Laser Hair Removal

Laser Hair Removal

Laser hair removal is a procedure to remove hair for the long term. In comparison to shaving, tweezing, threading, or waxing, laser hair removal can be more permanent. Shaving leaves blunt tips which can cause ingrown hairs. Tweezing can have a slower regrowth period, but it is not practical for larger areas of the body. Threading is also impractical for larger areas and requires one to learn the skill. Waxing has a slower regrowth period than shaving, but still not as permanent as laser hair removal.

Lasers remove hair by selective photothermolysis. The target of this treatment is melanin located in the hair shaft, follicular epithelium, and hair matrix. Light is emitted at a specific wavelength between 600 to 1200 nanometers which is absorbed by melanin. The extended theory of selective photothermolysis is that melanin in the shaft and matrix absorbs the energy from the laser and distributes it to the follicle. There is thermal injury from absorption of the light by melanin without damage to the skin. Lasers are best for those with thick, dark hairs, and light, pale skin. Lasers do not work well for thin, white, gray, or red hairs. Adverse events are more common in those with darker skin types and include erythema, edema, burns, folliculitis, skin damage, pigmentation changes, blisters, and crust formation (Kang, C. et al.). It is recommended to shave before treatment to allow for stubble to develop, instead of waxing or plucking. Complications arise when the laser energy is absorbed by pigment in the epidermis causing epithelial damage.

Caution needs to be taken in patients with dark skin types. There is an increased amount of melanin in the epidermis which competes for absorption of the laser. To avoid damaging the skin, less fluence can be used but this will reduce the efficacy of the procedure (Arsiwala, S. Z. & Majid, I. M.). For those with dark skin and dark hair, it is recommended to use: average fluence, long wavelength, and long pulse duration.

Laser hair removal works best in patients with normal hormonal status. Patients with polycystic ovarian syndrome, thyroid dysfunctions, adrenal hyperplasias, and hyperprolactinemia can influence the regrowth of hair after laser hair removal. Before starting laser hair removal, tests measuring FSH, LH, thyroid function tests, insulin, sugar, hormones, and serum prolactin should be performed (Arsiwala, S. Z. & Majid, I. M.).

The skin has a flora that protects the body from the external environment. The axillary skin is mostly populated by staphylococci, corynebacteria, or propionibacteria. The axilla produces odorless fluids to keep the environment moist. The interaction of this fluid with the microbiome in the axillae produces the smell of sweat. A study was conducted to measure whether there was an improvement in the smell of sweat after laser hair removal. There was a significant increase in S. epidermis after laser treatment and a decrease in S. aureus and M. luteus. In 63.3% of cases in the study, there was improved sweat odor. The effect on each bacterial strain is dependent on the amount of energy, wavelength, the area of skin, and the structural membrane of the microorganism (Fazel, Z. et al.). Further research is required to determine the effect of lasers on bacteria. It is not clear whether the laser increases the growth of certain bacteria or if the inhibition of other bacteria allows for another to flourish. It is still not fully established, but it seems that laser hair removal can improve the smell accompanied by sweat.

Laser hair removal is the most long lasting strategy for removal of hair. It allows for a reduction in the time of regrowth of hair. It is dependent on many properties of the patients to be successful. Studies must be conducted to investigate techniques to avoid adverse effects in those with darker skin types and whether there is an effect on axillary microorganisms after laser hair removal.

Resources

Arsiwala, S. Z., & Majid, I. M. (2019). Methods to overcome poor responses and challenges of laser hair removal in dark skin. Indian journal of dermatology, venereology and leprology, 85(1), 3–9. https://doi.org/10.4103/ijdvl.IJDVL_1103_16

Fazel, Z., Majidpour, A., Behrangi, E., Fathizadeh, S., Nokandeh, M., Atefi, N., & Ghassemi, M. R. (2020). Using the Hair Removal Laser in the Axillary Region and its Effect on Normal Microbial Flora. Journal of lasers in medical sciences, 11(3), 255–261. https://doi.org/10.34172/jlms.2020.43

Kang, C. N., Shah, M., Lynde, C., & Fleming, P. (2021). Hair Removal Practices: A Literature Review. Skin therapy letter, 26(5), 6–11.

Vaidya, T., Hohman, M. H., & Kumar D, D. (2023). Laser Hair Removal. In StatPearls. StatPearls Publishing.

Laser hair removal is a noninvasive procedure to remove unwanted body hair by destroying the hair follicle. Results are permanent, but results require about six treatments or more. Laser treatment affects hair in the active growth phase. The laser beam is made up of controlled pulses of energy that are absorbed by melanin or pigment in the hair, reaching the active hair follicle that lies beneath the skin. The energy heats up the hair, right down to the root, and destroys it without damaging the surrounding tissue or skin, the process is also called photo thermal destruction.

When used as hair-removal methods, there are laser and intense pulsed light (IPL) therapy that use light to heat hair follicles and prevent regrowth. IPL technology is actually not a laser treatment. It uses a broad spectrum of light and multiple wavelengths, meaning there is more unfocused energy around the hair and skin area. So, IPL uses multi-spectrum lights whereas laser use single spectrum light, meaning IPL energy is more scattered and much weaker than laser, which has a densified light, and all energy is focused on this single light. In IPL, spectrum lights are measured as wavelength, for example 755 wavelength means that spectrum light can penetrate 755 nm deep beneath the skin. 755 nm wavelength light is best attracted to melanin, so it’s best used for hair removal.

The use of IPL for hair removal dates back to over 15 years and the first IPL for hair removal was researched and the findings published on its safety and efficacy following a single treatment, as well as long-term safety and efficacy with one- and two-year results. These studies proved that an IPL is a legitimate and useful light source for effective hair removal. Clinical results of IPL for hair removal on darker skin types were also published, showing appropriate cut-off filters, the IPL can be used successfully in all skin types.

In a clinical trial evaluating hair removal with Silk’N device, a IPL treatment, subjects were getting treatments biweekly and followed up. Two week hair reduction was noted to be 74%, then two weeks later, the hair reduction was noted to be 84%. At the three-month follow-up period, 95% of all the patients noted improvement with an average reduction of 64%. Milk, transient, perifollicular erythema was noted in 25% of the patients. A second published trial by Alster and Tanzi was evaluated for the same device. As in the previous study, three treatments were given and subjects were followed for one, three, and six months following the last treatment session. All the subjects in the clinical trial showed a response and the hair reduction was noted to be from 37.8% to 53.6% six months after three treatments. Side effects were also minimal at 25% of the subjects noting mild erythema following the treatment session. Overall patient satisfaction scores were high.

IPL will typically be cheaper than laser given that the results are less effective and in the long run would require more treatments. However, it is a good at-home hair removal option.

References:

• Gold, M. H., Foster, A., & Biron, J. A. (2010, February). Low-energy intense pulsed light for hair removal at home. The Journal of clinical and aesthetic dermatology. Retrieved March 23, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921762/

• Schroeder, B. M. and R. (2021, April 7). IPL vs laser hair removal: What's right for you. Harper's BAZAAR. Retrieved March 23, 2022, from https://www.harpersbazaar.com/uk/beauty/skincare/a30794701/ipl-vs-laser-hair-removal/

Laser Hair Removal

There are many forms of hair removal such as epilating, plucking, waxing, shaving, using chemical depilatories, electrolysis and eflornithine cream, and lasering and intense pulsed light (IPL) systems. Lasers and IPL systems are the best for long-term hair reduction. It works by emitting light with wavelengths ranging from 600 to 1200 nanometers to target melanin in the hair shaft, follicular epithelium, and hair matrix.

There are different types of lasers used such as ruby laser, alexandrite laser, diode laser, Neodymium-doped Yttrium-Aluminium-Garnet (Nd: YAG) laser, and Intense Pulse Light (IPL) or Broadband Light (BBL). Ruby laser is a red light from synthetic ruby crystals that is more effective for lighter skin types with dark hair. Alexandrite laser has greater penetration and is also good for lighter skin types. Diode laser goes even deeper and is safer in darker skin types. Neodymium-doped Yttrium-Aluminium-Garnet (Nd: YAG) laser penetrates even deeper and is also safe for darker skin types. Intense Pulse Light (IPL) and Broadband Light (BBL) are not true lasers and is not as effective. A flash lamp is used to deliver high-intensity pulses of polychromatic, non-coherent light. This is also safe to use in darker skin types.

At first, it takes around 4 to 6 sessions spaced 4 to 6 weeks apart to see noticeable difference and achieve adequate results. After that, a session every 6 to 12 months may be necessary to maintain the results. However, this is dependent on many factors such as hair location, skin and hair color, hair growth stage, laser type, hormonal status and treatment plan.

Before the treatment, the skin is cleaned and then a numbing gel may be applied to the area. Then, protective eyewear is used to cover the eyes from the lights. A laser removes hair by vaporizing it causing smoke that have a sulfur-like smell. After hair removal, it is necessary to avoid the sun as much as possible and to apply sunscreen daily.

Some common side effects of laser hair removal are post-treatment erythema, pain, and burning. Therefore, ice packs may be used to minimize pain and swelling. Topical steroid creams may also be used to minimize erythema and swelling. Topical antibiotics can also be used if there is an inadvertent epidermal injury. Some more severe side effects include blistering, crusting, dyspigmentation, purpura, and scarring. This may leave a permanent change in your skin, so it is best to choose a board-certified dermatologist to perform laser treatment. It is of utmost importance to take precautions such as adjusting fluence, spot size, wavelength and the use of appropriate cooling to prevent complications.

References

1. “Laser Hair Removal: Faqs.” American Academy of Dermatology, https://www.aad.org/public/cosmetic/hair-removal/laser-hair-removal-faqs.

2. Vaidya T, Hohman MH, Kumar D D. Laser Hair Removal. [Updated 2021 Aug 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

Thank you for sharing the information. I have always been wondering if modern technologies might harm hair texture. The laser hair removal actually does affect skin!

Natalie Eshaghian & Donna Salib

Laser Hair Removal

Waxing, shaving, and plucking have been major forms of hair removal for centuries. Laser hair removal is the new aesthetic treatment that is rising in popularity. Laser hair removal began in the mid to late 1900s. Its efficacy has been rising throughout the years, especially into the early 2000s. Unfortunately, where our hair grows is up to genetics, however, where we can keep our hair is up to us in the long term. Laser hair removal is a treatment option to remove unwanted hair on certain parts of your body using a heated laser to burn the hair follicles to inhibit hair growth within that follicle. Although it may be painful, newer techniques have been developed, such as a cooling laser, to make the treatment more bearable and tolerable.

A study was done to see the effectiveness of laser hair removal in patients receiving treatment of 755nm alexandrite laser, and was found to be safe and effective in the treatment. (3) Over 500 patients were included in this study, and treatment sights included areas such as the back, arms, legs, bikini, breast, face, and abdomen. About 50% of the patients studied were seen to have a decrease in hair growth after about 4 years after their last treatment. In addition, over 75% of the patients studied were found to have a full clearance of hair removal in the area they received treatment.

A common side effect of laser hair removal is perifollicular edema, which is swelling of the hair follicle. This is normal since it indicates that the energy was sufficiently absorbed into the skin by the hair follicle and the hair follicle will slowly be disabled and shrink to thin out the hair. This is important to be noted to the patient prior to and post receiving treatment since it may be a concern when seen. Its characteristics are bumpy bubble like blisters that should go away shortly after treatment. (1) If this swelling does not go down within a day or two of treatment, it is important for the patient to receive medical attention. Other side effects include redness, itching, and stinging of the skin. It is important for the patient to apply sufficient moisturizer after treatment to keep the epidermis hydrated after being exposed to the high heat of the laser. In addition, the patient should avoid the sunlight and avoid tanning at least 2 weeks before and after laser hair removal treatment. Many of the laser’s have cooling agents to decrease the pain and swelling that may be experienced during the laser treatment.

Another major side effect of laser hair removal is folliculitis, which is an infection of the hair follicle. It has been seen to be common amongst patients who have curly and/or coarse hair to develop folliculitis more easily. Many times patient’s may avoid getting laser hair removal treatment due to the fear of developing folliculitis. Patients who are found to develop the infection more easily or who develop folliculitis from the laser effects can take prophylactic methods to treat folliculitis, such as doxycycline and topical steroids in addition to gentle washing techniques to help in hair removal. (2)

It is important for medical professionals, including pharmacists, to be aware of the treatment options for hair removal, especially laser hair removal since it is growing in popularity. Its popularity makes it important to understand what the laser treatment entails, as well as how to treat and care for possible side effects, such as the itching, redness, and swelling that occurs. In addition, many patients may use creams such as silver sulfadiazine cream to treat possible burns that occur as negative side effects of the laser. Many patients may experience negative adverse effects from laser, such as skin burns, that can sometimes be severe and cause infections, such as folliculitis. If the patient does not have an infection, silver sulfadiazine cream may be used. For things like itching and swelling, creams and ointments such as hydrocortisone could be used to ease the symptoms. If infection is seen to be present, the patient can use doxycycline to decrease and minimize the length and severity of the infection, as discussed above. Overall, laser hair removal is growing in its usage throughout the years, and it could be associated with many adverse effects that require treatment. It is important for the patient to take the proper precautions and to receive medical attention, as well as the pharmacist to know which treatment options could be used to help alleviate the adverse event.

References:

1. Vaidya T, Hohman MH, Kumar D D. Laser Hair Removal. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 17, 2021.

https://www-ncbi-nlm-nih-gov.jerome.stjohns.edu/books/NBK507861/

1. Schuler A, Veenstra J, Tisack A. Folliculitis Induced by Laser Hair Removal: Proposed Mechanism and Treatment. J Clin Aesthet Dermatol. 2020;13(5):34-36.

https://www-ncbi-nlm-nih-gov.jerome.stjohns.edu/pmc/articles/PMC7380697/

1. Russe E, Purschke M, Herold M, Sakamoto FH, Wechselberger G, Russe-Wilflingseder K. Evaluation of Safety and Efficacy of Laser Hair Removal With the Long-Pulsed 755 nm Wavelength Laser: A Two-Center Study With 948 Patients. Lasers Surg Med. 2020;52(1):77-83. doi:10.1002/lsm.23160

https://onlinelibrary.wiley.com/doi/10.1002/lsm.23160