Do you want to read the rest of this article?
Literature Review
Laser Hair Removal: A Review
Abstract
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.
- ... 1 Melanin in the hair matrix absorbs light in the wavelengths of 600-1100 nm; thus, long-pulse ruby (694 nm), long-pulse Alexandrite (755 nm), long-pulse diode (810 nm), long-pulse Nd:YAG (1,064 nm), and intense pulsed light (IPL) (590-1200 nm) photothermally damage hair follicles. 2 In terms of efficacy and safety, the long-pulse alexandrite (755 nm) is one of the most popular systems. 2 The most common side effects of laser hair removal are skin reactions such as pain, transient erythema, perifollicular edema, burns, blisters, permanent scarring, hyperpigmentation or hypopigmentation, premature graying of hair. [2][3][4] Thermal, mechanical, and photochemical damage to ocular structures (corneal burns, iris atrophy, uveitis, pupillary distortion, posterior synechiae, cataract, and retinal burns) is another serious potential complication resulting from laser hair removal, eventually leading to common symptoms such as pain, conjunctival hyperemia, photophobia, blurred vision, and visual field defect. ...... 2 In terms of efficacy and safety, the long-pulse alexandrite (755 nm) is one of the most popular systems. 2 The most common side effects of laser hair removal are skin reactions such as pain, transient erythema, perifollicular edema, burns, blisters, permanent scarring, hyperpigmentation or hypopigmentation, premature graying of hair. [2][3][4] Thermal, mechanical, and photochemical damage to ocular structures (corneal burns, iris atrophy, uveitis, pupillary distortion, posterior synechiae, cataract, and retinal burns) is another serious potential complication resulting from laser hair removal, eventually leading to common symptoms such as pain, conjunctival hyperemia, photophobia, blurred vision, and visual field defect. ...... 2 In terms of efficacy and safety, the long-pulse alexandrite (755 nm) is one of the most popular systems. 2 The most common side effects of laser hair removal are skin reactions such as pain, transient erythema, perifollicular edema, burns, blisters, permanent scarring, hyperpigmentation or hypopigmentation, premature graying of hair. [2][3][4] Thermal, mechanical, and photochemical damage to ocular structures (corneal burns, iris atrophy, uveitis, pupillary distortion, posterior synechiae, cataract, and retinal burns) is another serious potential complication resulting from laser hair removal, eventually leading to common symptoms such as pain, conjunctival hyperemia, photophobia, blurred vision, and visual field defect. [5][6][7] Therefore, special eye shields should be worn when using laser epilation devices and periocular laser epilation should be avoided. ...Unwanted hair is an important aesthetic problem in many cultures. Laser epilation devices have become commonly available at the present time. Nowadays, laser hair removal is widely practiced as a cosmetic procedure, however, some ocular complications may occur. The retina is the most vulnerable to laser-related injury which can lead to serious visual impairment. Laser epilation can cause serious complications and medical costs if not performed carefully and appropriately. The use of laser hair removal devices by unskilled aestheticians who is untrained and do not have the proper protective equipment at the beauty centers, can cause serious ophthalmological and psychological disorders and thus substantial labour productivity loss and economic loss. Therefore, the protective eyewear must be used by both the aesthetician and the patient during the procedure of laser epilation. In this way, we can improve the safety of both patients and aestheticians and at the same time ensure their healths. I reported the case of a 49-year-old female with a unilateral maculopathy responsible for an acute visual field defect and consecutive psychological depression secondary to Alexandrite laser epilation. This report is important to raise the awareness of ophthalmology and dermatology society and public about risks of their misuse.
- ... Several lasers have been used successfully, including the long-pulse Alexandrite (755 nm), the long-pulse diode (810 nm), and the Nd:YAG (1064 nm). 5 These lasers share the principle of selective photothermolysis in which a select wavelength of light is preferentially absorbed by melanin in the hair follicle. 5 Intense pulsed light (IPL), which also functions via selective photothermolysis, is also effective. ...... Several lasers have been used successfully, including the long-pulse Alexandrite (755 nm), the long-pulse diode (810 nm), and the Nd:YAG (1064 nm). 5 These lasers share the principle of selective photothermolysis in which a select wavelength of light is preferentially absorbed by melanin in the hair follicle. 5 Intense pulsed light (IPL), which also functions via selective photothermolysis, is also effective. 5 Each device has advantages and disadvantages. ...... 5 Intense pulsed light (IPL), which also functions via selective photothermolysis, is also effective. 5 Each device has advantages and disadvantages. It has been suggested that the Nd:YAG laser is safest but may be less effective at achieving long-term hair removal. ...Objectives: To present a case series of 4 patients who underwent postoperative hair removal using the long-pulsed Alexandrite or Nd:YAG laser following intraoral cutaneous flap reconstruction. Methods: Patients underwent epilation in dermatology clinic with long-pulsed Alexandrite or Nd:YAG lasers, spaced 8 weeks apart, until hair removal was achieved. Results: All patients achieved improvement in hair removal regardless of initial flap donor site with significant improvement in quality of life and minimal side effects. Conclusions: The long-pulsed Alexandrite and Nd:YAG represent safe and effective treatment options to improve patient quality of life following intraoral flap repair following excision of malignancy.
- ... According to the American Society for Aesthetic Plastic Surgery laser hair removal (LHR) is the third most popular nonsurgical aesthetic procedure after injections of botulinum toxin type a and hyaluronic acid with an estimated one million procedures performed in the United States in 2016. Multiple studies have shown that LHR is a well-accepted, safe, and efficient procedure to reduce unwanted and dark-colored facial or body hair [1]. LHR is based on the concept called "selective photothermolysis" introduced by Anderson and Parrish [2], and works through selective damage to the hair follicle by using laser/light pulses that target the melanin in the hair, sparing the rest of the skin. ...... Cooling devices (contact windows, cold spray, and forced air) are needed to spare the epidermis and superficial dermis. The most common devices used for LHR are the ruby (694 nm), alexandrite (755 nm), diode (800-810 nm), Nd:YAG (1,064 nm) as well as the non-laser, broad-spectrum intense pulsed light (IPL) systems (590-1,200 nm) [1,4]. The long-pulse alexandrite laser is in the midrange of the melanin absorbing spectrum and therefore represents as an optimal choice to target the hair follicle [5], especially in lighter skin types I-III [1]. ...... The most common devices used for LHR are the ruby (694 nm), alexandrite (755 nm), diode (800-810 nm), Nd:YAG (1,064 nm) as well as the non-laser, broad-spectrum intense pulsed light (IPL) systems (590-1,200 nm) [1,4]. The long-pulse alexandrite laser is in the midrange of the melanin absorbing spectrum and therefore represents as an optimal choice to target the hair follicle [5], especially in lighter skin types I-III [1]. In addition, the longer pulse length is between the thermal relaxation time of the epidermis (3/10 milliseconds) and that of the hair follicles (40-100 milliseconds) so that in theory, the thermal energy is accumulated in the follicular melanin with minimal damage of the skin when using the appropriate pulse duration [6]. ...Background and objectives: Laser hair removal is the most common laser therapy and the third most commonly performed procedure with more than one million treatments in United States in 2016. This retrospective study was conducted to assess long-term efficacy and safety of the 755 nm laser for hair removal. Study design/materials and methods: Nearly, 3,606 laser treatments were performed with the long-pulsed 755 nm wavelength laser equipped with an epidermal cooling device between 1997 and 2005 and were followed till 2013. Standardized assessments were conducted by two treating physicians and patients at two follow-up intervals. At first follow-up, clearance was assessed by two physicians and clearance and satisfaction by patients. At the second follow-up, patients were assessed if hair clearance sustained compared with the first follow-up. Results: Nine hundred and forty-eight patients with Fitzpatrick skin types I-IV were treated with a total of 3,606 laser treatments in this study. The mean age at the beginning of the study was 35 years (±11), 95.1% of patients were female (n = 902) and 4.9% male (n = 46). Five hundred and seventy-four patients received a minimum of three treatments and an average of 5.31 (3-16) treatments on axilla, back, bikini, breast, abdomen, face, lower extremity, or upper extremity region. First, follow-up was conducted 3.9 (±1.5) years after the final laser treatment. Seventy-four percent of these patients received 75-100% clearance as reported by the physician and 48% clearance as reported by the patient. Fifty-two percent of patients reported slower hair growth and 42% change in hair texture. Ninety percent of patients treated on axilla, 82% treated on the bikini area, and 79% treated on lower extremities experienced 75% or more clearance after three treatments. Facial, as well as breast and abdomen treatments, only showed a 66% and 62%, respectively, after three treatments. For these locations, five and more treatments were needed to achieve a quote of 79% (face) or 80% (breast and abdomen) for a 75-100% clearance. Upper extremity and back treatments did not have enough physician ratings to draw conclusions. Long-term adverse events were minimal and were all located on the face (one patient scar, four patients herpes infection). Second follow-up of 173 patients was conducted after 11.5 years (±2.0) and 87.9% of patients reported that their improvement sustained. Conclusions: The long-pulsed 755 nm alexandrite laser is a safe and efficacious treatment for the reduction of unwanted body hair with permanent results and high patient satisfaction. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
- ... The duration of the laser pulse has to be shorter than the thermal relaxation time of the hair follicle in order to minimize collateral thermal damage [10]. The thermal relaxation time is defined as the time it takes for the heated tissue to cool half its peak temperature [78]. The thermal relaxation time of the hair follicle is 40-100 ms for terminal hair follicles measuring 200-300μm [72]. ...... Recently there are several studies showing comparable hair reduction and fewer side effects with low fluence devices as with high fluence device. The mechanism of hair removal with low fluencediod laser is supposed to be through photomodulation of germinative cells leading to altered hair growth and through induction of hair miniaturization of coarse terminal hair [78]. ...... The effectiveness in the long term need to be further studied. There are however several studies demonstrating hair reduction from 10% to even 72% after three to six months follow-up [78]. ...Hirsutism, excessive hair growth in women in a male pattern distribution, is an international issue and approximately 5 to 15% of the general population of women is reported to be hirsute. It causes profound stress in women. As hirsutism is a symptom and not a disease it is important to find the underlying cause. Polycystic ovary syndrome is the most common cause but other not so common endocrinology disorders must be excluded. Mild hirsutism could be seen in a woman with normal menses and normal androgen levels (idiopathic hirsutism). Ferriman-Gallwey scale (F-G) is used for assessment of hairiness. The maximum score is 36 and a score over 8 is considered as a hirsuid state. The aim of the medical treatment is to correct the hormonal imbalance and stop further progress. Oral contraceptives (OCP) are recommended as first line treatment. Spironolactone is the first choice if there is indication for antiandrogen therapy. Antiandrogens should be combined with an OCP as antiandrogens are teratogenic. Photo-epilation or electrolysis is mostly needed in order to reduce the amount of hair. Multiple treatments are required. Hair reduction with each session with photo-epilation is estimated to 15% to 30%. Medical therapy and laser or IPL should be combined for best result.
- ... In the peer-reviewed literature, diode laser systems have emerged aaps Archives of Aesthetic Plastic Surgery VOLUME 25. NUMBER 2. APRIL 2019 as the most effective hair removal method [4]. ...... Numerous clinical studies have reported that diode lasers provide a safe, fast, and comfortable platform that can be used to manipulate a wide range of fluences, making them suitable for use on hair throughout the body [9]. Diode and neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers have few and transient side effects, such as hyperpigmentation and pain, with skin types III to V because epidermal melanin absorption is lower for long-wave-length lasers [4]. Several previous clinical trials have compared the efficacy of hair removal between diode and Nd:YAG lasers in patients with darker skin types. ...Background Diode lasers are the gold standard for removing unwanted hair. Lowering the energy should result in less pain and could theoretically affect therapeutic efficacy. This study evaluated the efficacy of an 808-nm diode laser at different fluences for permanent axillary hair removal in Korean women. Methods Twenty-four Korean women were divided into two groups. Each patient received laser treatment at both axillae, which were divided into upper and lower parts. Each part received different fluence from an HR808 prototype diode at 1-month intervals: 8, 10, 12, and 14 J/cm2. Hair count and thickness were recorded at each follow-up visit and at a 3-month follow-up after the final laser treatment by photography and using a folliscope. At the final visit, pain and patient satisfaction were surveyed. Three plastic surgeons assessed the results on photographs. Results The mean hair follicle density reduction was 62.18%, 65.28%, 73.08%, and 78.29% on the right upper side, right lower side, left upper side, and left lower side, respectively. The mean hair follicle thickness reduction was 45%, 48%, 54%, and 59% on the right upper side, right lower side, left upper side, and left lower side, respectively. In the plastic surgeons’ assessment, the left upper and lower sides scored 2.71. The right upper and lower sides scored 2.38 and 2.04, respectively. Conclusions High-fluence (14 J/cm2) treatment with an HR 808 prototype diode laser efficiently removed unwanted hair. No significant difference in comfort was reported compared to the low-fluence mode (8–10 J/cm2).
- ... Several laser and light devices are available on the market for hair removal such as ruby laser (694 nm), alexandrite laser (755 nm), diode laser (800 nm), intense pulsed light (IPL) (590-1200 nm), neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (1064 nm), and lightbased devices for home use [2][3][4][5]. Since the American Food and Drug Administration (FDA) approved the first laser therapy for epilation in 1996, much progress has been made in light-based technology and lasers. ...... The long pulse 755 nm Alexandrite laser allows for deep penetration into the dermis permitting it to act on fair and black hair, but because of the competition with melanin, it is particularly indicated in patients with low skin types (up to [3][4] due to the risk of burning which results in hyper-or hypopigmentations. In order to counteract this problem, we used a specific handpiece with a cooled sapphire cylinder tip that conveys the laser beam into the patient's skin. ...Due to the difference in refraction coefficients between air and the corneal epithelium, irradiation of the skin with a light source can lead to reflection of the energy and its leakage to the skin causes epidermal injury. All of which decreases the efficacy of treatment. We evaluated cooling sapphire handpieces’ efficacy in decreasing pain and epidermal injuries and enhancing the treatment outcome in laser hair removal. A total of 49 patients with Fitzpatrick skin types of II to IV were treated for laser hair removal on face, limbs, inguinal, and axillary areas with pulsed 755-nm alexandrite laser equipped with a sapphire handpiece and the cooling system. Hair counts were performed by two independent observers at the baseline and 3 months after the final treatment. A marked reduction in hair regrowth was noted 3 months after the final treatment in all body locations studied. Clinical hair reduction was observed and fully assessed. There were no serious side effects with an average pain score of 4.6 out of 40. The cooled sapphire cylinder tip has been shown to minimize epidermal injury and reduce the system energy leaks to the skin.
- ... Even though the thermal relaxation time (TRT) of the melanin, and the time required for the laser energy to diffuse, is concise, the simple destruction it would cause only hair fragmentation and quite quick regrowth. The method is therefore solely effective in anagen phase of hair growth [6,14,15]. ...... In one of the studies, the treatment with Nd: YAG laser was assessed to be the least successful and significantly more painful. According to other reports, the effects are comparable as far as the above-mentioned photo epilation methods are concerned, and the diode laser itself is repeatedly considered not only effective but also safe [5,13,15,26,34]. ...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.
- ... The pulse width plays an important role in determining selective photothermolysis [60]. The duration of the pulse has to be shorter than the thermal relaxation time of the hair follicle, which in this case, is the time it takes for the heated hair follicle to cool half its peak temperature in order to minimize collateral thermal damage [9,52,61]. Fluence and pulse duration together influence the amount of heat absorbed in the target. To determine the thickness of the hair that should be removed is important in order to choose the right settings ( Figure 1). ...... Several IPL:s has default settings for dark skin and separate hand pieces as well. Diode laser has been reported to reduce hair count with 22% to 59% [61,[67][68][69][70][71][72]. Alexandrite and diode lasers are said to be slightly more efficacious than IPL in some studies but not to the point of statistical significance [53]. ...Hirsutism, excessive hair growth in women in a male pattern distribution, is the most common endocrine disorder in women and approximately 5 to 15% of the general population of women is reported to be hirsute. It causes profound stress in women. Polycystic ovary syndrome is the most common cause. However a woman could have normal menses, normal androgen levels but be hirsute (idiopathic hirsutism). Ferriman- Gallwey scale (F-G) is used for assessment of hairiness. The maximum score is 36 and a score over 8 is considered as a hirsuid state. As hirsutism is a symptom and not a disease it is important to find the underlying cause and exclude uncommon but serious causes. The aim of the medical treatment is to correct the hormonal imbalance and thereby stop further progress. Oral contraceptives (OCP) are recommended as first line treatment. Spironolactone is the first choice if there is indication for antiandrogen therapy. Antiandrogens should be combined with an OCP in women in child bearing age as antiandrogens are teratogenic. Photo-epilation or electrolysis is mostly needed in order to reduce the amount of hair. Multiple treatments are needed. Hair reduction with each session with photo-epilation is estimated to 15% to 30%. Medical therapy and laser or IPL should be combined for best result.
- ... Less frequently described cases are scarring, purpura, folliculitis, cyanobacteria, pruritus or urticaria. [3][4][5][6] The available literature describes the effectiveness of the diode laser as a method for all skin types according to the Fitzpatrick scale hair removal, but the question of patient safety and minimization of side effects and postoperative complications in mixed-race patients remains unanswered. [1][2][3][7][8][9][10][11][12][13][14] In diode laser, the hair removal principle of selective photothermolysis applies where the chromophore is melanin in the hair shaft itself and the bulge. ...... 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 also possible to experience pigmentary changes such as hyperpigmentation. 11,12 Less frequently described cases include scarring, purpura, folliculitis, cyanobacteria, pruritus or urticaria. [13][14][15] In this article, investigators present the results of a cohort study of side effects occurrence in groups of various ethnicities, as no similar research has been found so far. ...Introduction: As hair removal has become most popular in aesthetics, the management of its side effects is crucial for every practitioner. Available studies describe the effectiveness of the diode laser hair removal for all skin types according to the Fitzpatrick scale independently, but the question of the occurrence of side effects and adverse effects remains unanswered. This study aims to illustrate aspects of side effects for patients of various ethnicities and the impact of those on the effectiveness of the treatment. Methods: The research was carried out in Poland and the United Kingdom from March 2016 to March 2019. 217 people of various ethnic origins were qualified for the study, 206 sessions were completed and statistical analysis was performed. The procedure was performed in the pubic area with diode lasers with a wavelength of 805 nm, minimum peak power of 2100 W and pulse duration between 15 and 400 ms. ET sapphire cooling assisted handle 9 x 9 mm large and pulse energy density between 10 and 100 J/cm 2 were used for all treatments. In addition, in order to illustrate the effectiveness of treatments, the subjective and objective analyses of hair loss percentages were indicated. In statistical analysis, the chi-square test for independence was used to evaluate the correlation between the type and severity of side effects and the ethnic origin of patients, the number of treatments, the Fitzpatrick scale and the level of satisfaction. Results: The occurrence of sensitivity depended statistically significantly (P = 0.002) on ethnicity. Ethnicity had no significant effect on the occurrence of erythema. The occurrence of hyperpigmentation statistically significantly depended (P < 0.001) on ethnicity. The occurrence of burns depended statistically significantly (P = 0.001) on ethnicity. The number of treatments had a significant (P = 0.012) effect on the severity of side effects occurrence. Among participants who had 6 treatments, only half had side effects, including multiple effects occurring in 9.79% of cases. The occurrence of side effects such as sensitivity and hyperpigmentation did not depend on the number of treatments. However, the number of treatments had a significant impact on the incidence of erythema (P < 0.001) and burns (P = 0.005). More than half of the respondents (58.33%) had erythema after more than six procedures, whereas in the 6 treatments the erythema occurred only in 6.7% of cases. Conclusion: The treatment with the use of diode lasers for all subjects with different ethnicity and thus the recognized scale according to Fitzpatrick is effective and safe. The occurring side effects are transient and do not impact the effect of the whole therapy.
- ... Recent reports indicated laser hair removal as a possible novel cause of FFD [5]. Non-ablative laser hair removal devices target the melanin pigment in hair shaft cells, heat it up and destroy the basal stem cells in the follicle with a permanent hair reduction [6]. It is postulated that laser therapy could induce damage to the follicular infundibulum, resulting in epidermal detachment and altered keratinocytes maturation which led to keratin plugging. ...
- ... In darker-skinned individuals, the greater epidermal melanin content competes with the hair follicle for light absorption, increasing the risk of thermal blisters and hyperpigmentation. 3 For the purposes of this paper, the term "laser hair removal treatments" is used to describe hair removal that makes use of both laser and IPL devices. ...Background: Lasers and intense pulse light (IPL) sources are powerful devices that can cause skin burns, pigmentary changes, and scarring if used incorrectly. Adequate training is essential, and regulations are required to limit complications. Aims: The purpose was to investigate the qualifications and training obtained by laser hair removal operators in South Africa. Methods: Questionnaires were distributed and information gathered from owners/managers of laser clinics, suppliers of laser devices in South Africa, individuals in the workplace performing laser hair removal procedures, and accredited tertiary institutions. Results: A majority of clinic owners/managers (94.45%) felt that more emphasis should be placed on laser hair removal training at a tertiary level, and 66.67% outsource additional training provided by the manufacturer of laser devices. Based on the survey to manufacturers, 50% did not require any formal qualification as a minimum requirement, while 33.33% indicated laser hair removal training is incorporated at a NQF level 4 (National/Senior Certificate). The majority of individuals (68.89%) received training from tertiary institutions; however, they did not receive any practical training, and 60.87% felt the amount of training was insufficient. According to the survey sent to tertiary institutions in South Africa, only 27.78% offer laser hair removal training, and of these, 20% offer no practical training and 50% indicated that no practical examination is provided. Conclusions: There is a clear lack of training in laser hair removal in South Africa. The industry should have standard requirements in terms of minimum practical and theoretical hours with regards to the therapy.
- ... According to Karsten and Singh the absorption coefficient of the epidermis varies with the volume fraction of melanosomes and epidermal eumelanin concentration (8). Wavelengths between 700 and 1000 nm are selectively absorbed by melanin, whereas competing chromophores such as oxyhemoglobin and water absorb less energy at these wavelengths (9). Because of the high absorption of light by melanin, ruby and alexandrite lasers are not recommended for darker skin types as this could result in injury to the skin (8). ...Conventional treatments for excessive hair are tedious and time consuming. Laser hair removal has become the leading therapy option for long–term results. It works on the principle of selective photothermolysis, whereby photons destroy the hair follicle while sparing the surrounding tissue. As demand increases, there has been an increase in the regulation of these treatments. Laser hair removal is not risk-free and side effects are associated with the treatment. Adequate training is vital to minimise adverse side effects. Certain countries have regulatory boards that laser operators need to register with, as well as the completion of mandatory hours. Others require laser operators to register with a Care Quality Commission (CQC) to ensure that minimum training and safety standards are met. Currently, in South Africa, the lack of regulatory boards and mandatory hours poses a risk to the public as anyone with little or no qualification is allowed to perform laser hair removal treatments, placing patients at risk. This review looks at some of the devices used and basic mechanisms of action of laser hair removal, its associated risks, side effects and current regulation.
- ... With the rapid development and medical application of laser technology, hair removal is no longer a tedious procedure. Moreover, with effective hair removal by this technology, pre-expanded scalp skin may become the first-line donor tissues for reconstruction of facial defects [1,2]. Here we report our experiences with combined application of expanded scalp flaps and 800 nm diode laser hair removal for forehead reconstructions. ...Skin grafting is often the first choice for closing forehead defects. However, the aesthetics of skin grafting-reconstructed forehead defects are still not accepted by a large number of patients. With the technological advancement of laser hair removal, scalp flaps have been considered as donors for reconstruction of forehead defects. We evaluated 10 cases of forehead defect reconstructions with expanded scalp flaps followed by hair removal by an 800 nm diode laser. All flaps survived uneventfully and underwent 4–6 laser treatments for hair removal. The appearances of the reconstructed foreheads were similar to that of the adjacent skin, and all patients were satisfied with the treatment outcomes during the 6–24 months of follow-up. It is concluded that the combined treatments of expanded scalp flaps and diode laser hair removal are effective for repairing forehead defects.
- ... Therefore, background knowledge regarding the practical application of laser-tissue interactions and the principles of selective photothermolysis are vital for safe LHR practice [3]. In general, LHR is a safe modality, and common side effects include temporary pain, transient erythema, and perifollicular edema; these adverse events depend on variable factors such as skin type, treatment site, laser system, parameter set, and operator knowledge [4]. Unfortunately, untrained or unsupervised non-physician providers can practice LHR, increasing the risk of avoidable complications [5]. ...Background: Laser hair removal is an effective and safe method for the permanent reduction of unwanted hair. Common side effects include temporary pain, transient erythema, and perifollicular edema. Purpuric eruption is a rare adverse event. Case presentation: To the best of our knowledge, this is the second case report of purpura induced by laser hair removal. Our patient is a 50-year-old woman of Arab origin. Her positive reaction to a laser hair removal provocation test helped in the diagnosis; her condition was managed with an orally administered corticosteroid, leading to complete resolution within 5 days. Conclusion: Purpura induced by laser hair removal is a self-limiting and unusual side effect; physicians' awareness of such adverse events can help them to avoid unnecessary investigations and provide guidance for better management.
- ... [34] Because of its longer wavelength, the Nd:YAG is the best laser system for pigmented skin. [35,36] The use of medical device reports to monitor medical device performance and identify potential safety issues helps to maintain databases and formulate recommendations. [37] First two sessions of LHT for our patient were supervised by the medical care provider and then she was left unattended to self-administer laser to vulva for hair removal. ...Cosmetic laser use has many pros and cons. The worldwide use of laser for body hair removal has led to many medical complications. Unsupervised use of the laser for hair removal in vulva may result in many problems and can merely damage the vulva, although rarely, affecting the body image. This rare and novel case report is a 21 year old virgin who presented with acute urinary retention and cryptomenorrhea due to complete synlabia secondary to unsupervised vulval laser hair removal. The urinary retention was relieved by suprapubic catheterization initially. During examination under anesthesia, the fused labia were separated by a surgical incision with drainage of hematocolpos and then, a Foley's urethral catheter was inserted. She had an uneventful recovery. We report this case to emphasize on the supervised use of laser by trained and qualified personnel for hair removal in vulva to minimize its complications.
- ... In the randomized controlled trial, typical settings generally used a 10-mm spot size with a 10ms pulse duration and 35 to 50 J/cm 2 in patients with Fitzpatrick skin type I to III and a 20-ms pulse duration and 25 to 40 J/cm 2 in patients with skin types IV to VI. 56 In general, settings may vary by specific device and selected spot size and their use should be guided by operator experience with an end point of delayed post-treatment perifollicular erythema and/or edema for follicular destruction. 209 In most studies, 3 or 4 treatment sessions were performed, though additional treatment to further reduce follicular units may provide more lasting benefit. CO 2 lasers were the first to be used for HS, and they are used for excision, marsupialization, and vaporization of affected skin. ...Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.
- ... The contour of the helical rim sulcus is diminished following surgery and excessive hair may grow at the skin grafting site [ 40 ] . This can be corrected with laser treatment six months after surgery or by initial transplantation of a split-thickness skin graft without hair follicles [ 41 ] . ...The main causes of acquired auricular defects are surgical treatment of skin tumors and trauma. Due to the complex anatomy of the external ear, surgical reconstruction of defects in this area is challenging for surgeons, especially in case of midhelix‐antihelix involvement with significant loss of soft tissue and cartilage. Our purpose is to illustrate the main reconstructive techniques of large midhelix and antihelix defects, as well as the advantages or disadvantages associated with each surgical procedure. Primary closure/wedge technique is mainly used in elderly, multimorbid subjects where single‐stage procedures are desirable, but several complex chondrocutaneous, retroauricular, temporoparietal full‐thickness flap procedures can also be used to recreate an ear with normal appearance. Auricular reconstruction of large midhelix‐antihelix defects requires a good knowledge of auricular anatomy and the various surgical procedures available for such defects.
- ... The contour of the helical rim sulcus is diminished following surgery and excessive hair may grow at the skin grafting site [ 40 ] . This can be corrected with laser treatment six months after surgery or by initial transplantation of a split-thickness skin graft without hair follicles [ 41 ] . ...Zusammenfassung Die Hauptursachen erworbener Ohrmuscheldefekte sind chirurgische Behandlung von Hauttumoren und Traumata. Wegen der komplexen Anatomie des Außenohrs ist die chirurgische Rekonstruktion von Defekten in dieser Region für Operateure herausfordernd, insbesondere wenn die mittlere Helix und Anthelix von größeren Weichteil– und Knorpelverlusten betroffen sind. Wir stellen hier die wichtigsten Techniken zur Rekonstruktion großer Defekte der mittleren Helix und Anthelix sowie die Vor– und Nachteile jedes chirurgischen Verfahrens vor. Bei älteren, multimorbiden Patienten werden meist einstufige Verfahren mit primärem Verschluss/Keilexzision angewandt; es können aber auch mehrere komplexe chondrokutane, retroaurikuläre, temporoparietale Vollhautlappen–Verfahren durchgeführt werden, um ein normal aussehendes Ohr zu rekonstruieren. Die aurikuläre Rekonstruktion großer Defekte der mittleren Helix‐Anthelix Region erfordert gute Kenntnisse der Ohrmuschel–Anatomie und der verschiedenen chirurgischen Verfahren zur Korrektur solcher Defekte.
- ... This approach provides a prolonged solution for hirsutism after multiple treatments. The light can also be absorbed by epidermal melanin, which is greater in darker skinned individuals, increasing the risk of blisters, dyspigmentation, and scarring [196]. The neodymium-doped yttrium laser has longer wavelengths, which is less absorbed by epidermal melanin of darker skinned individuals, decreasing side effects. ...Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. Depending on diagnostic criteria, 6% to 20% of reproductive aged women are affected. Symptoms of PCOS arise during the early pubertal years. Both normal female pubertal development and PCOS are characterized by irregular menstrual cycles, anovulation, and acne. Owing to the complicated interwoven pathophysiology, discerning the inciting causes is challenging. Most available clinical data communicate findings and outcomes in adult women. Whereas the Rotterdam criteria are accepted for adult women, different diagnostic criteria for PCOS in adolescent girls have been delineated. Diagnostic features for adolescent girls are menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia. Pelvic ultrasound findings are not needed for the diagnosis of PCOS in adolescent girls. Even before definitive diagnosis of PCOS, adolescents with clinical signs of androgen excess and oligomenorrhea/amenorrhea, features of PCOS, can be regarded as being "at risk for PCOS." Management of both those at risk for PCOS and those with a confirmed PCOS diagnosis includes education, healthy lifestyle interventions, and therapeutic interventions targeting their symptoms. Interventions can include metformin, combined oral contraceptive pills, spironolactone, and local treatments for hirsutism and acne. In addition to ascertaining for associated comorbidities, management should also include regular follow-up visits and planned transition to adult care providers. Comprehensive knowledge regarding the pathogenesis of PCOS will enable earlier identification of girls with high propensity to develop PCOS. Timely implementation of individualized therapeutic interventions will improve overall management of PCOS during adolescence, prevent associated comorbidities, and improve quality of life.
- ... In the peer-reviewed literature, the diode laser systems have emerged as the most effective hair removal method. 1 Current laser treatments rely on the technique of selective photothermolysis. The goal of which is to target a defined structure using a particular wavelength of light delivered in or about the time that the target structure loses 50% of its heat, also known as the thermal relaxation time. ...
- ... Temporary erythema and post-inflammatory hyperpigmentation are the most frequent adverse effects, just like in most authors reviewed[4,5]. A similar situation is observed in our literature review[6,7]. The occurrence of adverse effects varies greatly based on anatomical location: no significant facial complications have been observed, while the most serious adverse effects occur on limbs, arms and legs. ...
- ... We speculate that a specific form of the photothermal effect, called selective photothermolysis (SPT), may be the mechanism responsible. 12,20 SPT, which has been applied extensively in the context of laser hair removal, where high energy lasers at 800 nm are similarly applied in a pulsatile manner to target for melanin in hair, a protein that imparts the ability to absorb M a n u s c r i p t 800 nm light, 21 posits that this manner of exposure can achieve selective and precise heating of pigmented structures based on their geometry without significant heating of the surroundings. For example, a 3 ms pulse of light would be able to preferentially heat spherical targets with diameters 100 µm or smaller, while a 300 ms pulse can heat structures up to 1 mm. ...Background Liposuction is one of the most performed cosmetic surgery procedures. In a previously reported study, gold-nanoparticle (GNP) laser-assisted liposuction (NanoLipo) was shown to improve procedure parameters and outcomes in a porcine model. Objective An ex vivo human liposuction model was developed to assess the ease, efficacy, and outcomes of NanoLipo, and to further explore its mechanism of action in facilitating liposuction. Methods NanoLipo was compared to a Control without GNPs in sets of fresh, non-perfused, anatomically-symmetric, matched tissue specimens from 12 patients. A subset of three experiments was performed under single-blinded conditions. Intraoperative assessments included lipoaspirate volume, percentage of free oil, ease of removal, and temperature rise. Specimens were palpated, visualized for evenness, and graded with and without skin. Postoperative assessment included viability staining of the lipoaspirate and remaining tissues. Micro-computed tomography was used to assess the distribution of infused GNPs within the tissues. Results NanoLipo consistently removed more adipose tissue with more liberated triglycerides compared to Control. NanoLipo specimens were smoother, thinner, and had fewer and smaller irregularities. Infused solutions preferentially distributed between fibrous membranes and fat pearls. After NanoLipo, selective structural-tissue disruptions, indicated by loss of metabolic activity, were observed. Thus, NanoLipo likely creates a bimodal mechanism of action whereby fat lobules are dislodged from surrounding fibro-connective tissue, while lipolysis is simultaneously induced. Conclusions NanoLipo showed many advantages compared to Control under blinded and non-blinded conditions. This technology may be promising in facilitating fat removal.
- 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.
- In the United States, an increasing number of individuals are identifying as transgender. Males at birth who identify as females are called male-to-female (MTF) transgender individuals or trans women, and females at birth who identify as males are called female-to-male (FTM) transgender individuals or trans men. The transgender patient population possess unique health concerns disparate from those of the general populace. Exogenous hormone therapy for transgender patients leads to changes in the distribution and pattern of hair growth. Exogenous testosterone can lead to male pattern hair loss and hirsutism, while estrogen therapy usually results in decreased facial and body hair growth and density. A thorough understanding of the hormonal treatments that may be used in transgender individuals as well the unique and complex biologic characteristics of the hair follicle is required for appropriate diagnosis, counseling and treatment of patients. The aim of this article is to provide a framework for understanding hair disorders in transgender individuals and effective treatment options.
- Introduction: Due to hormonal stimulation during puberty, changes occur in hair type and distribution. In both sexes, body and facial unwanted hair may have a negative psychological impact on the teenager. There are several available methods of hair removal, but the choice of the most suitable one for each individual can raise doubts. Objective: To review the main methods of hair removal and clarify their indications, advantages and disadvantages. Development: There are several removal methods currently available. Shaving and depilation with chemicals products are temporary methods, that need frequent repetition, because hair removal is next to the cutaneous surface. The epilating methods in which there is full hair extraction include: epilation with wax, thread, tweezers, epilating machines, laser, intense pulsed light, and electrolysis. Conclusions: The age of beginning hair removal and the method choice must be individualized and take into consideration the skin and hair type, location, dermatological and endocrine problems, removal frequency, cost and personal preferences.
- Poly cystic ovarian syndrome (PCOS) has been described as the common diagnosis for hirsutism in women. Facial hirsutism is by far the most distressing symptom of hyperandrogenism in women with PCOS. A statistically significant improvement in psychological well-being has been reported in patients with PCOS allocated for laser-assisted hair removal. The theory of selective photothermolysis has revolutionised laser hair removal in that it is effective and safe, when operated by sufficiently trained and experienced professionals. Long-pulsed ruby (694nm), long-pulsed alexandrite (755nm), Diode (800-980nm), long-pulsed Nd:YAG (1064nm) are commercially available laser devices for hair removal most widely studied. This article will introduce the fundamentals and mechanism of action of lasers in hair removal, in a contemporary literature review looking at medium to long term efficacy and safety profiles of various laser hair removal modalities most widely commercially available to date.
- Individuals with skin of color represent a growing group of patients who are seeking cosmetic treatments. This chapter explores the most common cosmetic concerns in darker racial and ethnic groups. Treatment strategies tailored toward skin of color will also be reviewed in this chapter as this population is often at higher risk of side effects from cosmetic procedures.
- Topical steroids are one of the most abused creams among dermatological products because of their strong anti-inflammatory action being misused for acne and fungal infections and hypomelanotic activity where they are misused as “fairness creams.” This leads to adverse effects such as skin atrophy, striae, acneiform eruptions, telangiectasia, hypertrichosis, and masking of skin infections. Management of these adverse effects is a long-drawn process due to steroid dependence and difficulty in reversing the cutaneous side effects. Most of these are managed with medical treatment, but occasionally procedural treatments are required to expedite therapy. Chemical peels for the treatment of acne, lasers, and light systems for the treatment of telangiectasia, striae, and hypertrichosis are the common procedures that can be of benefit, if chosen wisely and according to patient’s skin type. The need of the hour is appropriate patient and society education regarding the potential adverse effects of topical corticosteroids following inappropriate use to stem the epidemic of steroid misuse.
- Background: Home optical devices are becoming an increasingly popular treatment modality sought out by patients for dermatologic pathologies such as acne, hair removal and anti-aging, as these devices are a low-cost and convenient therapy choice. Methods: An Internet search using PubMed.gov was completed with search terms, "home device dermatology," "home device acne," "home device hair" or "hair removal," and "home device aging." Results: Currently, there are multiple home optical devices available on the market. These devices have been approved for the treatment of acne, scars, hair removal, and wrinkles using intense pulsed light, light-emitting diode, heat, infrared, low-level light therapy, and laser. Although studies on home devices are limited, current dermatologic literature shows that these devices are promising with significant post-treatment results as well as a high level of safety. Conclusions: Home optical devices are mostly used without medical practitioner supervision. As home devices usually deliver less energy per session than with professional treatments, it is important that consumers are given realistic expectations of post-treatment outcomes. Patients may use home devices without disclosure to their physician and it is important as healthcare professionals to be aware of the existence of these devices, how to use the devices properly (including what diseases can be treated and which skin types are considered safe for use), as well as any adverse effects that may occur. New research endeavors are being completed to explore the used of home devices for the treatment of chronic inflammatory diseases such as psoriasis.
- Importance Hair removal can be an essential component of the gender affirmation process for gender-minority (GM) patients whose outward appearance does not align with their gender identity. Objective To examine the health insurance policies in the Affordable Care Act (ACA) marketplace and Medicaid policies for coverage of permanent hair removal for transgender and GM patients and to correlate the policies in each state with statewide protections of coverage for gender-affirming care. Design and Setting Private health insurance policies available on the ACA marketplace and statewide Medicaid policies were examined in a cross-sectional study from September 1 to October 31, 2019, and January 17 to 30, 2020. Policies were assessed for coverage of permanent hair removal. Language concerning hair removal was found in each policy’s medical or clinical coverage guidelines and separated into general categories. Main Outcomes and Measures Logistic regression analyses were performed to compare Medicaid policies and ACA policies in states with and without transgender protections. Results A total of 174 policies were analyzed, including 123 private insurance policies and 51 statewide Medicaid policies. Of these policies, 8 (4.6%) permitted the coverage of permanent hair removal without explicit restrictions. The remaining 166 policies (95.4%) broadly excluded or did not mention gender-affirming care; prohibited coverage of hair removal or did not mention it; or only permitted coverage of hair removal preoperatively for genital surgery. The ACA marketplace policies in states without transgender care protections were less likely to cover hair removal without restrictions than ACA policies in states with protections (2 of 85 policies [2.4%] in states without transgender care protections vs 5 of 38 policies [13.2%] in states with transgender care protections), and Medicaid policies were less likely to cover preoperative or nonsurgical hair removal compared with ACA policies (6 of 51 Medicaid policies [11.8%] vs 47 of 123 ACA policies [38.2%]). Conclusions and Relevance Despite adoption of statewide restrictions on GM health care exclusions by several states, most Medicaid and ACA policies examined in this study did not cover permanent hair removal for transgender patients. Many GM patients seeking hair removal may be required to pay out-of-pocket costs, which could be a barrier for gender-affirming care.
- Introduction Laser hair removal is a common light‐based aesthetic procedure. Diode lasers and specifically the long‐pulse diode laser 810 nm are the most popular preference for hair removal due to the deep penetration and targeting of the hair follicle. In a recently published article, we presented our hair removal clinical evaluation results using an 810 nm scanning diode laser. Three‐ and six‐month follow‐up hair counts demonstrated an average hair reduction of about 70%. Objective In the current article, we demonstrate long‐term follow‐up hair removal results of 1 year after last treatment. Methods Among 11 out of 14 female patients who received three axillary hair removal treatments, 4‐6 weeks apart, returned to the 1‐year follow‐up visit. Treatment area photographs and hair count of 1‐year follow‐up visit were compared to baseline. Results The average hair count reduction of about 70% at 1 year after the last treatment was maintained. Conclusions The examined 810 nm diode laser has been proven to be a safe and effective for hair removal. Results sustain not only for 3 or 6 months but also for 1 year after last treatment.
- Here, we describe a rapid and efficient synthetic method of peptide-conjugated perylene diimide (P-PDI) using solid-phase peptide synthesis (SPPS). Due to severe insolubility of perylene dianhydride (PDA) as a starting material of perylene diimide (PDI), PDA was initially conjugated with amino acids to obtain soluble PDI derivatives. Target peptides were synthesized on a 2-chlorotrityl chloride resin using the SPPS method and then conjugated with the amino acid-appended PDI. Various conditions such as loading levels, reaction times and solvents were optimized for introducing the peptides to both sides of the amino acid-appended PDI. The final P-PDI was obtained with a maximum yield of 80% in 12 h. Its singlet oxygen-derived phototoxicity on cells was confirmed, which could be applicable to photodynamic therapy.
- Lasers for hair removal are a fast-growing area in cosmetic dermatology. Selective photothermolysis allows for targeting of specific chromophores while minimizing cutaneous damage. Treatment of individuals should be individualized based on anatomical area, skin and hair color, by varying the wavelength, fluence, pulse duration, spot size, and cooling technique of the laser.
- Die in diesem Kapitel vorliegenden Richtlinien (die einen Vorschlag der o.g. Autoren darstellen) regeln die Aus- und Fortbildung von Anwendern, die Behandlungen mit Lasern und „Anderen Optischen Strahlungsquellen“ (AOS) mit vergleichbaren Wirkungen (z. B. IPL = Intense Pulse Light o. ä.) an der menschlichen Haut durchführen. Diese Richtlinien dienen zum erforderlichen Wissensnachweis über die Physik, die biologischen Wirkungen und dem anatomischen Grundwissen zur richtigen Anwendung und Vermeidung von Schäden und unerwünschten Wirkungen. Dies ist durch entsprechende, fachgerechte theoretische (Fachkunde) und praktische Ausbildung (Sachkunde) und anwendungsspezifische Einweisung und Weiterbildung sicherzustellen und nachzuweisen (Tätigkeitszeugnis, Schulungs- und Befähigungsnachweis), z. B. durch erfolgreiche Teilnahme an einer entsprechenden Schulung einer (staatlich) anerkannten oder akkreditierten Stelle oder besonders zu benennende Ausbildungsinstitutionen. Die wichtigsten Aspekte dazu werden in diesem Kapitel vorgestellt.
- Background: Novel protocols are evolving to enhance hair follicle damage while preserving safety and improving efficacy. Objectives: The safety and tolerability of a 755-nm diode laser was compared to a combined laser with topical photo-enhancer gel (“combined”) versus laser alone (“solo”). Methods: Twenty women (age 23–33 years old), Fitzpatrick skin type I–V, were randomized to side-by-side comparisons with a laser hair removal protocol. The combined side received reduced laser energy compared to the solo side. The laser used in-motion super hair removal technology. Subjects received up to four treatments. Subjects were assessed at baseline and at 1 and 6 months after the last treatment. Results: At the 1-month follow-up, there were no statistical differences in percent hair reduction between the combined (81 ± 16%) versus the solo (77 ± 15%) protocols (p > 0.05). Similarly, at 6-month follow-up, there are no statistical differences between the combined (71 ± 24%) versus the solo (70 ± 23%) treatment protocols (p > 0.05). The average accumulative laser energy in the combined side was half of the solo side (4.2 ± 1.6 vs. 7.6 ± 2.7 kJ, respectively). Pain during the procedure was significantly higher in the solo (5.5 ± 1.8) versus the combined (3.8 ± 1.7) protocol (p < 0.001). Conclusion: A laser hair removal paradigm that combines a 755-nm diode laser with a photo-enhancer gel (reduced kJ protocol) is clinically effective as a solo treatment protocol.
- Background: Unwanted hair growth is a common aesthetic problem. Intense pulsed light hair removal has emerged as a leading treatment option for long-term depilation. Material and methods: Patients with phototypes I to III (n = 800) were subjected to 4 regular sessions (n=3200) of intense pulsed light, with 2 months follow-up at the end of treatment. Two devices (Silk'n, and Rejuvene) were analyzed about adverse effects and satisfaction. Observation and results: This study of 3.200 ILP sessions did not show any serious side effects and the number of side effects was minimal (8.75% to 10.5%). Patient satisfaction was over 90%. Both devices provided a similar and significant reduction in hair density. Conclusions: Both tested sources proved its safety and efficacy for hair removal. Patient satisfaction scores were in agreement with the treatment efficacy. The incidence of side effects has no difference between devices. Axillary bromhidrosis was an unexpected side effect.
- Background: Unwanted hair growth is a common aesthetic problem. Intense pulsed light hair removal has emerged as a leading treatment option for long-term depilation. Material and methods: Patients with phototypes I to III (n = 800) were subjected to 4 regular sessions (n=3200) of intense pulsed light, with 2 months follow-up at the end of treatment. Two devices (Silk'n, and Rejuvene) were analyzed about adverse effects and satisfaction. Observation and results: This study of 3.200 ILP sessions did not show any serious side effects and the number of side effects was minimal (8.75% to 10.5%). Patient satisfaction was over 90%. Both devices provided a similar and significant reduction in hair density. Conclusions: Both tested sources proved its safety and efficacy for hair removal. Patient satisfaction scores were in agreement with the treatment efficacy. The incidence of side effects has no difference between devices. Axillary bromhidrosis was an unexpected side effect.
- Background and Objective Combined laser and ultrasound treatments have been found to have synergistic effects, which may be of particular note in dermatology. We aim to investigate the potential of this technology for dermatology through in vitro and ex vivo experiments. Methods In vitro tissue phantoms made of agar and tattoo ink and tattooed ex vivo chicken breast tissue were used. An integrated photoacoustic imaging and high intensity focused ultrasound (HIFU) system, using a 5‐ns tunable OPO laser system and a 5 MHz HIFU transducer, was used to perform photoacoustic analysis to identify the optical contrast, and perform combined laser and ultrasound ablation. On the tissue phantoms, lines of ablation were created under various operating conditions. The samples were then quantified to determine the level of ablation. Same procedures were performed on the tattooed chicken breast tissue and the tattoo was removed by using combined laser and ultrasound. Results Ablation in the in vitro tissue phantoms was observed with properly synchronized laser and ultrasound while no ablation was found with either laser or ultrasound alone. Increases to the intensity or pulse duration of ultrasound caused an increase in ablation to the samples. The tattoo was removed from the ex vivo chicken breast using combined laser and ultrasound with a radiant exposure of 1.2 J/cm² while laser and ultrasound alone were unable to remove the tattoo. Conclusions We determined that by supplementing nanosecond laser pulses with ultrasound, ablation, and tattoo removal can be achieved at laser radiant exposures levels would otherwise be ineffective. The area of ablation can be adjusted through changes in the intensity and duration of the ultrasound burst with a constant laser intensity. Additionally, the system can be used to perform photoacoustic analysis of the tissue to estimate the relative optical absorbance at various available wavelengths, allowing for pretreatment analysis. Lasers Surg. Med. 9999:1–9, 2019. © 2019 Wiley Periodicals, Inc.
- Herein, we describe a novel manifestation of facial nerve synkinesis, swallow-induced eyelid myokymia, and hypothesise that this phenomenon is due to synkinetic facial nerve innervations of the stylohyoid-posterior digastric complex of suprahyoid muscles and orbicularis oculi muscle. In our patient’s case, onabotulinum toxin A treatment provided good therapeutic response. Swallow-induced eyelid myokymia is a unique and previously unreported variety of facial nerve synkinesis.
- Laser hair removal since its availability has been primarily used for aesthetic purposes. Over the years, it has emerged as an important therapeutic modality in various dermatological and surgical disorders, both as an adjuvant and as a monotherapy. Depending on the skin type, all laser hair removal systems have been used with good results and minimal complications. We hereby review the diverse range of unconventional indications of laser hair removal.
- Background: Becker’s Nevus (BN) is a benign hamartoma with an aesthetically troublesome condition secondary to hyperpigmentation and hypertrichosis. Many treatment modalities have been utilized with variable outcomes. Objectives: To evaluate the efficacy and safety of intense pulsed light (IPL) in the treatment of BN. Patients and methods: IPL was used at filter of 590 nm, fluence of 18-22 J/cm², double-pulse mode (pulse width of 3-10 ms, pulse delay of 20-30 ms) at 3-month intervals. Final evaluations were performed by physician global assessment and patient satisfaction. Side effects were monitored at each treatment session and follow-up visit. Results: Twenty-four patients (9 females, 15 males) with BN (16 hypertrichotic, 8 atrichotic) completed the study. The mean number of treatment sessions was 5 ± 2.17. The improvement in atrichotic BN group (4.87 ± 0.35) was significantly greater than that observed in hypertrichotic BN group (3.63 ± 0.89) (P =0.001). Hair density simultaneously decreased with treatment in hypertrichotic BN. The mean satisfaction score was 5.75 ± 2.05 and 8 ± 0.93 in hypertrichotic and atrichotic BN group respectively (P =0.002). No repigmentation was noted during the follow-up period. No permanent side effects were observed. Conclusions: IPL is an effective and well-tolerated treatment option for patients with hypertrichotic and atrichotic BN.
- 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 .
- The hair follicle is a complex, hormonally active structure, which constitutes the foundation for hair growth. The hair growth cycle has three phases: anagen, catagen and telogen. The anagen phase is the growth phase, the catagen phase is the regression phase and the telogen phase is the rest phase. The hair follicle is the most susceptible to IPL treatment during the anagen phase. The melanin is the target chromophore for hair removal.
- 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.
- Introduction: Excessive hair removal is one of the issues discussed specifically in cosmetics. To this end, various methods are available, such as the electrolysis, chemicals, etc., but each of these methods provides advantages and disadvantages. Alexandrite laser device laser is one of the most popular systems available and suitable for skin type’s I–IV. In this study we aimed to evaluate this device to determine whether it can be used as an alternative device for other devices. Materials and Methods: A comprehensive search was conducted in 6 July 2019 via Medline (PubMed), Cochrane Library, Scopus, CRD, NIHR HTA, web of science, Clarivate and ProQuest databases using PICO-based selected keywords. Afterwards, the retrieved studies were selected by two reviewers. Studies with no inclusion criteria were excluded. Then, selected studies were assessed by two evaluators using CASP International tool. Finally, five studies were selected and the obtained data were meta-analyzed by RevMan 5.2 software. In order to compare the costs and outcomes, the Incremental Cost-effectiveness Ratio (ICER) index and the sensitivity analysis were implemented. Results: This method is effective and safe. Short-term complications in Diode laser are more than the Alexandrite, Whereas Nd:YAG lasers and Intense Pulsed Optical Systems(IPLs) generally show less complications than Alexandrite. Patient satisfaction was not different between any of the methods. There was no difference between the long-pulsed Alexandrite laser, Diode laser, and IPL systems in light of therapeutic effects, but the only significant difference was seen in reduction rate of the mean amount of hair. The long- pulsed Alexandrite laser reduced it 16.62% more than the Nd:YAG laser. Keywords: Alexandrite laser, Incremental Cost-effectiveness Ratio, Diode laser, Intense Pulsed Optical Systems
- Background and Aims: Laser hair removal has recently become a major indication. Diode lasers have become commercially available offering two modes of application: a stamping or static mode, and a dynamic mode whereby the handpiece is continuously moved across the target tissue. The present study was designed to compare the efficacy of these two approaches clinically and histologically. Subjects and Methods: Twenty-five subjects participated in the study, 12 males and 13 females, ages ranging from 20 to 57 yr (Mean age 41.6 yr). A baseline hair count was performed on both the target areas. The ms-pulsed diode laser delivered 810 nm via a handpiece with a cooled tip, offering both static and dynamic modes which were used on the subjects’ left and right crura, respectively. Pain during treatment was assessed using a visual analog scale (VAS) and gross inspection was performed immediately after treatment for any abnormality in the treated skin. Hair counts were performed on both crura at 1 and 3 months after the treatment, and compared with the baseline counts. Biopsies were performed in the dynamic mode treated skin at baseline and at 1 month after the treatment, and assessed with light microscopy, immunohistochemistry and transmission electron microscopy (TEM). Results: All subjects completed the study. Compared with baseline, hair counts were significantly lower at 1 and 3 months post-treatment with no significant difference between the static and dynamic laser depilation modes, nor in the severity of the pain experienced during the procedure. Histologically, degenerative changes in the hair follicles were noted immediately after laser treatment. At one month, cystic formation was seen in the hair follicles showing a strong tendency towards apoptotic cell death. Conclusions: With the diode laser system and at the parameters used in the present study, high depilation efficacy was seen with no significant difference between the static and dynamic modes. Interestingly, good long-term depilation is probably a result of induced apoptotic cell death in the follicles rather than any other mechanism.
Literature Review
- PURPOSE: To caution about ocular risks of dermatologic diode laser, including cataract formation and iris atrophy. DESIGN: Observational case report. METHODS: A 63-year-old woman underwent diode epilation in the upper eyelid area without protective eye shields and experienced a sharp ocular pain during treatment of her left eye. She later presented with decreased vision in that eye and sensitivity to light. RESULTS: Iris atrophy and a nuclear cataract were seen on examination. In the absence of any such observations at previous eye examinations and of any contributory ocular history, these findings were attributed to the diode laser treatment. CONCLUSION: Diode laser epilation in the upper eyelid region could entail risks for intraocular structures, including cataractogenesis and iris atrophy.
- Physicians frequently recommend electroepilation (electrolysis) in the management of hirsutism, but there have been no English language reports of its clinical effectiveness. We performed over 35,000 hours of electroepilation (electrolysis) on two hundred eighty-one women over a 4-year period. We used conventional, commercially available electroepilation (electrolysis) equipment that produced both thermolysis and blend type currents. We found that electroepilation (electrolysis) helps control hirsutism, and 93% of the patients improved. There was no scarring. For best results electroepilation (electrolysis) must be combined with treatment of excess androgens. Instructions about good grooming and stressing that shaving is not harmful will help to maximize improvement in appearance. Electroepilation (electrolysis) is expensive and not readily available to those lacking insurance or other funding.
- BACKGROUND: Although there are several different laser systems available for the reduction of unwanted hair, no single system has been shown to be superior in providing safe and effective hair removal in every skin type. The purpose of this study was to evaluate the safety and efficacy of a high-energy, long-pulsed, 1064-nm Nd:YAG laser with a contact cooling device for hair removal in skin phototypes I–VI. METHODS: Thirty-six adult patients (skin phototypes I–VI) with dark terminal facial or nonfacial hair were treated with a long-pulsed Nd:YAG laser (1064 nm, 10-mm spot size, fluence of 30 to 60 J/cm2). The selected pulse duration was dependent on the skin type of the patient: Skin types I/II, III/IV, and V/VI received 10, 20, and 30 ms, respectively. Three consecutive laser treatments were delivered to 36 skin sites at 4- to 6-week intervals. Hair counts and photographic evaluations of skin sites were obtained at baseline, immediately before each treatment session, and at 1, 3, and 6 months after the final laser treatment. RESULTS: Peak hair reduction was observed 1 month after the series of laser treatments with a mean hair reduction ranging from 58% to 62% on facial sites and 66% to 69% on nonfacial sites. At 6 months after a series of three long-pulsed Nd:YAG laser treatments, a mean hair reduction of 41% to 46% on the face and 48% to 53% on the body was found depending on the skin phototype. Adverse reactions included mild to moderate treatment pain, short-term erythema, and rare occurrences of transient pigmentary alteration without scarring. CONCLUSION: The long-pulsed 1064-nm Nd:YAG laser with contact cooling is a safe and effective method of hair reduction in patients of all skin types. Side effects were limited and transient. SINCE ITS INTRODUCTION in 1995, laser-assisted hair removal has continued to grow in popularity. Rapid technologic advances in photoepilation by lasers and noncoherent light sources have made it difficult for even the most experienced laser surgeons to keep abreast of the latest developments. Based on the theory of selective photothermolysis, 1 lasers and intense pulsed light (IPL) sources with wavelengths in the red or near-infrared region (600 to 1200 nm) are most often used for hair removal because they effectively target melanin within the hair shaft, hair follicle epithelium, and heavily pigmented matrix. 2–4 Laser systems and IPL sources currently approved by the Food and Drug Administration for the reduction of hair include the long-pulsed ruby (694 nm), alexandrite (755 nm), diode (800 nm), and Nd:YAG (1064 nm) lasers and IPL (500 to 1200 nm) sources. Although all of the aforementioned lasers and light sources meet the wavelength criteria for effecting selective follicular destruction, the treatment of darker skin phototypes has been particularly problematic because of the interference of epidermal melanin with laser absorption. To reduce epidermal energy absorption relative to follicular absorption, longer wavelength lasers such as the Nd:YAG have been shown to be best for patients with darker skin tones. 5–7 Additional advantages of the longer wavelength include reduced scatter and deeper penetration of the laser light. Although decreased absorption of the 1064-nm Nd:YAG wavelength by melanin-containing structures is an advantage in terms of epidermal heating and damage, it follows that the desired target (hair) also is less effectively heated. The use of high fluences and larger spot sizes can potentially compensate for the reduced melanin absorption capacity by taking advantage of reduced scatter of the laser energy as it passes through the epidermis. The long-pulsed Nd:YAG laser has demonstrated safe and effective hair removal in patients with darker skin phototypes in a number of studies. 5–9 However, there are limited data regarding its long-term effectiveness in patients with paler skin phototypes (I–III). Furthermore, no study to date has been performed to evaluate laser-assisted hair removal in all skin phototypes by a single laser system. Therefore, the purpose of this study was to evaluate the safety and efficacy of a high-energy, long-pulsed 1064-nm Nd:YAG laser for hair removal in skin phototypes I–VI.
- Background. Laser hair removal is the treatment of choice for hypertrichosis. The two most commonly used hair removal lasers are compared. Objective. To present the results of a comparative study examining the role of wavelength, fluence, spot size, pulse width, and cooling systems on long-term results after a series of four laser hair removal treatments using the 755 nm alexandrite and 800–810 nm diode lasers. Methods. The axillae of 15 untanned, type I–V patients were treated side by side four times at 4- to 6-week intervals with a 755 nm, 3-msec pulse width, cryogen spray-equipped alexandrite laser and an 800 nm, variable pulse width, cooled sapphire window-equipped diode laser. Each patient was pretested and treated with the maximum fluence tolerated at the largest spot size available for each laser (12 mm round/113 mm2 for the alexandrite and 9 mm for the diode). Results. Evaluations were done at 3, 6, 9, and 12 months after the last treatment. Twelve-month results with the alexandrite and diode lasers achieved 85% versus 84% hair reduction. The fact that tan avoidance was strictly followed permitted the use of relatively high fluences (25–30+ J/cm2) even in type IV patients. For most patients, four treatment sessions using high fluences (30–40 J/cm2) with relatively large spot sizes (12 mm round for the 755 nm alexandrite and 9 mm for the 800 nm diode) resulted in 12-month hair reductions in the 90% range. Conclusion. Both the alexandrite and diode lasers in this 12-month study produced excellent long-term hair reductions.
- Selective epidermal cooling during laser dermatologic surgery provides great benefit, allowing the use of higher fluences, permitting treatment of darker skin types, and decreasing procedure discomfort. Three main approaches to epidermal cooling have included contact cooling, cryogen spray cooling (CSC), and air cooling, all of which improve the margin of safety associated with laser procedures by increasing the threshold for epidermal damage.To be effective, the cooling medium should be placed in direct contact with the skin surface or the intervening layer between the cooling medium and skin will impair heat extraction. We have reviewed several cases of pitted scarring after laser treatment in conjunction with contact cooling, which presumably occurred because direct contact was not maintained between the cooling handpiece and skin surface.
- Background. Lasers with long wavelengths are less well absorbed by melanin and are considered to be particularly suitable for hair removal in dark-skinned patients.Objective. To compare the efficacy and complications of 800 nm diode and long-pulsed 1064 nm Nd:YAG lasers in laser-assisted hair removal in Chinese patients.Methods. Fifteen women had hair removal treatments (13 axillae and 2 legs) with diode laser on one side and Nd:YAG laser on the other. They were followed up for 36 weeks. Subjective assessments included the degree of immediate pain and the degree of hair regrowth. Clinical photographs were taken for evaluation by two independent observers to assess complications and the degree of hair regrowth.Results. Long-pulsed Nd:YAG laser was found to be significantly associated with a greater degree of immediate pain after laser surgery (P = .0001, independent sample t-test) and also had a longer laser time (P = .0001, independent sample t-test). Besides transit adverse effects such as erythema and perifollicular edema, only one patient developed hypopigmentation at week 6 which resolved by week 36. Although regrowth rates were low at week 6 (subjective rates were 23% and 19% for Nd:YAG and diode laser, respectively), most patients had significant regrowth at week 36 (subjective regrowth rate 91% for both long-pulsed Nd:YAG and diode lasers).Conclusion. Diode 800 nm and Nd:YAG 1064 nm lasers are safe in laser-assisted hair removal in Chinese patients, and besides immediate pain, there was no other significant adverse effect. Most patients experienced regrowth 36 weeks after a single treatment. Further study is necessary to determine the long-term clinical efficacy and complications of laser-assisted hair removal with these systems in dark-skinned patients.
- Background and Objective The 810-nm wavelength diode laser can safely and successfully treat all skin types, including dark pigmented skin.Study Design/Materials and Methods Eight Fitzpatrick level V–VI skin type patients, four of which presented with the diagnosis of pseudofolliculitis barbae, were treated with the diode laser for hair removal using low-energy settings and long pulse duration.ResultsAll eight patients had excellent results with unwanted hair greatly reduced, and pseudofolliculitis barbae resolved.Conclusions Diode lasers can be used on dark pigmented skin with positive outcomes. Complications such as hypopigmentation, or hyperpigmentation occurred, but all were transient and resolved within a few months. Lasers Surg. Med. 28:150–155, 2001. © 2001 Wiley-Liss, Inc.
- Background and Objectives The aim was to study hair removal efficacy, and possible side effects of two commercially available long pulsed diode lasers. The radiant exposure was selected to a value of 35 J/cm2, which is frequently used in the clinic in accordance with manufacturer's recommendations.Study Design/Materials and MethodsA prospective clinical study was performed on twenty-nine patients with hair color ranging from light brown to black on the upper lip. One half of the upper lip was randomly selected for treatment with the MedioStar® laser; the contralateral half of the lip was treated with the LightSheer® laser. Three treatments were performed at 6–8 week intervals. Percent hair reduction and acute- and long-term side effects were evaluated after treatment.ResultsThe average hair reductions 6 months after the first treatment were 49% with the MedioStar® laser and 48% with the LightSheer® laser. No scarring or pigmentary change of the skin was observed after any of the treatments with either laser. However, differences in acute side effects such as degree of erythema and burned hairs were observed.Conclusions No statistically significant differences in hair removal efficacy were observed. These results agree with mathematical modeling, which also offers a method to estimate hair removal efficacy and adverse effects for a range of hair characteristics and laser parameters. Lasers Surg. Med. 32:399–404, 2003. © 2003 Wiley-Liss, Inc.
- Background: Multiple laser systems are available for the purpose of hair removal. Objective: The purpose of this study was to determine the safety and long-term efficacy of the 800 nm, pulsed diode laser at reducing hair count. Methods: Fifty volunteers, primarily Fitzpatrick skin types II and III, with dark brown or black hair, were treated with a diode laser (800 nm, 10-40 J/cm2, 5-30 msec, 9 mm 9 mm, 5 degrees C chilled handpiece). Each subject had eight treatment sites at varying fluences and pulse durations, as well as a varying number of treatments and pulses. Hair counts were obtained at each site at baseline, 1, 3, 6, 9, and an average of 20 months after treatment. Results: After one treatment, hair regrowths ranged from 22 to 31% at the 1-month follow-up visit, then remained stable between 65 and 75% from the 3-month to the averaged 20-month follow-up. After two treatments there were relatively longer growth delays, with hair regrowths plateauing beginning at 6 months after treatment and ranging from 47 to 66% for the remainder of the follow-up evaluations. Side effects were limited to pigmentary changes, transient in subjects with skin types II and III. Conclusions: This 800 nm diode laser with a chilled sapphire tip and variable pulse duration is safe and effective for long-term hair reduction in individuals with skin types II and III.
- Background. Laser-assisted hair removal is becoming the treatment of choice for removing unwanted hair.Objective. The purpose of this work was to determine the long-term efficacy of the long-pulsed infrared (LPIR) laser at shortened treatment intervals for the treatment of bikini hair.Methods. Eleven patients received five treatments at 3-week intervals to the right groin using the LPIR laser. Laser parameters were held constant for all treatments: 10 mm spot size, 20 J, and 20-msec pulse duration. Results were evaluated 1 year after the last laser treatment. Hair counts were performed.Results. The average patient had a 78% clearance of hair noted at 1 year with no evidence of scarring or pigmentary changes.Conclusions. A simulated model of cutaneous hair follicles provides evidence that shorter treatment intervals (3 weeks) may be preferable for more complete destruction of the hair follicle bulb and bulge.
- Background: Treatments for hypopigmented scars have shown limited efficacy and variable safety profiles. OBJECTIVE This study evaluated the safety and efficacy of fractional resurfacing (1,550-nm Fraxel SR laser, Reliant Technologies, Mountain View, CA) for the treatment of hypopigmented scars on the face in seven patients. Materials and methods: Seven patients with hypopigmented scars on the face received between two and four successive treatments at 4-week intervals with the 1,550-nm Fraxel SR laser. Energy settings ranged from 7 to 20 mJ and a total density of 1,000 to 2,500 microthermal zones per square centimeter. Digital photographs were taken before each treatment and at 4 weeks after the last treatment. Independent physician clinical assessments were performed. Results: Independent physician clinical assessment 4 weeks after the final Fraxel SR laser treatment revealed improvements of 51% to 75% in hypopigmentation in six of seven patients. One patient had only 26% to 50% improvement in hypopigmentation. Additionally, clinical improvements were noted in the overall texture of the treated skin. The patient's degree of satisfaction paralleled the physician's assessment of improvement. All patients reported improvement in hypopigmentation lasting greater than 3 months after the last treatment. Side effects were limited to mild pain during the treatment and mild posttreatment erythema and edema, which resolved in 2 to 4 days. Conclusion: Fractional resurfacing is a potentially effective modality for the treatment of hypopigmented scarring on the face. No adverse effects were observed.
- Background: Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. Advances in laser technology over the past several years has led to the development and distribution of numerous red and infrared lasers and light sources to address this issue. Despite the impressive clinical results that have been reported with the use of individual laser hair removal systems, long-term comparative studies have been scarce. Objective: To compare the clinical and histologic efficacy, side effect profile, and long-term hair reduction of long-pulsed diode and long-pulsed alexandrite laser systems. Methods: Twenty women with Fitzpatrick skin types I-IV and dark terminal hair underwent three monthly laser-assisted hair removal sessions with a long-pulsed alexandrite laser (755 nm, 2-msec pulse, 10 mm spot) and a long-pulsed diode laser (800 nm, 12.5 msec or 25 msec, 9 mm spot). Axillary areas were randomly assigned to receive treatment using each laser system at either 25 J/cm2 or 40 J/cm2. Follow-up manual hair counts and photographs of each area were obtained at each of the three treatment visits and at 1, 3, and 6 months after the final laser session. Histologic specimens were obtained at baseline, immediately after the initial laser treatment, and 1 and 6 months after the third treatment session. Results: After each laser treatment, hair counts were successively reduced and few patients found it necessary to shave the sparsely regrown hair. Optimal clinical response was achieved 1 month after the second laser treatment, regardless of the laser system or fluence used. Six months after the third and final treatment, prolonged clinical hair reduction was observed with no significant differences between the laser systems and fluences used. Histologic tissue changes supported the clinical responses observed with evidence of initial follicular injury followed by slow follicular regeneration. Side effects, including treatment pain and vesiculation, were rare after treatment with either laser system, but were observed more frequently with the long-pulsed diode system at the higher fluence of 40 J/cm2. Conclusion: Equivalent clinical and histologic responses were observed using a long-pulsed alexandrite and a long-pulsed diode laser for hair removal with minimal adverse sequelae. While long-term hair reduction can be obtained in most patients after a series of laser treatments, partial hair regrowth is typical within 6 months, suggesting the need for additional treatments to improve the rate of permanent hair removal.
- Background: Various lasers have been developed for epilation of unwanted hair. Most studies, however, have been done in white patients with minimal reference to dark-skinned individuals. Objective: To determine the safety profile of a long-pulsed alexandrite laser for hair removal in patients with Fitzpatrick skin types IV-VI exclusively. Methods: Prospective clinical evaluation conducted from June 1998 to April 1999 at a referral private clinic. Prelaser skin testing was performed starting at 16 J/cm2 and energy fluence selected according to response. Complications were recorded at each visit. Results: One hundred and fifty patients are reported (18 men and 132 women) ranging in age from 15 to 50 years, for a total of 550 treatment sites. Complications occurred in only 2% of cases. Conclusion: The long-pulsed alexandrite laser is safe for hair removal in darker skin tones. Prelaser skin testing was not helpful in this study, as there was no relationship between skin reaction and the incidence of complications.
- Hypopigmented scarring is a challenging condition to treat, with current treatments showing limited efficacy and temporary results. Nonablative fractional resurfacing has been demonstrated to be an effective and safe modality in the treatment of hypopigmented scars. To demonstrate the efficacy and safety of combining fractional resurfacing with topical bimatoprost and topical tretinoin or pimecrolimus for the treatment of hypopigmented scars. Fourteen patients with hypopigmented scars were treated with a mean of 4.5 sessions of a fractionated 1,550-nm erbium-doped laser at 4- to 8-week intervals and subsequently started topical bimatoprost and tretinoin or pimecrolimus. An independent physician evaluated digital photographs taken before and 4 weeks after the last laser treatment using a quartile grading scale (grade 1, ≤25% improvement; grade 2, 26-50% improvement; grade 3, 51-75% improvement; grade 4, >75% improvement). Five patients had >75% improvement in hypopigmentation, and 12 had >50% improvement. After a mean follow-up of 20.1 months, all patients demonstrated prolonged results. Side effects were limited to transitory post-treatment edema and erythema. The combination of fractional resurfacing, topical bimatoprost, and tretinoin or pimecrolimus is a potential effective resource for the treatment of hypopigmented scars, with long-lasting results.
- The long-pulsed diode (800-810-nm) laser is one of the most commonly used and effective lasers for hair removal. Limitations of currently available devices include a small treatment spot size, treatment-associated pain, and the need for skin cooling. To evaluate the long-term hair reduction capabilities of a long-pulsed diode laser with a large spot size and vacuum assisted suction. Thirty-five subjects were enrolled in a prospective, self-controlled, single-center study of axillary hair removal. The study consisted of three treatments using a long-pulsed diode laser with a large spot size and vacuum-assisted suction at 4- to 6-week intervals with follow-up visits 6 and 15 months after the last treatment. Hair clearance was quantified using macro hair-count photographs taken at baseline and at 6- and 15-month follow-up visits. Changes in hair thickness and color, levels of treatment-associated pain, and adverse events were additional study endpoints. There was statistically significant hair clearance at the 6 (54%) and 15-month (42%) follow-up visits. Remaining hairs were thinner and lighter at the 15-month follow-up visit, and the majority of subjects reported feeling up to mild to moderate pain during treatment without the use of pretreatment anesthesia or skin cooling. A long-pulsed diode laser with a large spot size and vacuum-assisted suction is safe and effective for long-term hair removal. This is the largest prospective study to evaluate long-term hair removal and the first to quantify decreases in hair thickness and darkness with treatment.
- High fluence diode lasers with contact cooling have emerged as the mainstay modality for hair removal. However, the use of these devices is associated with pain and side effects, especially in patients with dark or tanned skin. A novel concept of depilation at low fluence using 810 nm diode laser has been introduced as a solution to these shortcomings. The purpose of this study was to evaluate the lasting efficacy and safety of low-level fluence 810 nm (15 J/cm(2) ) and high repetition rate (5 Hz) F1 Diode Laser™ therapy on hair reduction in patients with various skin types. This randomised, controlled, bilaterally paired within-patient, double-blind study compared low level fluence 810 nm (15 Joules/cm(2) ) laser diode therapy to nontreated shaved control areas on long-term hair reduction. Seventeen patients with skin type II-V were treated four times at 1 month intervals. Hair count was assessed monthly over 10 months using an objective computerised method. Safety and tolerability were assessed by adverse reactions monitoring. Statistically significant differences in hair count between treated and control sites were observed at each follow-up visit. The majority of patients reported a slight but bearable sensation of heat during the laser treatment, and transient erythema post-treatment. This study showed that laser hair removal with the F1 Diode Laser™ system was generally well tolerated, safe, and efficacious in this small sample study of patients with various skin types. After just four treatments, permanent hair reduction following one complete hair cycle has been shown. Controlled studies on larger groups of patients within each skin phototype are needed to confirm these promising results.
- Published reports indicate that corticosteroid injections can prevent recurrence after keloid excision, but the side effects of repetitive intralesional steroid injections may preclude treatment maintenance. Additionally, few of these studies employed a standardized treatment protocol. To analyze the results of a new uniform treatment protocol combining corticosteroid injections and ointment application designed to reduce recurrence rates after excisional surgery in individuals with keloids or hypertrophic scars. As a standard procedure, the first corticosteroid injection took place after removal of the sutures and then once every 2 weeks after that until it had been done five times. In addition, all postsurgical wounds received self-administered steroid ointment application twice daily for 6 months after suture removal. Postoperative follow-up in this series ranged from 24 to 57 months (median 32 months, mean 32.5 months). Recurrence occurred in three of the 21 keloid cases (14.3%) and one of the six hypertrophic scar cases (16.7%). We evaluated a new standardized adjuvant corticosteroid therapy to prevent recurrence after surgical keloid or hypertrophic scar excision. Using this method, we achieved low recurrence rates.
- 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.
- In the past 5 years since their US introduction, there has been a rapid proliferation of light-based hair removal devices intended for home-use. In the last 2 years in Europe, sales already run into many tens of thousands of units with well-known multi-national companies entering the market. These guidelines provide a definition of light-based home-use technology, to inform healthcare professionals about home-use light-based technology and encourage manufacturers wishing to sell in Europe to adopt 'best practice'. The review presents the current status on standards and regulation issues and considers home-use safety issues, encompassing human, device and electrical safety, given risks to the eyes and skin from optical radiation both to the consumer and persons in the vicinity. Proposed technical measurement methodology is considered with focus on recognized critical parameters for the safe use of light-based hair removal technology including recording the technical performance and safety claims of a range of home-use hair removal devices. The literature review emphasizes potential adverse incidents and safety aspects of treating cosmetic conditions, such as unwanted hair growth. Although some regulations exist, they differ from region to region and there is a specific need for international common principles and guidelines relating to the manufacture, marketing and use of intense pulsed light and laser devices, including manufacturing standards for home-use products intended, amongst others, for cosmetic hair removal and photo-rejuvenation procedures. In these guidelines, the European Society for Laser Dermatology (ESLD) provides a professional view of what 'best practice' may imply for manufacturers and consumers alike.
- To report a case of bilateral iritis and transillumination defects after laser hair removal of the eyebrows with an alexandrite laser. A 41-year-old male presented with bilateral eye pain and mild photophobia 2 days after receiving alexandrite (755 nm) laser epilation of both eyebrows. Examination showed visual acuity of 20/20 in both eyes, 2+ conjunctival injection in both eyes, 1+ cells in the anterior chamber of right eye and trace cells in left eye, poor right pupil dilation, and left pupil without movement. Intraocular pressure and fundus examination were normal. He was diagnosed with iritis and iris atrophy, associated with laser epilation. Topical steroids and cycloplegic drops were prescribed for 1 month. After 1 month of treatment, transillumination defects remained in both eyes, but greater in right. In dim light, the right pupil was 4 mm and oval and the left pupil was 6 mm and round. Visual acuity remained 20/20 in both eyes. Laser hair removal of the eyebrows can lead to permanent ocular damage even with eye protection, and should be avoided.
- Laser hair removal at lower fluences, delivered under certain conditions, may retain the efficacy of high-fluence lasers while improving tolerability. We performed a pilot study comparing the efficacy, safety and tolerability of laser hair removal using traditional settings compared to lower fluences, delivered from a larger handpiece and under vacuum. Fourteen healthy participants underwent 5 axillary hair removal treatments with an 800 nm diode laser at 1-month intervals, with follow-up 1 and 3 months after the 5th treatment. In all patients, one side was treated with standard parameters using a 9×9 mm chilled tip and gel, while the contralateral side was treated using a 22×35 mm vacuum-assisted handpiece at fluences up to 12 J/cm(2). Follow-up assessments were performed after each treatment and at each follow-up visit, and included photography and questionnaires. Eleven participants completed the study and follow-up. All experienced significant hair removal in all treated areas. At the 3-month follow-up visit, the high-fluence and low-fluence treated axillae demonstrated comparable hair reduction. Participants found the lower fluence treatments to be more tolerable. No adverse events were reported. Lower fluence diode laser, delivered under conditions of vacuum and using larger spot sizes, can provide significant hair reduction.
- Laser systems that are commonly used for the treatment of hirsutism include the ruby laser (694 nm), the diode laser (800 nm), the alexandrite laser (755 nm) and the Nd:YAG laser (1084 nm). The diode laser and alexandrite laser are considered effective in treatment of hirsutism in dark-skinned patients. The response of hairs to these laser systems is variable and not complete. In this study, we compared the efficacy of these two laser systems for permanent hair removal. This was a randomized, controlled clinical trial that was performed with women of the age range 15-45 years old. After obtaining informed consent, the samples were randomized into two groups using random allocation software. The first group was treated with alexandrite laser alone (four sessions, two months apart). The second group was treated sequentially with diode laser for the first two sessions and alexandrite laser for the next two sessions. Overall, 111 patients (57 patients in the alexandrite laser group and 54 patients in the sequential diode-alexandrite laser group) were evaluated. There was no significant difference regarding mean of hair reduction between the two groups during the courses of treatment. Except for the first session, there was no significant difference regarding percent of patient satisfaction between the two groups (P value >0.05). Comparison between the two groups showed no significant difference one month, three months and six months after the last treatment (P value >0.05). Regarding the results of our study, there is no significant difference between sequential treatment with diode and alexandrite lasers versus alexandrite laser alone in the treatment of hirsutism. We suggest that in further studies, the efficacy of sequential treatment with other laser systems is evaluated against single treatment methods.
- Although several lasers meet the wavelength criteria for selective follicular destruction, the treatment of darker skin phototypes is particularly challenging because absorption of laser energy by the targeted hairs is compromised by an increased concentration of epidermal melanin. To compare satisfaction level, safety and effectiveness of a long-pulsed Nd:YAG laser and intense pulsed light (IPL) in axillary hair reduction in subjects with dark skin. The study design was a within-patient, right-left, assessor-blinded, comparison of long-pulsed Nd:YAG laser and IPL. Fifty women (skin phototypes IV-VI) volunteered for removal of axillary hair. Five sessions at 4- to 6-week intervals were performed. Hair counts at both sides were compared at baseline and 6months after the last session. Final overall evaluations were performed by subjects and clinician at the end of the study. Satisfaction was scored for both devices. Thirty-nine women completed the study. At 6months, the decrease in hair counts on the laser side (79·4%, P<0·001 vs. pretreatment) was significantly (P<0·01) greater than that on the IPL side (54·4%, P<0·01 vs. pretreatment). Only temporary adverse effects were reported at both sides. Higher pain scores and more inflammation were reported with Nd:YAG laser; however, it was preferred by 29 volunteers (74%). Volunteers reported higher satisfaction score with Nd:YAG laser (P<0·01). Dark skin can be treated by both systems safely and effectively; however, long-pulsed (1064 nm) Nd:YAG laser is more effective as reported by both subjects and clinician.
- A low fluence, high repetition rate 810 nm diode laser using constant motion technique has been recently introduced with advantages of less treatment discomfort and fewer side effects compared with traditional laser hair removal. To compare hair reduction and side effects of low fluence high repetition rate 810 nm diode with high fluence low repetition rate 1064 nm Nd:YAG lasers. Forty-nine subjects were randomly received five monthly treatments with diode laser on one side of their axilla and long-pulsed Nd:YAG laser on the other side. Hair count was recorded at baseline, 1- and 6-month follow-up visits. Percentage of axillary hair reduction at 1-month follow-up visit after receiving diode and Nd:YAG laser treatment were 71.0% and 82.3%, respectively, and at 6-month follow-up were 35.7% and 54.2%, respectively. There were significant differences in hair reduction between both laser systems at 1- and 6-month follow-ups (P < 0.001 and P < 0.001, respectively). Patients reported lower pain on the diode laser side (P < 0.001). Side effects of both laser systems were mild and transient erythema and swelling. High fluence low repetition rate Nd:YAG laser was superior in hair reduction and provided higher patient satisfaction. However, low fluence high repetition rate diode laser was less painful.
- A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients with hypertrophic and keloid scarring of the sternotomy wound, is surgical excision with or without adjuvant treatment of any benefit in reducing the size of the scar? Altogether, more than 15 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. One of the studies showed no difference between surgery and adjunctive triamcinolone or colchicine. One study showed that incomplete excision resulted in higher recurrence rates. Postoperative radiation was found to be useful in two of the studies, although one study showed that it was not useful. One randomized control trial showed improvement after laser compared to no treatment. Two other trials showed no difference between laser, silicone gel, intralesional steroid or 5-fluorouracil. One trial showed that perioperative systemic steroid application gave rise to no improvement but in fact worsened scar formation. We conclude that small keloids can be treated radically by surgery with adjuvant therapy (radiation or corticosteroid injections) or by non-surgical therapy (corticosteroid injections, laser and anti-tumour/immunosuppressive agents, such as 5-fluorouracil). Large and multiple keloids are difficult to treat radically and are currently only treatable by multimodal therapies that aim to relieve symptoms.
- Hypertrophic scars are difficult to improve and remain a therapeutic challenge. Several lasers and light sources have been evaluated in the past decades and have been shown to improve hypertrophic scars. However, a systematic review is not available. To assess current evidence of efficacy of all laser and intense pulsed light therapies used in the treatment of hypertrophic scars, we performed a systematic review searching electronic databases MEDLINE, EMBASE and CENTRAL. The quality of the controlled clinical trials was evaluated according to the Cochrane Collaboration's tool for assessing risk of bias. Thirteen articles involving seven different lasers met the inclusion criteria. Most evidence was found for the pulsed dye laser (PDL) 585 nm (eight studies), followed by the PDL 595 nm (two studies), whereas limited evidence (one trial per laser) was available for the fractional nonablative laser 1540 nm, CO₂ laser 10,600 nm, low-level laser therapy, Nd:YAG laser 532 nm and Erbium:YAG laser 2940 nm. Treatment recommendations should be formulated with caution as current evidence is insufficient for comparing the efficacy of different laser therapies. The PDL 585 nm showed a low efficacy for the treatment of hypertrophic scars. With moderate efficacy, the PDL 595 nm is promising, although more research is necessary. Little evidence was found for the efficacy of other lasers. Future research, with a low risk of bias, well-defined scar characteristics, validated outcome measures, standardized measurement methods, follow-up periods of at least 6 months and well-defined laser settings, is needed.
- Although complications such as blister formation, erosion, and post-inflammatory hypo- and hyperpigmentation are well-known side effects of intense pulsed light (IPL) photoepilation, little is known about the paradoxical hypertrichosis after therapy. To report the paradoxically increased hair density and coarseness after IPL photoepilation. Within a period of 23 months, a total of 991 hirsute female patients were treated with IPL for photoepilation. The IPL system used was the Vasculight-SR, a multifunctional laser and IPL system (Lumenis Inc., Santa Clara, CA, USA). The cut-off filters frequently used were 695, 755 and 645 nm. Paradoxical hypertrichosis and terminal hair change were detected after a few sessions of IPL therapy among 51 out of 991 patients. Our serial digital photographs, schematic diagrams, and hair counts before and after treatment confirmed the patients' claims. The other more commonly seen complications were epidermal burning with blisters, erosion, and crust formation followed by post-inflammatory hypo- and/or hyperpigmentation. Paradoxical hypertrichosis and terminal hair change is a common complication of IPL photoepilation.
- This study was designed to evaluate the hypothesis that low-level fluences done repetitively on a hair follicle will produce permanent hair removal with less discomfort and fewer side effects than a single high-fluence pulse. To compare the safety and efficacy of a low-fluence, high-repetition rate versus a high-fluence, low-repetition rate 810-nm diode laser for permanent hair reduction in patients with facial hirsutism. Forty-two female patients with confirmed polycystic ovaries by ultrasonography with facial hirsutism were subjected to the low-fluence, high-repetition Soprano® XL laser in SHR mode and the LightSheer™ laser on each side of the face using preset parameters once a month for six sessions. Hair counts were done at the end of the sixth session using a 'Hi Quality Hair Analysis Program System' and the pain score was recorded by a visual analog scale. The overall median reduction of hair was 90.5% with the Soprano XL and 85% with the LightSheer, with a standard deviation of 7 and 8.5 respectively. This new technology, with low fluence and high repetition, showed a statistically insignificant increase in hair reduction compared to the LightSheer, but did show a significant reduction in hair thickness and a low pain score.
- Unwanted hair is a common problem for which a variety of laser treatments is available. Laser treatment in dark-skinned individuals carries a higher risk of complications like hyperpigmentation and burn. The objective of this study was to evaluate efficacy and safety profile of laser-assisted hair removal in individuals with Fitzpatrick type IV-VI skin using long-pulsed Nd:YAG laser. Retrospective data was collected from 150 individuals with Fitzpatrick type IV-VI skin who underwent laser-assisted hair removal. This included area treated, fluence, number of treatments, and outcome. Data was also gathered on patient satisfaction and complications. The most common phototype was type IV (94%). The most frequently treated area was the face (84.7%) followed by the underarms and legs. Among the facial areas, the chin was the most frequently treated area followed by the upper lip and jaw line. The mean number of treatments was 8.9 (range 4-22). The maximum fluence averaged 26.8 Joules/cm(2) and was significantly higher for facial hair. Of the patients, 78.7% felt that their treatment was good or satisfactory. Mean hair reduction was 54.3%. Satisfaction from the treatment was significantly higher in individuals undergoing treatment of non-facial areas. Subsequent hair growth was slower and finer in 79.3% of the patients. There were no complications in 86% of the patients. All the complications were transient, with hyperpigmentation being the most frequent complication. Our results show that laser hair removal using the long-pulsed Nd:YAG laser is safe and effective in dark-skinned individuals with satisfactory results in most patients.
- Non-ablative fractional resurfacing (NAFR) has been reported in case studies as an effective treatment for surgical and burn scars [Behroozan et al., J Cosmet Laser Ther 2006; 8(1):35–38; Haedersdal et al., Lasers Surg Med 2009; 41(3):189–195; Waibel and Beer, J Drugs Dermatol 2008; 7(1):59–61; Niwa et al., Dermatol Surg 2009; 35(5):773–777; discussion 777–778; and Tierney et al., Dermatol Surg 2009; 35(8):1172–1180]. We have performed a prospective, randomized controlled study with two different treatment arms to better characterize the response of hypertrophic scars to NAFR.
- Laser hair removal is the most popular laser procedure in the United States (U.S.), yet there has not been a prospective study demonstrating long-term efficacy of diode laser hair removal beyond six months. A prospective, single-center, bilaterally paired, blinded, randomized comparison split leg study was carried out with 22 patients comparing high-fluence, single-pass diode laser to low-fluence, multiple-pass diode laser. Hair counts were done six and 18 months following five treatment sessions and were found to be comparable t90-94 percent hair reduction. Hair counts at six months following the fifth treatment were comparable to hair counts at 18 months, indicating that sixth-month hair counts can be considered indicative of long-term results. The low-fluence, multiple-pass in-motion technique was associated with significantly less pain compared to the high-fluence, single-pass technique. Multiple passes of a diode laser at low fluences but with high average power results in permanent hair removal with less discomfort and fewer adverse effects, especially in darker skin.
- Laser therapy is clinically effective in hair removal; however, despite the development of various strategies, laser procedures still present a risk of adverse effects due to the overheating of the skin. To investigate the effects of 810-nm diode laser treatment on hair and on the biophysical properties of skin by using various non-invasive techniques on various parameters, including hair analysis, surface color changes, integrity of skin barrier, sebum production rate and pH level. In this randomized, right-left comparison study, 35 women with axillary hair received single-session diode laser therapy. Hair analysis and biophysical properties of the skin were assessed before treatment and at weeks 2, 4 and 6 after the therapy. Hair density and thicknesses statistically significantly decreased after the first post-treatment evaluation. Regarding comparison of the biophysical properties of the skin, there was no statistically significant difference in the assessments, except for the increase determined during the second week in the erythema index in the laser-treated areas. The findings of this study showed that the diode laser can perform a significant reduction in the hair amount without significant epidermal damage, at least for a short period.
- A handpiece with a 35 × 22-mm treatment window that uses vacuum technology has been designed for the diode laser system. Vacuum suction stretches the skin and brings the hair follicle closer to the surface with the intent to damage the hair follicle at a lower surface fluence. The objective of this study was to compare the degree of follicular thermal damage between the sapphire-cooled smaller handpiece at a higher fluence versus the larger vacuum-assisted handpiece at a lower fluence. Five male patients with Fitzpatrick skin types I-IV were enrolled in the study. Three test spots on the right back were treated with the vacuum-assisted laser handpiece at a setting of 10-12 J/cm², and 61-ms pulse duration. Three test spots on the left back were treated with the sapphire-cooled handpiece with a setting of 30-34 J/cm² and a pulse duration of 14-16 ms. A punch biopsy was obtained from one treated area for each handpiece type. The biopsies were sectioned horizontally and examined for the degree of thermal damage to the hair follicle at the level of the isthmus and the bulb. Immediate treatment response, pain score, and total treatment time were recorded. Biopsies from the skin treated with the sapphire-cooled handpiece and the vacuum-assisted handpiece showed the mean hair follicle diameter was 258.3 µm (SE [standard error] 41.7) and 225.1 µm (SE 17.1), respectively. The mean thermal damage diameter to hair diameter ratio was 0.91 (SE 0.10) and 0.72 (SE 0.12), respectively. The mean immediate treatment response, the mean pain severity, and the mean total treatment time were all lower for the vacuum-assisted handpiece. Treatment with the vacuum-assisted handpiece is faster and has a tendency to be more comfortable. Thermal damage to the hair follicle was greater with the sapphire-cooled handpiece.
- Laser hair removal is currently a popular cosmetic procedure. Traditional high-fluence laser treatment for hair elimination is associated with discomfort and adverse events and it is restricted to low phototype skins. A multicenter study of hair epilation with low fluences and high repetition pulse rate using an 810-nm diode laser was carried out on 368 patients (phototypes III to V) to test its efficacy in a 6-month follow-up after five treatments on the face and various body areas. Objective and subjective assessment as well as histologies show a high index of patient satisfaction due to high efficacy of hair elimination, also proved histologically by the damage observed at hair structure level. Results obtained a high degree of patient satisfaction and a low index of adverse events. Laser epilation was well accepted regarding discomfort and was also complication-free for dark and tanned skins. Treatment is easy to conduct and requires adapting the movement of the hand-piece to a constant speed in order to achieve high-energy deposit on tissue avoiding risks of burning.
- The 800 nm diode laser and the 1064 nm Nd:YAG laser have been used successfully for hair removal for many years. Objective: To compare the efficacy of a diode laser with a Nd:YAG laser regarding axillary fossa hair removal in Chinese women. Twenty-nine Chinese women underwent three treatment sessions at 4-week intervals with a diode laser (34-38 J/cm(2)) on one side and a Nd:YAG laser (34-40 J/cm(2)) on the other side. Assessments included the reduction of hair diameter following treatment, the regrowth rate in hair length, total hair reduction and the immediate pain associated with the treatments. At follow-up visit number 1 (4 weeks after the first session), the average reduction in hair diameter on the diode laser side and the Nd:YAG laser side was 2.44 μm and -0.6 μm, respectively. The regrowth rates of the hair were 61.93 μm/day and 59.84 μm/day, respectively, which were not statistically significant (p > 0.05). At follow-up visit number 1, hair reduction was 60.09% and 41.44%, respectively. At follow-up visit number 2 (4 weeks after the second session), hair reduction was noted to be 78.56% and 64.50%, respectively, which were both statistically significant (p < 0.05). Immediate pain scores at the first session were 6.97 and 6.17, respectively; at the second session were 5.48 and 6.69, respectively; and at the third session were 5.76 and 7.45, respectively; all statistically significant (p < 0.05). The diode laser showed more efficacy and was found to be more comfortable than the Nd:YAG laser for axillary fossa hair removal in Chinese women.
- Hirsutism is a common disorder in women of reproductive age, and androgen disturbances may aggravate the condition. Limited evidence exists regarding efficacy of hair removal in this specific population and no data are available for patients with verified normal testosterone levels. To compare efficacy and safety of intense pulsed light (IPL) vs. long-pulsed diode laser (LPDL) in a well-defined group of hirsute women with normal testosterone levels. Thirty-one hirsute women received six allocated split-face treatments with IPL (525-1200 nm; Palomar Starlux IPL system) and LPDL (810 nm; Asclepion MeDioStar XT diode laser). Testosterone levels were measured three times during the study period. Patients with intrinsically normal or medically normalized testosterone levels throughout the study were included in efficacy assessments (n = 23). Endpoints were reduction in hair counts assessed by blinded photoevaluations at baseline and 1, 3 and 6 months after final treatment, patient-evaluated reduction in hairiness, patient satisfaction, treatment-related pain and adverse effects. IPL and LPDL reduced hair counts significantly, with median reductions from baseline of 77%, 53% and 40% for IPL and 68%, 60% and 34% for LDPL at 1, 3 and 6 months, respectively. At 6 months follow-up, there was no significant difference between treatments in terms of hair reduction (P = 0·427), patient assessment of hairiness (P = 0·250) and patient satisfaction (P = 0·125). Pain scores were consistently higher for IPL [median 6, interquartile range (IQR) 4-7] than LPDL (median 3, IQR 2-5) (P < 0·001). Hirsute women with normal or medically normalized testosterone levels responded equally well to IPL and LPDL treatments of facial hairiness, but the efficacy declined over 6 months.
- Low-energy intense pulsed light for hair removal at home was evaluated in this clinical trial. Twenty-two female patients were enrolled into an institutional review board-approved clinical trial. Patients received six biweekly treatments with the device, and clinical results with hair counts and pictures were performed at four weeks and three months following the last treatment. Ninety-five percent of the patients noted hair count reduction at the end of this clinical trial. Overall hair reduction was 78 percent at the one-month follow up and 72 percent at the three-month follow up. No serious adverse events were noted. This clinical trial confirmed the safety and efficacy of this device for hair removal at home.
- The domestic market for home-use hair removal devices is rapidly expanding and there are numerous intense pulsed light (IPL) products now available globally to consumers. Technological challenges for the design of such devices include the need to be cost-effective in mass production, easy to use without training, and most importantly, clinically effective while being eye-safe. However inexpensively these light-based systems are produced, they are designed to cause biological damage to follicular structures, so precautions to prevent both ocular and epidermal damage must be considered. At present, there are no dedicated international standards for IPL devices. This review directly compares three leading domestic IPL hair removal devices: iPulse Personal (CyDen, UK), Silk'n/SensEpil (Home Skinovations, Israel), and SatinLux/Lumea (Philips, Netherlands) for fluence, emitted wavelength spectrum, time-resolved footprint, and spatial distribution of energy. Although each device has a primary mechanical or electrical safety feature to ensure occlusion of the output aperture on the skin to prevent accidental eye exposure, the ocular hazard of each device has been measured to IEC TR 60825-9 standard using an Ocean Optics HR2000+ photo spectrometer for both potential corneal and retinal damage. Using established measurement methods, this review has shown that the measured output parameters were significantly different for the three systems. Using equipment traceable to national standards, one device was judged at its two highest settings to be hazardous for naked eye viewing. This investigation also reports on the significantly different pulse durations of the devices measured and considers the potential impact on safety and efficacy in the light of the theory of selective photothermolysis. Although these devices offer low-cost personal convenience of treatment in the privacy of the home, ocular safety may be inadequate in the event of primary safety mechanism failure.
- The principle of selective photo-thermolysis has been studied extensively for hair removal applications in a medical setting. A new, portable, hand-held device featuring two filtered Xenon lamps that utilizes pulsed light in low optical fluencies for hair removal has been developed for consumer use. The purpose of this clinical study was to determine the efficacy and safety of this low-energy, pulsed-intense light device intended for home use hair removal. STUDY DESIGN/ MATERIALS AND METHODS: The treatment group consisted of 10 adults with skin types I-IV who possessed unwanted dark hair in the non-facial region. The subjects received between 4 and 6 treatments on a bi-weekly basis with the device by a trained member of the clinical staff. The clinical responses were evaluated by performing manual hair counts using magnified vision and photographs which were obtained prior to treatment and at each subsequent visit. Mean hair reduction was 36% 4 weeks after the final treatment and 10% 12 weeks after the final treatment. This resulted in a mean hair count reduction of 23% over the two follow-up appointments. There was no definitive correlation between customer satisfaction and hair count reduction. Adverse reactions were limited to transient, localized, post-treatment erythema. No complications were encountered. This low-energy, pulsed-light device is a quick, safe, and relatively effective at-home hair reduction treatment option in patients with various skin phototypes.
- Intense pulsed light (IPL) devices use flashlamps and bandpass filters to emit polychromatic incoherent high-intensity pulsed light of determined wavelength spectrum, fluence, and pulse duration. Similar to lasers, the basic principle of IPL devices is a more or less selective thermal damage of the target. The combination of prescribed wavelengths, fluences, pulse durations, and pulse intervals facilitates the treatment of a wide spectrum of skin conditions. To summarize the physics of IPL, to provide guidance for the practical use of IPL devices, and to discuss the current literature on IPL in the treatment of unwanted hair growth, vascular lesions, pigmented lesions, acne vulgaris, and photodamaged skin and as a light source for PDT and skin rejuvenation. A systematic search of several electronic databases, including Medline and PubMed and the authors experience on intense pulsed light. Numerous trials show the effectiveness and compatibility of IPL devices. Most comparative trials attest IPLs similar effectiveness to lasers (level of evidence: 2b to 4, depending on the indication). However, large controlled and blinded comparative trials with an extended follow-up period are necessary.
- Laser hair removal is a safe and effective procedure for the treatment of unwanted body hair but is not exempt from side effects. A rare but significant adverse effect with this treatment modality is paradoxical hypertrichosis. To evaluate the potential etiologies, risk factors, related laser types, and treatment options for the development of excess hair after laser therapy. An analysis of previously published case studies and review articles along with our own experience was used to gather information regarding this phenomenon. Paradoxical hypertrichosis has a low incidence, ranging from 0.6% to 10%, and most commonly occurs on the face and neck. All laser and light sources have the potential to cause hair induction, especially in individuals with darker skin types (III-VI); with dark, thick hair; and with underlying hormonal conditions. Possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Treatment for paradoxical hypertrichosis is laser therapy of the affected area. Paradoxical hypertrichosis is a rare side effect of laser hair removal; the pathogenesis of this event remains widely unknown. We recommend further large-scale studies to investigate this effect. The authors have indicated no significant interest with commercial supporters.
- Modern lasers and light-based sources that were developed based on the theory of selective photothermolysis are capable of destroying specific tissue targets while minimizing the risk of scarring and pigmentary changes. This is accomplished through the use of a wavelength and pulse duration that is best absorbed by a specific chromophore such as melanin or hemoglobin. However, not all lasers and light sources adhere to this principle. Continuous wave (CW) lasers are least selective and may produce unwanted tissue damage and scarring through heat conduction to normal skin. Quasi-CW lasers limit excessive thermal destruction by delivery of a series of brief laser pulses but still pose a higher risk of nonspecific tissue damage and thermal injury. The pulsed and Q-switched (QS) systems adhere most closely to the principles of selective photothermolysis and result in the highest degree of selective destruction with the lowest risk of scarring from excessive thermal diffusion. Certainly, any laser system potentially can result in scarring and tissue damage when used incorrectly; therefore, adequate operator education and skill are essential. Side effects and complications that occur as a consequence of laser treatment can be significantly reduced if diagnosed and treated in an expeditious manner.
- Unwanted facial hair can have adverse psychological effects on women and reduce their quality of life. To assess the effects of unwanted facial hair removal with laser on improving quality of life. In this study, 70 patients treated for unwanted facial hair by laser were assessed by Dermatology Life Quality Index (DLQI) questionnaire on admission and 3 months later after three sessions of laser treatment. The DLQI score before treatment was 9.42 +/- 5.99, which was reduced to 3.12 +/- 3.40 after laser treatment (p <0.05). Unwanted facial hair removal with laser can improve the quality of life of patients.
- To provide retrospective clinical review of some uncommonly reported side effects of long-pulsed alexandrite laser treatment for hair removal. Two hundred and fifty female patients suffering from hirsutism of the face were subjected to treatment by long pulse alexandrite laser for a maximum of 15 sessions per patient at 5- to 7-week intervals. Apart from the commonly reported side effects of pigmentary changes, occasional blistering and rare scarring, other untoward effects have been observed. These include - among others - de-novo growth of hair outside the area treated by laser, potentiation of co-existing vellus hair in the treatment area, induction or aggravation of acne, rosacea-like rash, premature grayness of hair, tunneling of hair under the skin, prolonged diffuse redness and edema of the face, focal hypopigmentation of the lip, angular cheilitis, allergic reaction to the cooling gas, and inflammatory and pigmentary changes of pre-existing nevi. Although the efficacy of long-pulsed alexandrite laser seems unmistakable, the short- and long-term untoward effects of such treatment have yet to be carefully delineated and the underlying mechanisms are yet to be adequately clarified.
- High fluence diode lasers with contact cooling have emerged as the gold standard to remove unwanted hair. However, laser hair removal is associated with pain and side effects, especially when treating dark or tanned skin. A novel diode laser with low level fluence (5-10 J/cm2) with a high repetition rate at 10 Hz (Soprano XL in SHR mode, Alma Lasers, Chicago, IL) using multiple passes in constant motion technique was compared to traditional one pass high fluence (25-40 J/cm2) diode laser (LightSheer ET, Lumenis, Santa Clara, CA) in a prospective, randomized split-leg study on 25 patients with Fitzpatrick skin types I-V. Hair counts were done six months following the fifth treatment and were found to be comparable with a 86-91% hair reduction. There was one superficial burn with the high energy diode treatment. The rapid, multiple pass in-motion technique was faster and associated with significantly less pain. Multiple passes of diode laser at low fluences but with high average power results in permanent hair removal with less discomfort and fewer adverse effects, especially on darker skin.
