Safety and efficacy of low fluence,high repetition rate versus high fluence,low repetition rate 810-nm diode laser for axillary hair removal in Chinese women

Background: High-fluence diode lasers with contact cooling have emerged as the gold standard to remove unwanted hair. Lowering the energy should result in less pain and could theoretically affect the efficacy of the therapy. Objective: To compare the safety and efficacy of a low fluence high repetition rate 810-nm diode laser to those of a high fluence, low repetition rate diode laser for permanent axillary hair removal in Chinese women. Methods: Ninety-two Chinese women received four axillae laser hair removal treatments at 4-week intervals using the low fluence, high repetition rate 810-nm diode laser in super hair removal (SHR) mode on one side and the high fluence, low repetition rate diode laser in hair removal (HR) mode on the other side. Hair counts were done at each follow-up visit and 6-month follow-up after the final laser treatment using a “Hi Quality Hair Analysis Program System”; the immediate pain score after each treatment session was recorded by a visual analog scale. Results: The overall median reduction of hair was 90.2% with the 810-nm diode laser in SHR mode and 87% with the same laser in HR mode at 6-month follow-up. The median pain scores in SHR mode and in HR mode were 2.75 and 6.75, respectively. Conclusion: Low fluence, high repetition rate diode laser can efficiently remove unwanted hair but also significantly improve tolerability and reduce adverse events during the course of treatment.     

A split axilla comparison study of axillary hair removal with low fluence high repetition rate 810 nm diode laser vs. high fluence low repetition rate 1064 nm Nd:YAG laser

Background A low fluence, high repetition rate 810 nm diode laser using constant motion technique has been recently introduced with advantages of less treatment discomfort and fewer side effects compared with traditional laser hair removal. Objective To compare hair reduction and side effects of low fluence high repetition rate 810 nm diode with high fluence low repetition rate 1064 nm Nd:YAG lasers. Methods Forty‐nine subjects were randomly received five monthly treatments with diode laser on one side of their axilla and long‐pulsed Nd:YAG laser on the other side. Hair count was recorded at baseline, 1‐ and 6‐month follow‐up visits. Results Percentage of axillary hair reduction at 1‐month follow‐up visit after receiving diode and Nd:YAG laser treatment were 71.0% and 82.3%, respectively, and at 6‐month follow‐up were 35.7% and 54.2%, respectively. There were significant differences in hair reduction between both laser systems at 1‐ and 6‐month follow‐ups (P < 0.001 and P < 0.001, respectively). Patients reported lower pain on the diode laser side (P < 0.001). Side effects of both laser systems were mild and transient erythema and swelling. Conclusions High fluence low repetition rate Nd:YAG laser was superior in hair reduction and provided higher patient satisfaction. However, low fluence high repetition rate diode laser was less painful.     

Clinical and microscopic evaluation of long‐term (6 months) epilation effects of the ipulse personal home‐use intense pulsed light (IPL) device

Background  The aim of this study is to investigate the cellular mechanism of long‐term hair reduction using a novel, square pulse, low‐fluence home‐use IPL device. Methods Ten subjects’ axillae (Fitzpatrick III–V) were treated once weekly for four consecutive weeks in a simulated home‐use trial. Treated and control site punch biopsies were taken from axillary sites for H&E staining and blinded histological examination before, immediately after and six months after the fourth treatment. The contralateral axilla served as a control. Results Histologically, four sequential weekly treatments gave a significant increase in telogen compared with anagen follicles. Six months after the fourth treatment, an 87% reduction in terminal hair count (P ≤ 0.00005) was recorded. An atypical telogen with infundibular dilatation and plugging of keratin and clumping of melanin with disintegration and/or retraction of the intraluminal hair shaft were observed. The papillae remained viable and some new anagen follicles were evident after four treatments. Vellous hairs appeared unaffected by IPL exposures. A mixed inflammatory infiltrate of lymphocytes and eosinophils around vessels of the superficial and deep dermis was sometimes present but the epidermis appeared always normal. Conclusion A highly significant hair density reduction through induction of telogen followed by miniaturization similar to that achieved in professionally delivered permanent laser hair reduction appears to be the major mechanism of hair reduction using home‐use IPL. IPL‐induced damage to the isthmus and upper stem may inhibit or interfere with the hair regrowth process. Longer term studies are required to determine if this observed damage is clinically permanent.     

Safety and efficacy of low-fluence,high-repetition rate versus high-fluence,low-repetition rate 810-nm diode laser for permanent hair removal – A split-face comparison study

Abstract

Background: This study was designed to evaluate the hypothesis that low-level fluences done repetitively on a hair follicle will produce permanent hair removal with less discomfort and fewer side effects than a single high-fluence pulse. Objective: To compare the safety and efficacy of a low-fluence, high-repetition rate versus a high-fluence, low-repetition rate 810-nm diode laser for permanent hair reduction in patients with facial hirsutism. Methods: Forty-two female patients with confirmed polycystic ovaries by ultrasonography with facial hirsutism were subjected to the low-fluence, high-repetition Soprano^® XL laser in SHR mode and the LightSheer? laser on each side of the face using preset parameters once a month for six sessions. Hair counts were done at the end of the sixth session using a ‘Hi Quality Hair Analysis Program System’ and the pain score was recorded by a visual analog scale. Results: The overall median reduction of hair was 90.5% with the Soprano XL and 85% with the LightSheer, with a standard deviation of 7 and 8.5 respectively. Discussion: This new technology, with low fluence and high repetition, showed a statistically insignificant increase in hair reduction compared to the LightSheer, but did show a significant reduction in hair thickness and a low pain score.     

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.     

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.     

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.     

Hair reduction: 48 months of experience with 800nm diode laser

BACKGROUND: The goal of hair removal methods has always been permanent or at least long‐term epilation. Laser technology and the axiom of selective photothermolysis allowed a new approach to this subject.

OBJECTIVE: The aim of this retrospective study was to determine the long‐term efficacy of a solid state, 800nm pulsed near infrared diode laser system for the reduction of pigmented hair, and extending habitual hair plucking intervals.

METHODS: In 48 months 242 patients received 703 diode laser treatments on 477 sites. Treatment data and an anonymous patient questionnaire on data concerning undesired hair growth (e.g. predisposition, psychological aspects), and hair plucking habits were retrospectively evaluated to verify the benefit of 800‐nm diode laser application for the reduction of excess hair.

RESULTS: After an average of 1.97 treatments (range 1–6) sufficient reduction of pigmented hair was achieved for a mean period of 8.1 months. The habitual hair plucking interval was raised from a mean of 3.69 days before treatment to 15.19 days after laser epilation. The procedure was tolerated by 81.4% without local anesthetics and well accepted by 82.55% of the patients.

CONCLUSION: 800‐nm diode laser assisted hair removal represents a safe and effective treatment option for the reduction of pigmented hair.     

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.     

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.     

Photoepilation with a diode laser vs. intense pulsed light: a randomized,intrapatient left‐to‐right trial

Background Safe and efficient options for removing unwanted hair are in great demand. Laser devices and intense pulsed light (IPL) sources are the most commonly used treatment modalities. Yet, only a few randomized controlled trials (RCTs) comparing laser and IPL devices are available, and RCTs with long‐term results are missing from the literature. Objectives To compare the safety and long‐term efficacy of diode lasers (DL) and IPL sources for axillary hair removal, we conducted an intrapatient, left‐to‐right, assessor‐blinded and controlled trial. Methods IPL (Ellipse Flex PPT; Danish Dermatological Development, Hoersholm, Denmark; λ_em = 600–950 nm) and DL (LightSheer XC system; Lumenis Inc., Santa Clara, CA, U.S.A.; λ_em = 800 nm) treatments were evaluated in 30 study participants (skin type II–III) with unwanted axillary hair growth. Six treatments with each device were carried out at 4‐week intervals. Final assessment was conducted 12 months after the last treatment by means of hair counts using close‐up photographs. The primary endpoint was reduction in hair growth, analysed on an intention‐to‐treat and last‐observation‐carried‐forward basis (n = 30), and secondary endpoints were patient‐rated efficacy, treatment‐related pain, adverse effects and treatment duration. Results Both devices significantly reduced hair counts. Mean reductions from baseline (3 and 12 months after the last treatment) were 59·7% and 69·2% for DL and 42·4% and 52·7% for IPL treatment (P < 0·01), respectively. DL treatment induced significantly more pain [3·7 ± 2·1 (DL) vs. 1·6 ± 1·4 (IPL); P < 0·01; visual analogue scale] but could be conducted faster [33·1 ± 3·8 s (DL) vs. 40·1 ± 5·0 s (IPL); P < 0·01]. No severe side‐effects were observed for either therapy. Conclusions Both DL and IPL treatments are highly effective, long lasting and safe. DL was found to be more effective than IPL treatment. DL treatment was more painful but less time‐consuming than IPL therapy.     

Hair removal with a novel,low fluence,home-use intense pulsed light device

Objective: To evaluate the reduction in unwanted body and facial hair at various body sites of Fitzpatrick skin types I–III and the efficacy, comfort and safety of this treatment intended for home-use by the general public. Methods: In this non-randomized study, 29 individuals were given three sequential weekly treatments on a total of 31 body and facial areas including the axilla, bikini area, abdomen, neck, chin and upper lip using a novel intense pulsed light device. All participants completed a simple self-assessment questionnaire, as well as an evaluation of pain/discomfort. Results: The mean reduction in terminal hair counts was 47% at 4 weeks' follow-up and 41% at 6 months' follow-up after completing three sequential weekly treatments. Overall, 84% of participants showed a significant percentage of hair reduction (p<0.01) at the 6-month follow-up, with a mean of 51% (range 25–86%). No treatment-related side effects were reported, with little or no discomfort reported during the treatment. Only mild erythema was noted immediately post-treatment. In total, 85% of the participants were either pleased or very pleased with the results 1 month after the third treatment. Conclusions: In simulated consumer use, this home-use IPL demonstrated a significant, quantifiable and sustainable reduction in unwanted body and facial hair with minimal side effects.     

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.     

Paradoxical darkening of unperceived tattoo ink after relatively low fluence from a Q‐switched Nd:YAG (1064‐nm) laser in the course of treatment for melasma

Although Q‐switched (QS) lasers are the mainstay of modern tattoo removal, paradoxical darkening of tattoo ink may occur. This darkening of tattoo ink is dependent on laser wavelength, pulse duration and fluence, with high‐energy, nanosecond‐pulsed lasers more prone to induce tattoo‐ink darkening. Laser toning, consisting of multiple‐passed QS neodymium:yttrium–aluminum–garnet (Nd:YAG), 1064‐nm laser treatment with low fluence, short pulse duration (< 10 ns), and a repetition rate of 10 Hz has been successful in the treatment of melasma. A mistake commonly made during laser toning is to scorch scalp hair, eyebrows or eyelashes, but this phenomenon is reversible. A more problematic error is caused by treatment of eyeliner or eyebrow tattoos. We report a patient who experienced changes in unperceived, skin‐coloured tattoos, turning them blue after QS Nd:YAG laser treatment of melasma.     

Photoepilation

The field of dermatological laser medicine consists of four main areas: therapy for blood vessels, therapy for pigmented lesions, ablation of tissue, and photoepilation. The first tests were carried out in 1993, and since 1996 there has been a growing demand for "permanent hair removal." This strong demand and the rapid development of devices call for extensive knowledge in terms of current technical innovation or affirmation of proven procedures. This article gives a general survey of the different systems that can be used for "permanent hair removal" [ruby laser, alexandrite laser, diode, Nd:YAG laser, so-called intense pulsed light (IPL) systems, and combined radio frequency/IPL systems], including their inherent advantages and disadvantages. Physical and biological aspects necessary for photoepilation are pointed out. Furthermore, we emphasize new methods concerning removal of depigmented and therapy-resistant hair, as well as the treatment of female patients with polycystic ovary syndrome.     

A cross‐sectional,multi‐center study on treatment of facial acne scars with low‐energy double‐pass 1450‐nm diode laser

Acne scars are the ultimate outcome of acne vulgaris, a prevalent skin disorder affecting the pilo‐sebaceous unit. Laser resurfacing has been demonstrated to be an efficient therapy option for acne scars. Hence, we adopted this concept and conducted a study to evaluate the safety and efficacy of low‐energy double‐pass 1450‐nm diode laser on acne scars. This study was conducted on 48 patients with acne scars, treated at 4‐week interval with low‐energy double‐pass 1450‐nm diode laser. Patients were evaluated clinically and with photographs, at day 0, first month and third month post the final treatment and during follow‐up visit. Five treatment sessions were completed by all patients. Approximately, 79.2% of patients showed around 30% improvement. At the end of third month follow‐up, 92.9% of the patients demonstrated >30% improvement. Vesicle formation was observed in two cases, with no post‐inflammatory hyperpigmentation and transient hyperpigmentation was observed in one case, which vanished within 2 months. Our study showed that 1450‐nm diode laser treatment was efficient and well endured in facial acne scars when used with double‐pass at low‐energy.     

Long-pulsed Nd:YAG laser vs. intense pulsed light for hair removal in dark skin: a randomized controlled trial

Background Although several lasers meet the wavelength criteria for selective follicular destruction, the treatment of darker skin phototypes is particularly challenging because absorption of laser energy by the targeted hairs is compromised by an increased concentration of epidermal melanin. Objectives To compare satisfaction level, safety and effectiveness of a long‐pulsed Nd:YAG laser and intense pulsed light (IPL) in axillary hair reduction in subjects with dark skin. Methods The study design was a within‐patient, right‐left, assessor‐blinded, comparison of long‐pulsed Nd:YAG laser and IPL. Fifty women (skin phototypes IV–VI) volunteered for removal of axillary hair. Five sessions at 4‐ to 6‐week intervals were performed. Hair counts at both sides were compared at baseline and 6 months after the last session. Final overall evaluations were performed by subjects and clinician at the end of the study. Satisfaction was scored for both devices. Results Thirty‐nine women completed the study. At 6 months, the decrease in hair counts on the laser side (79·4%, P < 0·001 vs. pretreatment) was significantly (P < 0·01) greater than that on the IPL side (54·4%, P < 0·01 vs. pretreatment). Only temporary adverse effects were reported at both sides. Higher pain scores and more inflammation were reported with Nd:YAG laser; however, it was preferred by 29 volunteers (74%). Volunteers reported higher satisfaction score with Nd:YAG laser (P < 0·01). Conclusions Dark skin can be treated by both systems safely and effectively; however, long‐pulsed (1064 nm) Nd:YAG laser is more effective as reported by both subjects and clinician.     

810 nm diode laser for hair reduction with Chill-tip technology: prospective observational analysis of 55 patients of Fitzpatrick skin types III,IV,V

ABSTRACT

Background: Various light based technologies like Diode, long pulsed Nd:Yag and Intense Pulsed Light are used commonly for long-term hair reduction. The commonest indication is hirsutism.

Aim: 1. To evaluate efficacy and safety of 810 nm Diode laser in Fitzpatrick skin types III, IV and V.

2. To assess percentage of cases on the basis of indications, average number of sessions, fluence required, the long-term results and complications using diode laser in darker skin types.

Methods: A prospective observational study of 55 consecutive patients who came for laser hair reduction by 810 nm Light Sheer Diode laser with Chill tip technology was carried out. The sessions were conducted at an interval of 4–6 weeks and the patients were followed up over a period of 2 years. Data was analyzed using software SPSS (Statistical Package for Social Science. Ver.12, Inc. Chicago, USA).

Results: Fifty-five patients (51 females and 4 males) were studied. 67.3% (n = 37) had skin type IV. The most common area treated was chin (n = 23). The average growth reduction of terminal hair at the end of three sessions was 61.25%. Only 8% (n = 4) had short-term side effects.

Conclusion: Diode laser is highly effective for long-term hair reduction of terminal hair growth in Fitzpatrick skin type III, IV and V with no permanent side effects.

Abbreviations: LHR (Laser Hair Reduction)     

Hair removal using a combination radio‐frequency and intense pulsed light source

BACKGROUND AND OBJECTIVE: The long‐term removal of unwanted hair is achieved by many laser and intense pulse light sources. One limitation is the treatment of individuals with dark skin. The light energy with the current systems has to penetrate through the epidermis before being absorbed by the hair follicle. In individuals with dark skin the high melanin concentration in the epidermis absorbs high energies that can lead to complications. The objective of our study was to study a new system that combines optical energy, intense pulsed light (IPL), with radio frequency (RF). This allows for the use of less optical energy due to the addition of RF energy. The lower optical fluence allows for safer treatment of darker skin types. STUDY DESIGN/MATERIALS AND METHODS: This was a multicenter study, in which 87 patients were enrolled. A single treatment was performed on a specified body site. Twenty‐one of the 69 subjects that completed the study had skin types IV–VI. Each subject was evaluated at 1, 7, 30, and 90 days after the treatment session. RESULTS: Hair counts were significantly reduced from baseline after one treatment by an average of 46%. Individual patient data showed that the percentage in hair count reduction achieved ranged from 0 to 100%, with 43% of the patients having a 50% or greater decrease. CONCLUSIONS: The combination of optical energy and RF when delivered simultaneously achieves effective hair reduction with the use of less optical energy, allowing for the safe treatment of all skin types.     

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.