Photo-assisted epilation — review and personal observations

Laser treatment of dark skin: an updated review

The growing diversification of the patient population coupled with the increasing demand for cosmetic laser rejuvenation has highlighted the need to develop cutaneous laser systems and establish treatment protocols for patients with a wide range of skin conditions and phototypes. Recent technologic advancements have provided viable treatment options to achieve clinical outcomes that were previously only attainable in patients with lighter skin tones. This review provides an updated discussion of the range of laser treatments available for pigmented skin and sets the stage for further advancements. Pigment-specific laser technology with green, red, or near-infrared light targets a variety of pigmented lesions such as lentigines, ephelides, café-au-lait macules, and melanocytic nevi as well as tattoos and unwanted hair. Short-pulsed alexandrite, ruby, and neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers are used for pigmented lesions and tattoos, whereas their longer pulse-width laser counterparts are used for laser-assisted hair removal. Vascular lesions and hypertrophic scars can be treated with a variety of vascular-specific lasers, but it is the pulsed dye laser (PDL) that has long been the gold standard treatment for these lesions due to its high specificity for hemoglobin and its ability to improve skin surface texture in children and adults. Laser skin resurfacing techniques for photodamaged skin and atrophic scars have been optimized with fractional technology to produce excellent clinical outcomes and minimal complication risks. Radiofrequency and nonablative lasers are also used to provide skin tightening and collagen remodeling with virtually no postoperative recovery.

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.

Hair reduction using a new intense pulsed light irradiator and a normal mode ruby laser

OBJECTIVE

The main purpose of this clinical study was to compare the effectiveness of an intense pulsed light irradiator system (IPL) and a normal mode ruby laser for hair removal.

MATERIALS AND METHODS

Thirty-one patients were treated 3 times with a new IPL system on one side of the chin and neck and with a normal mode ruby laser on the other side. After 6 months, nine of the patients received 3 additional IPL treatments and 11 patients received 3 additional ruby laser treatments. All treatment intervals were 2 months. Hair reduction was measured by hair counts on close-up photographs.

RESULTS

Hair reduction was obtained by 93.5% of the patients after 3 IPL treatments and by 54.8% after 3 ruby laser treatments. The average hair count was reduced by 49.3% after IPL treatments and by 21.3% after ruby laser treatments. Three additional IPL treatments following 3 IPL treatments resulted in only 6.6% further hair reduction--in total 55.9%, whereas 3 IPL treatments following 3 ruby laser treatments resulted in an additional 35.5% hair reduction--in total 56.8%.

CONCLUSIONS

The IPL was found to be 3.94 times more effective than the ruby laser for hair removal. In the chin and neck region, more than 3 treatments with the IPL did not improve the therapeutic result significantly.

Long-term effects of postoperative razor epilation in pilonidal sinus disease

PURPOSE

To study potential benefits of postoperative epilation after pilonidal sinus surgery, the long-term effect of hair removal on pilonidal recurrence was investigated.

METHODS

A total of 1,960 patients with pilonidal sinus treated surgically from 1980 to 1996 in three hospitals of the Deutsche Bundeswehr were eligible for the study. Regular hair removal with a razor was recommended for all patients after surgery. A randomly selected sample of 504 patients was contacted for a follow-up telephone interview.

RESULTS

The mean follow-up time was 11.3 (standard deviation, 6.4) years. Overall, pilonidal sinus disease recurred in 111 (22 percent) of the 504 patients. A total of 113 patients followed the recommendation to perform epilation (mean duration, 7.5 months), and 391 patients did not. Recurrence was observed in 30.1 percent (34/113) of patients who performed postoperative epilation and in 19.7 percent (77/391) of patients who did not perform postoperative epilation (P = 0.01).

CONCLUSIONS

Razor hair removal increases the rate of long-term recurrence after surgery for pilonidal sinus disease and therefore should not be recommended. However, the rationale for hair removal in pilonidal sinus disease is compelling. Other epilation techniques such as laser hair removal should be investigated in appropriate studies.

Lasers and light sources for the removal of unwanted hair

The long-term removal of unwanted hair has become one of the most common and popular cosmetic laser treatments being performed around the world. This manuscript will review a variety of lasers and light sources that have been and are currently being used for epilation of the skin. All of the lasers and light systems currently available do work for long-term hair removal; it is the responsibility of the treating clinician to understand the varying technologies and what the limits of each device is and, most importantly, to be able to handle any untoward effects that might arise during the coarse of treatment. Then, hair removal can be successful for both the patient and the physician using their particular medical device.

Ninety percent permanent hair reduction in transsexual patients

Transsexualism as a condition requires hair removal. Twenty-five male-to-female transsexual patients were included in this study on epilation using the Intense Pulsed Light Source (IPLS). Patients received a varying number of treatments, depending on their response. A mean hair clearance rate of 90% was achieved in the studied patients. The average number of treatments per patient was nine. A negative correlation was found between hair removal and the age of the patient. Hair removal was also found to be more effective when the patients had not used any needle epilation. No difference in hair removal was found between transsexual patients, who were hormonal, and those who were not. Follow-up lasted an average of 44 months. This study proved that the IPLS has the potential to be effective, permanent, and painless especially in younger patients who have not used any mechanical methods for epilation before photoepilation.

Patient satisfaction study of unwanted facial and body hair: 5 years experience with intense pulsed light

OBJECTIVE

This study was performed in order to evaluate patient satisfaction with epilation using an intense pulsed light source.

METHODS

Between 1995 and 2000, 416 patients consulted the authors' practice because of unwanted facial and body hair. A total of 309 patients received treatment with a non-coherent, filtered flashlamp intense pulsed light source. In February 2000, a questionnaire was mailed to each patient and 207 replies were obtained.

RESULTS

Overall, 45 (22%) of patients were very satisfied, 93 (45%) were satisfied and 69 (33%) remained unsatisfied with the outcome of light-assisted hair removal. The non-coherent, filtered flashlamp intense pulsed light source satisfactorily removed unwanted dark hair. Hair-free periods from weeks to years could be observed.

CONCLUSION

Hair removal by a non-coherent, filtered flashlamp intense pulsed light source is an effective and safe method for long-term epilation of unwanted hair. This technique offers a more reliable and practical solution than any other hair removal method, especially for patients with skin irritation and ingrown hair.