduction: There is no satisfactory and efficient method for long-term removal of white-colored and thin hair. Methods: We conducted a randomised clinical trial of hirsute patients with excessive white and/or thin hair on the face and/or axilla. In Group I (n: 16), the facial hair on one side of the face was painted with a black eyelash mascara immediately before Nd:YAG laser and the other half was only treated by Nd:YAG. In Group II (n: 20), the axillary hair on one side was painted with the mascara before the Alexandrite laser with the other side being only treated by Alexandrite. Results: The terminal hair counts on the painted facial and axillary sides were significantly lower than those on the control sides throughout the study except for the first month. The decrease in the terminal hair count was significant from the beginning of treatment to the second and sixth months on the painted and control facial sides and to the first and sixth months on the axillary sides. Conclusion: Hair coloring with black eyelash mascara is a simple, efficient and safe adjunct to Alexandrite and Nd:YAG laser applications to enhance their clinical efficacy in eliminating white and thin facial or axillary hair.     

Photoepilation: a growing trend in laser-assisted cosmetic dermatology

Excess hair is an age-old condition plaguing both men and women alike, of all races. Conditions such as hirsutism or hypertrichosis, procedures that involve grafted donor sites, transsexual transformations from male to female, and genetics are all responsible for excess or unwanted hair. Previous options for people seeking to remove or lessen the presence of hair have either been painful or resulted in short-term hair removal. With the recent advent of laser technology, hair removal has been added to the many capabilities of the new generation nonablative lasers and light systems. Lasers are not yet a permanent solution for hair removal, but they are able to provide a safe, fast, and effective method of hair reduction.