Laser Hair Removal

A laser is a device that produces light of a single color or wavelength. In dermatology, these lasers produce pulses of high-energy light that is taken up by the desired target. In the case of hair removal, the target is the melanin pigment contained within the hair shaft.

The tricky part of laser hair removal is targeting the hair shaft without damaging the melanin pigment in the surface of the skin. Thus the laser light has to be on long enough to heat the hair, but not too long to allow that heat to spread to the surrounding skin causing damage. In addition, the darker a patient’s skin, the more difficult it is to avoid injuring the surface of the skin while treating the hair. For this reason, there are three main types of hair removal lasers that are used today, and depending on the thickness of the hair and the color of the skin, one laser may provide benefits as compared to another.

In addition to lasers, intense pulsed light sources are also used for hair removal. These light sources do not emit a single color or wavelength of light, but emit light containing many colors. It may be more difficult to predict the outcome and avoid complications when using light sources that contain many wavelengths of light. However, the results with any device depend upon the experience of the practitioner.

Due to the fact that a laser targets melanin, the more melanin an individual has in his/her hair, the more effective a laser will be. Therefore, someone with gray, red, or blonde hair is not as good a candidate for laser hair removal.

In addition, the more melanin in your skin, the darker it looks. Since the laser does not distinguish between melanin in hair and melanin in skin, the more melanin present in the skin, the more the laser is going to target the skin rather than the hair. Therefore, someone with darker skin is not as good a candidate for laser hair removal.

Light skin and dark hair are the best combination for laser hair removal. The more closely an individual’s skin tone matches his/her hair color, the less likely he/she is to benefit from laser hair removal.

Normally, a series of three to five treatments are administered at four to eight week intervals depending upon the location of the hair. Following the initial series of treatments, subsequent treatments are administered, usually at longer and longer intervals. Some number of maintenance of treatments may be needed to keep all the hair away in a given area. After a single treatment, the hair in a given area is usually reduced in amount and thickness for a very long period of time. However, it may not be completely gone. To keep an area completely devoid of hair, maintenance treatments are always required. These maintenance treatments may eventually be required at only yearly intervals or even longer. This depends on the area being treated as well as the individual. As with any other traits in an individual, the frequency of maintenance treatments varies considerably from person to person.

While the number of treatment varies from person to person, on an average, everyone requires at least three treatments for good results. This is typical because while all hair is temporarily disabled during each treatment, not all of the hair follicles are removed. Hence, a sequence of treatments is necessary in order for results to become apparent. Overall, most people do not require more than six treatments, though people with hormonal imbalances or people who normally wax or pluck a lot may require more sessions.

A Series of Treatments Needed

Laser hair removal is accomplished in a series of sessions generally done monthly or every other month. The average number of sessions to achieve over 80 percent permanent hair reduction in 80-90 percent of good candidates is approximately 4 to 7 sessions.

In between these monthly sessions some of the hair will regrow as hairs cycle. Hairs that may have been dormant during your previous laser hair removal session may now be in the growth phase. This is where the need for multiple treatment sessions arises. Multiple sessions ensures that all the hairs are subjected to the treatment. These hairs may be shaved by the patient between sessions if desired.

Some Maintenance Sessions may be Required Annually

Many patients find that maintenance sessions done once or twice a year are ideal for keeping hair at bay after completing the initial treatment protocol.

In a minority of patients who are good candidates hair loss may only be temporary and complete regrowth may occur. The complete regrowth is generally seen in white or blond haired patients.

The first session hurts the most because the laser energy is absorbed in the hair follicle producing heat; there is some sensation when performing laser hair removal. Certain areas of the body hurt more than others during laser hair removal. In addition, patients with very thick, dark hair may experience more discomfort than those with thin hair. This is because the thicker, darker hair will absorb more of the laser light during any given treatment. Generally, the hair becomes thinner and less dense after each subsequent treatment. Therefore, the most discomfort is usually experienced during the first treatment.

Pain Varies Between Individuals. The discomfort associated with laser hair removal varies considerably between individuals, and is a function of the patient’s skin type, the laser being used, the thickness and density of the hair, the area of the body where the hair is being treated, and one’s ability to tolerate or feel pain. In some situations, numbing creams can be used. However, numbing creams partially eliminate the ability of the patient to report on the discomfort associated with a treatment, which may be an indication of how this treatment compares with previous treatments.

Discomfort Rarely Limits Treatment

Discomfort is one of the many factors the person administering the laser treatment will use to determine the appropriate setting for the laser. Patients should be discouraged from applying numbing cream themselves to large areas of the body prior to laser treatment. Although prescription numbing creams are generally safe, putting them on large areas of the body can result in the numbing medications being absorbed into the bloodstream in significant amounts. In my office, I prefer to have my staff apply numbing creams while the patient is in my office when they are needed, so that I can control the amount of cream applied and the surface area over which it is applied. In general, discomfort rarely limits the ability to perform laser treatment. However, in a small number of patients it does limit ones ability to receive laser hair removal treatments.

The Risk is Rather Small

Any laser procedure can cause scarring, and this is included as a risk on most consent forms you will sign prior to laser treatment. However, the risk of scarring from laser hair removal is rather small and is a function of many things including:

• The experience, skill, knowledge and training of the laser operator
• Your particular ability to heal
• The amount of melanin pigment in your skin with greater risk for darker skin types
• Type of laser used

Temporary Pigmentary Changes

Many people experience pigmentary changes, either lightening of the skin or darkening of skin, following a laser procedure. Most of time this is not scarring, even though people often believe that it is. Pigmentary changes following laser procedures are usually resolve in a period of weeks to months.

Experienced Operators Diminish Risk

Although the risk of scarring from a laser procedure is quite small, you can minimize your risk by selecting an experienced operator to perform your laser treatment who is supervised by an on-site physician.

Melanin exists in the plant, animal and protista kingdoms, where, among other functions, it serves as a dark pigment. This pigment is visible in human hair and is the primary determinant of human skin color.

The process of laser hair removal works by directing the laser onto the skin, where the laser high-energy light becomes absorbed by melanin located in the hair follicles. Once absorbed, the light transforms into heat, destroying the entire part of the follicle responsible for the growth of new hair.

Due to the fact that a laser targets melanin, the more melanin an individual has in his/her hair, the more effective a laser will be.

Dark hair absorbs more laser energy and is, therefore, much easier to treat. Coarse dark hair responds the best to laser treatment. Light hair is more difficult to treat, while blonde or red hair being extremely difficult to treat. Multiple treatment sessions are required, and results are variable. Blonde or red hair usually contains pheomelanin, which absorbs laser energy less avidly than the eumelanin pigment which is present in black or brown hair.

Light skin makes laser hair removal easier to perform. Fewer treatments are required, and better, faster results are obtained. People with darker skin can be treated, but results are slower, more sessions are required, and greater expertise is required on the part of the laser center. Laser hair removal must be individualized for each patient.

While hair removal works on all skin types and colors, our procedure works best on those with dark hair. True blondes have a difficult time achieving full results.

Treating a person with dark skin is one of the most challenging tasks for any laser surgeon. This is true for almost any laser and almost any condition a patient may have. The reason this is true is that melanin pigment, which lives in the surface of our skin in our epidermis, is designed to absorb light. Lasers emit light and very often we are aiming at a condition that resides deeper in the skin, below the epidermis. To get there a laser has to go through the epidermis. If there is melanin pigment in the epidermis that melanin pigment will do two things:

• Melanin will steal the light away from what we’re really trying to treat and
• It will make it possible for the laser to injure the epidermis

The laser doesn’t know that the surface of the skin containing melanin pigment is not a target that we’re trying to destroy. So a doctor has to be very careful in choosing the right lasers and the right energies when treating patients with dark skin.

Laser Hair Removal for Darker Skin

For laser hair removal it is extremely important, because hair removal lasers are designed to be absorbed by the melanin pigment in the hair shaft, that we avoid treating the melanin pigment in the surface of the skin. The way to do that is by cooling the surface of the skin to protect it. That can be done with contact cooling, something cold that touches the skin such as two sapphire plates with water running between, or by using a chilled plate, or by a spray that is applied to the skin and cools the skin through evaporation. These are all ways we protect the surface of the skin. The lighter the surface of the skin is, the less chance the laser is going to hurt the skin.

Shorter Laser Wavelengths

If we’re treating patients with very dark skin what we often do is use lasers with the longest wavelength of light. We do this because melanin is designed to absorb short wavelengths of light such as UV Light, and the ability of melanin to absorb light decreases as you go to longer and longer wavelengths, thereby decreasing risk to darker skin. Melanin will still absorb the longer wavelength reasonably well, even at very long wavelengths.

Different Laser for Different Patients

For laser hair removal there are really three types of lasers that we use today, the Alexandrite laser, the Diode laser and the Nd:YAG laser. In the early days of laser hair removal the ruby laser was one of the first lasers that was ever produced, that had the shortest wavelength of all, at 694nm. The Alexandrite laser emits light at 755nm, the diode laser emits light at 810nm, and the Nd:YAG has the longest wavelength at 1064nm. Having someone with different lasers who is highly experienced is a must if you have darker skin.

Having a tan increases your risk of side effects such as blistering and discoloration. Due to the fact that on a tanned skin, the laser tends to aim at the surrounding skin rather than the hair, scarring of the skin may also occur.

There are several laser and laser-like devices currently used for hair removal. Some of the more common ones are detailed below:

• Alexandrite: The long-pulse alexandrite laser accomplishes deep penetration into the skin where the hair follicles are located. The heat build-up in the hair shafts disables those follicles in the active growth phase.
• Diode: The diode laser is a very efficient device that contains small diodes or semiconductors that are arranged together to produce light. The diode laser has a longer wavelength than other lasers used for hair removal, which may improve treatment results on darker skin types.
• Light based sources: In many circumstances, intense pulsed light devices also operate on similar principles to lasers. Using the photoepilation process, the device offers a broad spectrum of light to treat a variety of hair and skin colors as well as hair depths. Some of the commonly used light-based sources include:
  • Q-Switched Nd:YAG: This laser delivers two different wavelengths of light. One is an invisible infrared light used for deeper penetration. This wavelength is used to reach deeper hair follicles. The other wavelength, a green light, is used for treating hair follicles closer to the surface. In both cases, the Q-switching device emits rapid bursts of laser light to the treatment site.
    o Ruby: In this type of a light-based source, the red-colored beam seeks out the target melanin inside the hair shafts.
    What is Photoepilation?
• Photoepilation destroys the hair follicle using controlled flashes of light. The light used is very powerful. The hair absorbs the light projected by the device and the intense heat destroys it. This heating is painless. In order to obtain the best results with photoepilation, we need all the light energy sent by the machine to be absorbed by the hair and not by the nearby tissues.

Many salon and spa processes are now beginning to produce modified versions of laser hair removal treatments which can be carried out at home. There are certain laser hair removal machines that are sold for personal use in the home. However, it is highly advised that experienced professionals, whether they are experienced laser technicians or certified dermatologists, perform laser hair removal sessions. A patient is at an advantage with professionals performing the laser hair removal process, as they know how to operate the machines so as to produce the best results. Additionally, they can complete the task in a safe manner, and they are informed as to how to decrease discomfort, if pain should occur. This method of removing unwanted hair is highly discouraged. Always make sure the take-home product is approved by the FDA.

It is important to note that laser hair removal is a non-invasive method of photoepilation, which does not require needles or chemical creams. The advantages of laser hair removal include:

•  The technique is safe if performed properly
• It is considered to be painless as compared to other methods
• Many consumers have experienced long-lasting hair removal or even permanent hair reduction
• The method is very useful for removing hair from large areas such as backs or legs

Although laser hair removal is an excellent treatment option, some patients may experience hair regrowth. However, this hair is usually finer and lighter in color. Possible side effects, though very rare, may include damage to the surrounding healthy tissue in the form of scars, burns, redness and swelling. The process is also not as effective on unpigmented (gray) hairs and red or blonde hair.

In most cases there are no side effects associated with the procedure. However, pigmentary change of the skin treated can occur, including either dark or light areas. Pigmentary changes may persist for months, but are almost always temporary. They are very rare in patients with fair skin, who are untanned. Blisters and burns are rare, but occasionally occur, particularly in patients with dark skin.

Any area, except adjacent to the eye, where there is excess hair can be treated with laser. The most common areas requested are the face, upper lip, neck, chest, periareolar, underarms, back, abdomen, bikini line, and legs.

One of the main advantages of laser hair removal procedures is the speed of the treatment in combination with the long lasting results. For example, to remove hair from the back with laser hair removal usually takes about an hour. In contrast, a full back hair removal with electrolysis can take up to and over 125 hours.

One of the more common problems you see in darker skinned patients, particularly when the hair is curly is pseudofolliculitis. Pseudofolliculitis is bumps in the area where the hair is and that problem improves very rapidly following laser treatment. In fact, after a single laser treatment pseudofolliculitis can improve tremendously even though all of the hair is not removed.

Diet is generally unrelated to laser hair removal treatment, except for Beta-carotene, which interferes with the treatment. Beta-carotene, which is normally found in carrots, vitamin A supplements, squash, and other vegetables, is deposited in the skin, producing a subtle orange or yellow color in the skin. This pigment absorbs laser energy, preventing it from reaching the hair follicle, and increasing the absorption of laser energy in the skin. Beta-carotene persists for months after ingestion. Patients interested in the best results from laser hair removal will benefit from discontinuation of the use of all forms of beta-carotene.

Laser hair removal is considered to be cosmetic and is therefore, not covered by insurance. The patient is responsible for payment, though financing options are usually available.