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Meta-analysis of hair removal laser trials
Abstract
Traditional hair-removal techniques have included shaving, waxing, chemical depilation, and electrolysis. All of these methods result in temporary hair removal. The theory of selective photo thermolysis led to the development of a variety of different laser systems. These lasers range from the short end of spectrum, with the 694-nm ruby laser, to the middle, with the 755-nm alexandrite and 810-nm diode lasers, and to the long end with the 1,064-nm Nd:YAG laser. We made a systematic review on the clinical trials with use of various laser sources for hair removal, so all clinical trials related to hair removal lasers in 1998-2003 were considered after elimination of heterogenite sources in data store. Trial results were synthetized on the basis of kind of laser. Our study clarified that hair reduction at least 6 months after the last treatment and hair reductions were 57.5, 42.3, 54.7, and 52.8% after three sessions for diode, Nd:YAG, alexandrite and ruby, respectively. We compared the result with use of analysis of variance method (Scheffes) and double comparison with use of Student's t test. Our results clarified that diode laser is the most effective, and Nd:YAG has the least effect of hair removal.It seems that diode and alexandrite lasers are proper for hair removal, but as we need high fluence in the darker skin types and this is accompanied with higher complications, diode is advised for lighter skin, and we advised alexandrite laser for darker skin types.
... Various lasers of different wavelengths (including intense pulsed light, Nd:YAG, diode, alexandrite, and ruby) 37,38 have been used for LHR. Each afford unique benefits and risks. ...
... 41,44,49,50 One meta-analysis of comparison trials for LHR with various laser types recommends diode laser for lighter skin and Nd:YAG laser for darker skin. 37 Our study had all Fitzpatrick skin types well-represented in all treatment categories. Corroborating prior studies, we found excellent hair clearance among patients with darker skin. ...
Introduction
Permanent genital hair removal is required before gender-affirming vaginoplasty to prevent hair-related complications. No previous studies have directly compared the relative efficacy, costs, and patient experiences with laser hair removal (LHR) vs electrolysis treatments. Food and Drug Administration (FDA) oversight of medical devices is poorly understood and commonly misrepresented, adversely affecting patient care.
Aim
This study compares treatment outcomes of electrolysis and LHR for genital hair removal and investigates FDA regulation of electrolysis and LHR devices.
Methods
Penile-inversion vaginoplasty and shallow-depth vaginoplasty patients completed surveys about their preoperative hair removal, including procedure type, number/frequency of sessions, cost, and discomfort. Publicly available FDA-review documents and databases were reviewed.
Main Outcomes Measure
Compared to electrolysis, LHR was associated with greater efficiency, decreased cost, decreased pain, and improved patient satisfaction.
Results
Of 52 total (44 full-depth and 8 shallow-depth) vaginoplasty patients, 22 of 52 underwent electrolysis only, 15 of 52 underwent laser only, and 15 of 52 used both techniques. Compared to patients that underwent LHR only, patients that underwent only electrolysis required a significantly greater number of treatment sessions (mean 24.3 electrolysis vs 8.1 LHR sessions, P < .01) and more frequent sessions (every 2.4 weeks for electrolysis vs 5.3 weeks for LHR, P < .01) to complete treatment (defined as absence of re-growth over 2 months). Electrolysis sessions were significantly longer than LHR sessions (152 minutes vs 26 minutes, P < .01). Total treatment costs for electrolysis (981, P < .01). Electrolysis was associated with greater pain and significantly increased need for pretreatment analgesia, which further contributed to higher net costs for treatment with electrolysis vs laser. Many LHR and electrolysis devices have been FDA-cleared for safety, but the FDA does not assess or compare clinical efficacy or efficiency.
Clinical Implications
For patients with dark-pigmented hair, providers should consider LHR as the first-line treatment option for preoperative hair removal before gender-affirming vaginoplasty.
Strength and Limitations
This is the first study to compare electrolysis and LHR for genital hair removal. The discussion addresses FDA review/oversight of devices, which is commonly misrepresented. Limitations include the survey format for data collection.
Conclusion
When compared with electrolysis, LHR showed greater treatment efficiency (shorter and fewer treatment sessions to complete treatment), less pain, greater tolerability, and lower total cost. Our data suggests that, for patients with dark genital hair, providers should consider recommending laser as the first-line treatment for permanent genital hair removal before vaginoplasty.
Yuan N, Feldman A, Chin P, et al. Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria. Sex Med 2022;10:100545.
... growth site targeted and hair-cycle phase effect laser/IPL efficacy is key in maximizing therapeutic effects in those who experience psychological stress due to unwanted hair; however, limited evidence is currently available. Few reviews have compared efficacy of lasers and light sources (23)(24)(25)(26). To the best of our knowledge, this is the first systematic review that has evaluated data on long-term laser hair-reduction outcomes while also taking into account differing hair growth cycles of treatment sites when comparing "long-term" efficacy of hair reduction. ...
... Four (20)(21)(22)24) of the five studies were graded as moderate quality and one as low quality (23) for the outcome "long-term hair reduction" (Appendix 4). ...
Laser and light-based devices provide scope for long-term "hair-removal" however, there is limited evidence supporting their long-term efficacy. This study aimed to assess the long-term efficacy of laser and light-based "hair-removal" devices, taking into account variations in body site-specific variations in hair growthcycles. A systematic review of randomized controlled trials (RCTs) with follow-up periods greater than or equal to the length of one complete hair growth cycle in the body site targeted was conducted. Only five eligible RCTs were identified as suitable for inclusion, and these comprised a total of 223 patients. The average long-term hair reduction reported for neodymium:yttrium-aluminum-garnet (Nd:YAG) laser ranged from 30 to 73.61%, Alexandrite laser ranged from 35 to 84.25%, and Diode laser ranged from 32.5 to 69.2%. In all three devices, the greatest long-term reduction was observed from trials targeting leg hair (1-year growth cycle) and lowest from targeting facial hair (6-month growth cycle). Intense pulsed light (IPL) produced average long-term hair reduction of 52.7-27%; smallest reduction was observed from targeting the face area and greatest from targeting the axillary area (7-month growth cycle). In conclusion, greater long-term hair reduction was observed on body sites with longer hair growth cycles. Future trials should take into account the varyiation of hair growth cycles across body sites to provide accurate long-term data on treatment outcomes.
... The comparison of lasers used in photoepilation made by the method of meta-analysis of 24 prospective studies published between 1998 and 2003 did not show statistically significant differences in efficiency between different types of lasers. The average hair reduction 6 months after the last exposure was 57.5% for diode laser, 54.0% for alexandrite laser, 52.8% for ruby laser, 43.2% for Nd:YAG laser [60]. The effectiveness of laser therapy increases with the number of procedures performed, but complete hair reduction is rarely achieved. ...
... Porównanie laserów wykorzystywanych w fotoepilacji na podstawie metaanalizy obejmującej 24 prospektywne badania opublikowane w latach 1998-2003 nie wykazało statystycznie istotnych różnic w skuteczności poszczególnych typów laserów. Średnia redukcja owłosienia po 6 miesiącach od ostatniego zabiegu wyniosła 57,5% dla lasera diodowego, 54,0% dla lasera aleksandrytowego, 52,8% dla lasera rubinowego i 43,2% dla lasera neodymowo-yagowego [60]. Skuteczność laseroterapii wzrasta wraz z liczbą wykonywanych zabiegów, jednak rzadko udaje się osiągnąć całkowitą eliminację nadmiernego owłosienia. ...
Hirsutism is a common clinical diagnosis defined by the presence of excess growth of terminal hair in androgen-sensitive areas. It affects 5–15% of women, often having a significant impact on their daily functioning. Hirsutism is mainly caused by ovarian or adrenal hyperandrogenism, although it can be idiopathic, drug induced or caused by other endocrinopathies. Severity of the disease can be assessed using a modified Ferriman-Gallwey visual scoring scale. Therapeutic options include hair removal using lasers or electrolysis, combined oral contracetion, antiandrogens and topical eflornithine. This article presents a clinical scheme for diagnosis and management of hirsutism from a dermatological perspective.
... [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. However, the same chromophore can be found as skin pigment. ...
... 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.
... As mentioned above, patients who decide to do pubic area hair removal more often choose the methods which give permanent results [8,12,[17][18][19]. To achieve that, photo epilation treatment is introduced on the basis of selective thermolysis with the use of various lasers with a specified light wavelength: ruby (694 nm), alexandrite (755 nm), diode (805, 810 nm), Nd:YAG (1064 nm) and incoherent xenon light -IPL (Intense Pulse Light) with the wave range between 590 and 1200 nm, described in literature as permanent methods of hair reduction [2,3,6,7,14,[18][19][20][21][22][23][24][25][26][27][28][29][30]. ...
... As the melanin which is a skin pigment as well, competes with the one existing in hair, achieving a positive result and the treatment itself can be found to be difficult, especially in the body areas with increased pigmentation such as pubic areas [22][23][24]. Although the cooling is always carried out, laser hair removal treatment is often associated with the pain. ...
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.
... To overcome these drawbacks, longer wavelength lasers and longer pulse durations, together with adequate skin cooling, have been applied in darker skin [3,4]. Tailoring the proper settings (i.e., wavelengths, pulse duration, fluence) per skin type results in significant hair reduction, that generally persists for at least 6 months [5,6]. The diode laser system in this study incorporates two well established technologies, vacuum suction, and contact cooling, to reduce pain and epidermal damage [7][8][9]. ...
... In another study, similar results (to ours) for leg and axillary hair removal with the Nd:YAG laser have been reported with at least 70% hair reduction, maintained for 12 months [14]. It has been suggested that improved results can be reached by conducting more treatment sessions [6]. Correspondingly, in our study with 6-7 treatment sessions the mean hair count reduction at 6 months was 72.52% AE 15.5% (with the chilled sapphire tip) and 74.1% AE 16% (with the large spot size vacuum-assisted handpiece). ...
Objective
The purpose of this study was to determine the efficacy and safety of a 1060 nm diode laser system with multiple handpieces for permanent hair reduction.
Study Design
An open‐label, prospective, multi‐center study of adult subjects (≥18 years old) of any skin type, having dark brown or black hairs at the areas to be treated and seeking to permanently remove hair underwent six treatment sessions, at 4 to 6 weeks intervals with either a 1060 nm chilled sapphire tip or seven treatment sessions, at 6 weeks interval with a large spot vacuum based handpiece.
Methods
Subjects received treatments on various body areas using chilled sapphire tip or large spot size vacuum‐assisted handpiece. Hair counts as well as assessments of hair coarseness and color were performed using photographs taken at baseline, prior to pre‐selected treatments and at the follow up visits. At every visit, immediate skin responses and adverse events were evaluated by the investigator and treatment associated pain level experienced was quantified by the subjects. Subjects were asked to assess their improvement and satisfaction at pre‐selected treatment sessions and at all the follow up visits. A sub group of subjects that were treated with the large spot size vacuum‐assisted handpiece contributed two punch biopsy specimens for histological analysis.
Results
A total of 16 subjects age 33 ± 10.9 years were treated with the chilled sapphire tip, and 26 subjects age 36.3 ± 7.67 years were treated with the large spot size vacuum‐assisted handpiece. Treatment with chilled sapphire tip yielded a mean of 68%, 82%, and 76% skin type‐independent hair reduction in axillae, shin, and arm, respectively, at 6 month follow up visit as compared to baseline. The majority of subjects (≥80%) rated their hair reduction to be either good or very good and were satisfied to highly satisfied with the outcome. Treatment with the large spot size vacuum‐assisted handpiece, was most effective in axillae and calves, with a 77.9% and 78.5% hair count reduction, respectively, at the 6 month follow up visit. Subjects reported high satisfaction and improvement throughout the treatments and follow‐up periods. Treatments with both handpieces were not associated with intolerable pain levels and common post procedural responses included mild to moderate erythema and/or edema.
Conclusion
The 1060 nm diode laser system is safe and effective for hair removal and long‐term hair reduction in all skin types including darkly pigmented individuals. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
... This involves the application of an external chromophore such as carbon in a topical suspension. 10,11 3. Photochemical injury is due to destructive oxidation by singlet oxygen or free radicals. 2,3,10,11 This involves the administration of a photodynamic agent followed by exposure to light. ...
... 10,11 3. Photochemical injury is due to destructive oxidation by singlet oxygen or free radicals. 2,3,10,11 This involves the administration of a photodynamic agent followed by exposure to light. ...
Advances in aesthetic laser technology over the past two decades have allowed physicians to choose from a variety of fluences, spots sizes, pulse durations and wavelengths in treating hair, vascular lesions and pigmentation. With the development of Multiplex (MPX), a proprietary technology that sequentially combines wavelengths to potentiate clinical effect, now clinicians have the ability to choose treatment with a single wavelength or a combination. Combining synergistic wavelengths in multiplex modality allows for a safer treatment profile with lower total fluence used to treat cutaneous pigmented and vascular lesions and for laser hair removal. A second advancement has been integrated cooling which enables epidermal melanin protection while deliv-ering treatment to the chromophore being targeted. The purpose of this article is to present a novel dual wave-length workstation employing multiplex technology which effectively treats hair, telangiectasias and lentigenes.
... Currently, the Ruby laser is not used in hair removal due to hypopigmentations observed even in skin type II (6). Melanin absorption of normal mode Alexandrite (755 nm) lasers are very good. ...
... Melanin absorption of normal mode Alexandrite (755 nm) lasers are very good. However, a few, postlaser pigmentation disorders are reported (6,7). Due to longer wavelength, Nd: YAG (1064 nm) lasers partially absorb melanin but deeper penetrance is achieved. ...
Objective:
Multiple lasers and light sources are currently available for hair removal and many studies comparing efficacy and safety exist. SHR mode IPL is a technique that gives the total energy in divided doses with fewer side effects. We compared a SHR mode IPL system with alexandrite and Nd: YAG lasers for leg hair reduction.
Material and methods:
Twenty-five female participants with skin types II-IV, underwent treatment of unwanted hair on the cruris. Three selected areas were randomly treated with the SHR mode IPL system, Alexandrite laser and Nd: YAG laser in three sessions. Hair reduction was evaluated with digital photography by a blinded assessor every 6 weeks and 6 months after the last session. Pain severity, side effects and patient satisfaction analysis were also investigated.
Results:
Twenty-one participants completed the trial. The mean hair reductions in 6 weeks after the last treatment were 50% for the IPL system, 53% for Alexandrite and 39% for the Nd: YAG lasers. However after 6 months; 40%, 49% and 34% hair reduction was observed, respectively. The Alexandrite laser was the least painful system.
Conclusion:
Although there is no obvious advantage of one laser system over the others in terms of treatment outcome, the Alexandrite laser is still the most efficient and reliable way of hair removal in fair skinned individuals.
... The net reduction of hair ranges from around 40 to 80% depending on the type of laser used, the number of treatment cycles provided and the pigmentation of the hair. [58] Hairs that are white or blonde have very less amount of melanin and thus are not treatable with photoepilation. Lasers with a longer wavelength should be used as they penetrate deeper reaching more up to the hair follicles and thus reducing the chances of getting absorbed by the melanin pigment of the skin and causing burn injuries. ...
Idiopathic hirsutism (IH) is a common clinical condition with multiple diagnostic and therapeutic uncertainties. There are no clear recommendations for the diagnosis and management of the condition. This practice update was developed to guide the primary care physicians and the specialists in better and more systematic management of IH particularly in the Indian context. Twelve experienced members consisting of eminent endocrinologists, physicians, a dermatologist, a gynaecologist and a psychiatrist were invited by the Integrated Diabetes and Endocrine Academy (IDEA). A literature search was performed using online databases from PubMed, Cochrane Library and Google Scholar. Published articles from peer-reviewed indexed journals, with a preference for meta-analyses and randomized controlled trials, were selected. A meeting took place with all the 12 members individually giving their opinions on predetermined questions of interest. After the initial meeting during IDEACON 2023, two more meetings were held and the practice update was formulated after voting. Practice updates were made on important areas such as the cut-off for modified Ferriman-Gallwey Score for the Indian population, conditions to be excluded before diagnosing IH, when to refer to specialists, investigations in a suspected case of IH and choice of therapies for its management.
... A small spot size causes the photons to scatter radially not reaching the hair bulbs, leading to greater dispersion and a decreased fluence. The spot size should be larger than the depth of the light penetrating the tissue, namely 5-10 nm [11]. • Pulse frequency: The number of shots per second that helps to reduce the time of the treatment session. ...
Because some people seek consultations for the removal of unwanted body hair, a permanent, safe, and non-invasive method of hair removal is needed. Laser hair removal has been a popular cosmetic procedure. It is a monthly treatment that may take up to ten sessions for permanent results. However, its efficacy varies due to the patient’s biological skin hair traits, the adjustment of the optimal parameters of the laser, and the protocols. The purpose of this review is to discuss the properties and parameters employed for laser hair removal. Once parameters for laser hair removal have been optimized, this treatment offers an effective and permanent solution for unwanted body hair.
... An IPL is a good option if you have the finest, thinhaired patients or lighter-haired patients. It's inexpensive, and but lowefficiency or you can use a Diode laser with very short Pulse Width and high energy which has its own risk of burning but is effective.Here an Alexandrite like wavelength maybe usefull and many users feel its pretty safe,although risk of burning a darker skin type exists [18,23]. When it comes to the hand-pieces, the large hand-piece can be used for greater body surface areas with low fluence and smaller areas like upper lip with small hand piece and higher fluence. ...
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 .
... A meta-analysis of 24 prospective trials published between 1998 and 2003 found that hair reduction at least 6 months after the last treatment averaged 57.5%, 54.0%, 52.8%, and 42.3% for diode, alexandrite, ruby, and Nd:YAG lasers, respectively. Although diode had the highest percentage reduction rate, the differences among all four lasers were not statistically significant (131). An earlier systematic review of 11 RCTs involving 444 people reported a similar 50% reduction in hair growth for up to 6 months with alexandrite and diode lasers (132). ...
Objective
To update the “Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline,” published by the Endocrine Society in 2008.
Participants
The participants include an Endocrine Society–appointed task force of seven medical experts and a methodologist.
Evidence
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
Consensus Process
Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.
Conclusion
We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen–progestin contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For most women who choose hair removal therapy, we suggest laser/photoepilation.
... 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.
... Partial long-term hair removal efficacy (beyond 6 months) has been observed for all laser therapies after repetitive treatments, although the data are limited [212]. The data comparing different laser methods are few and contradictory; however, the available studies show that diode and alexandrite offer the higher success rate, whereas Nd:Yag provides the lowest [213]. The studies comparing laser and IPL devices are few and of low quality; all have been performed in adults with mixed forms of hirsutism, hyperandrogenism, or unwanted hair growth. ...
This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)1. The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents.
... 2,3 Although previous studies have compared the efficacy between different photo-epilatory systems, no trials have been undertaken comparing alexandrite and IPL in Korean skin. 4 In this study a randomized trial was conducted to compare the photoepilatory efficacy of long pulsed alexandrite with that of IPL in the removal of axillary hair in 13 Korean women. The primary objective of our study was to evaluate any differences between the two systems in terms of efficacy, patient satisfaction and rate of side effects. ...
... However, post-laser pigmentation may be troublesome with alexandrite devices whilst the need for high levels of fluence increase the risk of complications with diode systems in darker skin types. 11 IPL systems are possibly more technique-dependent to limit the risk of local pain and irritation. However, they offer the benefit to be highly versatile due to the wide range of emitted wavelengths when hair or skin colors are not ideal for laser photoepilation. ...
The effectiveness of intense pulsed light (IPL) and laser devices is widely accepted in aesthetic dermatology for unwanted hair removal and treatment of a variety of cutaneous conditions. Overall, most comparative trials have demonstrated similar effectiveness for IPL and laser devices. Literature studies alternatively favor the IPL and laser concepts, but the incidence of severe local pain and side effects were generally lower with IPL. IPL phototherapy, already established as a sound option in photoepilation and treatment of photoaging, hyperpigmentation and other skin conditions, is also considered first choice in the phototherapy of skin vascular malformations. When treating large areas, as often required in photoepilation and many aesthetic dermatology indications, IPL technologies show advantages over laser-based devices because of their high skin coverage rate. Compared to lasers, the wide range of selectable treatment settings, though a strong advantage of IPL, may also imply some more risk of local thermal side effects, but almost only in the hands of poorly trained operators. Overall, the strongest advantages of the IPL technologies are robust technology, versatility, lower purchase price, and the negligible risk of serious adverse effects in the hands of skilled and experienced operators.
... LHR achieves best results for dark hair on light skin, as it targets the melanin in the hair bulb. Patients with darker skin should be treated with longer wavelength lasers to protect the epidermis (34). For these same reasons, LHR is not suitable for blond or white hair, and patients with these features should be directed to undergo electrolysis instead. ...
Genital gender affirming surgery (GAS) involves reconstruction of the genitals to match a patient's identified sex. The use of hair-bearing flaps in this procedure may result in postoperative intra-vaginal and intra-urethral hair growth and associated complications, including lower satisfaction with genital GAS. Despite the significant increase in genital GAS within the past 50 years, there is limited data regarding hair removal practices in preparation for genital GAS and notable variation in hair removal techniques among dermatologists and other practitioners. We present a literature review, recommendations from our experience, and a practical laser hair removal (LHR) approach to hair removal prior to genital GAS.
... Patients with darker skin tones (Fitzpatrick skin phototypes IV-VI) should only receive treatment with the alexandrite, diode or the Nd:YAG lasers, which safely deliver longer wavelengths and avoid unwanted postoperative skin dyspigmentation. [35][36][37] Th e Nd:YAG laser with its longer wavelength is the safest type to treat darker skin tones, but the alexandrite and diode lasers are more eff ective because their shorter wavelengths are more greatly absorbed by melanin in the hair shaft and follicle. ...
... The hair count reduction reported with the longpulse 810-nm diode laser ranges from 22% to 59%. 15,[24][25][26][27][28] In skin treated with the diode laser, histologic analysis showed a statistically significant reduction in hair density and thickness. 29 Lasers with longer wavelengths such as the diode and the 1,064-nm Nd:YAG lasers are preferred when treating darker skin types because they result in fewer side effects such as pain and postinflammatory hyperpigmentation than lasers with shorter wavelengths. ...
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.
BACKGROUND
Permanent hair reduction is an integral part of gender-affirming medical care, especially for transgender patients undergoing surgeries such as phalloplasty and vaginoplasty. Hair removal helps reduce complications and alleviate gender dysphoria associated with unwanted facial and body hair.
OBJECTIVE
To examine the methods, efficacy, and access issues of hair removal in transgender patients, with a focus on its role in surgical preparation and gender dysphoria reduction.
MATERIALS AND METHODS
A literature review was conducted to analyze the effectiveness of laser hair removal (LHR) and electrolysis for permanent hair reduction. The review also explored regional regulatory barriers and insurance coverage limitations affecting access to these services.
RESULTS
Laser hair removal and electrolysis are both effective for hair removal, with LHR being less painful and faster. Laser hair removal is often preferred but requires multiple treatments and proper laser settings. Insurance coverage remains inconsistent, limiting access to these procedures. Postoperative hair regrowth in neovaginal or neourethral sites can be managed with hormonal adjustments and further treatments.
CONCLUSION
Hair removal plays an essential role in reducing surgical complications and gender dysphoria in transgender patients. A multidisciplinary approach between dermatologists and surgeons is essential, and addressing regulatory and access barriers is critical for equitable care.
Hirsutism is the medical term that refers to the presence of excessive terminal (coarse) hair in androgen-sensitive areas of the female body (upper lip, chin, chest, back, abdomen, arms, and thighs). Virilization is more extensive than hirsutism with additional evidence of masculinization. In particular, the term virilization refers to the concurrent presentation of hirsutism with a broad range of signs suggestive of androgen excess, varying with age, such as ambiguous external genitalia, increased muscle mass, acne, balding, deepening of the voice, breast atrophy, amenorrhea/oligomenorrhea, and increased libido.Hirsutism and virilization usually have different underlying pathologic conditions, generally more severe in virilization that is frequently an expression of a life-threatening disorder such as malignancy (ovarian or adrenal tumors) (Bonfig et al., Eur J Pediatr 162:623–628, 2003) or classic congenital adrenal hyperplasia (CCAH) (White and Speiser, Endocr Rev. 21:245–291, 2000; New, Mol Cell Endocrinol 211:75–83, 2003). Hirsutism commonly results from relatively benign functional disorders. Sometimes, however, it is the presentation of a more severe disorder, and it may be the first manifestation of a condition that will ultimately lead to virilization, if untreated. Therefore, both hirsutism and virilization must be seriously considered by practitioners not only for the disorder that they express but also for the considerable psychological negative impact that they exert in the individual affected, especially among young women (Barth et al., J Psychosom Res 37:615–619, 1993; Sonino et al., Postgrad Med J 69:186–189, 1993; Assante et al., International workshop “disorders of sex development: new directions and persistent doubts”, 14–15 Nov 2011, Bologna, Italy, 2011; Guidi et al., Clin Endocrinol (Oxf) 83:872–878, 2015).KeywordsHirsutismVirilizationEtiologyDiagnosisTherapy
Heterotopic hair growth is characterised by excessive hair growth in an abnormal anatomical location. The most common causes in the general population include an overproduction or increased sensitivity to circulating androgens, although most patterns of hair growth vary depending on sex and ethnicity [1]. In patients who have required reconstructive surgery, this can lead to hair-bearing donor tissue being present in non-hear-bearing areas, or an excess. Examples include: ear reconstruction with hair-bearing scalp skin leading to hairy ears; skin grafts such as full-thickness skin from the groin causing course or even pubic hair on the reconstructed areas including the face; and internal reconstructions such as tongue, floor of mouth, nose, lumen of the penis or neovagina after reconstruction growing hair.
We demonstrate a passive Q-switching fiber laser using silver (Ag) as saturable absorber. The Ag-SA was fabricated using electron beam deposition technique onto a polyvinyl alcohol (PVA) thin-film and possessed a low modulation depth of 2% at 1.5-micron wavelength. The Ag-SA then was incorporated into two fiber laser cavities, 1.5- and 2-micron. At 1.5-micron, a laser with average output power of 3.8 mW was produced, with narrowest pulse of 3.1 μs. Besides, 2-micron able to produce high pulse energy of 161.7 nJ at pump power of 498 mW. Our experimental work suggest that the Ag saturable absorber is an effective solution for Q-switched generation in erbium-doped and thulium-doped fiber laser.
Menstrual irregularities and cutaneous signs of androgen excess are commonly encountered when caring for adolescent girls. Polycystic ovary syndrome (PCOS) is the most common cause of these symptoms in adult women, and it can be diagnosed in adolescents as well. Diagnostic criteria used to diagnose adult women are not applicable in adolescents, as some diagnostic criteria overlap with the normal physiology of a maturing reproductive system. Thus, application of adult criteria will overdiagnose adolescents with PCOS. Two recent guidelines on the diagnosis and treatment of PCOS in adolescence were created to provide clarity in the diagnosis of PCOS in adolescent girls and to guide best practices in treatment. This review summarizes the recommendations and gives practical advice on the application of these recommendations to everyday pediatric practice. [Pediatr Ann. 2019;48(8):e304-e310.].
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.
Background:
High-fluence diode lasers with contact cooling have emerged as the gold standard to remove unwanted hair. Lowering the energy should result in less pain and could theoretically affect the efficacy of the therapy.
Objective:
To compare the safety and efficacy of a low-fluence high-repetition rate 810-nm diode laser to those of a high-fluence low-repetition rate diode laser for permanent axillary hair removal in Chinese women.
Methods:
Ninety-two Chinese women received four axillae laser hair removal treatments at 4-week intervals using the low-fluence, high-repetition 810-nm diode laser in SHR mode on one side and the high-fluence, low-repetition diode laser in HR mode on the other side. Hair counts were done at each follow-up visit and 6-month follow up after the final laser treatment using a 'Hi Quality Hair Analysis Program System' , the immediate pain score after each treatment session was recorded by a visual analog scale.
Results:
The overall median reduction of hair was 90.2% with the 810-nm diode laser in SHR mode and 87% with the same laser in HR mode at 6-month follow-up. The median pain scores in SHR mode and in HR mode were 2.75 and 6.75 respectively.
Conclusion:
Low-fluence high repetition rate diode laser can efficiently remove unwanted hair but also significantly improve tolerability and reduce adverse events during course of treatment.
At early stage, high power semiconductor lasers have been mainly applied in pumping of solid-state lasers and fiber lasers. However, with the development of chip/bar technology and packaging technology in recent years, semiconductor lasers as light sources have been directly used in many new fields, such as medical and cosmetic, IR illumination, and material surface processing which includes cladding, hardening, and annealing [1–3]. The main applications of semiconductor lasers are shown in Fig. 10.1 [4]. In this chapter, we discuss the applications of high power semiconductor lasers in pumping of solid-state and fiber lasers, in material surface processing as well as medical and cosmetic fields. For pumping application, we mainly discuss the advanced pumping structure and the requirement on semiconductor laser pumping source. For material surface processing application, we introduce a high power semiconductor laser head and discuss its key technologies and applications. For medical and cosmetic, we mainly use laser hair removal as an example to discuss the direct semiconductor laser application in this field.
Unwanted hair is a common problem in women. The condition may be caused by androgen overproduction, increased sensitivity to circulating androgens, or other metabolic and endocrine disorders, and should be properly evaluated. The use of lasers in hair removal allows selective targeting of the hair bulb and can diminish regrowth for at least 3 months. The energy of the laser converts into heat, causing the selective destruction of the hair bulb. The mechanism of action of lasers is discussed and the procedure described.
Today removal of unwanted hair is the leading cosmetic procedure requested by our patients. Thus, laser hair removal is the fastest growing and evolving area in cosmetic dermatology. The aim of this review is to remind the reader the properties that belong to the hair follicle and that belong to the laser beam which enable the laser hair removal, and to pass along the information about basic physical principles of laser tissue interaction and various laser systems used in laser hair removal. Proper patient selection, preoperative and postoperative care, principles of laser safety, postoperative complications will also be discussed.
Hirsutism is defined as the development of a malelike pattern of excess hair especially in women. Hirsutism often results from raised androgen levels in the body and may indicate the existence of a serious underlying endocrine condition, such as polycystic ovary syndrome (PCOS). Treatment of hirsutism may require both medical and cosmetic actions. Medical therapy aims to counteract any suspected hormonal imbalance and can include administration of oral contraceptives and antiandrogens. Cosmetic treatment directly addresses excess hair and seeks to either remove the hair or diminish its appearance. Cosmetic options range from conventional methods, such as shaving and waxing, to modern techniques, such as laser photoepilation.
Photoepilation has made it possible to broad the possibilities of increasing indications of epilation. But, at the same time, some contraindications, side effects and complications have delimited in accordance with the years of experience of this technique, its clinical application. As in other technologies, photoepilation must take into account cases that are more difficult to treat, according to hair location, complications, skin type and possible associated pathology leading to hirutism of hypertrichosis. The aim of this paper is to present cases whose location leads to greater treatment difficulties as well as how to approach possible alternatives treatment in order to obtain good efficacy and few complications. Locations such as the eyebrows and periocular region, the nose, ears, anus, scrotum, vulva and prominent areas, must be regarded in photoepilation as being the most difficult ones to treat, in search of the highest efficacy, avoiding side effects and complications. This article deals with limitations of the tecnique.
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.
Despite the many advances in manufacturing of high power semiconductor lasers, the basic packaging process has not been changed significantly. This chapter reviews the steps used to package and assemble high power semiconductor laser with open packages and fiber-coupled modules. The fabrication procedure of open packages contains a sequence of processes, which involve incoming materials inspection, raw materials cleaning, metallization, solder deposition, die bonding, wire bonding, assembling, screening, before burn-in (BBI) test, burn in (BI), after burn-in (ABI) test, and final inspection. The details are presented in Sects. 7.1–7.10. Fiber-coupled modules typically use an open package, optics, and a fiber to couple the light into the fiber. The packaging process for fiber-coupled module is introduced in Sect. 7.11.
Skin exposure to laser or intense pulsed light results in differentiation on the surface and deep down depending on the parameters used. It has been proposed that lasers and intense pulsed light sources can cause follicular damage leading to the miniaturization or full destruction of the hair follicle. The aim of this study was to evaluate histologically the hair follicle damage in the skin of mice caused after exposure to diode laser and intense pulsed light. The results of this study show that the laser treatment, compared to intense pulsed light, is more effective in mice skin.
The objectives are as follows:
To assess the efficacy and safety of interventions (except laser and light-based therapies) for hirsutism.
BACKGROUND:
Hirsutism occurs in 5% to 10% of women of reproductive age when there is excessive terminal hair growth in androgen-sensitive areas (male pattern). It is a distressing disorder with a major impact on quality of life. The most common cause is polycystic ovary syndrome. There are many treatment options, but it is not clear which are most effective.
OBJECTIVES:
To assess the effects of interventions (except laser and light-based therapies alone) for hirsutism.
SEARCH METHODS:
We searched the Cochrane Skin Group Specialised Register, CENTRAL (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974), and five trials registers, and checked reference lists of included studies for additional trials. The last search was in June 2014.
SELECTION CRITERIA:
Randomised controlled trials (RCTs) in hirsute women with polycystic ovary syndrome, idiopathic hirsutism, or idiopathic hyperandrogenism.
DATA COLLECTION AND ANALYSIS:
Two independent authors carried out study selection, data extraction, 'Risk of bias' assessment, and analyses.
MAIN RESULTS:
We included 157 studies (sample size 30 to 80) comprising 10,550 women (mean age 25 years). The majority of studies (123/157) were 'high', 30 'unclear', and four 'low' risk of bias. Lack of blinding was the most frequent source of bias. Treatment duration was six to 12 months. Forty-eight studies provided no usable or retrievable data, i.e. lack of separate data for hirsute women, conference proceedings, and losses to follow-up above 40%.Primary outcomes, 'participant-reported improvement of hirsutism' and 'change in health-related quality of life', were addressed in few studies, and adverse events in only half. In most comparisons there was insufficient evidence to determine if the number of reported adverse events differed. These included known adverse events: gastrointestinal discomfort, breast tenderness, reduced libido, dry skin (flutamide and finasteride); irregular bleeding (spironolactone); nausea, diarrhoea, bloating (metformin); hot flushes, decreased libido, vaginal dryness, headaches (gonadotropin-releasing hormone (GnRH) analogues)).Clinician's evaluation of hirsutism and change in androgen levels were addressed in most comparisons, change in body mass index (BMI) and improvement of other clinical signs of hyperandrogenism in one-third of studies.The quality of evidence was moderate to very low for most outcomes.There was low quality evidence for the effect of two oral contraceptive pills (OCPs) (ethinyl estradiol + cyproterone acetate versus ethinyl estradiol + desogestrel) on change from baseline of Ferriman-Gallwey scores. The mean difference (MD) was -1.84 (95% confidence interval (CI) -3.86 to 0.18).There was very low quality evidence that flutamide 250 mg, twice daily, reduced Ferriman-Gallwey scores more effectively than placebo (MD -7.60, 95% CI -10.53 to -4.67 and MD -7.20, 95% CI -10.15 to -4.25). Participants' evaluations in one study with 20 participants confirmed these results (risk ratio (RR) 17.00, 95% CI 1.11 to 259.87).Spironolactone 100 mg daily was more effective than placebo in reducing Ferriman-Gallwey scores (MD -7.69, 95% CI -10.12 to -5.26) (low quality evidence). It showed similar effectiveness to flutamide in two studies (MD -1.90, 95% CI -5.01 to 1.21 and MD 0.49, 95% CI -1.99 to 2.97) (very low quality evidence), as well as to finasteride in two studies (MD 1.49, 95% CI -0.58 to 3.56 and MD 0.40, 95% CI -1.18 to 1.98) (low quality evidence).Although there was very low quality evidence of a difference in reduction of Ferriman-Gallwey scores for finasteride 5 mg to 7.5 mg daily versus placebo (MD -5.73, 95% CI -6.87 to -4.58), it was unlikely it was clinically meaningful. These results were reinforced by participants' assessments (RR 2.06, 95% CI 0.99 to 4.29 and RR 11.00, 95% CI 0.69 to 175.86). However, finasteride showed inconsistent results in comparisons with other treatments, and no firm conclusions could be reached.Metformin demonstrated no benefit over placebo in reduction of Ferriman-Gallwey scores (MD 0.05, 95% CI -1.02 to 1.12), but the quality of evidence was low. Results regarding the effectiveness of GnRH analogues were inconsistent, varying from minimal to important improvements.We were unable to pool data for OCPs with cyproterone acetate 20 mg to 100 mg due to clinical and methodological heterogeneity between studies. However, addition of cyproterone acetate to OCPs provided greater reductions in Ferriman-Gallwey scores.Two studies, comparing finasteride 5 mg and spironolactone 100 mg, did not show differences in participant assessments and reduction of Ferriman-Gallwey scores (low quality evidence). Ferriman-Gallwey scores from three studies comparing flutamide versus metformin could not be pooled (I² = 62%). One study comparing flutamide 250 mg twice daily with metformin 850 mg twice daily for 12 months, which reached a higher cumulative dosage than two other studies evaluating this comparison, showed flutamide to be more effective (MD -6.30, 95% CI -9.83 to -2.77) (very low quality evidence). Data showing reductions in Ferriman-Gallwey scores could not be pooled for four studies comparing finasteride with flutamide as the results were inconsistent (I² = 67%).Studies examining effects of hypocaloric diets reported reductions in BMI, but which did not result in reductions in Ferriman-Gallwey scores. Although certain cosmetic measures are commonly used, we did not identify any relevant RCTs.
AUTHORS' CONCLUSIONS:
Treatments may need to incorporate pharmacological therapies, cosmetic procedures, and psychological support. For mild hirsutism there is evidence of limited quality that OCPs are effective. Flutamide 250 mg twice daily and spironolactone 100 mg daily appeared to be effective and safe, albeit the evidence was low to very low quality. Finasteride 5 mg daily showed inconsistent results in different comparisons, therefore no firm conclusions can be made. As the side effects of antiandrogens and finasteride are well known, these should be accounted for in any clinical decision-making. There was low quality evidence that metformin was ineffective for hirsutism and although GnRH analogues showed inconsistent results in reducing hirsutism they do have significant side effects.Further research should consist of well-designed, rigorously reported, head-to-head trials examining OCPs combined with antiandrogens or 5α-reductase inhibitor against OCP monotherapy, as well as the different antiandrogens and 5α-reductase inhibitors against each other. Outcomes should be based on standardised scales of participants' assessment of treatment efficacy, with a greater emphasis on change in quality of life as a result of treatment.
The authors present physical properties of laser light, operating principles, kinds of lasers and also physical and biochemical bases of biological laser light action on human cells, tissues and living organisms. The authors discuss a broad range of biological mechanisms of laserotherapy, which were examined on different levels (cell, tissue, organ) and which let them explain the positive influence of laser light in different diseases. Currently known therapeutic effects of lasers may be in many cases beneficial, allowing for effective rehabilitation of the chronically ill, the possibility of replacing hospital-based surgery with outpatient conservative treatment (which is significantly shorter and the costs are reduced), as well as creating opportunities for the treatment of diseases as yet incurable.
Introducción La fotodepilación se encuentra situada en primer lugar dentro de los procedimientos médico-estéticos más frecuentemente realizados. Su práctica es muy común y la más demandada en los Estados Unidos de América y en Europa. En el año 2007, en EE.UU. se realizaron más de tres millones y medio de fotodepilaciones, situándose como el segundo acto médico más practicado después de las inyecciones de Toxina Botulínica. La fotodepilación convencional, realizada con láseres y con aparatos de luz intensa pulsada, cuya indiscutida eficacia no esta exenta de complicaciones como quemaduras, cambios de la pigmentación cutánea, y que su aprendizaje precisa de periodos largos para adquirir experiencia, en la actualidad dispone de una alternativa tecnológica basada en la re-interpretación del concepto clínico de la Fototermolisis Selectiva . En efecto, la acción térmica muy precisa que ocurre sobre la diana y que es predicada por la fototermólisis selectiva, se ofrece con un concepto diferente basado en la acumulación de calor progresivo a fin de conseguir una depilación con energías bajas, disparadas de forma quasi continua por los pulsos de alta frecuencia de repetición que propone el láser Soprano® SHR (Alma Lasers™, Caesarea, Israel).
Background
Hirsutism has a relatively high prevalence among women. Depending upon societal and ethnic norms, it can cause significant psychosocial distress. Importantly, hirsutism may be associated with underlying disorders and co-morbidities. Hirsutism should not simply be looked upon as an issue of cosmesis. Patients require appropriate evaluation so that underlying etiologies and associated sequelae are recognized and managed. Treatment of hirsutism often requires a multidisciplinary approach, and a variety of physical or pharmacologic modalities can be employed. Efficacy of these therapies is varied and depends, among other things, upon patient factors including the underlying etiology, hormonal drive, and local tissue sensitivity to androgens.
Objective
The objective of this paper is to review and summarize current evidence evaluating the efficacy of various treatment modalities for hirsutism in premenopausal women.
Methods
Online databases were searched to identify all relevant prior systematic reviews and meta-analyses as well as recently published (2012–present) randomized controlled trials (RCTs) on hirsutism treatment.
Results
Four recently published RCTs met criteria for inclusion in our review. In addition, one meta-analysis and one systematic review/treatment guideline were identified in the recent literature. Physical modalities and oral contraceptive pills (OCPs) remain first-line treatments. Evidence supports the use of electrolysis for permanent hair removal in localized areas and lasers (particularly alexandrite and diode lasers) for permanent hair reduction. Topical eflornithine can be used as monotherapy for mild hirsutism and as an adjunct therapy with lasers or pharmacotherapy in more severe cases. Combined OCPs as a class are superior to placebo; however, antiandrogenic and low-dose neutral OCPs may be slightly more efficacious in improving hirsutism compared with other types of OCPs. Antiandrogens are indicated for moderate to severe hirsutism, with spironolactone being the first-line antiandrogen and finasteride and cyproterone acetate being second-line antiandrogens. Due to its risk for hepatotoxicity, flutamide is not considered a first-line therapy. If used, the lowest effective dose should be administered with careful monitoring of liver enzymes. Monotherapy with an insulin sensitizer does not significantly improve hirsutism. While insulin sensitizers improve important metabolic and endocrine aberrations in polycystic ovary syndrome, they are not recommended when hirsutism is the sole indication for use. Lifestyle modification counseling is recommended. Gonadotropin-releasing hormone analogs and glucocorticoids are only recommended in specific circumstances. Additional therapies without sufficient supportive evidence of efficacy are ovarian surgery, statins (HMG-CoA reductase inhibitors), and vitamin D supplementation.
Limitations
In general, most therapies garner recommendations that are weak (where the estimates of benefits versus risks of therapy are either closely balanced or uncertain) and are based on low- to moderate-quality evidence.
Conclusions
Risks and benefits of treatment must be carefully considered and discussed with the patient. Expectations for efficacy should be appropriately set. A minimum of 6 months is required to see benefit from pharmacotherapy and lifelong treatment is often necessary for sustained benefit.
Photoepilation has made it possible to broad the possibilities of increasing indications of epilation. But, at the same time, some contraindications, side effects and complications have delimited in accordance with the years of experience of this technique, its clinical application. As in other technologies, photoepilation must take into account cases that are more difficult to treat, according to hair location, complications, skin type and possible associated pathology leading to hirutism of hypertrichosis. The aim of this paper is to present cases whose location leads to greater treatment difficulties as well as how to approach possible alternatives treatment in order to obtain good efficacy and few complications. Locations such as the eyebrows and periocular region, the nose, ears, anus, scrotum, vulva and prominent areas, must be regarded in photoepilation as being the most difficult ones to treat, in search of the highest efficacy, avoiding side effects and complications. This article deals with limitations of the tecnique.
The diode laser, with a wavelength of 980 nm, has promising characteristics for being used for the fenestration during stapedotomy. It is known that at this wavelength absorption in pigmented tissues is high, and absorption in water is relatively low compared with medical lasers in the infrared, making it theoretically an applicable laser for stapes surgery in patients with otosclerosis. Another important advantage is that, with respect to other lasers, this device is relatively inexpensive. Despite the potential advantages, the available literature only shows limited reports of this laser being used in stapes surgery. The present article evaluates the thermal, mechanical, and acoustic properties of the diode laser during stapes surgery.
For the mechanical effects, high-speed imaging with a frame rate up to 4000 f/s (=250 μs resolution) was performed in an inner ear model. For thermal effects, the high-speed Schlieren technique was used. Acoustics were recorded by a hydrophone, incorporated in the model. Pulse settings were 100 ms, 3 W, which are the same settings used during stapes surgery.
The application of the diode laser resulted in limited mechanical and thermal effects. Impulse noise was low with an average of 52 (SD, 7.8) dB (A). Before carbonization of the tip of the delivery laser, fiber enhances ablation of the footplate.
The 980-nm diode laser is a useful tool for laser-assisted stapedotomy in patients with otosclerosis. Mechanical, thermal, and acoustic effects are limited and well within the safety limits.
Albert Einstein is undoubtedly the father of lasers. But it is not until 1964 that the first dermatological lasers were introduced. The Nd-YAG laser, the CO2 laser were developed by Kumar Patel. In a 40 year period lasers not only were diversified but have also become safer and miniaturized. This article hopes to strengthen general practionners' and specialist's knowledge of the different categories of available lasers. The most frequently used ones are ablative lasers (CO2-Erbium), vascular lasers (Nd-YAG, KTP, pulsed dye laser) and the pigment lasers (Q-Switched Nd-YAG, Alexandrite). A description of these lasers and their indications in dermatology will be discussed.
Herlitz junctional epidermolysis bullosa (H-JEB) is a rare, heritable mechanobullous disease that affects infants at birth and causes early death. This disease is primarily caused by compound heterozygous or homozygous mutations in one of three genes affecting the function of one of the three chains of the laminin-332 (formerly laminin-5) protein. Here we report a case of H-JEB with a novel heterozygous mutation in LAMB3,c.1597G>A (p.Ala533Thr). These findings attest to the molecular heterogeneity of JEB and emphasize the importance of genetic analysis to help make an accurate diagnosis, predict clinical prognosis, and identify phenotypic-genotypic relationships that may aid in prenatal diagnosis and genetic counseling for the future.
Background:
Safe and efficient options for removing unwanted hair are in great demand. Laser devices and intense pulsed light (IPL) sources are the most commonly used treatment modalities. Yet, only a few randomized controlled trials (RCTs) comparing laser and IPL devices are available, and RCTs with long-term results are missing from the literature.
Objectives:
To compare the safety and long-term efficacy of diode lasers (DL) and IPL sources for axillary hair removal, we conducted an intrapatient, left-to-right, assessor-blinded and controlled trial.
Methods:
IPL (Ellipse Flex PPT; Danish Dermatological Development, Hoersholm, Denmark; λem=600-950 nm) and DL (LightSheer XC system; Lumenis Inc., Santa Clara, CA, U.S.A.; λem=800 nm) treatments were evaluated in 30 study participants (skin type II-III) with unwanted axillary hair growth. Six treatments with each device were carried out at 4-week intervals. Final assessment was conducted 12 months after the last treatment by means of hair counts using close-up photographs. The primary endpoint was reduction in hair growth, analysed on an intention-to-treat and last-observation-carried-forward basis (n=30), and secondary endpoints were patient-rated efficacy, treatment-related pain, adverse effects and treatment duration.
Results:
Both devices significantly reduced hair counts. Mean reductions from baseline (3 and 12 months after the last treatment) were 59·7% and 69·2% for DL and 42·4% and 52·7% for IPL treatment (P<0·01), respectively. DL treatment induced significantly more pain [3·7±2·1 (DL) vs. 1·6±1·4 (IPL); P<0·01; visual analogue scale] but could be conducted faster [33·1±3·8 s (DL) vs. 40·1±5·0 s (IPL); P<0·01]. No severe side-effects were observed for either therapy.
Conclusions:
Both DL and IPL treatments are highly effective, long lasting and safe. DL was found to be more effective than IPL treatment. DL treatment was more painful but less time-consuming than IPL therapy.
Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses.
Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews.
Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision.
In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias.
A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution.
To determine the safety and effectiveness of a long-pulsed Nd:YAG laser at 1064 nm in effecting long-term hair reduction in patients with darkly pigmented skin.
Nonrandomized before-after clinical and histological trial.
Private practice, ambulatory care facility.
Twenty women with skin phototypes IV through VI and dark brown to black terminal hair on the face, axillae, or legs.
A series of 3 long-pulsed (50-millisecond) 1064-nm Nd:YAG laser treatments at fluences ranging from 40 to 50 J/cm(2) were delivered to the identified treatment areas on a monthly basis by a single operator.
Global clinical grading scores of comparable before-after treatment photographs were determined by 2 independent medical assessors during each laser session and 1, 3, 6, and 12 months postoperatively. A dermatopathologist reviewed unmarked histological specimens obtained at baseline, immediately after the initial laser treatment, and at 1 and 6 months after the final laser session.
Substantial hair reduction was seen after each of the 3 treatment sessions. Prolonged hair loss was observed 12 months after the final laser treatment (70%-90% hair reduction). Axillary hair was substantially more responsive to laser irradiation than was hair located on the legs and face. Adverse effects included mild to moderate treatment pain and rare occurrences of vesiculation and transient pigmentary alteration without fibrosis or scarring. Histological tissue changes mirrored clinical response rates, with evidence of selective follicular injury without epidermal disruption.
The long-pulsed 1064-nm Nd:YAG laser is a safe and effective method of long-term hair reduction in patients with darkly pigmented skin.
BACKGROUND: Alexandrite laser hair removal can be quite successful in lighter skin types. Effective hair removal in Asians can be difficult, and multiple treatments are usually required for effective treatment. OBJECTIVE: To evaluate the safety and efficacy of alexandrite laser hair removal in Asian skin, to determine the benefit of multiple treatments, and to evaluate the value of test patches before laser treatment. METHODS: One hundred forty-four Asian subjects with Fitzpatrick skin types III to V were treated with a cooled 40-ms alexandrite laser with fluences of 16 to 24 J/cm2. Initially, all treated subjects underwent test patch application. After test patch application, 35 subjects with 66 anatomic sites received three treatments. Thirty-five subjects with 66 anatomic sites received two treatments, and 74 subjects with 124 anatomic received a single treatment. All subjects were followed for 9 months after their final treatment. RESULTS: In subjects that were treated three times, a 55% hair reduction was noted at 9 months after the third treatment. In subjects treated two times a 44% hair reduction was noted at 9 months after the second treatment. In subjects treated only one time, a 32% hair reduction was noted at 9 months after the single treatment. No subjects had scarring or long-term pigmentary changes. There appeared to be no correlation between test patch acute complications and those seen after actual treatments. CONCLUSION: Although Asian skin can be effectively treated with a cooled, long-pulsed alexandrite laser, complications do occur. Laser hair removal efficacy was increased with multiple treatments. There does not appear to be an exact correlation in Asian skin between complications occurring after test patch treatment and those seen with subsequent treatments. Traditional hair removal techniques have included shaving, waxing, tweezing, chemical depilation, and electrolysis. All of these methods result in temporary hair removal. The theory of selective photothermolysis 1 led to the development of a variety of different laser systems. A variety of wavelengths have now been shown to remove hair effectively. Clinical observations show that there is some variation in both treatment efficacy and safety profile among individuals. It has been suggested that multiple treatments are more effective than single treatments 2–6 and that darker skin types are more difficult to treat without complications. 7 The purpose of this study was to evaluate prospectively the efficacy and adverse effects in Asian skin treated with an alexandrite hair removal laser, to correlate complications following test patches with those seen after actual treatments, and finally, to evaluate the benefits of single versus double versus triple treatments.
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: Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal have proved unsatisfactory. A variety of laser systems with varying wavelengths, pulse durations, and energy fluences are currently utilized for hair removal. Optimal laser parameters continue to require further investigation. OBJECTIVE: To evaluate the efficacy and safety of a long-pulse millisecond Nd:YAG hair removal laser utilizing fluences of either 50, 80, or 100 J/cm2. METHODS: Fifteen subjects were treated with a contact cooled 50 msec Nd:YAG laser at fluences 30, 50, or 100 J/cm2. Reduction in hair regrowth was measured at 3 months after treatment by comparing the terminal hair count to the baseline values. Potential complications were also evaluated. RESULTS: Average hair reduction at 3 months after treatment was 29%, 29%, and 27% in areas treated with a 50-msec Nd:YAG laser at fluences of 50, 80, and 100 J/cm2, respectively. Although short-term blistering was noted in two subjects, no hyperpimentation, hypopigmentation, or scarring was observed at 3 months after treatment. CONCLUSION: Long-pulse millisecond Nd:YAG laser hair removal with fluences of either 50, 80, or 100 J/cm2 leads to similar efficacy with no significant adverse effects.
: The goal of this study was to prospectively assess the long-term results of ruby laser depilation in 346 consecutive patients who underwent hair removal at 402 anatomical sites. The patients were treated using a ruby laser, with mean power ranging from 8.6 J to 15.7. according to skin type. Results were assessed using two outcome measures-the percentage reduction in hair density and the hair-free interval. The median reduction in hair density was 55 percent (range, 0 to 100 percent) at a median time of 1 year after the last treatment session. The median hair-free interval was 8 weeks. Patients underwent a median number of four treatment sessions. Forty-three of the 346 patients were treated at more than one anatomical site. Of the sites treated, 75 percent reduction in hair density was achieved in 22 percent, 90 percent reduction was achieved in 2.2 percent, and complete depilation was achieved in only 0.7 percent. Darker colored hair was more effectively treated. Treatment efficacy was not affected by anatomical site, with the exception of the faces of male patients, which were found to be particularly resistant to treatment. There was a significant correlation between the number of treatments given and the outcome. The overall complication rate was 9.0 percent (36 of 402 sites) with respect to pigmentary changes and blistering, but varied according to Fitzpatrick skin type. The complication rate was highest in skin types V and VI (24.7 percent), with no complications in skin type I. Although a greater than 50 percent reduction in hair density was achieved in half of the 346 patients treated, complete depilation was achieved in only an extremely limited number of patients.
(C)2002American Society of Plastic Surgeons
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.
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 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. Different techniques have been used for hair removal. Electrolytic epilation is a widely accepted method for this purpose. Recently laser hair removal was introduced.Objective. To evaluate and compare the effectiveness of long-pulse alexandrite laser hair removal with electrolytic epilation.Methods. Twenty-four areas of unwanted axillar hair in 12 patients were included in the study. The right axillar area of the patients was treated by electrolysis with an intensity of 4–8 mA, and the left area was treated with long-pulse alexandrite laser with fluences between 30 and 50 J/cm2. Electrolysis was performed four times at 3-week intervals, and laser treatment was performed three times at 4-week intervals. Before each session, the hairs in a 4 cm2 area centered in the axilla were counted. The last evaluation was done 6 months after the initial treatment. The pain, time, and cost of each procedure are compared.Results. The average clearance rate of the hairs was 74% by laser and 35% by electrolysis 6 months after the initial treatment.Conclusion. Alexandrite laser hair removal is a more reliable and practical solution than electrolysis. Laser hair removal is more expensive than electrolysis, but is 60 times faster and less painful than electrolysis; also fewer sessions are needed with the laser with better results.
Background:
Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal exist, with laser hair removal rapidly becoming the most widely used modality.
Objectives:
Our objective was to evaluate the efficacy and side effects of a long-pulsed ruby laser for epilation in patients with varying skin types and hair color 6 weeks and 6 months after treatment.
Methods:
Seventy-four patients received one to four treatments with a long-pulsed ruby laser (694 nm, 5-msec pulse length, 6 mm spot size, 17.5-32 J/cm2) in different body areas.
Results:
After a mean number of treatments of 1.98 (range 1-4) the mean clearance was 51-75% after 6 weeks and less than 25% after 6 months. A lower percentage of hair regrowth was observed in the facial region than on the trunk or legs and in dark hair compared to blond hair.
Conclusion:
Laser epilation provides a quick and relatively comfortable, but nonpermanent modality for hair removal with few side effects.
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:
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.
This paper examines eight published reviews each reporting results from several related trials. Each review pools the results from the relevant trials in order to evaluate the efficacy of a certain treatment for a specified medical condition. These reviews lack consistent assessment of homogeneity of treatment effect before pooling. We discuss a random effects approach to combining evidence from a series of experiments comparing two treatments. This approach incorporates the heterogeneity of effects in the analysis of the overall treatment efficacy. The model can be extended to include relevant covariates which would reduce the heterogeneity and allow for more specific therapeutic recommendations. We suggest a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
Different techniques have been used for hair removal. Electrolytic epilation is a widely accepted method for this purpose. Recently laser hair removal was introduced.
To evaluate and compare the effectiveness of long-pulse alexandrite laser hair removal with electrolytic epilation.
Twenty-four areas of unwanted axillar hair in 12 patients were included in the study. The right axillar area of the patients was treated by electrolysis with an intensity of 4-8 mA, and the left area was treated with long-pulse alexandrite laser with fluences between 30 and 50 J/cm2. Electrolysis was performed four times at 3-week intervals, and laser treatment was performed three times at 4-week intervals. Before each session, the hairs in a 4 cm2 area centered in the axilla were counted. The last evaluation was done 6 months after the initial treatment. The pain, time, and cost of each procedure are compared.
The average clearance rate of the hairs was 74% by laser and 35% by electrolysis 6 months after the initial treatment.
Alexandrite laser hair removal is a more reliable and practical solution than electrolysis. Laser hair removal is more expensive than electrolysis, but is 60 times faster and less painful than electrolysis; also fewer sessions are needed with the laser with better results.
The Candela alexandrite and the Coherent diode laser systems come equipped with built-in skin cooling systems that are designed to both protect the epidermis, allowing higher fluences, and to alleviate discomfort. Nevertheless, pain can be a significant problem especially with treatment of larger areas. Scatter of the laser beam is reportedly affected by the spot size. It is claimed that larger spot sizes are more effective at identical fluences.
This study evaluated the effectiveness of a topical 5% lidocaine cream (ELA-Max) to control pain and compared pain levels at identical fluences between the 8 mm and 12 mm spot size of the alexandrite laser and between the alexandrite and diode laser with its 9 mm spot size.
The study was conducted in the axillae of 12 patients. Each axilla was divided in half for side-by-side comparison. Half of the right axilla was treated with the alexandrite 8 mm and the other half with the 12 mm spot size at identical fluences. The left axilla was treated at the maximum tolerated fluences with the alexandrite 12 mm spot size and the diode 9 mm spot size.
At identical fluences and other parameters, there was significantly more pain with the alexandrite 12 mm spot size than with the alexandrite 8 mm spot size, both with or without topical anesthesia. The alexandrite laser was significantly less painful than the diode laser both with and without topical anesthetic. The difference was most noticeable between the alexandrite 8 mm spot size and the diode 9 mm spot size. Topical 5% lidocaine anesthesia was effective in reducing pain, though not completely, for both the alexandrite and the diode lasers.
Topical 5% lidocaine cream is a simple and effective method for reducing patient discomfort during laser hair removal procedures, even when a skin cooling device is being used. A larger spot size causes more pain than a smaller spot size at identical fluences. The 800 nm diode laser causes greater discomfort than the 755 nm alexandrite laser.
Laser-assisted hair removal is becoming the treatment of choice for removing unwanted hair.
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.
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.
The average patient had a 78% clearance of hair noted at 1 year with no evidence of scarring or pigmentary changes.
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.
Laser hair removal is a relatively new procedure. Our purpose was to study the efficacy and safety of a high-power, pulsed diode laser array for removing unwanted hair.
A total of 38 subjects were treated with a prototype of the 800-nm diode laser system. Fluences ranging from 10 to 40 J/cm(2) (mean, 33.4 J/cm(2)) were used and 1 to 4 treatments (mean, 2.7) were performed. Evaluation of hair loss was performed at least 4 months after the last treatment (mean, 8.7 months) by a blinded assessment of clinical photographs.
A total of 59% of the subjects had only sparse hair regrowth at the final follow-up. Higher fluences and multiple treatments produced greater long-term efficacy. Transient pigmentary changes occurred in 29% of the subjects and were more common in darker skin types IV to VI (P =. 047).
The 800-nm diode laser is an efficient and safe technique for hair reduction. Adverse pigmentary effects occur, but are transient.
Unwanted hair is a widespread cosmetic problem. Many temporary methods of hair removal have proved unsatisfactory. A variety of laser systems with varying wavelengths, pulse durations, and energy fluences are currently utilized for hair removal. Optimal laser parameters continue to require further investigation.
To evaluate the efficacy and safety of a long-pulse millisecond Nd:YAG hair removal laser utilizing fluences of either 50, 80, or 100 J/cm2.
Fifteen subjects were treated with a contact cooled 50 msec Nd:YAG laser at fluences 30, 50, or 100 J/cm2. Reduction in hair regrowth was measured at 3 months after treatment by comparing the terminal hair count to the baseline values. Potential complications were also evaluated.
Average hair reduction at 3 months after treatment was 29%, 29%, and 27% in areas treated with a 50-msec Nd:YAG laser at fluences of 50, 80, and 100 J/cm2, respectively. Although short-term blistering was noted in two subjects, no hyperpimentation, hypopigmentation, or scarring was observed at 3 months after treatment.
Long-pulse millisecond Nd:YAG laser hair removal with fluences of either 50, 80, or 100 J/cm2 leads to similar efficacy with no significant adverse effects.
Lasers with long wavelengths are less well absorbed by melanin and are considered to be particularly suitable for hair removal in dark-skinned patients.
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.
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.
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).
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.
Laser hair removal is the treatment of choice for hypertrichosis. The two most commonly used hair removal lasers are compared.
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.
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).
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/cm(2)) even in type IV patients. For most patients, four treatment sessions using high fluences (30-40 J/cm(2)) 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.
Both the alexandrite and diode lasers in this 12-month study produced excellent long-term hair reductions.
Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established.
To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I-V.
Eighty-nine untanned patients with skin types I-V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4-6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10-15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm(2), a spot size of 12 mm was used for fluences of 35-40 J/cm(2), and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm(2). Fluences ranging from 20 to 50 J/cm(2) (mean fluence 36 J/cm(2)) were used.
The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm(2) (35-50 J/cm(2)) and a 10-12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm(2) (30-40 J/cm2) and a 12-15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm(2) (25-40 J/cm(2)) and a 12-15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25-35 J/cm(2)) and a 12-15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm(2) (20-25 J/cm(2)) and a 12-15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring.
The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I-V. The best results are achieved in untanned patients with skin types I-IV.
The aim was to investigate the efficacy, side effects, and the long-term results of a long pulsed Nd:YAG-Laser for hair removal in different hair colors and skin types.
We performed a prospective clinical study with 29 volunteers. Treatment was performed on the lower leg with a long pulsed Nd:YAG-Laser. Five test areas were treated 1-5 times in monthly intervals; one served as control. Follow-up investigations were performed at each session, and 3, 6, and 12 months after the last therapy. No depilatory treatment except shaving was allowed during the time of follow-up. Percentual hair loss, short- and long-term side effects, and pain during the treatment were evaluated.
After one month, a hair loss of greater than 50% was found in 44.9% of the areas treated once. With up to five treatments, this percentage increased up to 71.5%. One year after therapy, a greater than 50% hair reduction was still present in 40% of the five-treatment-areas and in 0% of the areas treated only once. There were no permanent side effects despite one small scar after a folliculitis.
The long pulsed Nd:YAG is suitable to remove hair for more than 12 months effectively, although 4-5 sessions are necessary for these results. Blond hair can also be removed, although much less effective. No lasting side effects could be seen. Darker skin types or tanned skin can also be treated without side effects. A cooling may be advisable due to the pain reported by the volunteers.
Laser hair removal is based on the dual concepts of selective photothermolysis and thermal relaxation time. In most laser hair removal systems, light with emitted pulse durations of 2-50 msec targets hair follicles. A novel concept of laser hair removal uses the thermal damage time rather than the thermal relaxation time of the hair follicle. The follicle's thermal damage time is the amount of time required for diffusion of delivered laser energy from the treated hair to follicular-associated hair stem cells. This can range from 170 to 1000 msec.
To investigate the theory of thermal damage time, we performed a pilot study to evaluate the clinical efficacy and side effect profile of a modified 810 nm diode laser device operating in a super-long-pulse mode (200-1000 msec).
Ten female subjects with Fitzpatrick skin types I-VI received either one or two laser treatments at eight test sites. Super-long pulse durations of 200-1000 msec were evaluated with delivered fluences ranging from 23 to 115 J/cm2. Subjects were followed for 6 months after the first treatment. Subjects were evaluated for hair removal efficiency, optimal pulse duration and delivered fluence, and associated complication rate.
The clinical results show that safe hair removal in all skin types can be accomplished with an 810 nm diode laser delivering super-long pulse durations. Pain and complications were greatest at the highest pulse duration (1000 msec) and the highest fluence (115 J/cm2). Optimal hair reduction at 6 months (31%) was achieved at a thermal diffusion time of 400 msec (46 J/cm2).
The super-long pulsed 810 nm diode laser can safely remove unwanted hair in a full variety of skin types. Pain and increased risk of complications may preclude the use of the laser at very high fluences and pulse duration in the range of 1000 msec.
The goal of this study was to prospectively assess the long-term results of ruby laser depilation in 346 consecutive patients who underwent hair removal at 402 anatomical sites. The patients were treated using a ruby laser, with mean power ranging from 8.6 J to 15.7 J according to skin type. Results were assessed using two outcome measures-the percentage reduction in hair density and the hair-free interval. The median reduction in hair density was 55 percent (range, 0 to 100 percent) at a median time of 1 year after the last treatment session. The median hair-free interval was 8 weeks. Patients underwent a median number of four treatment sessions. Forty-three of the 346 patients were treated at more than one anatomical site. Of the sites treated, 75 percent reduction in hair density was achieved in 22 percent, 90 percent reduction was achieved in 2.2 percent, and complete depilation was achieved in only 0.7 percent. Darker colored hair was more effectively treated. Treatment efficacy was not affected by anatomical site, with the exception of the faces of male patients, which were found to be particularly resistant to treatment. There was a significant correlation between the number of treatments given and the outcome. The overall complication rate was 9.0 percent (36 of 402 sites) with respect to pigmentary changes and blistering, but varied according to Fitzpatrick skin type. The complication rate was highest in skin types V and VI (24.7 percent), with no complications in skin type I. Although a greater than 50 percent reduction in hair density was achieved in half of the 346 patients treated, complete depilation was achieved in only an extremely limited number of patients.
The histology of hair follicles in both animal and human skin treated with ruby lasers has been evaluated to a limited extent in previous studies. We have previously looked at such follicles up to 2 months after treatment. This study examines the longer-term effects at a microscopic level and attempts to further elucidate the mechanism of ruby laser hair reduction.
Thirty-six patients underwent 1, 2, or 3 treatments of their axillary or bikini area skin with a 3 milliseconds ruby laser at 10, 20, 30, or 40 J/cm(2). Biopsies were taken 3, 4(1/2), or 6 months after the last treatment and examined histologically. Nine control biopsies were taken from comparable bikini areas of untreated patients and similarly evaluated histologically.
There was a significant increase in telogen compared to anagen follicles in treated skin, which was slightly increased by multiple compared to single treatments, but unaffected by different time intervals since the last treatment. There was also a significant increase in miniaturized compared to terminal hairs in treated compared to control skin, a finding that was further increased with higher energies used. Multiple treatments and time after treatment had a slight, but not statistically significant effect on follicle size.
Induction of telogen in terminal follicles followed by miniaturization appears to be the main mechanism of ruby laser hair reduction.
The use of the long-pulsed 755-nm alexandrite laser has been an effective tool in hair removal. A dynamic cooling device (DCD) is commonly used with this laser in order to minimize epidermal damage. No studies have examined how fine changes in DCD duration may affect comfort and epidermal damage during laser hair removal. This study was designed to determine what effect, changes in the duration of dynamic cooling would have on pain and epidermal damage with laser hair removal (755 nm alexandrite) in patients with darker skin types.
Ten volunteers with Fitzpatrick skin types III-V were enrolled. A 755-nm alexandrite laser with a pulse duration of 3 milliseconds and equipped with a DCD was used with the 12 mm spot size on matched treatment sites. We compared cryogen spurt durations of 0, 20, 40, 60, 80, and 100 milliseconds on pain and epidermal changes. The spray delay was set at 1 millisecond. Pain rating scales and epidermal changes (skin sloughing, hyperpigmentation, hypopigmentation and scarring) were assessed.
Overall a decrease in pain was seen with increases in spurt duration. A spurt duration of 20 milliseconds was beneficial for pain reduction in all patients. Longer spurt durations were associated with additional pain relief especially when geographic spacing of pulses was maximized to prevent thermal build-up. In regards to epidermal protection, most patients benefited with shorter cryogen durations of 20-60 milliseconds. There was little advantage with longer spurt durations. Some patients treated at higher fluences without cooling had no detectable side effects.
Increasing DCD spurt duration in laser hair removal provides its strongest benefit in the area of pain reduction, particularly in type V patients. Increasing cryogen spurt durations above a protective threshold shows no significant benefit in terms of epidermal protection. Changing the spurt duration may not be as important in some patients with darker skin types.
Recent reports indicate that laser hair removal is most effective on anagen hairs. However, no published trials have examined laser epilation after hair cycle synchronization.
To evaluate the potential for enhanced laser hair removal after the induction of telogen hairs into anagen by wax epilation.
We identified four 2.5-cm square areas with equivalent hair length and density on the backs of 13 dark-haired white men. To induce typically telogen hairs into anagen, two areas on each patient were wax epilated. Two weeks later, one waxed area and one unwaxed area were treated with a long-pulsed alexandrite laser. One month after laser treatment, a subjective comparison was made based on hair density, length, and thickness.
In 12 of 13 patients, lasered areas that had been pretreated with wax epilation were clearer of hair as compared with areas that had been pretreated by shaving (P=0.0034). No significant difference was noted between waxed and unwaxed control areas that had not been laser treated (P=1.0).
Wax epilation 2 weeks before laser hair removal improves cosmetic outcomes at 1 month. This effect may be secondary to the recruitment and heightened sensitivity of early anagen hairs.
Lasers permit treatment of unwanted excess hair with less discomfort than other methods of epilation. Many lasers with different parameters are now available from which the dermatologist can choose. Improved clinical results are made possible by the high specificity and selectivity of the laser systems to pigmented hair because of the use of an appropriate wavelength with the proper pulse and duration.
We aimed to compare the results of treatment of skin types IV, V, and VI using three different laser systems.
One hundred female patients were compared using different laser systems: 35 patients underwent epilation using a Nd-Yag laser, 33 patients using an Alexandrite laser, and 32 patients using a Diode laser.
Follow up 12 months after the multiple treatments (three to six sessions) showed an insignificant difference between these three groups (35-40%).
Our findings indicate that all three laser systems tested can be used for dark skin; however, one should select a system that minimizes side-effects, primarily hypo- and hyper-pigmentation, especially when used for skin types IV, V, and VI.
Alexandrite laser hair removal can be quite successful in lighter skin types. Effective hair removal in Asians can be difficult, and multiple treatments are usually required for effective treatment.
To evaluate the safety and efficacy of alexandrite laser hair removal in Asian skin, to determine the benefit of multiple treatments, and to evaluate the value of test patches before laser treatment.
One hundred forty-four Asian subjects with Fitzpatrick skin types III to V were treated with a cooled 40-ms alexandrite laser with fluences of 16 to 24 J/cm2. Initially, all treated subjects underwent test patch application. After test patch application, 35 subjects with 66 anatomic sites received three treatments. Thirty-five subjects with 66 anatomic sites received two treatments, and 74 subjects with 124 anatomic received a single treatment. All subjects were followed for 9 months after their final treatment.
In subjects that were treated three times, a 55% hair reduction was noted at 9 months after the third treatment. In subjects treated two times, a 44% hair reduction was noted at 9 months after the second treatment. In subjects treated only one time, a 32% hair reduction was noted at 9 months after the single treatment. No subjects had scarring or long-term pigmentary changes. There appeared to be no correlation between test patch acute complications and those seen after actual treatments.
Although Asian skin can be effectively treated with a cooled, long-pulsed alexandrite laser, complications do occur. Laser hair removal efficacy was increased with multiple treatments. There does not appear to be an exact correlation in Asian skin between complications occurring after test patch treatment and those seen with subsequent treatments.
Postinflammatory pigmentary changes are a frequently encountered problem with numerous dermatologic procedures. Limited literature is available that documents this complication with laser hair removal.
It is important for all physicians performing laser hair removal to be aware of this potential complication. We present our experience with postinflammatory pigmentary change and discuss some potential etiologic factors.
Seven patients who experienced postinflammatory complications after alexandrite laser hair removal are presented. These are all the patients who developed this complication in our office over the past 2.5 years.
The patients who we describe in this article all developed a similar pattern of initial hyperpigmented rings, later developing into a thin wafer-like crust followed by hypopigmentation with gradual return to their normal skin color.
In general, the alexandrite laser is both safe and effective for hair removal in patients of varying skin types. Complication rates will increase as skin pigment increases and as the power used increases. However, even in light-skinned individuals without recent pretreatment or posttreatment sun exposure, with proper treatment parameters, complications, and side effects can arise. We have found this to be especially true when treating areas other than the face.
Background:
The theory of selective photothermolysis has led to the development of a variety of different hair removal laser systems.1,2 These lasers use follicular melanin as a target chromophore. At present the delivery of adequate fluences, optimizing wavelengths and pulse duration, and adequate epidermal cooling are the factors required to achieve effective hair removal. To further evaluate these factors a study was initiated to further investigate a new laser system.
In the last years several lasers have proven their efficacy for hair removal. However, little is known about the efficacy of varying the spot size with those lasers.
To evaluate the long-term efficacy of hair removal using a diode laser with different spot sizes.
A long-pulsed diode laser (2 x 60 msec) was used. The spot size was 8 mm, 12 mm, or 14 mm. Twenty consenting volunteers were treated three times at regular intervals of 3 weeks. The ratio of the number of hairs in the treated area to an adjacent area left untreated (control) was referred to as regrowth.
One month after laser treatment, regrowth was 23% (8 mm), 12% (12 mm), and 13% (14 mm). After 3 months regrowth was 67% (8 mm), 54% (12 mm), and 55% (14 mm). Fifteen months after treatment 4 of 16 volunteers had a regrowth rate of less than 25%.
The results provide evidence for an effective and long-lasting growth delay of hairs using the long-pulsed diode laser. The use of large spot sizes improved the growth delay of hairs measured 1 month after treatment.
Preliminary study of fine changes in the duration of dynamic cooling during 755-nm laser hair removal on pain and epidermal damage
- Nahm Wk
- Mm
- Falanga
Nahm WK, Tsoukas MM, Falanga V et al (2002) Preliminary study of fine changes in the duration of dynamic cooling during 755-nm laser hair removal on pain and epidermal damage. Lasers Surg Med 31(4):247–251
Effect of wax epilation before hair removal with along pulsed Alexandrite laser
- M Llehrer
- G Grawford
- Gerfand
Llehrer M, Grawford G, Gerfand G et al (2003) Effect of wax epilation before hair removal with along pulsed Alexandrite laser. Dermatol Surg 29:118–123
Topical anesthesia for laser hair removal
- S Eremia
- Newman
Eremia S, Newman N (2000) Topical anesthesia for laser hair removal. Dermatol Surg 26:667–669
Hair removal with long pulsed Nd:YAG
- S Lorenz
- S Brunnberg
- Landthaler
Lorenz S, Brunnberg S, Landthaler M et al (2002) Hair removal with long pulsed Nd:YAG. Lasers Surg Med 30(2):127–134
Long pulsed ruby laser for permanent hair reduction
- Vens A James
Mccoys G, Vens A, James C (2002) Long pulsed ruby laser for permanent hair reduction. Lasers Surg Med 30(5):401–405
Long pulsed Nd: TAG laser assisted hair removal in pigmented skin
- Bryan T H Alster
- Williams
- Cm
Alster T, Bryan H, Williams CM (2001) Long pulsed Nd: TAG laser assisted hair removal in pigmented skin. Arch Dermatol 137:885–889