Laser hair removal: guidelines for management

Complications of dermatologic lasers in high Fitzpatrick phototypes and management: an updated narrative review

This article explores the intricacies of laser surgery, acknowledging inherent risks and complications. Patients with higher Fitzpatrick phototypes, characterized by unique biological traits, face heightened vulnerability during laser treatments. Limited experience with darker skin tones necessitates a higher level of laser expertise and a conservative approach. The study aims to comprehensively review laser therapy's side effects and complications, with a specific focus on Fitzpatrick phototypes IV through VI. We searched the MEDLINE database from 1972 to 2023 to consolidate knowledge. Results illuminate nuanced challenges associated with laser surgery in higher phototypes. In conclusion, this research emphasizes the need for enhanced expertise and caution in laser procedures for individuals with darker skin, offering valuable insights to optimize patient safety and outcomes.

Efficacy and safety of diode laser for facial hair reduction in hirsutism-a clinico-trichoscopic evaluation

Background

Hirsutism is the presence of excessive terminal hair on androgen-dependent sites of the body. Lasers like Alexandrite, diode, and Nd:Yag lasers have been used for hair reduction with varying efficacy. Trichoscopy of hair is a simple noninvasive method of hair assessment. However, it has not been used in the assessment of diode laser hair reduction.

Objectives

This study aimed to assess the efficacy and safety of diode laser hair reduction in skin color with the help of clinical and trichoscopic assessment.

Materials and Methods

This prospective observational study included 73 patients of hirsutism recruited in 18-month period. All participants received sessions of 805 nm diode laser at monthly intervals up to six sessions. Clinical and trichoscopic evaluation along with photographs were obtained at each visit. Side effects, if any, were noted in every sitting.

Results

All patients were females of Fitzpatrick skin types III-V. All clinical parameters showed statistically significant hair reduction when compared with baseline. Trichoscopic parameters of hair reduction like total hair count, terminal hair count, and terminal/vellus hair ratio showed reduction compared to baseline which was statistically significant (P < 0.05). The most common side effect noted in our study was pain followed by erythema and perifollicular edema.

Conclusions

Diode laser is an effective and safe procedure for the reduction of unwanted facial hair, even in darker skin types. We also wish to emphasize that trichoscopy for the assessment of laser hair reduction is a recent, noninvasive, simple, and underutilized tool. No serious adverse events were noted in our study.

Clinical and Dermoscopic Findings of Nevi after Photoepilation: A Review

Atypical clinical and dermoscopic findings, or changes in pigmented melanocytic lesions located on body areas treated with lasers or intense pulsed light (IPL) for hair removal (photoepilation), have been described in the literature. There are three prospective studies in a total of 79 individuals with 287 melanocytic nevi and several case reports reporting the dermoscopic findings and changes after photoepilation. Clinical changes have been reported in 20-100% of individuals, while dermoscopic changes have been observed in 48% to 93% of nevi. More frequent dermoscopic changes included bleaching, the development of pigmented globules, and irregular hyperpigmented areas and regression structures, including gray areas, gray dots/globules, and whitish structureless areas. The diagnostic approach for pigmented lesions with atypical dermoscopic findings and changes after photo-epilation included reflectance confocal microscopy, sequential digital dermoscopy follow-up, and/or excision and histopathology. Challenges pertaining to these diagnostic steps in the context of photoepilation include the detection of findings that may warrant a biopsy to exclude melanoma (ugly duckling, irregular hyperpigmented areas, blue-gray or white areas, and loss of pigment network), the potential persistence of changes at follow-up, and that a histopathologic diagnosis may not be possible due to the distortion of melanocytes or complete regression of the lesion. Furthermore, these diagnostic approaches can be time-consuming, require familiarization of the physician with dermoscopic features, may cause anxiety to the individual, and highlight that avoiding passes of the laser or IPL devices over pigmented lesions is key.

Efficacy of Laser in Hair Removal: A Network Meta-analysis

BACKGROUND

Laser hair removal is an increasingly prevalent trend of cosmetic procedures. The purpose of this study was to assess the effectiveness of hair reduction among several types of laser interventions.

METHODS

The selected studies searched in PubMed and EMBASE were assessed for quality of evidence, and extracted data on absolute hair count and hair reduction rate. Qualitative data were synthesized using standardized mean difference (SMD) in frequentist network meta-analysis because various measurement units were used among selected studies. Inconsistency and small study effects were examined by design-by-treatment interaction model and comparison-adjusted funnel plot.

RESULTS

A total of 13 randomized controlled trials (RCTs) (n = 652) were contributed to network meta-analysis. Pooled results revealed that diode laser showed significantly lower absolute hair count within three-month (SMD = -13.21, 95% confidence interval [CI]: -22.25 to -4.17) and around six months follow-up (SMD = -11.01, 95% CI: -18.24 to -3.77) as compared with those in control group, but no significant difference among laser interventions. All side effects observed were transient without leaving any permanent scars.

CONCLUSION

Eliminating unwanted hair with lasers or intense pulsed light is safe and effective; however, which type of intervention is more beneficial in the long-term process should be studied with a longer follow-up time.

Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria

Introduction

Permanent genital hair removal is required before gender-affirming vaginoplasty to prevent hair-related complications. No previous studies have directly compared the relative efficacy, costs, and patient experiences with laser hair removal (LHR) vs electrolysis treatments. Food and Drug Administration (FDA) oversight of medical devices is poorly understood and commonly misrepresented, adversely affecting patient care.

Aim

This study compares treatment outcomes of electrolysis and LHR for genital hair removal and investigates FDA regulation of electrolysis and LHR devices.

Methods

Penile-inversion vaginoplasty and shallow-depth vaginoplasty patients completed surveys about their preoperative hair removal, including procedure type, number/frequency of sessions, cost, and discomfort. Publicly available FDA-review documents and databases were reviewed.

Main Outcomes Measure

Compared to electrolysis, LHR was associated with greater efficiency, decreased cost, decreased pain, and improved patient satisfaction.

Results

Of 52 total (44 full-depth and 8 shallow-depth) vaginoplasty patients, 22 of 52 underwent electrolysis only, 15 of 52 underwent laser only, and 15 of 52 used both techniques. Compared to patients that underwent LHR only, patients that underwent only electrolysis required a significantly greater number of treatment sessions (mean 24.3 electrolysis vs 8.1 LHR sessions, P < .01) and more frequent sessions (every 2.4 weeks for electrolysis vs 5.3 weeks for LHR, P < .01) to complete treatment (defined as absence of re-growth over 2 months). Electrolysis sessions were significantly longer than LHR sessions (152 minutes vs 26 minutes, P < .01). Total treatment costs for electrolysis ($5,161) were significantly greater than for laser ($981, P < .01). Electrolysis was associated with greater pain and significantly increased need for pretreatment analgesia, which further contributed to higher net costs for treatment with electrolysis vs laser. Many LHR and electrolysis devices have been FDA-cleared for safety, but the FDA does not assess or compare clinical efficacy or efficiency.

Clinical Implications

For patients with dark-pigmented hair, providers should consider LHR as the first-line treatment option for preoperative hair removal before gender-affirming vaginoplasty.

Strength and Limitations

This is the first study to compare electrolysis and LHR for genital hair removal. The discussion addresses FDA review/oversight of devices, which is commonly misrepresented. Limitations include the survey format for data collection.

Conclusion

When compared with electrolysis, LHR showed greater treatment efficiency (shorter and fewer treatment sessions to complete treatment), less pain, greater tolerability, and lower total cost. Our data suggests that, for patients with dark genital hair, providers should consider recommending laser as the first-line treatment for permanent genital hair removal before vaginoplasty.

Yuan N, Feldman A, Chin P, et al. Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria. Sex Med 2022;10:100545.

High-power quasi-CW diode-pumped 750-nm AlGaAs VECSEL emitting a peak power of 29.6 W and an average power of 8.5 W

A peak output power of 29.6 W and an average output power of 8.5 W at a wavelength of 750 nm were demonstrated in quasi-CW multi-mode operation using an AlGaAs-based vertical external-cavity surface-emitting laser (VECSEL) diode-pumped at a wavelength of 675 nm. The comparatively low bandgap of the barrier material that was tuned to the pump-photon energy allowed a good compromise between low heat generation due to the quantum defect and strong absorptance of the pump radiation. The limitations for the average output power came mainly from insufficient heat flow from the intra-cavity heat spreader to the heat sink. These results show the potential for power scaling of diode-pumped VECSELs and the importance of effective heat removal.

Using blend wavelengths in order to improve the safety and efficacy of laser hair removal

BACKGROUND

As the pursuit for a safe and effective device for laser hair removal continues, the use of simultaneous multiple wavelengths in a single device requires further exploration.

AIM

To evaluate the safety and efficacy of a novel multi-wavelength laser device for hair removal.

PATIENTS AND METHODS

This retrospective cohort study included adult participants of both sexes with Fitzpatrick skin types of III and IV. Hairy sites were treated by a multiple wavelength (810nm, 940nm, and 1064nm) laser device (Primelase, Coccoon medical, Barcelona, Spain). Laser parameters included: fluence of 14-20 J/cm² , pulse duration of 7-30 ms, and spot size of 20*9 mm² . Participants underwent up to 7 treatments at 6-8 weeks intervals and were followed for 6 months after the last treatment session. "Before" and "after" clinical photographs were acquired and were used to evaluate efficacy by 2 independent dermatologists. They employed the Global Aesthetic Improvement Scale (GAIS; scale of 0 [no improvement] to 4 [excellent improvement; Over 75% hair reduction]). Participants' satisfaction was rated on a scale of 1 (not satisfied) to 5 (very satisfied). Pain perception and adverse events were recorded as well.

RESULTS

Eighteen participants (6 men, 12 women) were included with a total of 49 treatment sites. Mean hair reduction was 3.6 out of 4 in the GAIS. Participants' satisfaction rate was high (mean 4.5). Beside mild transient discomfort during the procedure, no adverse events were recorded.

CONCLUSION

The use of a multiple wavelengths' laser device is safe and effective for hair removal.

Efficacy & safety of intense pulsed light therapy for unwanted facial hair: a retrospective analysis in skin of color

Unwanted facial hair growth is a common esthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation. The theory of selective photothermolysis has revolutionized laser hair removal in that it is effective and safe, when operated by sufficiently trained and experienced professionals. Long-pulsed ruby (694 nm), long-pulsed alexandrite (755 nm), diode (800-980 nm), and long-pulsed Nd: YAG (1064) are commercially available laser devices for hair removal most widely studied. The authors wish to share the efficacy and safety of intense pulse light therapy for permanent facial hair reduction in Indian population.

Light-cell interactions in depth-resolved optogenetics

Light as a tool in medical therapy and biological research has been studied extensively and its application is subject to continuous improvement. However, safe and efficient application of light-based methods in photomedicine or optogenetics requires knowledge about the optical properties of the target tissue as well as the response characteristics of the stimulated cells. Here, we used tissue phantoms and a heart-like light-sensitive cell line to investigate optogenetic stimulation through tissue layers. The input power necessary for successful stimulation could be described as a function of phantom thickness. A model of light transmission through the tissue phantoms gives insights into the expected stimulation efficiency. Cell-type specific effects are identified that result in deviations of the stimulation threshold from the modelled predictions. This study provides insights into the complex interplay between light, tissue and cells during deep-tissue optogenetics. It can serve as an orientation for safe implementation of light-based methods in vivo.

Complications of laser hair removal-How we could reduce them?

Laser hair removal became a very popular intervention, with a permanently increasing number of procedures being performed worldwide. The procedure is often performed by nonmedical personnel, and even by untrained personnel, that could be associated with different kind of adverse events, from mild to serious. The complications associated could be lower if the operators understand the basic of laser physics and the working principles of devices. We propose a simple acronym, WATCH, in order to increase the safety and efficiency of laser interventions.

Diode Laser 805 Hair Removal Side Effects in Groups of Various Ethnicities - Cohort Study Results

Introduction: As hair removal has become most popular in aesthetics, the management of its side effects is crucial for every practitioner. Available studies describe the effectiveness of the diode laser hair removal for all skin types according to the Fitzpatrick scale independently, but the question of the occurrence of side effects and adverse effects remains unanswered. This study aims to illustrate aspects of side effects for patients of various ethnicities and the impact of those on the effectiveness of the treatment. Methods: The research was carried out in Poland and the United Kingdom from March 2016 to March 2019. 217 people of various ethnic origins were qualified for the study, 206 sessions were completed and statistical analysis was performed. The procedure was performed in the pubic area with diode lasers with a wavelength of 805 nm, minimum peak power of 2100 W and pulse duration between 15 and 400 ms. ET sapphire cooling assisted handle 9 x 9 mm large and pulse energy density between 10 and 100 J/cm² were used for all treatments. In addition, in order to illustrate the effectiveness of treatments, the subjective and objective analyses of hair loss percentages were indicated. In statistical analysis, the chi-square test for independence was used to evaluate the correlation between the type and severity of side effects and the ethnic origin of patients, the number of treatments, the Fitzpatrick scale and the level of satisfaction. Results: The occurrence of sensitivity depended statistically significantly (PP=0.002) on ethnicity. Ethnicity had no significant effect on the occurrence of erythema. The occurrence of hyperpigmentation statistically significantly depended (P<0.001) on ethnicity. The occurrence of burns depended statistically significantly (P=0.001) on ethnicity. The number of treatments had a significant (P P=0.012) effect on the severity of side effects occurrence. Among participants who had 6 treatments, only half had side effects, including multiple effects occurring in 9.79% of cases. The occurrence of side effects such as sensitivity and hyperpigmentation did not depend on the number of treatments. However, the number of treatments had a significant impact on the incidence of erythema (P<0.001) and burns (P=0.005). More than half of the respondents (58.33%) had erythema after more than six procedures, whereas in the 6 treatments the erythema occurred only in 6.7% of cases. Conclusion: The treatment with the use of diode lasers for all subjects with different ethnicity and thus the recognized scale according to Fitzpatrick is effective and safe. The occurring side effects are transient and do not impact the effect of the whole therapy.

Alexandrite laser induced uveitis & pigment dispersion: A case report and review of the literature

Purpose

To describe a complication of an upper eyelid alexandrite laser procedure.

Observations

A 55-year-old woman presented with left eye blurred vision and photophobia after a left upper eyelid procedure with an alexandrite laser. She had elevated intraocular pressure (IOP), anterior chamber cell and pigment, posterior synechiae, and retroillumination defects in the left eye. She was treated with topical prednisolone and brimonidine. Six months later, although her anterior chamber had cleared and IOP had normalized, the patient reported decreased vision-related quality of life from persistent photophobia.

Conclusions and Importance

Alexandrite lasers are commonly used for hair removal and skin depigmentation. When used periocularly without proper eye protection, they have the potential to create irreversible ocular complications. This case demonstrates the importance of proper eye protection with periocular laser procedures.

Hair and bare skin discrimination for laser-assisted hair removal systems

Laser-assisted hair removal devices aim to remove body hair permanently. In most cases, these devices irradiate the whole area of the skin with a homogenous power density. Thus, a significant portion of the skin, where hair is not present, is burnt unnecessarily causing health risks. Therefore, methods that can distinguish hair regions automatically would be very helpful avoiding these unnecessary applications of laser. This study proposes a new system of algorithms to detect hair regions with the help of a digital camera. Unlike previous limited number of studies, our methods are very fast allowing for real-time application. Proposed methods are based on certain features derived from histograms of hair and skin regions. We compare our algorithm with competing methods in terms of localization performance and computation time and show that a much faster real-time accurate localization of hair regions is possible with the proposed method. Our results show that the algorithm we have developed is extremely fast (around 45 milliseconds) allowing for real-time application with high accuracy hair localization ( 96.48 %).

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.

Literature Review of Cosmetic Procedures in Men: Approaches and Techniques are Gender Specific

The proportion of men receiving non-surgical cosmetic procedures has risen substantially in recent years. Various physiologic, anatomic, and motivational considerations differentiate the treatments for male and female patients. Nevertheless, research regarding approaches to the male cosmetic patient is scarce. We sought to provide an overview and sex-specific discussion of the most popular cosmetic dermatologic procedures pursued by men by conducting a comprehensive literature review pertaining to non-surgical cosmetic procedures in male patients. The most common and rapidly expanding non-surgical interventions in men include botulinum toxin, filler injection, chemical peels, microdermabrasion, laser resurfacing, laser hair removal, hair transplantation, and minimally invasive techniques for adipose tissue reduction. Important sex-specific factors associated with each of these procedures should be considered to best serve the male cosmetic patient.

Development of a Novel Automated Hair Counting System for the Quantitative Evaluation of Laser Hair Removal

OBJECTIVE

We aimed to develop and validate a novel computer-assisted automated hair counting system for the quantitative evaluation of laser hair removal (LHR).

METHODS

We developed a computer-aided image processing system to count hairs on shaved skin and validated its performance through clinical trials. Five volunteers of Fitzpatrick skin type III-IV volunteered and were tested on both thighs. The system automatically detects hair and places a "+" sign on each hair site for every positive detection. This method allows clinicians to check whether a hair has been counted or not. We analyzed the difference in the hair counts between the proposed system (automatic) and those by human observers (manual).

RESULTS

The hair counts from the proposed system and the manual counts were compared. The percentage error between automatic and manual counting was <5% in each subject. The data of the two groups were statistically verified with Student's independent t-test. The averages were statistically equivalent between the two groups. The proposed system showed significant time saving in terms of counting.

CONCLUSIONS

A dependable, accurate, and fast method of counting hairs on shaved skin through a computer-aided image processing system was developed and validated. The "+" signs on the image to indicate detection allows clinicians to compare with the original image and detect any omission or redundancy. The proposed system is expected to be reliable in analyzing the results of multiple skin-related treatments, including LHR and hair transplantation. Further, it is expected to be widely applicable for use in the clinic.

The Effect of Topical Glycerol Trinitrate on Laser-Aided Facial Hair Removal: A Triple-Blinded Randomized Clinical Trial

OBJECTIVE

Our purpose in this study was to assess the effect of topical glyceryl trinitrate on the efficacy of long-term white hair removal aided by laser therapy in hirsute women.

BACKGROUND DATA

Nitric oxide (NO) induces vasorelaxation and augmented perfusion when released from endothelial cells or from an alternatively provided exogenous source. Separately, vascular endothelial growth factor (VEGF)-mediated angiogenesis during the anagen phase, the phase most susceptible to laser elimination, and modulation of VEGF by NO, has been discussed previously, but there are limited data regarding an efficient method for long-term white hair removal.

METHODS AND MATERIALS

We conducted a triple-blinded randomized controlled clinical trial. Hirsute women with excess facial hair without a known allergy to nitroglycerin derivatives were recruited, and randomly allocated to receive either premedication with 2 g glycerol trinitrate 3 days before the laser sessions once a day, or placebo. All the participants underwent six laser sessions with 1-month intervals. Baseline hair numbers were counted before, 3, 6, and 12 months after the first session. Data were analyzed with repeated measures ANOVA test.

RESULTS

A total of 83 patients were enrolled in control (43) and case (40) groups. The trends for hair reduction in both studied groups were significant (p < 0.001), but there were no significant differences between the case and control groups during the study period.

CONCLUSIONS

According to our findings, all patients, regardless of whether or not they used trinitrate, had significant success with hair removal. This study could not differentiate hair removal efficacy between the study groups. Studies with other laser types and larger sample sizes are suggested to investigate the effect of NO on hair production.

Anterior uveitis following eyebrow epilation with alexandrite laser

Ocular tissues are known to be sensitive to damage from exposure to laser emissions. This study reports the case of a female patient with acute unilateral anterior uveitis caused by alexandrite laser-assisted hair removal of the eyebrows. We report a 38-year-old female who presented with unilateral eye pain, redness, and photophobia after receiving alexandrite (755 nm) laser epilation of both eyebrows. Best corrected visual acuity was 20/20 in both eyes. Right eye examination was normal. Left eye examination showed conjunctival injection and 2+/3+ cells in the anterior chamber. Intraocular pressure and fundus examination were normal. Topical steroids and cycloplegic drops were prescribed for 3 weeks. At the end of the 3-week follow-up, best corrected visual acuity was 20/20, and intraocular pressure and fundus examination were normal in both eyes. The left eye was white, and the anterior chamber was clear. The patient continues to be monitored. In conclusion, without adequate protective eyewear, laser hair removal of the eyebrows with alexandrite laser can lead to ocular damage.

Two cases of anterior uveitis after laser eyebrow epilation

PURPOSE

Laser-assisted epilation of eyebrow hair has become a common practice, but a number of ocular complications can occur. We report the cases of 2 patients who had unilateral anterior uveitis after having undergone laser removal of eyebrow hair.

METHODS

This report describes 2 patients who experienced eye pain, photophobia, redness, and edema after undergoing alexandrite (755 nm) laser epilation of the eyebrow area while not wearing protective eyewear or a corneal shield.

RESULTS

Eye examinations revealed that both patients had conjunctival injection, endothelial keratic precipitates, and cells in the anterior chamber of one eye. They were treated with topical cyclopentolate and steroid eye drops. Within a week, their symptoms had disappeared, and anterior chamber reactions were not seen. At their 3-month follow-ups, their visual acuity was 20/20, and eye examination results were normal for both eyes of each patient.

CONCLUSIONS

Laser-assisted epilation of eyebrow hair can lead to unilateral anterior uveitis, and individuals must be informed about the risks involved in laser eyebrow epilation.

Anterior uveitis associated with laser epilation of eyebrows

Background

The objective of the study is to report a case of unilateral anterior uveitis after laser hair removal of the eyebrows with an alexandrite laser.

Findings

A 36-year-old female presented with painful red eye and photophobia in her left eye 2 days after receiving alexandrite (755 nm) laser epilation of both eyebrows. Visual acuity was 20/20 in both eyes. Right eye examination was normal. Left eye examination showed conjunctival injection, 2+ cells in the anterior chamber, and local posterior synechiae. Intraocular pressure and fundus examination were normal in both eyes. Topical steroids and cycloplegic drops were prescribed. Three days after the initiation of topical treatment, there was a reduction in anterior chamber cells to 1+, but posterior synechiae was enhanced. One week after, there were 0.5+ cells in the anterior chamber and no further enlargement of posterior synechiae. At the 2-month follow-up, uncorrected visual acuity remained 20/20 in both eyes. Slit-lamp biomicroscopy of the right eye was normal. Intraocular pressure and fundus examination were still normal in both eyes. Although anterior chamber of the left eye was clear, posterior synechiae persisted. We are still following the patient.

Conclusion

Laser hair removal of the eyebrows can lead to ocular damage and should be avoided.

A case of faun tail naevus treated by intense pulsed light

A faun tail is abnormal lumbar hypertrichosis that is characterized by a wide, often triangular or lozenge-shaped patch of coarse hair, and this hair is usually several inches long. Faun tail is a rare entity. A 36-year-old male presented with a triangular shaped hair tuft with terminal hair on the lumbosacral area, and he'd had this unusual hair since birth. There were no neurologic signs or abnormality on his spine X-ray. The MRI scan showed disc degeneration and loss of lodordosis. We report here on a rare case of faun tail, which was a form of localized hypertrichosis on the lumbosacral area, and this was successfully treated with intense pulsed (IPL) light.

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 (approximately 50%) and hair coverage (approximately 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.

Biological and clinical aspects in laser hair removal

INTRODUCTION

In the past century, unwanted hair has been traditionally treated with multitudes of techniques that were found to be slow, tedious, painful, impractical, and resulted in poor long-term efficacy. Consequently, there has been a public demand for a novel, rapid, reliable, safe, and affordable hair removal technique. In the last decade, laser and light-based technology for hair removal became one of the fastest growing procedures in modern cosmetic dermatology.

OBJECTIVE

To discuss the latest scientific and clinical issues in the field of photoepilation as evolved in the past decade: hair biology, laser physics and skin optics, technology and clinical experience.

RESULTS

From substantial clinical experience, it becomes apparent that in the ideal subject with fair skin and dark hair, a single treatment can reduce hair by 10-40%; three treatments by 30-70%; and repeated treatments by as much as 90%. These results persist for as long as 12 months. Diffuse and perifollicular cutaneous erythema and pigmentary changes are the most common adverse side effects. Most complications are generally temporary.

CONCLUSIONS

Photoepilation, when properly used, offers clear advantages when compared with older, traditional techniques. Although an ever-increasing number of published studies have confirmed the safety and short and long-term efficacy of photoepilation, the technology still has limits and risks.

Comparative study on a single treatment response to long pulse Nd:YAG lasers and intense pulse light therapy for hair removal on skin type IV to VI – Is longer wavelengths lasers preferred over shorter wavelengths lights for assisted hair removal

OBJECTIVE

To investigate the safety and effectiveness of a long pulsed Nd:YAG (1064nm) laser compared to a shorter wavelength intense pulse light system for assisted hair removal in volunteers with skin type 1V, V and VI.

METHODS

Eleven patients of Fitzpatrick skin type IV-VI were recruited into the study. The area treated included the face (upper lips, chin and jaw area), axillae and legs. One half of the body was treated with the long pulse Nd:YAG laser and the other half was treated with the IPL system randomly under topical anesthesia. Degree of pain experienced during treatment, the treatment outcome and any complications were observed. Patients were reviewed at 2 weeks and 6 weeks post-treatment.

RESULTS

Volunteers generally described pain from the IPL system as "prolonged burning sensation" but tolerable. Pain from Nd:YAG laser treatment was described as "pinprick" and more intense but tolerable. "Slowing of hair growth"was reported with IPL and Nd:YAG, but with a greater effect from Nd:YAG. Sixty-four percent and 73%(8/11) noticed hair reduction <20% after 6 weeks on IPL and Nd:YAG treated side respectively (ns). Post-inflammatory pigmentation occurred in some volunteers on the IPL treated sides whereas this was not seen on any Nd:YAG treated side, and three of these patients experienced blistering, followed by post-inflammatory pigmentation.

CONCLUSION

In our experience the long pulse width 1064 nm Nd:YAG laser, which can penetrate 5-7 mm into the dermis depths to reach the whole length of the hair follicle, would be expected to produce sufficient follicular injury with less epidermal damage in patients with darker skin type compared to shorter wavelength laser and light system.