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Laser Hair Removal

Authors:
Sandeep Arora at Mehektagul Dermaclinic
Sandeep Arora
  • Mehektagul Dermaclinic
Arora Gulhima at Mehektagul Dermaclinic, New Delhi, India
Arora Gulhima
  • Mehektagul Dermaclinic, New Delhi, India
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Laser Hair Removal
Gp Capt Sandeep Arora1, Dr Gulhima Arora2
Author affiliations
1. Senior Advisor (Dermatology), Base Hospital Delhi Cantt
2. Consultant dermatologist, Primus Superspecialty Hospital, New Delhi
Introduction
Human hair plays a defining role in our day-to-day life. Dermatologists are uniquely placed
as they manage both sparse as well as excess hair growth. This excessive hair growth
may either be a reflection of the individuals’ race or may be organic in nature. Those
seeking removal of these hair usually have excess growth in undesirable locations, or have
issues arising out of abnormal hair growth patterns on normal skin. Darker skin types such
as ours are more predisposed to complications and hence a thorough understanding of
pathophysiology of excess hair growth as well as their modalities of their treatment must
be understood.
Historical aspects
Traditional hair removal methods of shaving, epilation, waxing and tweezing have been
around for a long time. Radiograph machines were used in the early twentieth century for
removal of facial hair, however with attendant complications. Electrolysis was used for a
fairly long time and has served well depending upon the expertise of the treatment giver.
Advent of medical lasers led to increased research in management of skin disorders
including hair removal. Ohshiro et al1 initially noted the incidental effect of ruby lasers on
hair growth while managing nevi. CO2 laser, Ruby, Alexandrite, Q switched Nd:YAG,
continuous-wave Nd:YAG, long pulse Nd:YAG, Diode and intense pulse light in similar
wavelengths have since then all been used.
Laser and Hair removal - what we need to know
Removal of excessive hair using laser requires an understanding of optical and
physiological (hair cycle) properties of skin. Selective-photothermolysis2 ensures laser
absorption only by the target chromophore and subsequent microscopic damage to the
concerned tissue. The colour of skin and hair as well as hair shaft characteristics play a
role in successful laser hair removal.
Lasers used in hair removal include Ruby, Alexandrite, Diode, long pulse Nd:YAG as well
as Intense Pulse Light sources (not a laser). The treating dermatologist should be aware of
the terms: thermal damage time, thermal relaxation time of the target tissue and
wavelength, pulse, pulse duration, spot size and fluence of the laser in use. The choice of
laser depends upon the skin type and availability of the laser machine, as it may not be
possible to offer all in one centre.
The general rules to follow in laser hair removal are:
• Determine the cause of hirsutism/ hypertrichosis
• Laser hair removal may be initiated along with the above and you do not need to
complete the work up.
• Observe the skin colour type. Longer wavelengths are better suited to darker skin types.
• Consent as in any cosmetic procedure is a must and parameters including photographs
for initial and all follow up sessions must be recorded3.
• Although it is good to start with a low fluence/ test patch, avoid an over cautious
approach/ lower fluencies to prevent compensatory hypertrichosis 4.
• Dark thicker terminal hair are easier targets compared to finer hair. White and grey hair
cannot be targeted by laser alone unless an additional chromogen is used.
• Achieve your realistic end point and stop!
Hair removal devices were required to demonstrate a 30% reduction in hair growth at the
end of three months5. This does not strictly correlate with hair cell cycle, which may differ
in different sites of the body. Although a definite reduction in hair growth is seen with early
sessions, follow up sessions are needed every few weeks to synchronise the anagen
phase, overcome the telogen and the catagen phase as well target the follicles not treated
with single sessions. Seven to ten or more sessions may be needed in selected patients.
Indications of laser hair removal the author has encountered included hirsutism especially
on account of polycystic ovarian syndrome, hypertrichosis, pseudofolliculitis, and recurrent
pilonidal sinus and faun tail nevi apart from the usual cosmetic indications.
Contraindications include strong history of post inflammatory hyper-pigmentation, history of
keloid or hypertrophic scarring, herpes simplex infections, photosensitive disorders or on
intake of known photosensitizing drugs. It is best deferred during pregnancy.
Complications of laser hair removal include pain, pigmentary changes both hypo-
pigmentation and hyper-pigmentation, burns, scarring and textural changes.
Infrastructure and Setup
Procuring and installing a laser hair removal device must be done after preparing a set up
fit to receive the machine6. A stand-alone room/ chamber with opaque partitions is a must.
A fire point must be handy. In an Armed Forces setup the following issues must be
addressed:
• Since the treatment offered is free, who all will be offered treatment? Cosmetic
indications may soon outweigh those on treatment for hirsutism in whom laser hair
removal has been offered as an adjunct.
• Whole body hair removal session can last anywhere between two to three hours! Will
laser hair removal be offered only for face/neck/arms or exposed areas; etc need to be
specified in a standard operating protocol depending upon the patient load of the centre.
• Who is going to administer the laser session? Typically in a civil set up the trained and
certified laser technician should administer based on parameters provided by the
dermatologist/ aesthetic medicine provider under their supervision. The authors over the
past six years has trained female attendants (nursing staff) provided to his laser centres
for administering the sessions. The author himself treats face.
Conclusion
Laser hair removal is no longer a forte of ‘state-of-the-art’ centres. All dermatology centres
may soon be equipped with facilities of laser hair removal. However, despite our
theoretical knowledge about laser hair removal, issues remain unresolved. Treatment
parameters laid out are generalized and need to be more patient specific rather than
machine specific. This fact is complicated in darker skin types where the chances of side
effects are more. The same patient may respond variably to same parameters in different
sessions since hair follicle energy absorption may vary with the phase of hair cycle. The
paper at this conference shall attempt to clear the air and put forth recommendations
based on the author’s experience.
References
1. Ohshiro T, Maruyama Y. The ruby and argon lasers in the treatment of naevi. Ann
Acad Med Singapore. 1983;12:388-95
2. Patil Uddhav A, Lakshyajit D. Dhami. “Overview of Lasers.” Indian Journal of Plastic
Surgery!: Official Publication of the Association of Plastic Surgeons of India 2008;
41. S101–S113.
3. Goldberg DJ. LASERS and the LAW: what the dermatologist needs to know. Semin
Cutan Med Surg. 2013;32:205-8.
4. Desai S, Mahmoud BH, Bhatia AC, Hamzavi IH. Paradoxical hypertrichosis after
laser therapy: a review. Dermatol Surg. 2010;36:291-8
5. Goldberg DJ. Laser hair removal. Dermatol Clin 2002;20:561-7
6. Buddhadev RM. Standard guidelines of care: Laser and IPL hair reduction. Indian J
Dermatol Venereol Leprol 2008;74, Suppl S1:68-74
... This protocol was developed in house at this centre after our experience in epilation with IPL. 3 The patients were assessed and the results graded according to a 4-point Global Physician Assessment scale (GPAS) as excellent, >75% reduction in surface area; good, 50-75% reduction; fair; 25-50% reduction; and poor, <25% reduction in terminal hair density. Average terminal hair count was done of four quadrants in 1cm 2 area as observed through the hair densitometer (Fig. 3) before starting treatment, at end of treatment sessions and end of six months of follow up thereafter. ...
... Our protocol included initial low fluence session to watch for side effects followed by six, monthly sessions and assessment, monthly, at the end of treatment and after six months of follow up. 3,16 Improvement at the end of treatment was maintained in all but patient No. 10. She initially responded with a fall in hair count from 26 to 10 at the end of six treatment sessions, with a relapse to 16 observed at the end of follow up period. ...
Faun tail nevus: A series of 15 cases and their management with Intense Pulse Light
Article
Full-text available
  • Aug 2018
Background: Localized lumbosacral hypertrichosis presenting as faun tail nevus often represents an underlying spinal occult or overt abnormality. This study was undertaken to study these abnormalities and assess their treatment outcome with Intense Pulse Light (IPL) for permanent hair reduction. Methods: Patients reporting with localized spinal hypertrichosis underwent clinical examination and radio imaging. Symptomatic neurological deficit underwent definitive neurosurgical intervention (if indicated) before hair removal. IPL was administered as 30 J/cm2 four weekly for six sessions. Treatment assessment was based on a Global Physician Assessment Scale and by averaged terminal hair count at four quadrants in 1 cm2 area as observed through the hair densitometer before starting treatment, every four weeks and at the end of six months of follow up thereafter. Averaged hair count was interpreted with paired t-test. Results: This neurocutaneous marker was observed in 15 patients out of a total of 360,767 patients (0.004%) over a four-year period. Age group of patients ranged from 3 to 26 years, comprising of all female patients. Radio imaging revealed diastematomyelia in 10, spina bifida in 04 and 01 had both as the primary spinal abnormality. Thirteen patients were treated with IPL for a period of six months, assessment after six months revealed a highly statistical significant p > 0.0001 reduction in hair growth consistent when followed up after 18 months. Conclusion: This article aims to present a series of this rare neurocutaneous marker and highlight our experience in their management with IPL served as an effective alternative to traditional lasers.
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Overview of lasers
Article
Full-text available
  • Oct 2008
  • Indian J Plast Surg
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LASERS and the LAW: what the dermatologist needs to know
Article
  • Dec 2013
  • SEMIN CUTAN MED SURG
Dermatologic laser surgery is a continuously evolving field of medicine. According to the American Society for Dermatologic Surgery, over 100 million laser and light source cosmetic procedures were performed by its members in 2003. Procedures, which include hair removal, nonablative treatments, as well as removal of pigmented lesions, tattoos, and unwanted vascular lesions, have revolutionized this field. With an increasing number of physicians and nonphysicians performing these procedures and with the availability of increasingly powerful laser technologies, the potential for problems and their legal consequences continue to increase. This article will address the concept of negligence and the potential for a resultant medical malpractice lawsuit that may arise in such a setting. Inherent in this issue are the associated problems that arise when these procedures are performed by physician extenders. An understanding of the basic principals of a cause of action in medical malpractice will likely protect a physician from losing such a case in a court of law.
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Paradoxical Hypertrichosis After Laser Therapy: A Review
Article
  • Mar 2010
  • DERMATOL SURG
Laser hair removal is a safe and effective procedure for the treatment of unwanted body hair but is not exempt from side effects. A rare but significant adverse effect with this treatment modality is paradoxical hypertrichosis. To evaluate the potential etiologies, risk factors, related laser types, and treatment options for the development of excess hair after laser therapy. An analysis of previously published case studies and review articles along with our own experience was used to gather information regarding this phenomenon. Paradoxical hypertrichosis has a low incidence, ranging from 0.6% to 10%, and most commonly occurs on the face and neck. All laser and light sources have the potential to cause hair induction, especially in individuals with darker skin types (III-VI); with dark, thick hair; and with underlying hormonal conditions. Possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Treatment for paradoxical hypertrichosis is laser therapy of the affected area. Paradoxical hypertrichosis is a rare side effect of laser hair removal; the pathogenesis of this event remains widely unknown. We recommend further large-scale studies to investigate this effect. The authors have indicated no significant interest with commercial supporters.
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Standard guidelines of care: Laser and IPL hair reduction
Article
  • Feb 2008
Unlabelled: Laser-assisted hair removal, Laser hair removal, Laser and light-assisted hair removal, Laser and light-assisted, long-term hair reduction, IPL photodepilation, LHE photodepilation; all these are acceptable synonyms. Laser (Ruby, Nd Yag, Alexandrite, Diode), intense pulse light, light and heat energy system are the different light-/Laser-based systems used for hair removal; each have its advantages and disadvantages. The word "LONG-TERM HAIR REDUCTION" should be used rather than permanent hair removal. Patient counseling is essential about the need for multiple sessions. PHYSICIANS' QUALIFICATIONS: Laser hair removal may be practiced by any dermatologist, who has received adequate background training during postgraduation or later at a centre that provides education and training in Lasers or in focused workshops providing such training. The dermatologist should have adequate knowledge of the machines, the parameters and aftercare. The physician may allow the actual procedure to be performed under his/her direct supervision by a trained nurse assistant/junior doctor. However, the final responsibility for the procedure would lie with the physician. Facility: The procedure may be performed in the physician's minor procedure room. Investigations to rule out any underlying cause for hair growth are important; concurrent drug therapy may be needed. Laser parameters vary with area, type of hair, and the machine used. Full knowledge about the machine and cooling system is important. Future maintenance treatments may be needed.
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The ruby and Argon lasers in the treatment of naevi
Article
  • May 1983
  • ANN ACAD MED SINGAP
There are many kinds of abnormally coloured skin lesions, or naevi, which cannot be successfully treated by using conventional techniques. From experience gained in treating over 6,700 patients in the last 6 years, we find that the visible light ruby and argon lasers are useful in the treatment of naevi. However, to use the laser effectively and safely, both skill and knowledge are necessary so that it can become an additional and effective tool in the management of certain dermatological conditions.
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Laser hair removal
Article
  • Aug 2002
  • DERMATOL CLIN
Laser hair removal created controversy when it was first described over 5 years ago. It has now become an accepted modality for long-term hair reduction. It rivals electrolysis in the successful treatment of small hair-bearing areas. It surpasses any modality in the treatment of larger hair-bearing anatomic areas.
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