Laser Hair Removal
What conditions are treated with lasers/energy-based devices?
Excess or unwanted hair is a common problem affecting both genders. Over time, this problem has been dealt with in various ways, including plucking, threading, shaving, waxing, and electrolysis. Although effective for short-term control of hair growth, most of these methods are associated with significant pain and prolonged treatment times, making them fairly impractical for larger areas such as the human trunk.
What devices are used to treat this condition?
First introduced in the mid-1990’s, laser hair removal has become an accepted treatment modality for patients seeking to reduce unwanted hair and has been found to improve quality of life for many patients. Lasers currently in use for hair removal include the normal-mode ruby, normal-mode alexandrite, diode, and neodymium: yttrium-aluminum-garnet (Nd:YAG) lasers, as well as intense pulsed light devices.
When should lasers/energy-based devices be used?
The majority of laser procedures aimed at hair removal in both genders are not performed for medically excessive hair growth, but rather for unwanted hair. Patient preferences may be influenced by social or personal perceptions of normal hair distribution and density. Thus, clear understanding of the patient’s specific expectations and of the actual capabilities of laser hair removal is a must for anyone undertaking such procedures.
Description of treatment
No matter which laser or light-based device is used, the concept of how laser hair removal works is the same - selective photothermolysis. The “selective” in the case of this treatment means that the lasers are more highly absorbed by some things than others. The lasers that are used for laser hair removal are specifically chosen because their wavelength is more highly absorbed by darker colors than lighter ones. This concept is exploited in laser hair removal because there is more melanin in hair (the dark pigment that gives our skin and hair color) than there is in the surrounding skin.
The “photothermolysis” basically means using light (photo) to create heat (thermo) to destroy cells. As the laser (or light in the case of Intense Pulsed Light or IPL) passes over the skin it is absorbed by all the pigments in the skin and hair. As the pigment absorbs the light, it changes that light energy into heat energy. The more pigment there is, the more heat is produced. Because dark hair has much more pigment than the surrounding skin, it absorbs more light and creates more heat than the surrounding skin. As that heat is generated very quickly, it radiates out from the hair shaft almost like a shockwave, and in so doing it super-heats the hair follicle, where the papilla that feeds and grows the hair lies. If enough heat is generated, it can kill (lysis) the cells in the hair follicle and prevent it from ever growing a hair again.
For this concept to work, there are a few conditions that have to be met:
- Quite obvious from the description, the hair must be dark. If there is no melanin in the hair, such that it is white, gray, or blonde, laser hair removal cannot work. Even red hair does not absorb the light well because it has a different kind of melanin than brown or black hair. This also means that thicker hairs (simply because they are bigger and hold more melanin) tend to be better treated than finer hairs.
- The hair must be in the hair follicle. If it is pulled out by waxing, tweezing, threading, etc. there is no “heating coil” to absorb the light energy and create heat to kill the follicle. Since the hair follicle has no melanin itself, there is currently no way to target the follicle directly, only indirectly through the hair.
- Only a certain percentage of hair follicles can be destroyed at any one time, because hairs must be targeted when they are in the “anagen” or growth stage, one of three phases of the natural hair production cycle. Different body parts have differing numbers of hairs in the “anagen” phase at any one time, the scalp being the highest with about 70% of hairs actively growing at once. As a result, multiple treatments are necessary.
- While all skin types can be treated (given the appropriate laser), the greater the difference in pigmentation between the skin and the hair, generally the better the result. The darker an individual’s skin becomes, the more melanin they have, and the skin begins to heat more with the application of laser or light. Therefore darker skinned individuals must be treated at lower energy levels and often require more treatments to attain good hair reduction.
Success rates/potential complications
Attempts to correlate effective hair removal with targeting various hair cycles have, in general, failed. Further research in this area is needed; in the meantime, most laser sessions for hair removal are currently carried out in 4- to 8-week intervals, with small, if any, regard as to the body site. There is, however, an apparent difference in response to laser treatment based on location. The upper lip, chin, scalp, and back are generally associated with the weakest response, whereas the remainder of the face, chest, back legs, and axillae typically demonstrate higher clearance rates.
Most published studies with any laser hair removal systems do not distinguish response rates between different anatomic areas. In one study non-facial skin, such as the trunk, did show somewhat better clearance rates compared to facial sites when treated with a long-pulsed Nd:YAG laser. Conversely, paradoxical increase in hair growth, a rare complication of laser hair removal, has also been reported on the trunk after alexandrite laser hair removal.
What outcome should patients expect?
In general, the goals of laser hair removal must be realistic. It is rare to see 100% total clearance of all treated hairs in this area. In general patients need to understand that the purpose of treatment is to decrease the amount and thickness of hair in the treated sites. Younger treated patients must also understand that they will continue to grow “new” hairs for decades. Even older patients, especially men on their backs and women for facial hair, are genetically programmed to continue to activate new hair follicles over time. Thus periodic re-treatments will be required.