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Comparative evaluation of different hair removal lasers in skin types IV, V, and VI
Abstract
Lasers permit treatment of unwanted excess hair with less discomfort than other methods of epilation. Many lasers with different parameters are now available from which the dermatologist can choose. Improved clinical results are made possible by the high specificity and selectivity of the laser systems to pigmented hair because of the use of an appropriate wavelength with the proper pulse and duration.
We aimed to compare the results of treatment of skin types IV, V, and VI using three different laser systems.
One hundred female patients were compared using different laser systems: 35 patients underwent epilation using a Nd-Yag laser, 33 patients using an Alexandrite laser, and 32 patients using a Diode laser.
Follow up 12 months after the multiple treatments (three to six sessions) showed an insignificant difference between these three groups (35-40%).
Our findings indicate that all three laser systems tested can be used for dark skin; however, one should select a system that minimizes side-effects, primarily hypo- and hyper-pigmentation, especially when used for skin types IV, V, and VI.
... The Nd:Yag Laser results in between 10-40%, 25 to 85% and 75 to 97% hair reduction after1, 3 and 6 sessions respectively of Laser hair removal. 3,5,7,[10][11][12][13]16 Also, Nd:Yag Laser is not associated with scarring. 12 The end point of Laser hair removal are; decreased hair density in the treated hair area, decreased hair shaft thickness, decreased hair density, decrease in hair colour, decreased terminal versus vellus hair ratio and a hair growth cycle longer than that natural to the hair. ...
... 18 This has led to studies on the safe, effective fluence and pulse duration of Laser devices in different skin types. 4,7,10,11,13 Laser hair removal is a new practice in Nigeria. There are no studies on its use, efficacy and safety in Nigerians; neither are there studies on the safe and effective fluence, pulse duration and number of sessions needed to achieve permanent hair reduction. ...
... 4,7,19 The other studies of Laser hair removal report a high fluence as used in this study to be required for effective PLHR. 4,6,10,18,19 Laser hair treatment is new in Nigeria and patients pay out of pocket. Consequently, not many individuals can afford the treatment and in those who engage in the treatment, inconsistency with treatment schedules is common. ...
Background: There are no studies examining the use, safety, efficacy, effective fluence and pulse duration of Laser hair reduction in Nigerians. This study aimed to document the safety, efficacy, effective fluence and pulse duration, and the number of Laser sessions to achieve permanent hair reduction. Methods: A retrospective review of Laser hair removal in 87 FitzPatrick skin type V and VI patients from January 2017 to August 2021 using the neodymium-doped yttrium aluminium garnet (Nd:Yag). The fluence (Joules/cm3), pulse duration (msecs), Laser site and interval between Laser sessions were documented. Data was summarized using frequencies and percentage proportion. Comparison of pulse duration, fluence, and the number of sessions between different body sites was tested using analysis of variance. Results: A total of 354 laser sessions were performed in 87 patients made up of 80 females and 7 males; mean age of 35.8±9.24 years. The face was the most frequently treated site (67.5% of the sessions). The mean number of laser sessions, pulse duration and fluence were 4.07±4.22, 19.38±1.48 (msec) and 18.22±1.29 (J/cm3) respectively. An average of 6 sessions was required to achieve permanent hair reduction: the face required a significantly lower number of sessions, p=0.043. Conclusions: The long pulse Nd:Yag 1064 laser is an effective and safe Laser for hair removal in skin types V and VI. The effective, safe pulse duration and fluence are 16 to 22 msec and 15 to 20 J/cm2 respectively. The face requires fewer number of Laser sessions.
... Follow-up was 18 months post-final treatment and showed greater long-term hair-count reduction using 18 mm Alexandrite (84.25%), followed by 12 mm Alexandrite (75.89%) then Nd:YAG (73.61%); however, these differences were non-significant (p = .25). Galadari et al. (36) also performed an RCT comparing Nd:YAG, Alexandrite, and Diode in 100 volunteers of skin types IV-VI, with treatment directed to the face. Again, 12-month follow-up showed superior long-term hair-count reduction using Alexandrite (35%) followed by Diode (32.5%) then Nd:YAG (30%); however, statistical tests and drop-out rate were not reported; thus, data were difficult to interpret. ...
... The average hair reduction reported from trials of Nd:YAG laser (n = 2) for short-term follow-up varied from 60 to 73.60% and long-term ranged from 30 to 73.61%. The trial reporting both greatest short-term and long-term efficacy (35) focused on treatment of leg hair vs the other trial focused on treating the facial area (36). As leg hair has a longer growth cycle (1-year) compared with the face (6-months) (22), this may account for the greater reduction of hair seen in this trial. ...
... As leg hair has a longer growth cycle (1-year) compared with the face (6-months) (22), this may account for the greater reduction of hair seen in this trial. Interestingly, one trial (36) implemented different numbers of treatment sessions between groups and found that increasing treatment sessions from 3 to 6 improved percentage hair reduction by 20% short-term and 10% long-term; hence, number of treatments may also affect efficacy. ...
Laser and light-based devices provide scope for long-term "hair-removal" however, there is limited evidence supporting their long-term efficacy. This study aimed to assess the long-term efficacy of laser and light-based "hair-removal" devices, taking into account variations in body site-specific variations in hair growthcycles. A systematic review of randomized controlled trials (RCTs) with follow-up periods greater than or equal to the length of one complete hair growth cycle in the body site targeted was conducted. Only five eligible RCTs were identified as suitable for inclusion, and these comprised a total of 223 patients. The average long-term hair reduction reported for neodymium:yttrium-aluminum-garnet (Nd:YAG) laser ranged from 30 to 73.61%, Alexandrite laser ranged from 35 to 84.25%, and Diode laser ranged from 32.5 to 69.2%. In all three devices, the greatest long-term reduction was observed from trials targeting leg hair (1-year growth cycle) and lowest from targeting facial hair (6-month growth cycle). Intense pulsed light (IPL) produced average long-term hair reduction of 52.7-27%; smallest reduction was observed from targeting the face area and greatest from targeting the axillary area (7-month growth cycle). In conclusion, greater long-term hair reduction was observed on body sites with longer hair growth cycles. Future trials should take into account the varyiation of hair growth cycles across body sites to provide accurate long-term data on treatment outcomes.
... Among the phototherapeutic light sources available for this treatment are intense pulsed light (IPL) at 500-1200 nm as well as lasers, specifically alexandrite at 755 nm, diode at 810 nm, ruby at 694 nm, and neodymium-doped yttrium aluminum garnet (ND:YAG) at 1064 nm. Among these, the ND:YAG 1064 nm laser was tested for the first time by Geusic et al. [4] and it was one of the first lasers to have been approved by the Food and Drug Administration (FDA) for epilation [5][6][7]. ...
... The radiation is absorbed by the tissue, generating heat, which is subsequently conducted to the pilous follicle, making it inactive for producing another hair in that location [8,9]. The significant advantage of using a ND:YAG laser in epilation is that it reaches a specific penetration depth when using a 1064 nm wavelength, and to obtain selective photothermolysis of the pilous follicle, the radiation only needs to penetrate at a depth of at least 3 mm [4,9]. ...
... Regarding the study designs, although all of them were randomized clinical trials, the randomization showed great variety: five were randomized controlled trials [2][3][4][5][6]9], three were randomized split face/axilla clinical trials [1,7,10], and four were assessor-blinded randomized trials [8,[11][12][13]. ...
Using light sources in phototherapy has presented promising results regarding several types of facial and body skin affections for centuries. The neodymium-doped yttrium aluminum garnet (ND:YAG) 1064 nm laser has become a standard treatment in dermatology for dermatological disturbances related to the pilous follicle and the structures surrounding it. Despite the reports of its clinical benefits, few scientific studies show its actual safety and efficacy. To substantiate the effects, benefits, and safety of applying an ND:YAG 1064 laser in the epilation process during esthetic treatment, a systematic review was carried out between October 2018 and January 2019, on studies published in the last 20 years. Randomized clinical trials in humans were considered that evaluated the efficacy, safety, and benefits of ND:YAG laser application at 1064 nm wavelengths for hair removal. A total of 198 articles were identified; 58 articles remained after their titles and abstracts were read; and 21 articles were selected after the removal of duplicates. After the integral reading, 13 of these articles were included in the systematic review (734 patients). The ND:YAG 1064 nm laser presents safety and promising, beneficial effects in epilation. However, further scientific studies with better methodologic quality are necessary to better standardize ND:YAG laser therapy and clarify its parameters for photoepilation.
... Unfortunately, practitioners performing these treatments focus only on using the basic minimum information -like the Fitzpatrick skin phototype, colour and hair structure. [24][25][26] Those are not the only factors which affect the safety of the treatment or treatment parameter settings. When treating mixed-race patients, it is essential to consider their ethnicity and a detailed ethnic history. ...
... 27 The scientific literature presents numerous reports on the effectiveness of LHR but is limited to different parts of the body and no reports on mixed-race participants have been found. 6,8,10,11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Objective The authors of this study have noticed that mixed-race patients' skin reacts differently than similar skin types according to the Fitzpatrick scale of non-mixed-race patients and so far no related research was found. The objective of the study was to investigate the occurrence and types of side and adverse effects after performing diode laser 805 nm hair removal in a group of mixed-race participants with phototypes III-V and to assess its impact on the results of the treatment measured as a percentage of hair reduction in the treated area. ...
Introduction: Laser hair removal (LHR) has become one of the most popular treatments in aesthetics. Side effects are an inevitable part of laser therapy, therefore managing them is crucial for every laser practitioner to ensure patients' safety along with achieving the best results. The available references describe the effectiveness of the diode LHR for all skin types according to the Fitzpatrick scale, but the question of patient safety and minimization of side effects and postoperative complications in mixed-race patients remains unanswered. This study aims to illustrate aspects of specific side effects in patients of mixed ethnicity and the impact of those effects on the results of the treatment. Methods: The study was conducted in Poland and the United Kingdom on 216 patients of various ethnic backgrounds. This study analyses the frequency of side effects in a mixed-race group of 32 participants, taking into account their skin type according to the Fitzpatrick scale. The patients received a course of 6 treatments using diode laser 805 nm. An objective and a subjective method were used to analyse treatment results and side effects, with adverse effects documented, if observed. Treatment settings were adjusted to skin reaction during the patch test. Results: Objective analysis was different from the subjective analysis of the treatment's effectiveness. No adverse effects were observed. Side effects such as hyperpigmentation, skin irritation, skin burns, and skin hypersensitivity were found. Conclusion: 805 nm diode laser is effective and efficient at hair removal in mixed-race patients. It is a safe treatment in terms of skin reaction as only short-term side effects were observed in the treated area and no adverse effects were noted. To achieve the best results and to avoid adverse effects it is necessary to adjust treatment settings according to the individual patient's skin reaction.
... It is of primary concern to the patient due to social and aesthetic reasons. Nowadays, not only people with hypertrichosis and hirsutism but those with an average distribution of unwanted hairs also are seeking long-term hair removal techniques (1)(2)(3)(4)(5)(6)(7). ...
... The best patient for laser epilation is white-skinned person with dark hair and normal hormonal status. The commonly used devices for hair removal are the Nd:YAG (1064 nm) laser, intense pulsed light (IPL), ruby (694 nm) laser, Alexandrite (755 nm) laser and diode (810 nm) laser (2,3,4). All of these devices are known to yield up to 75% hair reduction in patients with light skin (phototypes I-III) (5,6). ...
Background and objectives:
There are no large volume comparative studies available to compare the efficacy of lasers over lights for hair removal in Fitzpatrick V and VI skin types. This study is designed to compare the efficacy of Nd:YAG Laser versus IPL in the darker skin types.
Study design/materials and methods:
Thirty nine patients included in Group-1 were treated with Nd:YAG and 31 in group-2 with IPL. Both groups received 5 sessions of treatment. The hair counts were assessed using digital photography and manual counting method before and after treatment and results were analysed. Patient satisfaction scores and pain scores were recorded in each session and compared.
Results:
Mean hair reduction in the IPL group was 25.70 and Nd:YAG group was 24.12 (95% CI). In the Nd:YAG group, 59% of subjects had burning sensation while the figure was 32.3% in IPL group. Burning was less in IPL group (p<0.023). There were no statistically significant difference noticed regarding hyperpigmentation in both the groups (p<0.115).
Conclusion:
Both Nd:YAG and IPL are equally effective for epilation of the darker skin types. Nd:YAG is associated with mild burning sensation in a significant number of patients. Patient satisfaction scores were comparable in both the groups.
... Among these commercially available lasers, the 800∼810 nm long-pulsed diode laser (LPDL) is one of the most commonly used devices. Compared with the ruby (694.3 nm) or alexandrite (755 nm) lasers, the LPDL is less absorbed by melanin in the epidermis, making it effective for hair removal even in the darker skin types [6][7][8][9][10][11] . The efficacy of LPDL in hair removal is determined with various physical parameters, including the wavelength, pulse duration, fluence, spot size, treatment interval, and number of treatment sessions, as well as by the patient's individual characteristics, such as skin color, hair color, hair thickness, and the treated site 6,10,[12][13][14][15] . ...
... The efficacy of LPDL in hair removal is determined with various physical parameters, including the wavelength, pulse duration, fluence, spot size, treatment interval, and number of treatment sessions, as well as by the patient's individual characteristics, such as skin color, hair color, hair thickness, and the treated site 6,10,[12][13][14][15] . LPDLs have thus far only been available with a small spot size (around 1 cm in diameter) 4,7,8,11,[13][14][15] , which is associated with large energy loss due to scattering and with a high demand of time and operators' efforts for hair removal in large areas. Recently, LPDLs with a bigger spot size have been developed and are commercially available. ...
Background:
The efficacy of the long-pulsed diode laser (LPDL) in hair removal is determined with various physical parameters. Recently, LPDLs with a larger spot size are commercially available; however, the independent effect of spot size on hair removal has not been studied.
Objective:
This study aimed to compare the efficacy of the LPDL in hair removal depending on the spot size.
Methods:
A randomized, evaluators-blind, intrapatient comparison (left vs. right) trial was designed. Ten healthy Korean women received three hair removal treatment sessions on both armpits with the 805-nm LPDL and followed for 3 months. A 10×10 mm handpiece (D1) or a 10×30 mm handpiece (D3) was randomly assigned to the right or left axilla. The fluence, pulse duration, and epidermal cooling temperature were identical for both armpits. Hair clearance was quantified with high-resolution photos taken at each visit. Postprocedural pain was quantified on a visual analogue scale. Adverse events were evaluated by physical examination and the patients' self-report.
Results:
The mean hair clearance at 3 months after three treatment sessions was 38.7% and 50.1% on the armpits treated with D1 and D3, respectively (p=0.028). Procedural pain was significantly greater in the side treated with D3 (p=0.009). Serious adverse events were not observed.
Conclusion:
Given that the pulse duration, fluence, and epidermal cooling were identical, the 805-nm LPDL at the three times larger spot size showed an efficacy improvement of 29.5% in axillary hair removal without serious adverse events.
... Among the three types of lasers, redness was the most frequent side effect. 12 In people of color, Nd:YAG (1064 nm) systems are the preferred method, which has been shown to be safe with no permanent side effects. 8,11 Induction or aggravation of acne is another rare side effect of LHR, which has been reported by Carter et al. in about 6.4% of patients, slightly higher than the participants in our Around 10% of the participants in this study were persuaded that LHR can cause skin cancer. ...
Background:
Laser hair removal (LHR), including the use of home-based devices, is becoming very popular in Oman. Despite this, some people still have many misconceptions about this procedure, especially of its long-term complications. This study aimed to assess the awareness and knowledge of LHR among dermatology clinic attendees in Muscat, Oman.
Methods:
A cross sectional survey study was conducted at Al Seeb and Bowshar polyclinics in Muscat, Oman, to attendees between the ages of 18 and 70 years. The Chi-square test was used to assess the association between different categorical variables. Results were considered to be statistically significant if P < 0.05.
Results:
Of the 500 questionnaires which were distributed, 403 were completed (response rate = 80.6%). The mean (± standard deviation [SD]) age of participants was 32.9 (8.5) years old. In this study, 45.7% (184/403) of participants had used LHR, and of those, 88.6% (163/184) were satisfied with the results. The knowledge percentage among individuals was higher among those who used LHR compared to those who did not use LHR (46% vs. 27%, respectively; P < 0.001). However, there were no significant differences in LHR knowledge percentages based on employment status or monthly income. Female participants and subjects with an educational level of a college degree or above had superior knowledge regarding the safety of LHR use during pregnancy (P < 0.05).
Conclusions:
This study noted a lack of knowledge, with various misconceptions, about LHR among patients attending dermatology clinics in Oman, especially in individuals who had not used LHR before.
... 17 When comparing devices, IPL devices were found to be less painful than the alexandrite laser, yet more painful than the 810 nm diode laser; Nd:YAG lasers have been associated with more severe inflammation and the highest pain scores among all devices. 15,17,[19][20][21][22] The intensity of pain sensation with various light devices is illustrated in Figure 2. spectrum. Because melanin absorbs shorter wavelengths more strongly than longer ones, the risk of burn increases with shorter wavelengths and higher fluence. ...
Background:
With light-assisted hair removal becoming widely used, reports of adverse effects are increasing.
Objective:
To review all the reported optical incidents and cutaneous complications of laser or intense pulse light-assisted hair removal.
Methods:
A PubMed database systematic search was performed to identify studies reporting such adverse events before July 2022 using the Mesh terms "adverse effects" AND "hair removal" AND ("laser" OR "intense pulse light").
Results:
Altogether, 358 references were identified. After excluding duplicates, unrelated articles, guidelines, and conference abstracts, then adding references from studies bibliography, 104 publications were included. Ocular incidents consisted of anterior uveitis, iritis and iris atrophy, pupillary distortion, posterior synechiae, anterior chamber pigment, and cataracts in the anterior subcapsular region. Cutaneous complications consisted of pain, burns, folliculitis, leukotrichia, paradoxical hypertrichosis, pigmentary changes, changes in nevi, pili bigemini, herpes infection, hyperhidrosis, bromhidrosis, Fox-Fordyce disease, and frostbite from the cooling system. They were mostly correlated to skin type and body area as well as to light device and set parameters. Intense pulse light devices were found to be less painful than alexandrite laser, yet more painful than diode laser; Nd:YAG laser had the highest pain score.
Conclusion:
Optical incidents can be systematically avoided. Cutaneous complications are usually related to professional errors and patient characteristics. Better knowledge of laser physics and adequate training of laser operators are key recommendations to avoid undesirable side effects. Safety recommendations help prevent most of the reported complications.
... Also, the percentage of hair reduction was 64.3%. This agrees with the study of Galadari [19] that showed reduction of 70% after 6 sessions of ND: YAG and with the study of Moftah et al., [20] that showed reduction of hair density at 1 month after the 5 th laser session in both long-pulsed Nd: YAG laser as well as Multipass Alex laser compared to the baseline. ...
... 2,3 Lasers most commonly in use for hair removal include alexandrite, neodymium: yttrium-aluminum-garnet (Nd:YAG) and diode. [4][5][6][7][8][9][10][11] Currently, laser hair removal is being performed using either a stamping or a brushing ("in-motion") technique. 6 With the "stamping" technique the laser handpiece is positioned over the treated skin from spot to spot without any overlapping, and single high fluence pulses are delivered at a relatively low repetition rate to each of the spots. ...
Background and objectives:
In this study, we investigate the photothermal response of human hair using a pulsed laser source employed in the hair removal treatment. The purpose is to understand the dynamics behind the most common clinical practice to better define the salient features that may contribute to the efficiency of the process.
Study design/materials and methods:
Temperature changes of hair samples (dark brown color) from a human scalp (skin type Fitpatrick II) were measured by a thermal camera following irradiation with single and multiple neodymium: yttrium-aluminum-garnet (Nd:YAG) (1064 nm) and alexandrite (755 nm) laser pulses. Particularly, the hair was treated with an individual laser pulse of a sufficiently high fluence, or with a series of lower fluence laser pulses. We investigated the temperature increase in a broad range of fluence and number of pulses. From the data analysis we extrapolated important parameters such as thermal gain and threshold fluence that can be used for determining optimal parameters for the hair removal procedure. Our experimental investigations and hypothesis were supported by a numerical simulation of the light-matter interaction in a skin-hair model, and by optical transmittance measurements of the irradiated hair.
Results:
An enhancement of the temperature response of the irradiated hair, that deviates from the linear behavior, is observed when hair is subjected to an individual laser pulse of a sufficiently high fluence or to a series of lower fluence laser pulses. Here, we defined the nonlinear and rapid temperature built-up as an avalanche effect. We estimated the threshold fluence at which this process takes place to be at 10 and 2.5 J/cm2 for 1064 and 755 nm laser wavelengths, respectively. The thermal gain expressed by the degree of the deviation from the linear behavior can be higher than 2 when low laser fluence and multiple laser pulses are applied (n = 50). The comparison of the calculated gain for the two different laser wavelengths and the number of pulses reveals a much higher efficiency when low fluence and multiple pulses are delivered. The avalanche effect manifests when the hair temperature exceeds 45°C. The enhanced temperature increase during the subsequent delivery of laser pulses could be ascribed to the temperature-induced changes in the hair's structural properties. Simulations of the hair temperature under Nd:YAG and alexandrite irradiation indicate that the avalanche phenomenon observed in the hair suspended in air may apply also to the hair located within the skin matrix. Namely, for the same fluence, similar temperature increase was obtained also for the hair located within the skin.
Conclusion:
The observed "avalanche" effect may contribute to the reported clinical efficacy of laser hair removal and may at least partially explain the observed efficacy of the brushing hair removal procedures where laser fluence is usually low. The repeated irradiation during the brushing procedure may lead to an avalanche-like gradual increase of the hair's thermal response resulting in sufficiently high final hair temperatures as required for effective hair reduction.
... 3,4 Nd:YAG (1064 nm) lasers have the deepest penetration and appear to be safe in skin of color patients with less side effects reported, compared with other wavelengths. 3,[5][6][7][8][9] LHR works on the principle of selective photothermolysis-the laser light is selectively absorbed by melanin, which is abundant in the hair shaft, and damages the hair follicle without damaging the skin. 10 The theory states that the pulse duration should be equal or shorter to the thermal relaxation time (TRT) of the hair shaft in order to be effective in hair follicle destruction. ...
Background:
Laser hair reduction gained popularity in the last decade and is presently the most frequently used long-term hair removal method. It works on the principle of selective photothermolysis - the laser damages the hair follicle without damaging the skin. Shorter Nd:YAG pulses are also effective in hair reduction, while maintaining better comfort for the patient.
Aims:
The aim of this study was to compare the short and long pulsed methods of Nd:YAG for facial hair removal on darker Fitzpatrick skin types (IV-V).
Patients/methods:
This prospective split face, evaluator-blinded comparison of short-pulse Nd:YAG laser vs long-pulse Nd:YAG laser study included 10 untanned healthy women. There were two outcome measers, two blinded dermatologists compared baseline photographs to those taken 3 months after last session and FotoFinder was used to compare the terminal hair count reduction at the baseline and 3 months after 6th session.
Results:
Both blinded assesors observed significant hair reduction with both lasers; excellent results were achieved in 20% with long pulse and in 55% with short pulse. Both treatment options showed reduction in number of terminal hair with statistical significance using FotoFinder. Comparison of the efficacy of the two pulse durations measured by percent reduction in the number of terminal hair 3 months after the last session showed no significant difference between the groups.
Conclusion:
Hair reduction using 1064 nm Nd:YAG is a safe and effective method of hair reduction especially in darker skin types. We have shown that short pulses are better or at least equally safe and effective as the "gold standard" long pulses.
... It is worth mentioning that while it is not recommended, the 755 nm Alexandrite laser can be used in darker skin type but required fine-tuning of the laser parameters [64]. ...
... The prevalence of hirsutism has been different among various ethnic groups [4] independent of androgen levels. Permanent hair reduction is defined as a significant [5]. The intense heat of the laser damages the hair follicle, resulting in reduction of the number of hairs and the quality of hair [6]. ...
Lasers are widely used for the hair removal. But the choice of the right laser for the right skin type is very important. The aims of this study is to compare the efficacy of Diode laser and intense pulsed light (IPL) on hair removal. Patients and Methods: Fifty female patients with hirsutism were selected for a randomized controlled study in Samawa city at Al-Muthana government. The patients were divided into two groups, in group I patient's diode laser was used, in group II patients intense pulsed light (IPL) was used. The patients were evaluated at 1st, 3rdand 6thmonths after the last session was done and medical history, hormonal assay and abdomino-pelvic ultrasonographyh were performed to differentiate between idiopathic and pathological hirsutism. Hair thickness, rate of hair reduction and regrowth and patient satisfaction questionnaire, were recorded by using hair counts before treatment and during the period of follow up. Results: It was seen that the percentage of hair reduction after two sessions of treatment was maximum (45%) in the diode laser group, and 30% hair reduction in the IPL group. The percentage of hair reduction after four sessions of treatment was maximum (58%) in the diode laser group, followed by 37% hair reduction in the IPL group. The percentage of hair reduction after six sessions of treatment was maximum (80%) in the diode laser group, followed by 42% hair reduction in the IPL group. Conclusions: The number of hair follicles and shafts was significantly decreased with the diode laser and IPL, but diode laser was more effective. No dangerous or permanent damage were observed with both methods.
... Several studies have already investigated the combination of subsequent emissions of Alexandrite and Nd:YAG lasers on the same area and have showed them to be more effective than their use in single mode. 16,17 The difference between Thunder MT and other reference devices (12)(13)(14)(15)(16)(17)(18) is the simultaneous emission. This mode can be used with very short pulse widths to potentially provide efficacy and safety even on the treatment of very thin hair and border-line skin types, which may be easily subjected to undesired effects or poor efficacy using single wavelengths. ...
This retrospective cohort study regarding hair removal procedures considers all the data collected in three different clinical centers from 2017 to 2019. The device used to perform the treatments was composed of an Alexandrite 755 nm and an Nd:YAG 1064 nm laser, that delivered both wavelengths in a blended simultaneous emission (Thunder MT, Quanta System, Samarate, Italy). The improvement evaluated after 5 sessions of treatment by an external referee was: 83.0% for armpits, 82.1% for the bikini line, 82.2% for legs, 79.6% for thorax and 81.6% for the back.
The collected temporary skin reaction data reported in this study were all acceptable and transitory resolving in less than one week. The level of erythema and perifollicular edema were all signs of the reached treatment endpoint. First degree burns, hyper and hypopigmentation were also reported in a few cases but these, all resolved before the follow‐up visit without any permanent skin effects. No adverse effects were thus reported to have happened.
This retrospective study demonstrates the efficacy of combining Alexandrite and Nd:YAG lasers in a mixed modality with simultaneous emission. This technology permitted to treat patients with skin types I‐V without any reported permanent side effects and with a high pain tolerability compared to the use of Nd:YAG in single mode.
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... The long-pulsed alexandrite laser (755 nm) has been shown to be effective for hair removal in multiple studies and may be used in Fitzpatrick skin types I-III [29]. However, there are a few studies that demonstrate safety in darker skin types [30][31][32]. In a single-center randomized trial assessing efficacy and safety of long-pulsed alexandrite and Nd:YAG lasers, patients (aged 16-50 years with skin phototypes III-IV) were found to have 76-84% hair reduction at 18-month follow-up after four sessions at two-month intervals (12 and 18 mm spot size, 1.5 ms pulse duration and fluences of 20 or 40 J/ cm 2 ) [33]. ...
Excessive unwanted hair has a significant psychological effect for children and adolescents. Laser hair removal (LHR) is best suited for darkly pigmented hair in light‐skinned individuals. Importantly, darker skin may absorb emitted light along with the hair follicles and incur skin damage. It is important to screen patients carefully. However, with careful choice of laser parameters including wavelength, pulse duration, energy fluence, spot size, and repetition rate, LHR may be safely and effectively utilized in darker skin types. Long‐pulsed Nd:YAG is often considered safest for use in darker skin types. Depending on the source consulted, long‐pulsed diode or long‐pulsed alexandrite laser may also be suggested for use in darker skin types. Current knowledge of lasers for hair removal in the pediatric population is limited by a dearth of studies. LHR has the potential to decrease the emotional burden of children and adolescents suffering with hirsutism and hypertrichosis and should be considered where appropriate.
... As mentioned above, patients who decide to do pubic area hair removal more often choose the methods which give permanent results [8,12,[17][18][19]. To achieve that, photo epilation treatment is introduced on the basis of selective thermolysis with the use of various lasers with a specified light wavelength: ruby (694 nm), alexandrite (755 nm), diode (805, 810 nm), Nd:YAG (1064 nm) and incoherent xenon light -IPL (Intense Pulse Light) with the wave range between 590 and 1200 nm, described in literature as permanent methods of hair reduction [2,3,6,7,14,[18][19][20][21][22][23][24][25][26][27][28][29][30]. ...
Introduction: As hair removal (LHR) has become most popular in aesthetics, its side effects management 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 side effects and adverse effects occurrence remains unanswered. This study aims to illustrate aspects of side effects in patients of various ethnicity and the impact of those on the effectiveness of the treatment.
Methods:This is a part of a cohort study which s was conducted in Poland and the United Kingdom on patients of various ethnic backgrounds.
The patients received a course of 6 treatments using diode laser 805 nm. An objective and a subjective method were used to analyze treatment results and side effects, with adverse effects documented, if observed. Treatment settings were adjusted to skin reaction during the patch test. Ethnicity was defined according to the Census 2001 scheme acknowledged in the UK.
Results: Diode laser 805 nm hair reduction is an effective in any groups of ethinicity patients, hovewer authors can see trends related particulary to ethicnity not to skin types of the patients.
Conclusion: 805 nm diode laser is a safe treatment tool in terms of effectiveness but there is a need to assess not only skin phototype but its ethinicty.
... Another comparative evaluation of 100 patients with FST IV-VI skin types was performed with Nd: Yag, Alexandrite, and Diode lasers; all three lasers had comparable results at 12 month follow-up with 35% reduction for the Nd: YAG, and 40% for the Alexandrite and Diode. However, the Nd: Yag laser had fewer side effects including redness (22.8%), superficial burns (14.2%), scarring (2.2%), and dyspigmentation (2.2%), while 60.6% of patients using the Alexandrite experienced superficial burns and 31% of Diode users experienced hyperpigmentation [29]. A study on 33 patients FST V-VI utilizing the Alexandrite laser gathered objective data on epidermal thickness using a skin ultrasound machine and found significant epidermal thinning and decrease in density (p<0.001) that can be considered in conjunction with histological findings the previous study [30]. ...
... Wavelengths between 700 and 1000 nanometers (nm) are selectively absorbed by melanin; the competing chromophores (oxyhaemoglobin and water) absorb less energy at these wavelengths. [5][6][7][8] The following are the types of lasers for hair reduction: [9,10] • The diode laser is most effective for darker terminal hair and is less effective on lighter, finer hair. It covers large areas and has fast repetition rates, allowing brisk treatment of large body areas. ...
Lasers are widely used for the treatment of hirsutism. But the choice of the right laser for the right skin type is very important. Before starting with laser therapy, it is important to assess the skin type, the fluence, the pulse duration and the type of laser to be used.
To compare the efficacy and side effects of Diode laser, Neodymium-yttrium aluminum - garnet (Nd: YAG) laser and intense pulsed light (IPL) on 30 female patients of hirsutism.
Thirty female patients with hirsutism were selected for a randomised controlled study. The patients were divided into three groups of 10 patients each. In group I patients diode laser was used, in group II patients long pulsed Nd: YAG laser was used and in group III, IPL was used. The patients were evaluated and result graded according to a 4-point scale as excellent, >75% reduction; good, 50-75% reduction; fair; 25-50% reduction; and poor, <25% reduction in hair density.
It was seen that the percentage of hair reduction after two sessions of treatment was maximum (40%) in the diode laser group, followed by 35% hair reduction in the Nd: Yag laser group and 10% hair reduction in the IPL group. The percentage of hair reduction after four sessions of treatment was maximum (64%) in the diode laser group, followed by 62% hair reduction in the Nd: Yag laser group and 48% hair reduction in the IPL group. The percentage of hair reduction after eight sessions of treatment was maximum (92%) in the diode laser group, followed by 90% hair reduction in the Nd: YAG group and 70% hair reduction in the IPL group.
To conclude for the Indian skin with dark hairs, the diode laser still stands the test of time. But, since the diode laser has a narrow margin of safety, proper pre and post-procedure cooling is recommended. Although, the side effects of Nd: YAG laser are less as compared to the diode laser, it is less efficacious as compared to the diode laser.
... Therefore, the management of dark skin phenotypes remains problematic for laser and IPL assisted treatments. 5,[19][20][21] An increasing number of studies have confirmed the long-term hair removal efficacies of IPL systems that emit a broad spectrum of longer wavelengths. [12][13][14][15][16][22][23][24][25] Flashlamp-assisted hair removal enables a wide choice of emitting wavelengths to be chosen simply by choosing different cut-off filters, and thus this modality may be effective in a wide range of skin types, especially in darker skins. ...
BACKGROUND: Recently, intense pulsed light (IPL) sources have been shown to provide long-term hair removal. OBJECTIVE: This study examined the photoepilatory effects of different wavelengths and pulse width application in the same device and compared their efficiencies in Asian skin. METHODS: Twenty-eight Korean women were treated using HR (600–950 nm filter) and 27 using HR-D (645–950 nm filter) in the axillar area. Four treatments were carried out at intervals of 4 to 6 weeks; follow-ups were conducted 8 months after the last treatment. Mean energy settings were 14.9±2.0 J/cm2 for HR and 17.1±0.6 J/cm2 for HR-D. Longer pulse widths were applied in case of HR-D treatment. Hair counts and photographic evaluation of skin sites were made at baseline and at the last follow-up. Final overall evaluations were performed by patients and clinicians. RESULTS: Average clearances of 52.8% and 83.4% were achieved by HR and HR-D, respectively. No significant adverse effects were reported after HR-D treatment. One case each of hypopigmentation and hyperpigmentation was reported for HR. CONCLUSION: An IPL source by removing 45 nm of the emitted spectra and applying longer pulse width was found to provide a safer and more effective means of photoepilation in Asian patients.
... for the Treatment of Hair Removal and Vascular Lesions DISCUSSION Nd:YAG lasers have emerged as the most effective laser for the treatment of hair removal and leg veins in patients of darker skin types [6][7][8][9][10]. Although Ruby and Alexandrite lasers have been shown to be much more efficacious in hair removal due to better absorption by melanin their use in darker skinned patients is limited due to their side effect profile [11]. With the development of the extended theory of selective photothermolysis, lasers with pulse durations of the order of 10 -100 ms have been developed to selectively target and destroy the regenerative component of the hair follicles that resides in the outer root sheath approx 1 mm below the epidermal surface [12]. ...
... skin. [40][41][42][43] The longer wavelength of the Nd:YAG allows for less epidermal melanin absorption. Patients with skin types IV to VI can tolerate higher fluences with minimal adverse events such as epidermal burns or dyspigmentation. ...
Background:
Unwanted hair growth is a common aesthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation.
Objectives:
To extensively review the literature on laser hair removal pertaining to its theoretical basis, current laser and light-based devices, and their complications. Special treatment recommendations for darker skin types were considered.
Materials and methods:
A comprehensive literature search related to the long-pulse alexandrite (755 nm), long-pulse diode (810 nm), long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG; 1,064 nm), and intense pulsed light (IPL) system, as well as newer home-use devices, was conducted.
Results:
The literature supports the use of the alexandrite, diode, Nd:YAG and IPL devices for long-term hair removal. Because of its longer wavelength, the Nd:YAG is the best laser system to use for pigmented skin. Further research is needed regarding the safety and efficacy of home-use devices.
Conclusion:
Current in-office laser hair removal devices effectively provide a durable solution for unwanted hair removal.
... Therefore, the management of dark skin phenotypes remains problematic for laser and IPL assisted treatments. 5,[19][20][21] An increasing number of studies have confirmed the long-term hair removal efficacies of IPL systems that emit a broad spectrum of longer wavelengths. [12][13][14][15][16][22][23][24][25] Flashlamp-assisted hair removal enables a wide choice of emitting wavelengths to be chosen simply by choosing different cut-off filters, and thus this modality may be effective in a wide range of skin types, especially in darker skins. ...
BACKGROUND Recently, intense pulsed light (IPL) sources have been shown to provide long-term hair removal.OBJECTIVE This study examined the photoepilatory effects of different wavelengths and pulse width application in the same device and compared their efficiencies in Asian skin.METHODS Twenty-eight Korean women were treated using HR (600–950 nm filter) and 27 using HR-D (645–950 nm filter) in the axillar area. Four treatments were carried out at intervals of 4 to 6 weeks; follow-ups were conducted 8 months after the last treatment. Mean energy settings were 14.9±2.0 J/cm2 for HR and 17.1±0.6 J/cm2 for HR-D. Longer pulse widths were applied in case of HR-D treatment. Hair counts and photographic evaluation of skin sites were made at baseline and at the last follow-up. Final overall evaluations were performed by patients and clinicians.RESULTS Average clearances of 52.8% and 83.4% were achieved by HR and HR-D, respectively. No significant adverse effects were reported after HR-D treatment. One case each of hypopigmentation and hyperpigmentation was reported for HR.CONCLUSION An IPL source by removing 45 nm of the emitted spectra and applying longer pulse width was found to provide a safer and more effective means of photoepilation in Asian patients.
Introduction
In the realm of dermatological advancements, the alexandrite laser has carved out a significant niche in hair removal treatments. Operating at a 755 nm wavelength, it is adept at targeting melanin in hair follicles, making it particularly suitable for individuals with fair skin tones. Despite its advantages, the application of alexandrite lasers presents challenges, especially in individuals with darker skin tones due to a higher risk of adverse effects.
Objective
This comprehensive review explores the literature to examine the role and advancements of the alexandrite laser within the evolving landscape of laser hair removal. It discusses the technology's strengths, limitations, and prospects, aiming to provide a comprehensive understanding of its current state and identify avenues for further research.
Methods
Comprehensive searches were conducted in databases such as PubMed, Google Scholar, and the Cochrane Library from January 1990 to April 2024. The search included keywords and MeSH terms like ‘laser therapy,’ ‘hair reduction,’ ‘phototherapy,’ ‘hair removal,’ and ‘alexandrite.’ Studies focusing specifically on alexandrite lasers for hair removal, including reviews and clinical trials, were included.
Results
The alexandrite laser is highly effective for light skin tones but poses risks for darker skin. Nd:YAG lasers are safer for darker skin but may require more sessions for fine or light‐colored hair. Diode lasers are versatile for various skin types but less efficient for very dark or very light skin. IPL is adaptable but often needs more sessions and has higher side effect risks. Long‐term studies show sustained hair reduction with alexandrite lasers, resulting in high patient satisfaction. Side effects are generally mild and temporary, such as redness and swelling. Recent advancements in alexandrite laser technology, such as integration with other laser types, larger spot sizes, and improved cooling systems, have enhanced its safety and efficacy. Combining alexandrite with Nd:YAG lasers has expanded its applicability to darker skin tones. These innovations, along with high‐frequency treatments and shorter pulse durations, promise improved patient outcomes. However, considerations of cost and the need for multiple sessions must be weighed.
Conclusion
No single hair removal technology is universally superior; the optimal choice varies based on individual skin and hair characteristics. Advancements in alexandrite laser technology have broadened its applicability and enhanced its effectiveness and comfort for patients. Ongoing research and technological developments promise to refine these techniques further, revolutionizing long‐lasting hair reduction and making it an increasingly accessible and sustainable choice.
Importance
Hirsutism represents a significant concern for women with polycystic ovary syndrome (PCOS), with deleterious psychological effects warranting acknowledgment and a clear imperative to provide effective management. To our knowledge, this is the first review to exclusively examine the effectiveness of laser and light-based therapies in addressing hirsutism in women with PCOS.
Objective
To synthesize the existing literature regarding the effectiveness of laser and light hair reduction therapies, either as stand-alone treatments or in combination with systemic agents, in treating hirsutism for women with PCOS.
Evidence Review
A systematic literature review was performed using MEDLINE, Embase, EMCARE, and CINAHL according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses ( PRISMA ) reporting guidelines. Articles written in English, reporting on patients who met pre-established inclusion criteria were selected. Objective and subjectively measured outcomes relating to the effect of laser or light-based hair reduction therapies on hirsutism were abstracted. Heterogeneity among included studies precluded a meta-analysis, necessitating a narrative synthesis.
Findings
Six studies reporting data on 423 individual patients with PCOS who underwent laser or light-based hair reduction therapies were included: 4 randomized clinical trials and 2 cohort studies. Alexandrite laser demonstrated significant improvements in hirsutism severity and psychological outcomes, particularly at high-fluence application. Alexandrite laser was also found to be more effective than intense pulsed light (IPL). The combination of diode laser with either metformin or combined oral contraceptive pill was superior to the application of diode laser alone, just as the addition of metformin to IPL demonstrated superior results to IPL treatment alone. Overall, most interventions were well tolerated. The overall certainty of evidence across all outcomes and comparisons was limited in part due to the observational nature of some studies.
Conclusions and Relevance
This systematic review highlights the potential of laser and light hair reduction therapies, both as stand-alone treatments and in combination with other pharmacological agents in PCOS. However, this review was limited by low certainty of the evidence, few studies evaluating effectiveness and safety in those with skin of color, and heterogeneity in outcome assessment. Future studies are needed to provide more robust evidence among diverse individuals with PCOS and hirsutism.
Unwanted hair is a common concern among patients presenting to pediatric dermatology clinics, and parents and patients alike inquire about the safety of methods employed for elective removal. Various methods of hair removal exist with different levels of invasiveness and permanence, from simple mechanical depilation to light-based therapies. All methods of hair removal appear to be safe and generally well tolerated in children, and there are no age restrictions to any modality. In this review, we aim to address the available literature on the safety and efficacy of hair removal modalities in pediatric patients and propose guidance on how to manage requests for at-home and in-office therapies within an ethical framework.
Light-based therapies, including laser, have evolved in dermatology and cosmetic fields over the last few decades. Practitioners must thoroughly understand the mechanism of action and the impact of various laser parameters on treatment outcomes and safety profiles. Furthermore, practitioners could not improve or develop new laser treatment protocols unless they understood the fundamentals of light and the various laser-skin interactions. This chapter helps practitioners build a strong foundation of knowledge in skin anatomy and light physics concepts such as wavelengths, fluence, and pulse width. Moreover, the chapter discusses the possible interaction of photo energy and different skin components and chromophore and then the possible histological changes resulting from that interaction. The chapter starts with basic information about skin and light and then delves into the advanced concepts such as selective photothermolysis, thermal relaxation, photosensitization, photoacoustic properties, sequential pulsing, and pulse delay.KeywordsChromophorePhotosensitizationPhotoacoustic propertiesSelective photothermolysisSequential pulsing and pulse delayThermal relaxation
Background
Diode laser (810 nm) is frequently employed for hair reduction. There are few studies determining the efficacy in Indian population.
Objectives
Assessment of efficacy and safety of 810 nm diode laser in facial/axillary hair reduction and objective assessment of the improvement with dermoscopy, photographs, and novel Gabor filter-based hair detection algorithm.
Methodology
This hospital-based study included 40 adult women with 108 treatment sites over 5.4 sessions (range 4–8). Evaluation of treatment areas (hair texture, density) was done using modified Ferriman–Galwey scoring. Photography and dermoscopic images were taken before each session and 6 weeks after the last. Immediate and delayed adverse reactions were noted. Assessment of efficacy was done by patient, principal, and blinded investigator using Global Aesthetic Improvement scale (GAIS) and hair detection algorithm (evaluating characteristics of dermoscopic hair).
Results
The fluences ranged from 16 to 29 Joules/cm² with pulse width of 30 ms. Upper lip (n = 29, 26.9%) and chin (n = 25, 22.1%) were commonly treated areas. Improvement in hair texture and density (reduction in uniformly distributed, terminal hair from 37.1% to 13.9%) was statistically significant (p < 0.0001). Excellent improvement of 75–100% (GAIS) was noted by principal and blinded investigator in 24.1% and 33.3% total sites, respectively. The median improvement, calculated by the algorithm, was 60% for side locks, 53.9% for axilla, 24.1% for upper lip, and 14.9% for chin. Axilla and upper lip were sites associated with maximum discomfort. Epidermolysis and paradoxical hypertrichosis were seen in five patients each.
Conclusion
The 810 nm diode laser is safe and effective in the reduction of dark, coarse terminal hairs in Fitzpatrick skin types III–V. Inter-observer variation and investigator bias in the assessment of efficacy can be successfully overcome by using the algorithm.
Background Laser treatment for controlling unwanted hair or laser-assisted hair removal is ever-increasing in popularity. This technology has been introduced to our practice for more than a decade, and it is fast advancing. Many factories that produce laser machines, and even beauty or aesthetic centers, claim commercially that laser hair removal in all skin types is free of side effects. This study aims to detect the degree of patients’ satisfaction with current practice in laser hair removal and the incidence of adverse effects after laser and light systems therapy for hair removal. Objectives To find out the degree of patients’ satisfaction with laser treatment of unwanted hair or hirsutism in addition to assessing the safety of laser-assisted hair removal, through detecting post-treatment side effects (e.g. redness, pain, scarring, post-laser hyper or hypopigmentation). Materials and Methods A cross-sectional study in a private dermatology and laser clinic in Sulaimania city/Iraq-Kurdistan Region.Three hundred (300) patients were involved in our study. They attended ongoing laser hair removal sessions. All patients were interviewed and treated by Dual head Alexandrite/Nd-yag Laser or Diod laser. Results Out of 300 patients, included in our study, two hundred eighty-eight were females and their ages ranged from 15 to 64 yrs. The number of sessions was from one to 37 sessions in this group. Duration of laser treatment, found to range from 1 to 50 months. Immediate side effects like redness, blistering, and pain were reported in 76 patients (25.3%), while long-term side effects like hyperpigmentation, acne flare, or scarring were seen in 28 patients (9.3%). Regarding the degree of patients’ satisfaction,167 patients (55.6%) were highly satisfied, 120 (40%) were less satisfied, while 13 (4.3%) were unsatisfied with the results of laser-assisted hair control. Our study found no correlation between both immediate and long-term side effects with the age of the patients. The sessions’ number was also well-tolerated and effective treatment modality not related significantly to the age, or the number of sessions. Conclusion Laser treatment of unwanted hair is a safe, well-tolerated, and effective treatment modality, which leads to high patient satisfaction.
The American Society for Aesthetic Plastic Surgery estimates that in 2015 more than 1,200,000 laser hair-removal treatments were performed in the USA. Laser hair removal is currently the third most requested treatment in dermatology/aesthetic medicine. The effectiveness of photoepilation was first illustrated in 1996 by a group of researchers from Massachusetts General Hospital, who, with partial results, used light pulses generated by a ruby laser. In this chapter, we illustrate which are the best indications of hair removal, and we detailed different laser systems.
Light‐based therapies are one of the most effective and widely used strategies for removal of undesired hair, with a broadly favorable safety profile. However, subjects with pigmented skin are found to be more prone to laser‐related adverse events. While prolonged pulse‐width and longer treatment duration were proposed to minimize adverse events, the optimal treatment option among available phototherapy modalities—long‐pulsed (Nd: YAG), pulsed diode, and alexandrite lasers as well as intense pulsed light (IPL)—remains unclear, particularly for skin of color. To determine superiority in terms of effectiveness and tolerability, we conducted a systematic review of literature on different types of in‐office laser and IPL for hair removal in subjects with Fitzpatrick skin types III‐VI. The meta‐analysis was performed using Review Manager (RevMan) version 5.3 and included 12 eligible comparative trials (9 randomized controlled trials and 3 quasi‐randomized). In terms of hair count reduction, pooled effect estimates for long‐pulsed ND:YAG laser (OR 0.26, 95% CI [0.1, 0.78]) and diode laser (SMD ‐0.11, 95% CI [‐0.62, 0.39) were not statistically significant from those of IPL; in contrast, alexandrite laser was found to be superior to IPL in reducing hair count (SMD ‐1.7, 95% CI [‐2.6, ‐0.78]. In terms of adverse events, the pooled effect estimates favoured long‐pulsed Nd: YAG laser to IPL with respect to post‐inflammatory hyperpigmentation (OR 0.26, 95% CI [0.1, 0.78]). However, both pulsed diode and alexandrite lasers exhibited a comparable safety profile to IPL, despite higher pain scores with lasers. In conclusion, this systematic review suggests that treatment outcomes for different in‐office laser devices and IPL in subjects with skin type III‐VI are broadly similar; nevertheless, we observed a trend toward greater hair reduction following laser therapy compared to IPL.
This is article is about whats new in Laser hair removal when treating skin of colour.An up to date review of the evolution and existing technology .
Unwanted facial and body hair presents as a common finding in many patients, such as females with hirsutism. With advances in laser and light technology, a clinically significant reduction in hair can be achieved in patients with light skin. However, in patients with darker skin, Fitzpatrick skin types (FST) IV–VI, the higher melanin content of the skin interferes with the proposed mechanism of laser-induced selective photothermolysis, which is to target the melanin in the hair follicle to cause permanent destruction of hair bulge stem cells. Many prospective and retrospective studies have been conducted with laser and light hair-removal devices, but most exclude patients with darkly pigmented skin, considering them a high-risk group for unwanted side effects, including pigmentation changes, blisters, and crust formation. We reviewed the published literature to obtain studies that focused on hair reduction for darker skin types. The existing literature for this patient population identifies longer wavelengths as a key element of the treatment protocol and indicates neodymium-doped yttrium aluminum garnet (Nd:YAG), diode, alexandrite, and ruby lasers as well as certain intense pulsed light sources for safe hair reduction with minimal side effects in patients with FST IV–VI, so long as energy settings and wavelengths are appropriate. Based on the findings in this review, safe and effective hair reduction for patients with FST IV–VI is achievable under proper treatment protocols and energy settings.
Hidradenitis suppurativa (HS) is a complex dermatological disease characterized by recurrent painful nodules and suppuration in areas such as the axilla and groin. The disease is poorly understood and treatment is not satisfactory. In October 2016, the Canadian and United States Hidradenitis Suppurativa Foundations organized the inaugural Symposium on Hidradenitis Suppurativa Advances (SHSA) in Toronto, Canada. This meeting brought together experts from Canada, the United States, and Europe to discuss the latest advances in HS. After this important event, we considered that it would be helpful to outline current HS knowledge and to identify important gaps in treatment and research in order to move forward more efficiently. This paper briefly summarizes current knowledge in key areas including epidemiology, clinical presentation and morphological classification, natural history and prognosis, genotype-phenotype correlations, clinico-pathological correlation, pathogenesis, optimal treatment and outcome measures. General and initial suggestions for addressing these gaps are presented.
Background:
Photothermal destruction of hair shaft melanin with intense pulsed light (IPL) and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has become an effective treatment of hair removal.
Aims:
Our aim was to compare efficacy, satisfactory levels, safety, and side effects of Nd:YAG and IPL in hair reduction.
Methods:
This was a prospective randomized intrapatient, right-left, assessor-blinded comparison of Nd:YAG vs IPL. There were 38 volunteers recruited. Seven sessions were performed. Hair count, efficacy, and side effects were compared before and after each treatment and 6 months after the last treatment. In respect of 12 volunteers, we have examined the reduction in hair after 18 months.
Results:
Initially, there was no significant difference between the numbers of hair follicles. There was significant hair reduction after each treatment on the Nd:YAG-treated side. The hair reduction became significant after the third treatment with IPL. Comparison of the efficacy of the two devices on each visits showed no significant difference. There was statistically lower pain score on the IPL-treated side and statistically higher erythema, burning sensation, and edema on the Nd:YAG-treated side. Statistically lower side effect score was observed on the IPL-treated side. Eight months after the last treatment, there was significant hair reduction both on the Nd:YAG and on the IPL-treated side, and there was no difference between the efficacy. The patient satisfaction scores were higher with the IPL.
Conclusion:
Unwanted hair can be reduced by both systems safely and effectively; however, IPL has less side effects and higher satisfaction scores.
Today removal of unwanted hair is the leading cosmetic procedure requested by our patients. Thus, laser hair removal is the fastest growing and evolving area in cosmetic dermatology. The aim of this review is to remind the reader the properties that belong to the hair follicle and that belong to the laser beam which enable the laser hair removal, and to pass along the information about basic physical principles of laser tissue interaction and various laser systems used in laser hair removal. Proper patient selection, preoperative and postoperative care, principles of laser safety, postoperative complications will also be discussed.
Laser hair removal, when performed appropriately, has a low incidence of complications. © 2012 Springer-Verlag Berlin Heidelberg. All rights are reserved.
Introduction: Diode laser and intense pulsed light are among the most frequently used technologies for epilation. Objective: To compare diode laser with intense pulsed light in axillary epilation. Methods: Patients with phototypes II and III (n = 15) were subjected to 3 regular sessions of intense pulsed light (695 nm) - Quantum HR® Platform (Lumenis, Yokneam, Israel) in the right axilla and diode laser (810 nm) - Light Sheer® (Lumenis, Yokneam, Israel) in the left axilla. The number of axillary hairs were counted before and after treatment, and patients were administered a questionnaire about adverse effects, pain and satisfaction. Results: Both techniques provided a similar and significant reduction in hair density. The pain score and degree of inflammation were significantly higher for intense pulsed light (p < 0.01 and p = 0.03, respectively). There was a significant correlation between the fluence employed, the severity of pain, and the degree of inflammation for the two techniques (p < 0.05). The patients considered the final results to be similar, however more side effects were attributed to intense pulsed light. There was no difference in the proportion of preference between the two methods (p = 0.80). Conclusion: The two techniques produced similar results, but the diode laser caused less pain and fewer side effects compared to intense pulsed light.
This chapter discusses the dermal safety of laser and light-based systems. The use of light energy as a treatment modality in dermatology is as old as civilization itself. The dermal safety of laser devices commonly used in dermatology is based on photothermolysis/thermal relaxation time. There are many different lasers, which can be categorized based on the type of lasing material. The ruby laser was the first of such devices to be used in dermatology. This laser has been used to treat congenital melanocytic lesions, benign pigmented lesions, remove tattoos, and also as a hair epilating device. The diode laser used in dermatology emits infrared light at 810 nm. Port wine stains and congenital nevi are a couple of dermatological conditions that have been treated with lasers. The therapeutic outcome can, in many instances, be remarkable, leading to improved quality of life for patients. Depending on the nature of the lesion, the targeted chromophore may be oxyhemoglobin or melanin. Further, this chapter reviews the toxicological or adverse events associated with the laser treatments of nonablative dermatological conditions. When skin is exposed to infrared light, there is the distinct possibility that some of the energy will result in secondary molecular/biochemical events. In the dermatological setting, a careful patient history and thoughtful selection of laser, including fluence, wavelength, and treatment frequency, can minimize any potential adverse events. Nonetheless, there are several conditions/situations that warrant further consideration.
This chapter discusses melanogenesis in skin and hair follicle, how melanin granules or melanosomes are formed, some basic thermal principles describing how hair follicles respond to heat, the relevance of using the Fitzpatrick scale, various cooling systems designed to protect the epidermis, and the efficacy and safety of various lasers and IPL systems for darker skin types. Laser hair removal allows a physician or trained professional to treat large areas of the body quickly, with long-lasting or permanent reduction in hair growth. These reductions in growing hair are caused by the interaction of the laser with the hair melanin. While initially developed for the ideal contrast of dark hair against a fair skin background, an increasing demand is foreseen to treat all individuals regardless of base skin color, particularly in the United States, where the population is becoming more ethnically diverse. Significant hair growth reduction has been reported in people with darker skin types; however, the interaction of the laser with skin melanin must be taken into account to prevent long-lasting side effects. Permanent changes in pigmentation and skin texture, focal atrophy, and scarring are some of the adverse effects that have been reported with improper laser use. As the understanding of the variations in response in people of color to the laser grows, these side effects associated with laser hair reduction can be reduced.
Publisher Summary
This chapter discusses the different techniques for the treatment of pseudofolliculitis barbae. Pseudofolliculitis barbae (PFB) is a condition of the beard area occurring in black men and other people with curly hair. Highly-curved hair can grow back into the skin, causing inflammation and a foreign-body reaction surrounding the site of the ingrown hair. A variety of treatment options exist for managing PFB, and a judicious use of a combination of treatment options may offer the best opportunity for controlling the formation of ingrown hair that results in shaving bumps and inflammation. The magnitude of improvement resulting from compliance with a daily shaving regimen to provide a very safe, effective, economical, and convenient method to manage PFB can, in some subjects, equal that of professional lasers. The use of appropriate topical treatments such as glycolic acid may enhance the ability to comply with daily shaving, as well as alter superficial skin topography to minimize the occurrence of ingrown hair and maximize shaving efficiency. Topically applied hair-growth retardants such as Eflornithine HCl have been demonstrated to slow hair growth, modify the morphology of the hair follicle and the hair shafts in a manner that can reduce ingrown hair, and also improve compliance with a daily-shave regimen.
Removing unwanted hair has been an accepted procedure since the beginning of civilized time. Prior to the onset of laser hair removal, popular procedures ranged from abrasion, threading, plucking, waxing, chemical depilatories, and shaving. These conventional procedures had different levels of effectiveness and were used mainly for hair growth delay and temporary hair removal. Permanent depilation became possible with the onset of electrolysis; however, the procedure was tedious and time consuming and led to a high incidence of postinflammatory hyperpigmentation and scarring in patients with curly hair and darker skin types (phototypes IV–VI). The safest and most effective hair removal lasers to treat darker skin types are the long-pulsed diode and the long-pulsed Nd:YAG laser systems. Conservative fluences and longer pulse durations are necessary in order to provide safe and effective treatments to patients with darker skin types.
Unwanted hair is a common problem for which different types of light therapy have been developed as the treatment of choice. Since 1996, when the American Food and Drug Administration approved the first laser therapy for depilation, much progress has been made in light-based technology and lasers. Lasers and intense pulsed light sources with red or near infrared wavelengths (600 to 1200 nm) are the most widely used for removing hair as they target the melanin of the hair shaft, hair follicle epithelium, and hair matrix. The aim of this review is to describe and compare the different photodepilation methods currently available.
Laser hair removal (LHR) is increasingly popular for the treatment of unwanted hair. To date, there have been few studies to evaluate patient satisfaction and complications after LHR among people of color.
To determine patient satisfaction and complications with long-pulsed Nd:YAG laser assisted hair removal in dark-complexioned skin individuals from the patient's point of view.
A survey questionnaire was administered to subjects with Fitzpatrick skin type VI between the ages of 21-70 years who had been treated with long-pulsed Nd:YAG for unwanted hair. Questions were comprised of those related to satisfaction and complications from treatment with LHR. Satisfaction was recorded on a linear analogue scale (LAS=not at all satisfied; 100=extremely satisfied).
Fifty patients (female 41, male 9) completed the survey. All patients were satisfied with Nd:YAG LHR treatment with the mean satisfaction score of 84.2. All patients favor LHR treatment as compared to alternative methods. The majority of patients (79.3%) who had completed six or more LHR treatments were removing their hair less frequently than before LHR treatment. Hyperpigmentation after treatment was noted in three patients (6%), which lasted for 3-10 days. No hypopigmentation, blistering, or scarring was observed. All patients completing the study would recommend LHR for patients with unwanted hair with the mean recommendation score of 91.5.
Nd:YAG laser-assisted hair removal gives a high rate of patient satisfaction in terms of hair reduction with minimal complication among subjects of color.
Laser hair removal, previously contraindicated in patients with ethnically dark (phototypes IV-VI) or sun-tanned skin, is now recognized as a safe and effective method of permanent hair reduction in all patients. Longer wavelengths, conservative fluences, longer pulse durations and appropriate cooling methods are necessary to minimize untoward side effects and maximize efficacy. The longer wavelength Nd:YAG laser is considered safest in treating darker skin of color. An added benefit of laser epilation is that side effects of conventional hair removal such as pseudo-folliculitis barbae and post inflammatory dyspigmentation, more commonly seen in skin of color, may also respond favorably to the laser, thus increasing the potential for patient satisfaction.
To determine the most effective treatment parameters for laser-assisted hair removal using a Q-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser.
Prospective study to determine the effectiveness of Q-switched ND:YAG laser-assisted hair removal under varying pretreatment protocols. Hair growth was assessed after laser treatment, and the results were compared with those of wax epilation at 4, 12, and 24 weeks.
A private ambulatory laser facility and academic referral center.
Laser-assisted hair removal was performed under 4 different pretreatment conditions. Eighteen areas of unwanted body and facial hair from 12 study subjects were divided into 4 quadrants. Wax epilation followed by application of a carbon-based solution and exposure to Q-switched Nd:YAG laser radiation was performed on 1 quadrant. A second quadrant was wax epilated and exposed to Q-switched Nd:YAG laser radiation without prior carbon solution application. A third quadrant was exposed to laser radiation alone, and a final quadrant was wax epilated to serve as the control. Follow-up evaluations at 1, 3, and 6 months consisted of photographic documentation, manual hair counts, and patient hair-density estimates.
Percentage of hair regrowth as assessed by objective hair counts and patient subjective evaluations.
Mean percentage of hair regrowth at 1 month was 39.9% for the wax-carbon-laser quadrant, 46.7% for the wax-laser quadrant, 66.1% for the laser-alone quadrant, and 77.9% for the wax control quadrant. The percentage of hair regrowth approximately doubled by 3 months but was significantly delayed in all laser-treated quadrants regardless of pretreatment protocol. Full hair regrowth in all anatomic locations was observed by month 6. Patient subjective evaluations of hair density closely approximated hair count data. No adverse effects or long-term complications were observed.
A single hair-removal treatment with the Q-switched Nd:YAG laser is safe and effective in delaying hair growth for up to 3 months. Although the combination of pretreatment wax epilation and topical carbon solution application was effective, laser irradiation alone, with or without wax epilation, also provided a significant delay in hair growth.
A laser is a device that produces a parallel bundle of photons of equal wavelength that are temporally and spacially in phase. The laser light can be focused to produce high energy in very small spots. The pulsed dye laser, the argon laser and the carbon dioxide laser are commonly used in dermatology. The pulsed dye laser and the argon laser are especially effective for cutaneous vascular lesions such as port-wine hemangiomas. It is important for the physician to be knowledgeable about laser-tissue interaction and laser safety to avoid laser accidents.
Suitably brief pulses of selectively absorbed optical radiation can cause selective damage to pigmented structures, cells, and organelles in vivo. Precise aiming is unnecessary in this unique form of radiation injury because inherent optical and thermal properties provide target selectivity. A simple, predictive model is presented. Selective damage to cutaneous microvessels and to melanosomes within melanocytes is shown after 577-nanometer (3 x 10(-7) second) and 351-nanometer (2 x 10(-8) second) pulses, respectively. Hemodynamic, histological, and ultrastructural responses are discussed.
Although many temporary treatments exist for hirsutism and hypertrichosis, a practical and permanent hair removal treatment is needed.
Our purpose was to study the use of normal-mode ruby laser pulses (694 nm, 270 microseconds, 6 mm beam diameter) for hair follicle destruction by selective photothermolysis.
Histologically assessed damage in ex vivo black-haired dog skin after the use of different laser fluences was used to design a human study; 13 volunteers with brown or black hair were exposed to normal-mode ruby laser pulses at fluences of 30 to 60 J/cm2, delivered to both shaved and wax-epilated skin sites. An optical delivery device designed to maximize light delivery to the reticular dermis was used. Hair regrowth was assessed at 1, 3, and 6 months after exposure by counting terminal hairs.
Fluence-dependent selective thermal injury to follicles was observed histologically. There was a significant delay in hair growth in all subjects at all laser-treated sites compared with the unexposed shaven and epilated control sites. At 6 months, there was significant hair loss only in the areas shaved before treatment at the highest fluence. At 6 months, four subjects had less than 50% regrowth, two of whom showed no change between 3 and 6 months. Transient pigmentary changes were observed; there was no scarring.
Selective photothermolysis of hair follicles with the normal-mode ruby laser produces a growth delay consistent with induction of prolonged telogen with apparently permanent hair removal in some cases.
Many individuals seek to decrease facial and body hair density. Although a variety of epilating methods are available, improved techniques would be of interest to patients and physicians alike.
To determine the safety and clinical efficacy of a new laser-based method of hair removal.
A Q-switched Nd:YAG laser was used to scan skin with increased hair after applying a topical carbon-based solution. Thirty-five healthy, adult volunteers were treated with a single treatment to selected facial, neck, and axillary sites.
Twelve weeks after a single treatment, integrated site scores revealed that the majority of patients had over 25% fewer hairs. The 12-week mean percentage of hair reduction, based on anatomic sites, ranged up to 66% and 44% as judged by physicians and subjects, respectively. Adverse events were minimal and temporary.
Topical suspension-assisted Q-switched Nd:YAG laser therapy reduces hair density after a single treatment. Advantages include its speed, technical ease, and minimal adverse effects.
Laser-assisted hair removal with the long pulsed ruby laser is a promising new technique based on selectively targeting melanin in hair follicles.
The purpose of this study was to evaluate the efficacy and safety of the long pulsed ruby laser (EpiTouch) for hair removal.
The Epitouch laser was used for hair removal of the arms of 20 patients. The areas were evaluated immediately post-treatment, and at 1, 4, 8, and 12 weeks, for efficacy and complications.
Postoperative results showed 40-80% regrowth after 12 weeks.
Selective melanin-based photothermolysis with a free running pulsed ruby laser seems to be a promising, noninvasive technique for long-term hair removal. More than one treatment is necessary since only anagen hair will be affected.
The long-term epilation of hair is the goal of several lasers and intense pulsed light systems.
The purpose of the study is to use the EpiLight Hair Removal System to assess long-term epilation and to assess its safety profile following a single treatment session.
Patients received a single treatment with the Epilight Hair Removal System after entering the patient's skin type, skin color, hair color, and hair density into the system's computer software. Treatment parameters include various wavelengths of light, pulse duration, pulse delay, and energy fluence. Thirty-seven subjects received a single treatment using one of four cut-off filters consisting of two to five pulses with energies of 34-55 J/cm2.
The results of a single treatment show hair clearances occurring immediately and over a 12-week study period. Approximately 60% hair removal was noted at 12 weeks.
The EpiLight Hair Removal System is an effective and safe method for long-term epilation of unwanted hair.
Determination of the efficacy of pulsed Alexandrite Laser technology for rapid noninvasive hair removal.
Although previous studies have already shown that Ruby lasers are capable of noninvasive hair removal, a technology for the substantial increase of treatment speed is of great interest.
We have used a 2 msec free running pulsed Alexandrite (lambda = 755 nm) laser operated at a repetition rate of up to 5 pps at energy fluences of 25-40 J/cm2 to treat a wide range of body sites on 126 patients in conjunction with a fiber delivery system and a transparent target ruler. A transparent gel was used as epidermal heat sink. The study lasted 15 months. Pretreatment as well as follow-up hair count per cm2 was performed to determine the level of success. Treatments were repeated when 1-2 mm growth was observed.
The average hair count before the second treatment was found to be close to 65% of the pretreatment count. The average hair count 3 months after the last treatment, was found to be lower than 12%. The interval between treatments ranged from 4 weeks to 3 1/2 months.
The 2 msec pulsed Alexandrite laser technology is effective for the removal of unwanted hairs, ranging from fair to dark, except when hairs are absent in the shaft depending on the stage of their growth cycle. This results in the necessity of a few treatments or touchups. Adverse effects are minimal and transient.
The recent development of numerous laser-assisted hair removal techniques has produced confusion in the field of cutaneous laser surgery.
A systematic review of the hair removal laser systems currently available is attempted. Appropriate patient selection, treatment protocols, and discussion of each system's advantages, disadvantages, and complications is provided.
Techniques involving the use of selective Q-switched Nd:YAG and long-pulsed alexandrite and ruby laser systems provide a significant delay in hair growth. With further technologic advances and understanding of proper treatment parameters and intervals, it is expected that permanent hair removal may eventually be possible.
Every year thousands of young children, exploring the mysteries of cupboards and cabinets around the house, manage to get into more than simple mischief. A variety of harmful substances, ranging from corrosive acids to cosmetics and medicines are swallowed by these inquisitive youngsters. Poison Prevention Week, observed annually during the third week in March, serves to remind adults of their responsibilities for keeping poisons and children apart.
Laser-assisted hair removal has become popularized using wavelengths in both the red and infrared regions of the electromagnetic spectrum. These photoepilation devices target follicular melanin or an exogenous pigment placed within the follicle resulting in thermal damage to the hair follicle and shaft. However, melanocytes and keratinocytes located within the superficial layers of the skin also absorb red and infrared laser radiation. This may result in unwanted epidermal injury during the hair removal process.
The purpose of this study was to examine a large patient population to determine the frequency of side effects using 3 different hair removal laser systems with various wavelengths, pulse durations, and treatment protocols.
A retrospective chart review and digital photographic analysis of the side effects resulting from 900 consecutive laser-assisted hair removal treatments delivered over a 24-month study period, by means of either a Q-switched Nd:YAG laser with pretreatment wax-epilation and topical carbon solution, a long-pulse ruby laser with a contact cooling tip, or a long-pulse alexandrite laser are reported.
Treatment pain, erythema, edema, hypopigmentation and hyperpigmentation, blistering, crusting, erosions, purpura, and folliculitis were observed. The majority of undesirable tissue effects occurred on tanned skin or in Fitzpatrick skin phototypes III and higher. The ruby and alexandrite laser systems resulted in the majority of side effects seen. The effects of seasonal variations, anatomic treatment location, and sun exposure were striking within the ruby and alexandrite laser groups. No infections, scarring, or long-term complications occurred.
Laser-assisted hair removal is a safe procedure when patient characteristics such as skin type, anatomic location, and sun-exposed or tanned skin are considered during selection of laser treatment parameters. Lasers emitting wavelengths with high melanin absorption capabilities should be used in a conservative manner when treating patients with dark skin phototypes or suntans. No long-term complications, infections, or scarring occurred in this study population.
Laser‐assisted hair removal: optimizing treatment parameters to improve clinical results
- Nanni CA
Some basics on hair removal products
- Willis J