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.     

Uncommonly reported side effects of hair removal by long pulsed‐alexandrite laser

Objective To provide retrospective clinical review of some uncommonly reported side effects of long‐pulsed alexandrite laser treatment for hair removal. Material and methods Two hundred and fifty female patients suffering from hirsutism of the face were subjected to treatment by long pulse alexandrite laser for a maximum of 15 sessions per patient at 5‐ to 7‐week intervals. Results Apart from the commonly reported side effects of pigmentary changes, occasional blistering and rare scarring, other untoward effects have been observed. These include – among others – de‐novo growth of hair outside the area treated by laser, potentiation of co‐existing vellus hair in the treatment area, induction or aggravation of acne, rosacea‐like rash, premature grayness of hair, tunneling of hair under the skin, prolonged diffuse redness and edema of the face, focal hypopigmentation of the lip, angular cheilitis, allergic reaction to the cooling gas, and inflammatory and pigmentary changes of pre‐existing nevi. Conclusion Although the efficacy of long‐pulsed alexandrite laser seems unmistakable, the short‐ and long‐term untoward effects of such treatment have yet to be carefully delineated and the underlying mechanisms are yet to be adequately clarified.     

Comparison of hair reduction with three lasers and light sources: Prospective,blinded and controlled study

Abstract

Objective: The main goal of this study was to compare the hair removal efficacy of three methods: intense pulsed light (IPL), a combination of IPL and radio frequency (RF) and diode laser (810 nm). Methods: Forty participants were treated within three standardized squares on lateral sites on their legs. Each of these squares was treated twice with an interval of 4–6 weeks. The fourth square was left as a control. A blinded physician counted the hairs in each square before the first treatment and 8 months after the second treatment. Immediate and delayed side effects as well as pain scores were recorded. Results: The mean hair count reduction achieved by the diode laser, IPL and IPL+RF was 49.90%, 39.16% and 47.15%, respectively. This study did not show any serious side effects and the number of side effects was minimal. The mean pain scores for the first and second treatments by diode laser, IPL and IPL+RF were 4.65 and 4.58, 2.43 and 2.53, and 3.95 and 4.03, respectively. At the end of the study, a free hair removal treatment for both legs was chosen by patients in the proportion 20 diode laser, 10 IPL and eight IPL+RF. Conclusions: The combination of RF and optical energies proved its safety and efficacy for hair removal, which is comparable with diode lasers and approximately 20% more efficient than ‘pure’ IPL.     

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.     

Long-term outcome of a patient with paradoxical hypertrichosis after laser epilation

One underreported, rare side effect of laser hair removal is paradoxical hypertrichosis. It is largely unknown what the long-term outcomes are of patients who develop this complication. We report a 21-year-old, Fitzpatrick II, male patient, who had patchy areas of dark hair affecting various body areas. An Alexandrite 755 nm laser was used to address the desired areas at energies between 20 and 22 J/cm² at 10–12-week intervals over a course of seven treatments. After three treatments, the patient noted a significant increase in the density and length of hairs involving the back, shoulders, neck, and upper arms. The patient was followed on a biannual basis, without further epilatory intervention. After 10 years, the areas of paradoxical hair growth were sparser compared to immediate post-treatment but remained denser compared to pre-treatment. This case illustrates improvement in the condition over time without intervention. Further studies are needed to determine the etiopathogenesis of this phenomenon.     

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.     

Treatment of injection‐induced ecchymoses with light/laser‐assisted technology

An increasing number of minimally invasive cosmetic procedures, such as filler or botulinum toxin injections, are performed annually. These procedures are associated with a high risk of post‐procedure bruising or ecchymosis. Ecchymoses arise following hemorrhage and extravasation of red blood cells into the subcutaneous tissue, leading to local skin discoloration. Although ecchymoses generally resolve within 14 days, their appearance is cosmetically bothersome, and they may be painful and cause major distress to patients. Recent clinical evidence suggests that light/laser technology with pulsed dye laser (PDL) or intense pulsed light (IPL) can dramatically alleviate and minimize bruising when delivered within 24–72 hr of the injection. This article, will review reports of treatment of ecchymosis by lasers and IPL.     

Poxvirus‐induced angiogenesis after a thermal burn

Orf (contagious ecthyma) is a zoonotic infection caused by a dermatotropic parapoxvirus that commonly infects sheep, goats, and oxen. Parapoxviruses are transmitted to humans through contact with an infected animal or fomites. Orf virus infections can induce ulceration, and papulonodular, pustular, or ecthymic lesions of the skin after contact with an infected animal or contaminated fomite. Rarely, orf virus provokes extensive vasculo‐endothelial proliferation as a skin manifestation. Here, we present the case of an 8‐year old female with poxvirus‐induced vascular angiogenesis that developed 10 days after a thermal burn. An 8‐year‐old female presented at our outpatient clinic with red swellings and a yellow‐brown crust on them. After a thermal burn with hot water, she went to a clinic and the burn was dressed with nitrofurazone and covered for 2 days. When the dressing was removed after 2 days, nodules were seen in the burnt areas. When the clinical findings were considered with the histopathological features, a reactive vascular proliferation due to a viral agent was suspected. Following PCR, parapoxvirus ovis was detected. Viral infections such as pox virus can trigger pyogenic granulomas or pyogenic granuloma‐like vascular angiogenesis. Infectious agents must be considered when dealing with pyogenic granuloma‐like lesions.     

Conversion of aesthetic lasers and intense pulsed light sources into inherently eye‐safe units

BACKGROUND: Laser systems used in aesthetic treatments pose a serious risk to the eyes of bystanders and equipment operators. Although much safer than lasers, intense pulsed light (IPL) sources are also not without risk.

OBJECTIVE: To present a technology that can convert most lasers and IPL units used in aesthetic clinics into inherently eye‐safe devices not requiring the use of protective eyeglasses, thus making them Class I devices. With the exception of Q‐switched lasers, this new technology also dramatically reduces the potential hazards of lasers that do not attain Class I level to below that attributed to flashlamps. A device that eliminates the annoying glare generated by the reflection of pulsed light from the skin is also presented.

MATERIALS AND METHODS: The new eye‐safe technology is based on the attachment of a highly efficient wide‐angle forward scattering optical diffuser to the distal end of the laser delivery handpiece. This device is used in contact with the treated area without modification of the conventional treatment parameters and preserves clinical efficacy. The handpiece is designed to act as an eye‐safe, extended diffusing light source complying with Class I eye safety standards in most laser types. The technology also makes IPL devices safer by reducing the radiance of the flashlamp, which is hazardous when viewed directly by operators or bystanders. Skin glare is also eliminated by a liquid crystal, glare‐free window activated in synchronization with the treatment pulses.

RESULTS: Clinical hair removal results with an 80?degree diffuser did not reveal any difference when compared with results obtained with the original laser source. The incorporation of a diffuser in an IPL unit has not modified its clinical efficacy.

CONCLUSION: With the exclusion of Q‐switched lasers, it is possible to convert a large number of lasers and IPL units utilized in aesthetic treatments into inherently eye‐safe units, thereby considerably enhancing the comfort and safety of aesthetic clinics without sacrificing clinical efficacy.     

Photoepilation: a potential threat to wound healing in a mouse

Background Theoretically, the bulge area which is known to be a reservoir of epidermal stem cells should be destroyed to achieve permanent photoepilation. We wished to determine whether wound healing capability is perturbed after photoepilation. Methods Twenty C57/BL6 mice were used. After wax epilation to synchronize the hair cycle, one‐half of the backs of mice were photoepilated in the early anagen stage. After the two hair cycles of the mice to confirm the hair removal effect, 30% trichloroacetic acid was applied to the both halves of the backs of the mice. A skin biopsy was performed on both sides before and just after the injury, and 2, 6, 9, and 14 days thereafter. The specimens were evaluated histologically after staining with hematoxylin and eosin, Masson trichrome, and Verhoeff‐van Gieson. Results No differences in wound healing times were evident upon gross observation by the naked eye. However, the photoepilated hairless skin was observed to have a thicker epidermis and dermis than normal hairy skin by histological evaluation. The cellularity of the healed wound was much denser in the photoepilated. Collagen production of the neodermis in the normal hairy skin was first observed around the lower part of hair follicle, while it started from the upper papillary dermis in photoepilated skin. Conclusion Photoepilation may disturb the normal wound healing process, especially dermal wound healing, and increases the risk of producing hypertropic scar or keloid.     

Hair removal in hirsute women with normal testosterone levels: a randomized controlled trial of long‐pulsed diode laser vs. intense pulsed light

Background Hirsutism is a common disorder in women of reproductive age, and androgen disturbances may aggravate the condition. Limited evidence exists regarding efficacy of hair removal in this specific population and no data are available for patients with verified normal testosterone levels. Objectives To compare efficacy and safety of intense pulsed light (IPL) vs. long‐pulsed diode laser (LPDL) in a well‐defined group of hirsute women with normal testosterone levels. Methods Thirty‐one hirsute women received six allocated split‐face treatments with IPL (525–1200 nm; Palomar Starlux IPL system) and LPDL (810 nm; Asclepion MeDioStar XT diode laser). Testosterone levels were measured three times during the study period. Patients with intrinsically normal or medically normalized testosterone levels throughout the study were included in efficacy assessments (n = 23). Endpoints were reduction in hair counts assessed by blinded photoevaluations at baseline and 1, 3 and 6 months after final treatment, patient‐evaluated reduction in hairiness, patient satisfaction, treatment‐related pain and adverse effects. Results IPL and LPDL reduced hair counts significantly, with median reductions from baseline of 77%, 53% and 40% for IPL and 68%, 60% and 34% for LDPL at 1, 3 and 6 months, respectively. At 6 months follow‐up, there was no significant difference between treatments in terms of hair reduction (P = 0·427), patient assessment of hairiness (P = 0·250) and patient satisfaction (P = 0·125). Pain scores were consistently higher for IPL [median 6, interquartile range (IQR) 4–7] than LPDL (median 3, IQR 2–5) (P < 0·001). Conclusion Hirsute women with normal or medically normalized testosterone levels responded equally well to IPL and LPDL treatments of facial hairiness, but the efficacy declined over 6 months.     

Long pulse 1,064‐nm neodymium‐doped yttrium aluminum garnet laser in aesthetic dermatology

Long pulse 1,064‐nm neodymium‐doped yttrium aluminum garnet (Nd:YAG) laser is a very versatile laser due to its deep penetration and absorption by hemoglobin, melanin, and water, which has gained increasing popularity over recent years for the treatment of leg veins and permanent hair removal as well as skin rejuvenation. The long‐pulse Nd:YAG laser was appointed as treatment of choice for the treatment of 0.5–3.0 mm deoxygenated, unsightly leg veins. Hair removal is another application of long pulse Nd:YAG lasers, and decreased light absorption by melanin at 1,064 nm reduces the risk of pigmentary side effects, which makes long pulse Nd:YAG laser the safest laser in darker skin types. The long pulse Nd:YAG lasers are also being employed for skin rejuvenation based on their ability to heat dermal water and stimulate collagen production. We have reviewed the parameters of Nd:YAG laser and shared our experiences in these indications that may be useful for good clinical response with minimal side effects.     

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.     

Intense pulsed light vs. pulsed‐dye laser in the treatment of facial acne: a randomized split‐face trial

Background Various laser and light therapy have been increasingly used for the treatment of acne vulgaris. Patients and methods Twenty patients with facial acne were treated using intense pulsed light (IPL) on one side of the face and pulsed dye laser (PDL) on the other to compare the efficacy and safety of IPL and PDL. Treatment was performed 4 times at 2‐week intervals. Treatment effectiveness was determined using lesion counts, acne severity, patient subjective self‐assessments of improvement, and histopathological examinations, which included immunohistochemical staining for transforming growth factor‐β (TGF‐β). Results Numbers of total acne lesions decreased following both treatments. For inflammatory lesions such as papules, pustules and nodules, IPL‐treated sides showed an earlier and more profound improvement than PDL‐treated sides. However, at 8 weeks after the 4th treatment, a rebound aggravation of acne was observed on IPL‐treated sides. On the contrary, PDL produced gradual improvements during the treatment sessions and these improvements lasted 8 weeks after the 4th treatment. Non‐inflammatory lesions as open and closed comedones also showed improvement following both treatments and PDL‐treated sides showed better improvement as the study proceeded. Histopathological examinations showed amelioration in inflammatory reactions and an increase in TGF‐β expression after both treatments, which were more prominent for PDL‐treated sides. Conclusion Both PDL and IPL were found to treat acne effectively, but PDL showed a more sustained effect. TGF‐β might play a key role in the resolution of inflammatory acne lesions.