ArticleLiterature Review

Evidence-based review of hair removal using lasers and light sources

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Abstract

Unwanted hair growth remains a therapeutic challenge and there is a considerable need for an effective and safe treatment modality. From an evidence-based view to summarize efficacy and adverse effects from hair removal with ruby, alexandrite, diode, and Nd:YAG lasers and intense pulsed light (IPL). Original publications of controlled clinical trials were identified in Medline and the Cochrane Library. A total of 9 randomized controlled (RCTs) and 21 controlled trials (CTs) were identified. The best available evidence was found for the alexandrite (three RCTs, eight CTs) and diode (three RCTs, four CTs) lasers, followed by the ruby (two RCTs, six CTs) and Nd:YAG (two RCTs, four CTs) lasers, whereas limited evidence was available for IPL sources (one RCT, one CT). Based on the present best available evidence we conclude that (i) epilation with lasers and light sources induces a partial short-term hair reduction up to 6 months postoperatively, (ii) efficacy is improved when repeated treatments are given, (iii) efficacy is superior to conventional treatments (shaving, wax epilation, electrolysis), (iv) evidence exists for a partial long-term hair removal efficacy beyond 6 months postoperatively after repetitive treatments with alexandrite and diode lasers and probably after treatment with ruby and Nd:YAG lasers, whereas evidence is lacking for long-term hair removal after IPL treatment, (v) today there is no evidence for a complete and persistent hair removal efficacy, (vi) the occurrence of postoperative side-effects is reported low for all the laser systems. The evidence from controlled clinical trials favours the use of lasers and light sources for removal of unwanted hair. We recommend that patients are pre-operatively informed of the expected treatment outcome.

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... To obtain permanent results, laser hair removal requires a series of treatments for which the patient reports in specific time intervals. The literature indicates that amount of the standard procedures to be considered effective should be determined at a minimum of 6, and the obtained treatment effects made laser hair removal the most popular method around the world [2][3][4][5][6][7][8][9][10][11]. ...
... 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]. ...
... Even though the thermal relaxation time (TRT) of the melanin, and the time required for the laser energy to diffuse, is concise, the simple destruction it would cause only hair fragmentation and quite quick regrowth. The method is therefore solely effective in anagen phase of hair growth [6,14,15]. ...
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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.
... Evidence based on 11 RCTs [211] and 21 controlled trials [212] supports the efficacy for up to 6 months of partial hair removal with laser or intense pulsed light (IPL), despite a great variability following photoepilation [212]. 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]. ...
... Evidence based on 11 RCTs [211] and 21 controlled trials [212] supports the efficacy for up to 6 months of partial hair removal with laser or intense pulsed light (IPL), despite a great variability following photoepilation [212]. 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]. ...
... Evidence based on 11 RCTs [211] and 21 controlled trials [212] supports the efficacy for up to 6 months of partial hair removal with laser or intense pulsed light (IPL), despite a great variability following photoepilation [212]. 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]. ...
Article
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.
... 4 LHR outcome can be influenced by multiple factors, which can be device-related (wavelength, fluence, spot size, pulse duration, skin cooling), patient-related (endocrine dysfunction, anatomical region, skin phototype, hair thickness, hair growth cycle and the depth of the follicles), or operator-related (proper knowledge and appropriate laser settings). 5 The FDA has defined permanent hair reduction as "a significant reduction in the number of terminal hairs after a given treatment, which is stable for a period of time longer than the complete growth cycle of hair follicles at the given body site." 6 The misinterpretations regarding LHR presented in newspapers and advertisements has led to unrealistic patient expectations regarding the procedure. ...
... Most people consider permanent hair reduction 100% efficient and persistent. 5 Therefore, the FDA amended the permanent hair reduction definition, stating that "the number of hairs regrowing must be stable over a time greater than the duration of the complete growth cycle of hair follicles, which varies from 4 to 12 months according to body location." ...
Article
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Laser Hair Removal (LHR) became a very popular intervention, with a permanently increasing number of procedures being performed worldwide. The procedure is often performed by non‐medical personnel, and even by untrained personnel, that could be associated with different kind of adverse events, from mild to serious. The complications associated could be lower if the operators understand the basic of laser physics and the working principles of devices. We propose a simple acronym, WATCH, in order to increase the safety and efficiency of laser interventions. This article is protected by copyright. All rights reserved.
... Unfortunately, practitioners performing these treatments focus only on using the basic minimum information -like the Fitzpatrick skin phototype, colour and hair structure. [24][25][26] Those are not the only factors which affect the safety of the treatment or treatment parameter settings. When treating mixed-race patients, it is essential to consider their ethnicity and a detailed ethnic history. ...
... 27 The scientific literature presents numerous reports on the effectiveness of LHR but is limited to different parts of the body and no reports on mixed-race participants have been found. 6,8,10,11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Objective The authors of this study have noticed that mixed-race patients' skin reacts differently than similar skin types according to the Fitzpatrick scale of non-mixed-race patients and so far no related research was found. The objective of the study was to investigate the occurrence and types of side and adverse effects after performing diode laser 805 nm hair removal in a group of mixed-race participants with phototypes III-V and to assess its impact on the results of the treatment measured as a percentage of hair reduction in the treated area. ...
Article
Full-text available
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.
... This is true when treating areas such as upper lip where chromophore in vellus hairs is less for laser wavelength absorption. 6,14,15 ...
... Though permanent hair loss is not expected in all individuals, lessening of hair density and thickness are. 14,15 White and gray hairs have no melanin and are not known to respond to lasers. Nd: YAG laser works less effectively than alexandrite and intense pulsed light due to its poor affinity for melanin, which illustrates the role of chromophores in determining responsiveness of hairs to lasers. ...
Article
Conventional and advance technologies are available for laser hair removal. Complete and permanent hair reduction is not yet possible by treatment with lasers. Ideal patient for any conventional laser hair removal treatment is one who has thick, dark terminal hair, light skin and normal hormonal status. Factors that contribute to variable outcomes in laser hair removal can be broadly divided into patient related ones and the technology related ones. Skin type, hair color, thickness and density, degree of tan, hormonal dysfunction etc., constitute the patient related factors. The wavelength, fluence, spot size and pulse duration of the laser system are the technology related factors. There are some patients who respond variably, unpredictably or poorly to laser hair removal despite ensuring that indication for treatment is appropriate with adequate parameters of the laser system. This article reviews various patient related and technology related factors which lead to variable-to-poor outcomes in laser hair removal; and various challenges and limitations of laser hair removal technology in patients with dark skin types.
... Numerous published clinical studies have demonstrated the safety and efficacy of different lasers at various wavelengths for hair removal [1] [3]. ...
... Based on clinical evidence, hair removal diode lasers of 810 nm are considered as the universal hair removal for all skin types, and these lasers are commonly used in the market [1] [2] [3]. Light color or fine hair may be resistant to the treatment due to scarcity of pigmentation in the hair shaft, whereas treatment of dark skin type patients is difficult due to skin melanin absorption [1]. ...
... Laser-assisted epilation is one of the most prevalent procedures in dermatology clinics worldwide. [8] This is due to its many advantages such as high patient satisfaction rate, [9] safety, and longevity of the results [6,10,11] in comparison with the other traditional methods of hair removal. [11] Long-pulsed lasers are commonly used for hair removal, especially alexandrite and Nd:YAG lasers with good safety profile even in patients with darker skin colors. ...
... [8] This is due to its many advantages such as high patient satisfaction rate, [9] safety, and longevity of the results [6,10,11] in comparison with the other traditional methods of hair removal. [11] Long-pulsed lasers are commonly used for hair removal, especially alexandrite and Nd:YAG lasers with good safety profile even in patients with darker skin colors. This is due to their longer wavelengths which avoid the competition with epidermal melanin. ...
Article
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Introduction: Laser hair removal (LHR) is a common procedure in dermatology. LHR using quality-switched (QS) 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) is very popular in our community despite lack of sufficient evidence on its efficacy and safety. Purpose: We report the characteristics of nine patients who developed hypopigmented macules after being treated with QS 1064 nm laser for hair removal. Methods: This was a retrospective study at a laser center in Saudi Arabia conducted between June 2014 and September 2018. Patients who developed white macules following treatment with QS 1064 nm Nd:YAG laser for removal of unwanted hair were included in the study. Results: All patients were Saudi females with a mean age of 28.8 years (range: 25–37 years). Well-defined hypopigmented to depigmented 1–3 mm macules developed after being treated with QS 1064 nm Nd:YAG laser for hair removal. The most commonly affected area was the face. Majority of patients had skin phototype IV. Hypopigmented macules developed after an average of 22 laser sessions (range: 4–48 sessions). None of the patients had either personal or family history of vitiligo. Lesions seem to be difficult to treat, with only two patients responding to topical tacrolimus and excimer laser. Conclusion: Hypopigmented macules might develop after QS 1064 nm LHR. Those macules appear to be resistant to treatment. Further prospective controlled studies needed to elaborate more on the safety profile of this procedure.
... Furthermore, the traditional flash lamp pulsed alexandrite laser has some limitations including the need to exchange the flash lamps regularly, type of cooling, problems of fragile transmission systems, and bulky scanner [14]. On the other hand, it has been shown that long pulse diode laser induces less pain and discomfort compared to the alexandrite laser [15]. ...
... Laser hair removal (LHR) is one of the most requested cosmetic procedures. Although a number of lasers and non-laser light sources have been developed for hair removal, the 755nm alexandrite and 800-810-nm diode lasers remain common options for this purpose among individuals with Fitzpatrick skin types I-IV [15,17]. Several clinical studies conducted to compare these two laser systems, indicated various benefits of each system as well as their limitations [9][10][11]. ...
Article
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The aim of this study was to compare the efficacy and safety of a novel diode system emitting 755 nm wavelength with conventional 755 nm alexandrite laser in skin types III and IV. It was a randomized, right-left comparison, assessor-blind, clinical study. Sixteen female volunteers age 29.52 ± 9.52 were randomly assigned to receive six treatment sessions using 755 nm diode laser on one axilla and 755 nm alexandrite on the opposite axilla. Efficacy was assessed by counting of hairs per square centimeter, 6 months after the last treatment. Treatment outcome was also evaluated by blind reviewing of before and after pictures, using Physician Global Assessment scale (GAS). Subject satisfaction was assessed using visual analogue scale (VAS), pain level and adverse effects were recorded. Skin biophysical parameters (transepidermal water loss, skin sebum, and erythema index) were also measured. Significant reduction in hair count was observed, 6 months after the last treatment session, for both devices (− 33% for 755 nm diode and − 35% for 755 nm alexandrite; p value = 0.85). The mean GAS score was 2.66 for alexandrite treated side vs. 2.00 for diode treated side (p value = 0.036). No severe adverse events were reported. The subject satisfaction score was significantly higher after treatment with alexandrite laser. No significant changes were detected in none of skin biophysical parameters. 755 nm diode laser is suitable for hair removal procedures and it is as effective and safe as the 755 nm alexandrite laser in skin types III–IV.
... Electrolysis may be cheaper per session, but many hours may be required to treat each area of hair; in contrast, LHR will treat the entire area for hair removal during each session with faster procedure times, low occurrence of side effects, and fewer needed sessions (25). In addition, a Cochrane systematic review of 30 controlled trials concluded that efficacy of LHR is superior to that of electrolysis (23,26). ...
... An evidence-based review reported that multiple LHR treatments result in increased efficacy of hair removal (22,26,43). The European Society for Laser Dermatology recommends three to eight LHR treatments (36), and the American Academy of Dermatology states that most patients need between two to six treatments. ...
Article
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.
... However, LHR is ineffective in treating light or vellus hairs. 11 Electrolysis is currently the only US Food and Drug Administration-approved method of permanent hair removal, whereas LHR is only approved for permanent hair reduction. 9 In this study, hair removal refers to the treatment of unwanted hair regardless of modality and refers to permanent hair reduction and removal in the clinical setting unless indicated otherwise. ...
Article
Importance Hair removal can be an essential component of the gender affirmation process for gender-minority (GM) patients whose outward appearance does not align with their gender identity. Objective To examine the health insurance policies in the Affordable Care Act (ACA) marketplace and Medicaid policies for coverage of permanent hair removal for transgender and GM patients and to correlate the policies in each state with statewide protections of coverage for gender-affirming care. Design and Setting Private health insurance policies available on the ACA marketplace and statewide Medicaid policies were examined in a cross-sectional study from September 1 to October 31, 2019, and January 17 to 30, 2020. Policies were assessed for coverage of permanent hair removal. Language concerning hair removal was found in each policy’s medical or clinical coverage guidelines and separated into general categories. Main Outcomes and Measures Logistic regression analyses were performed to compare Medicaid policies and ACA policies in states with and without transgender protections. Results A total of 174 policies were analyzed, including 123 private insurance policies and 51 statewide Medicaid policies. Of these policies, 8 (4.6%) permitted the coverage of permanent hair removal without explicit restrictions. The remaining 166 policies (95.4%) broadly excluded or did not mention gender-affirming care; prohibited coverage of hair removal or did not mention it; or only permitted coverage of hair removal preoperatively for genital surgery. The ACA marketplace policies in states without transgender care protections were less likely to cover hair removal without restrictions than ACA policies in states with protections (2 of 85 policies [2.4%] in states without transgender care protections vs 5 of 38 policies [13.2%] in states with transgender care protections), and Medicaid policies were less likely to cover preoperative or nonsurgical hair removal compared with ACA policies (6 of 51 Medicaid policies [11.8%] vs 47 of 123 ACA policies [38.2%]). Conclusions and Relevance Despite adoption of statewide restrictions on GM health care exclusions by several states, most Medicaid and ACA policies examined in this study did not cover permanent hair removal for transgender patients. Many GM patients seeking hair removal may be required to pay out-of-pocket costs, which could be a barrier for gender-affirming care.
... [8] Different laser systems and intense-pulsed light currently approved by the Food and Drug Administration, USA, for the reduction of hair are ruby (694 nm), alexandrite (755 nm), diode (800 nm) and long pulse Nd: YAG (1064 nm) laser and IPL (515-1200 nm) sources. [9] LHR is a slow process which takes at least six to eight sittings and spacing between the sessions is done depending on the hair cycle of that area. The apparent cosmetic improvement may be related to reduction in number of hairs or a decrease in diameter or pigmentation. ...
Article
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Background: Hirsutism means excessive terminal hair growth in a female in male pattern distribution. Perception of hirsutism is subjective. Permanent laser hair reduction is a slow process taking many sessions and tracking of improvement parameters is tedious. Hence, a lot of confusion still exists regarding the type of laser most beneficial for treatment. Aim: The aim of this study was to compare the effectiveness and safety profile of long-pulsed Nd: YAG laser (1064 nm) and intense pulse light (IPL)-755 nm in management of idiopathic facial hirsutism. Settings and design: Open-labelled, randomly allocated experimental study. Subjects and methods: The study included 33 cases of idiopathic facial hirsutism. Patients were randomly divided into Group A, treated with long-pulsed Nd: YAG laser and Group B, treated with IPL-755 for a total of six sessions at 1 month interval. Statistical analysis: Chi-square test was used in Medcalc(®) version 9.0 and the test of significance was taken to be P < 0.05. Results: Average percentage of improvement in Group A, according to patients at each sessions were 46.33%, 70.66%, 81.66%, 84.67%, 85.33%, 87.33% and that in Group B were 28.06%, 39.72%, 52.22%, 64.72%, 67.78%, 71.11%, respectively. Excellent response (>75% reduction in hair) after six sessions in Group A was seen in fourteen (93.33%) out of fifteen patients, whereas in Group B, it was seen only in three (16.66%) out of eighteen patients. In Group A, erythema was seen in 26.67%, perifollicular edema and hyperpigmentation in 13.33% each. In Group B, erythema was seen in 50% patients, perifollicular edema in 16.67% and hyperpigmentation in 38.89% patients. Conclusions: Long-pulsed Nd: YAG Laser (1064 nm) is better than IPL-755 nm in terms of safety and effectiveness in the management of idiopathic facial hirsutism.
... 24 female subjects with skin types II-IV were treated three times every four weeks. The study concluded that a mean hair removal efficiency of 74% was noted at 3 months, whereas 79% was reported at 6 months [10]. ...
Article
Background: Hair forms an important appendage of the body playing a significant role in an individual’s psychosocial personality. Hirsutism is the presence of terminal hair at androgen-dependent sites in a female. Hypertrichosis is excessive hair growth all over the body in a non-androgen dependent manner. Increased terminal facial hair growth leads to cosmetic embarrassment, psychological distress and a low self-esteem in women. Currently, the most effective and advanced procedure for unwanted hair removal is laser epilation. Diode laser (800-855nm) are the most frequently used for this purpose and can be used in two different modes FDP (Fast delivery pulse) and DP (delivery pulse). With this study we aim to compare the efficacy of these two modes of diode laser for facial hair reduction. Objectives: 1.To study the clinical presentation of unwanted facial hair in patients visiting the department. 2. To study the trichoscopic features of facial hair in patients. 3.To study the correlation between the endocrinal abnormalities and clinical presentation in patients with increased facial hair. 4. To study the effectiveness of two different modes of diode laser on facial hair. Methods: It is a prospective randomized control study with a total of 20 female patients in the age group of 18-50 years with complaints of unwanted facial hair. VIKINI Diode laser of wavelength 808nm will be used for treatment. Post randomization the participants will be divided into two groups, one of them will be treated with FDP (Fast delivery pulse) mode and the other with DP (delivery pulse) mode. A total of six sittings will be performed at an interval of 4 weeks. Baseline trichoscopy findings as well as trichoscopy at follow up visits at one, three and six months will be recorded. Post procedure patient satisfaction and pain assessment will be also be recorded. Expected Results: The result would be undertaken in SPSS software. This study will help in understanding which technique is superior for laser hair reduction for facial hair. Conclusion: The conclusion will be based on findings for study protocol.
... Effective treatment induces anagen to catagen transition and the hair fiber is subsequently shed resulting in hairfree skin. Depending on the temperature reached in specific follicular compartments during a certain time (Arrhenius damage integral) [4], temporary or permanent hair reduction can be achieved [6][7][8][9][10][11]. ...
Article
Objectives Photoepilation is a commonly used technology in home‐use devices (HUDs) and in professional systems to remove unwanted body hair using pulses of laser or intense pulsed light (IPL). Albeit HUDs and professional systems operate at different fluences and treatment regimes, both demonstrate high hair reduction. The underlying mechanisms, however, remain unknown partly due to high divergence of the existing literature data. The objective of this study was to develop an ex vivo photoepilation model with a set of criteria evaluating response to light pulses; and to investigate dose‐response behavior of hair follicles (HFs) subjected to a range of fluences. Methods After ex vivo treatment (single pulse, 810 nm, 1.7–26.4 J/cm², 4–64 ms pulse) human anagen HFs were isolated and maintained in culture for 7–10 days. Response to light was evaluated based on gross‐morphology and histological examination (H&E and TUNEL stainings). Results HFs treated ex vivo demonstrated a dose‐dependent response to light with five distinct classes defined by macroscopic and microscopic criteria. Fluences below 13.2 J/cm² provoked catagen‐like transition, higher fluences resulted in coagulation in HF compartments. Conclusion Observed changes in the HF organ culture model were reflected by clinical efficacy. The developed photoepilation model provides an easy and fast method to predict clinical efficacy and permanency of light‐based hair removal devices. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
... Patients with light hair may have inadequate clearance from laser techniques, and electrolysis would be necessary. However, a systematic review by Haedersdal and Wulf favored the efficacy of laser hair removal compared to electrolysis when feasible (2). ...
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Gender affirmation surgery is paramount in the treatment of gender dysphoria for transgender individuals. For transgender women, vaginoplasty offers the opportunity for removal of masculine-appearing genitalia and replacement with a gender-congruent appearance. While numerous techniques have been described in the past, approaches have standardized considerably. Herein, we describe a technique to penile inversion vaginoplasty and focus on some of the critical steps of the procedure to try to optimize patient outcomes. We also review relevant literature regarding perioperative outcomes.
... Intense pulsed light (IPL) is superior to the ruby laser, similar to the Nd: YAG laser and less effective than diode laser therapy (54). Data regarding efficacy of IPL are rather limited (55). It is associated with less risk of burning in patients with darker skin. ...
... This is attributed to it high levels of nordihydroguaiaretic acid (NDGA) which has antiproliferative, anti-inflammatory, antioxidant, 5 α reductase enzyme inhibitor and ornithine decarboxylase enzyme inhibitor effects. [6][7][8][9][10] Owing to the mentioned actions of capislow, the following study setting was designed to examine how much safe and effective is combining topical capislow cream and Nd-YAG laser for treating idiopathic hirsutism. ...
Article
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Introduction: Hirsutism is a condition that affects 10% of women worldwide. In many cultures, hirsutism is regarded as loss of femininity and can be psychologically traumatizing to the suffering females. The aim of the present study was to evaluate how topical capislow would affect or enhance the efficacy of laser hair removal. Methods: A randomized, monoblinded, placebo controlled split face study of combined topical capislow and long pulsed Nd-YAG laser on one side of the face versus long pulsed Nd-YAG laser alone on the opposite side of the face. Laser sessions were done at 4 weeks interval for maximum seven sessions. Topical capislow and placebo were applied once daily from the day of the first laser session to the day of the last laser session. Patients were evaluated both subjectively and objectively in each laser session and for six months after the last laser session. Results: Both treatment modalities were well tolerated and accepted with significantly better results in combined capislow and laser group versus laser alone. Conclusion: Topical capislow can represent a safe and effective synergistic method for laser with faster results but this is a temporary effect retained only to the time of its application.
... Diode lasers of 810 nm were FDA cleared for hair removal in 1997. They are currently considered among the most effective lasers for hair removal [6]. Its advantages in medical applications include wide implications, deeper penetration, a broader scope of energy and pulse width, lower cost, and higher reliability relative to other kinds of lasers [2,7,8]. ...
Article
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Skin grafting is often the first choice for closing forehead defects. However, the aesthetics of skin grafting-reconstructed forehead defects are still not accepted by a large number of patients. With the technological advancement of laser hair removal, scalp flaps have been considered as donors for reconstruction of forehead defects. We evaluated 10 cases of forehead defect reconstructions with expanded scalp flaps followed by hair removal by an 800 nm diode laser. All flaps survived uneventfully and underwent 4–6 laser treatments for hair removal. The appearances of the reconstructed foreheads were similar to that of the adjacent skin, and all patients were satisfied with the treatment outcomes during the 6–24 months of follow-up. It is concluded that the combined treatments of expanded scalp flaps and diode laser hair removal are effective for repairing forehead defects.
... These include ruby, alexandrite, diode, and neodymium-doped yttrium aluminum garnet (Nd: YAG) lasers and intense pulsed light sources. [2] The pulsed Nd: YAG laser produces a light energy at a wavelength of 1064 nm and targets the chromophore of melanin in the hair follicle. [3] PMMC flap, based on the thoracoacromial artery, whose first description is commonly attributed to Ariyan in 1979 who exhaustively described the technique and its anatomical basis, was however reported in 1977 by at least two authors. ...
... To our knowledge, this is the first report to present the application of laser therapy for hair removal of the forehead flap after nasal reconstruction. Several medical laser devices using related technologies have been approved worldwide for hair removal over the past 20 years, including diode lasers (630-900 nm), Nd:YAG (neodymium-doped yttrium aluminum garnet) lasers (1064 nm), alexandrite lasers (755 nm), ruby lasers (680 nm), CO 2 lasers, and noncoherent intense-pulsed light (IPL) (590-1200 nm) [13,14]. Although other laser techniques represent diverse therapeutic options, alexandrite laser appears to be the best option available; this hair removal technique is supported by more than 20 controlled trials [9,11,[15][16][17]. ...
Article
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The forehead flap is a dependable option for nasal reconstruction owing to its reliability and anatomic likeness to nasal skin. For patients with low hairlines, the vertical design of the paramedian forehead flap can intrude into the scalp, thus incorporating hair into the nasal reconstruction. The inadequate length of the forehead flap or shift to an oblique design may result in eyebrow elevation and asymmetry. Therefore, laser hair removal (epilation) on the forehead flap has been proposed to improve esthetic results. An alexandrite laser (755 nm, 10 to 20 ms, 18-mm spot size) with a Dynamic Cooling Device™ (DCD™) cooling system was used for hair removal in 22 patients (16 male and 6 female patients) after nasal reconstructions using forehead flaps from December 2011 to September 2016. All patients received cryogen spray cooling laser treatment (CSC-LT). The mean follow-up period was 24 months, with a range between 18 and 50 months. The average duration of treatment was 1.8 months (range, 1-5 months). The energy density ranged from 14 to 18 J/cm2 with an average of 17.2 J/cm2. The number of treatments ranged from 2 to 4 (mean 2.8). Patients had satisfactory esthetic results over 11.1 months (range, 8-18 months). Residual white hairs were observed in 3 patients, and 4 patients had tiny black residual hairs without deteriorating cosmesis. Using an alexandrite laser to remove hair on the forehead is safe and reliable in nasal reconstruction with superior recipient site cosmesis.
... Still, there are few literature reports on significant improvement of alopecia by the increased hair regrowth effect in patients [17]. Some studies show that in up to 10% of the cases, IPL devices (intense pulsed light) for hair removal can increase hair density, color or coarseness, a phenomenon called "paradoxical hypertrichosis" [46]. This may be caused by insufficient heat for the thermolysis of the hair follicle, which induces follicular stem cell proliferation and differentiation, together with follicular angiogenesis [33,47]. ...
Chapter
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Low Level Laser Therapy (LLLT) known as “cold or soft laser” represents a therapeutic method used since 1964, when the Nobel Prize for Physics was won for MASER (microwave amplification by stimulated emission of radiation) and the acronym LASER was described (Light Amplification by Stimulated Emission of Radiation). In 1967 LLLT was used by a Hungarian physician, Dr. Endre Mester, on a rat model of carcinogenesis, but proved an unexpected hair regrowth effect, becoming since then a promising treatment option in alopecia.
... Hair removal using pulsed laser or IPL technology is achieved by creating sufficient heat in the hair follicle to damage the follicle and the growth cells that cause hair regrowth. This is achieved In respect of light-based hair reduction and extended hair regrowth delay, threshold values for efficacy have been presented by Drosner et al. (28) and Manstein et al. (29) indicating that effective hair reduction may occur at energy densities as low as 5-6 J/cm 2 and there is a substantial body of evidence for hair removal efficacy, using professional high-powered laser and IPL devices, offering an average long-term ( 6 months) hair reduction of  50% (30,31). ...
... 16,22 Although a number of lasers and non-laser light sources have been developed for the purpose of hair removal, the 755 nm alexandrite and 800-810 nm diode lasers are considered as common options for hair removal among individuals with Fitzpatrick skin types I-IV. 23,24 Since laser hair removal is an elective procedure, pain is an important factor in determining treatment suitability and treatment compliance. It has been observed that intra-and post-operative pain is rated mild to moderate with the alexandrite laser but moderate to severe with the diode laser. ...
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Introduction: The axillary hair removal laser is one of the most often used procedures to treat unwanted hairs in that region. Employing this technology can be helpful in decreasing the bromhidrosis. Methods: In the present research, a clinical trial study over the effect of the hair removal laser on normal microbial flora at the axillary region is presented. The intervention group consisted of 30 women referred to the dermatologic clinic for the purpose of removing axillary hair by the alexandrite 755 nm laser and the control group consisted of 30 women referred to the same clinic for any other reasons. Both groups were evaluated for the type of bacterial strains on the first visit and after three and six months. Results: The results showed that the sense of sweat smell improved by about 63% after the last laser session. The frequency of all bacterial strains decreased in the intervention group except Staphylococcus epidermidis which was significant. In the control group, there was no significant decrement in any bacterial strains and even the prevalence of more strains including Staphylococcus aureus and S. epidermidis increased. Counting the mean bacterial colon showed a slight decrement of the bacterial count following the laser. Conclusion: The use of laser radiation, even with the aim of hair removal, can alter the microbial flora, and it can be accompanied by the improvement of the smell of sweat. The effect of the laser on different bacterial strains is quite different, which can depend on the amount of energy, the wavelength, the characteristics of the area under the laser, and also the structural properties of the membrane of the microorganism itself.
... 61,62 Light in the middle of this near-infrared (NIR) region (around 800 nm) can penetrate through skin and up to several centimeters into tissue, 17 (8) of PT applications in the tangential field of cosmetics. PT targeting of melanin, in the form of laser hair removal, 64,65 and PT targeting of hemoglobin, in the treatment of port-wine stains 66 and varicose veins, 67,68 and have been widely and successfully applied in the clinic for decades. These applications take advantage of the fact that in biological structures such as hair follicles and blood vessels, there is a locally higher concentration of melanin and hemoglobin, respectively, than is present within surrounding tissues. ...
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Photothermal therapy (PTT) involves the application of normally benign light wavelengths in combination with efficient photothermal (PT) agents that convert the absorbed light to heat to ablate selected cancers. The major challenge in PTT is the ability to confine heating and thus direct cellular death to precisely where PT agents are located. The dominant strategy in the field has been to create large libraries of PT agents with increased absorption capabilities and to enhance their delivery and accumulation to achieve sufficiently high concentrations in the tissue targets of interest. While the challenge of material confinement is important for achieving "heat and lethality confinement," this review article suggests another key prospective strategy to make this goal a reality. In this approach, equal emphasis is placed on selecting parameters of light exposure, including wavelength, duration, power density, and total power supplied, based on the intrinsic properties and geometry of tissue targets that influence heat dissipation, to truly achieve heat confinement. This review highlights significant milestones researchers have achieved, as well as examples that suggest future research directions, in this promising technique, as it becomes more relevant in clinical cancer therapy and other noncancer applications. © 2017 Society of Photo-Optical Instrumentation Engineers (SPIE).
... Finally, there are the dermatologic lasers useful for aesthetic purposes, such as devices for removal of benign pigmented lesions, hair removal, tattoo removal and patients resurfacing (Table 6) [23][24][25][26]. ...
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The authors discuss a brief history of lasers and their use in dermatology. Although the excellent results achieved by the use of laser in dermatology, this special treatment modality is in continuous evolution. At present, new devices have been under development for the therapy of different kind of diseases, while lasers, already in use, has been changing, in order to be more secure, effective and be useful in many others disorders. © 2017 Serena Gianfaldoni, Georgi Tchernev, Uwe Wollina, Massimo Fioranelli, Maria Grazia Roccia, Roberto Gianfaldoni, Torello Lotti.
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In the United States, an increasing number of individuals are identifying as transgender. Males at birth who identify as females are called male-to-female (MTF) transgender individuals or trans women, and females at birth who identify as males are called female-to-male (FTM) transgender individuals or trans men. The transgender patient population possess unique health concerns disparate from those of the general populace. Exogenous hormone therapy for transgender patients leads to changes in the distribution and pattern of hair growth. Exogenous testosterone can lead to male pattern hair loss and hirsutism, while estrogen therapy usually results in decreased facial and body hair growth and density. A thorough understanding of the hormonal treatments that may be used in transgender individuals as well the unique and complex biologic characteristics of the hair follicle is required for appropriate diagnosis, counseling and treatment of patients. The aim of this article is to provide a framework for understanding hair disorders in transgender individuals and effective treatment options.
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Androgen excess (AE) is a key feature of polycystic ovary syndrome (PCOS) and results in or contributes to the clinical phenotype of these patients. While AE will contribute to the ovulatory and menstrual dysfunction of these patients the most recognizable sign of AE includes hirsutism, acne and androgenic alopecia or female pattern hair loss (FPHL). Evaluation not includes scoring facial and body terminal hair growth using the modified Ferriman-Gallwey method, but also recording and possibly scoring acne and alopecia. Assessment of biochemical hyperandrogenism is also necessary, particularly in patients with unclear or absent hirsutism, and will include assessing total and free testosterone (T), and possibly DHEAS and androstenedione, although these latter add a limited amount to the diagnosis. Assessment of T requires use of the highest quality assays available, generally radioimmunoassays with extraction and chromatography, or mass spectrometry preceded by liquid or gas chromatography. Management of clinical hyperandrogenism involves primarily either androgen suppression, with a hormonal combination contraceptive, or androgen blockade, as with an androgen receptor blocker or a 5α-reductase inhibitor, or a combination of the above. Medical treatment should be combined with cosmetic treatment including the use of topical eflornithine hydrochloride, and short-term (shaving, chemical depilation, plucking, threading, waxing, and bleaching) and long-term (electrolysis, laser therapy, and intense pulse light therapy) mechanical treatments. Generally acne responds to therapy relatively rapidly, while hirsutism is slower to respond, with improvements observed as early as three months, but generally only after 6 or 8 months of therapy. Finally, FHLP is the slowest to respond to therapy, if it will at all, and it may take 12 to 18 months of therapy before response is begun to be observed.
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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.
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La medición de la presión arterial (PA) en la consulta de forma correcta permite una adecuada estratificación del riesgo de los pacientes, sin embargo, su técnica puede estar sometida a errores frecuentes que deben ser evitados. Los esfigmomanómetros de mercurio han sido el estándar de oro en la toma de PA, sin embargo, no están actualmente recomendados debido al riesgo de toxicidad; sus alternativas, el esfigmomanómetro aneroide, requiere calibración periódica para evitar mediciones erróneas, y los equipos oscilométricos deben ser validados y adecuadamente seleccionados para su función. Mediciones complementarias a la realizada en la consulta, como el monitoreo ambulatorio de PA y la medición en casa, suplementan algunas debilidades de la medición en la oficina. El objetivo de la presente revisión fue evaluar cada uno de los aspectos de la técnica para medir la PA en la consulta.
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Unwanted facial hair growth is a common esthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation. The theory of selective photothermolysis has revolutionized laser hair removal in that it is effective and safe, when operated by sufficiently trained and experienced professionals. Long-pulsed ruby (694 nm), long-pulsed alexandrite (755 nm), diode (800–980 nm), and long-pulsed Nd: YAG (1064) are commercially available laser devices for hair removal most widely studied. The authors wish to share the efficacy and safety of intense pulse light therapy for permanent facial hair reduction in Indian population.
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Background As the pursuit for a safe and effective device for laser hair removal continues, the use of simultaneous multiple wavelengths in a single device requires further exploration. Aim To evaluate the safety and efficacy of a novel multi-wavelength laser device for hair removal. Patients and methods This retrospective cohort study included adult participants of both sexes with Fitzpatrick skin types of III and IV. Hairy sites were treated by a multiple wavelength (810nm, 940nm, and 1064nm) laser device (Primelase, Coccoon medical, Barcelona, Spain). Laser parameters included: fluence of 14–20 J/cm², pulse duration of 7–30 ms, and spot size of 20*9 mm². Participants underwent up to 7 treatments at 6–8 weeks intervals and were followed for 6 months after the last treatment session. "Before" and "after" clinical photographs were acquired and were used to evaluate efficacy by 2 independent dermatologists. They employed the Global Aesthetic Improvement Scale (GAIS; scale of 0 [no improvement] to 4 [excellent improvement; Over 75% hair reduction]). Participants’ satisfaction was rated on a scale of 1 (not satisfied) to 5 (very satisfied). Pain perception and adverse events were recorded as well. Results Eighteen participants (6 men, 12 women) were included with a total of 49 treatment sites. Mean hair reduction was 3.6 out of 4 in the GAIS. Participants’ satisfaction rate was high (mean 4.5). Beside mild transient discomfort during the procedure, no adverse events were recorded. Conclusion The use of a multiple wavelengths’ laser device is safe and effective for hair removal.
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Background: Hirsutism is estimated to affect 10% to 20% of females, provoking significant psychological damage and social embarrassment. Polycystic ovary syndrome is a major cause of hirsutism. Aim: Assessing the impact of adding combined oral contraceptives (COCs) or metformin to laser hair removal on the quality of life of polycystic ovarian syndrome (PCOS) patients with hirsutism. Methodology: One-hundred-fifty PCO patients diagnosed with hirsutism were included in this study. Patients were randomized into three groups: group 1 received laser hair removal alone, group 2 received metformin and laser hair removal, and group 3 received COCs and laser hair removal. A diode laser with a wavelength of 810 nm was used for hair removal in all patients according to a protocol of 6 monthly sessions followed by another two sessions after three and six months. Patients were assessed using a visual analog scale (VAS) and Dermatology Life Quality Index (DLQI) and a customized questionnaire (Hirsutism Life Quality Index; HLQI). Results: All patients showed a significant improvement in both quality indices (DLQI and HLQI) after treatment relative to pretreatment. Group 3 showed significantly better improvements when compared with group 2 and group 1. At three and six months, group 3 showed non-significantly better DLQI and HLQI as compared with at zero months. On the other hand, group 2 patients displayed significant worsening of both DLQI and HLQI scores at three months, with subsequent improvements again at six. Finally, group 1 patients showed nonsignificant worsening at three months, and significant worsening at 6 months. Conclusion: Combining hormonal treatment with laser hair removal can achieve greater hair reduction, significant improvements in patients' QOL, and better maintenance as compared with when combining metformin with laser hair removal or conducting alone.
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This review provides a study of the complications related to laser hair removal (LHR) along with the complication management pertaining to laser hair removal therapy. Laser hair removal is a widely practiced cosmetic procedure that is considered safe and effective. Comparatively, it is more effective than shaving, waxing, plucking, and epilation in terms of pain, speed, accuracy, and many other factors. Nevertheless, it also has complications like any other procedure. The complications associated with LHR could be immediate or, it might take some time to occur, which depends on various factors. Most of the complications can be prevented by the healthcare provider, while others can be treated with minimal medications. Alongside managing these complications, pre-treatment and post-treatment care must be precisely followed for effective results. The management therapy includes the use of corticosteroids, topical analgesics, selective antiviral agents, emollients, moisturizing creams, and lotions as the aftercare of the procedure and some other agents depending on the type of complication observed in a patient. Hence, there is a broad scope for laser hair removal advancements to avoid complications and achieve the best results.
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Hair is a defining feature of mammals. In other species hair confers important functions that affect survival. Most have been lost or are irrelevant in humans but the role of hair in social and sexual signalling in women and in men survives and thrives. Departures from cultural norms, either physiological or due to pathology, can therefore cause much concern and anxiety. Following an introduction to hair biology, this chapter considers the approach to the diagnosis and management of the patient with hair loss before discussing specific hair disorders. These include the various forms of hair loss due to hair follicle pathology, disturbances in hair cycling and hair shaft dystrophies, and disorders associated with excessive hair growth. The chapter concludes with a discussion of acquired alterations in hair pigmentation.
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After Botulinum injections and dermal fillers, laser and light assisted hair removal is the third most common non-surgical cosmetic procedure requested worldwide, with the global market set to reach $1.5 billion by 2025. The procedure is routinely performed throughout the world and has been demonstrated to be a safe and effective method of epilation of dark hairs, in all skin types.
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Introduction: Hirsutism is a condition of unwanted malepattern hair growth in women. Perception of hirsutism is subjective and it is a common condition affecting 5-10% of unselected women. Objectives: To find out the efficacy and safety of long-pulsed Nd-YAG laser in the treatment of hirsutism. Materials and Methods: Fifty females of age between 18- 50 years with dark terminal facial hair and normal hormonal profile were treated with long-pulsed Nd-YAG laser (1064nm, 10mm spot size, pulse duration of 25-30 minutes and fluence of 25-40J/cm2). Six consecutive sessions of laser treatment were delivered to all the patients at 4 to 6 weeks’ interval. Photographic evaluations and percentage of hair reduction were done before each session and final assessment noted at the end ofninemonths. Results: All the patients completed the study. Good hair reduction (50-75%) was seen in 52% of patients after the first treatment session. After six consecutive treatment sessions at the end of nine-month excellent hair reduction (>75%) was noted in 86% of patients and good hair reduction (50-75%) seen in 12% patients. Side effects in our study were post-operative erythema in 40% and perifollicular oedema in 33.33%. Conclusion: The study supportslong-pulsed Nd-YAG laser with multiple six sessionsis safe and effective in the treatment of hirsutism. Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 169-172
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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 .
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Effective design of laser sources is crucial to optimum performance during Laser hair removal. Therefore, the thermal effect of laser sources was evaluated at wavelengths 694, 755, and 1064 nm at different fluence 4.5, 5.5, 10, and 15 J/cm2, respectively. The patient skin models are 3 photo types of a 3-layer 3D model of epidermis, dermis and hypodermis containing the hair shaft and follicle with thickness carefully selected to be in range of a normal human feature. Monte Carlo method, Bio heat transfer and thermal damage analysis using Arrhenius formula were employed. Results show that a laser source of 10-15 J/cm ² , at 755 nm wavelength is optimal for light skinned and moderate skinned while 4.5 -10 J/cm ² , 755-1064 nm is optimal for dark skinned people for a pulse width of 0.1 sec. This work would assist researchers and manufacturers in the design and development of hair photoepilation devices.
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Telinga dapat mengalami defek baik karena pasca pengangkatan tumor atau trauma. Berbagai teknik dapat digunakan untuk menutup defek pada telinga. Flap Dieffenbach merupakan salah satu teknik untuk merekonstruksi 1/3 medial daun telinga. Dilaporkan satu kasus seorang perempuan 48 tahun dengan keratosis seboroik pada 1/3 medial daun telinga yang kemudian dilakukan eksisi dan defek ditutup dengan flap Dieffenbach. Eksisi tumor daun telinga dapat menimbulkan defek pada telinga yang memerlukan rekonstruksi. Flap Dieffenbach dapat digunakan untuk menutup defek pada 1/3 medial daun telinga dengan hasil yang sangat baik dan memuaskan.
Chapter
For correct laser epilation, the anatomical and biological characteristics of the hair must be considered. The anagen phase is the ideal moment to perform the treatment. Nd:YAG laser (1064 nm), alexandrite (755 nm), diode (810 mn), and ruby (694 nm) laser sources are used for the epilation. The endpoint of treatment consists in the appearance of perifollicular erythema and edema. The most common side effect of laser hair removal is hypopigmentation, especially in darker skin types or on tanned skin.
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Telinga dapat mengalami defek baik karena pasca pengangkatan tumor atau trauma. Berbagai teknik dapat digunakan untuk menutup defek pada telinga. Flap Dieffenbach merupakan salah satu teknik untuk merekonstruksi 1/3 medial daun telinga. Dilaporkan satu kasus seorang perempuan 48 tahun dengan keratosis seboroik pada 1/3 medial daun telinga yang kemudian dilakukan eksisi dan defek ditutup dengan flap Dieffenbach. Eksisi tumor daun telinga dapat menimbulkan defek pada telinga yang memerlukan rekonstruksi. Flap Dieffenbach dapat digunakan untuk menutup defek pada 1/3 medial daun telinga dengan hasil yang sangat baik dan memuaskan.
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Light‐based therapies are one of the most effective and widely used strategies for removal of undesired hair, with a broadly favorable safety profile. However, subjects with pigmented skin are found to be more prone to laser‐related adverse events. While prolonged pulse‐width and longer treatment duration were proposed to minimize adverse events, the optimal treatment option among available phototherapy modalities—long‐pulsed (Nd: YAG), pulsed diode, and alexandrite lasers as well as intense pulsed light (IPL)—remains unclear, particularly for skin of color. To determine superiority in terms of effectiveness and tolerability, we conducted a systematic review of literature on different types of in‐office laser and IPL for hair removal in subjects with Fitzpatrick skin types III‐VI. The meta‐analysis was performed using Review Manager (RevMan) version 5.3 and included 12 eligible comparative trials (9 randomized controlled trials and 3 quasi‐randomized). In terms of hair count reduction, pooled effect estimates for long‐pulsed ND:YAG laser (OR 0.26, 95% CI [0.1, 0.78]) and diode laser (SMD ‐0.11, 95% CI [‐0.62, 0.39) were not statistically significant from those of IPL; in contrast, alexandrite laser was found to be superior to IPL in reducing hair count (SMD ‐1.7, 95% CI [‐2.6, ‐0.78]. In terms of adverse events, the pooled effect estimates favoured long‐pulsed Nd: YAG laser to IPL with respect to post‐inflammatory hyperpigmentation (OR 0.26, 95% CI [0.1, 0.78]). However, both pulsed diode and alexandrite lasers exhibited a comparable safety profile to IPL, despite higher pain scores with lasers. In conclusion, this systematic review suggests that treatment outcomes for different in‐office laser devices and IPL in subjects with skin type III‐VI are broadly similar; nevertheless, we observed a trend toward greater hair reduction following laser therapy compared to IPL.
Chapter
The hair follicle is a complex, hormonally active structure, which constitutes the foundation for hair growth. The hair growth cycle has three phases: anagen, catagen and telogen. The anagen phase is the growth phase, the catagen phase is the regression phase and the telogen phase is the rest phase. The hair follicle is the most susceptible to IPL treatment during the anagen phase. The melanin is the target chromophore for hair removal.
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Demand for long-term hair reduction treatments has increased dramatically around the world in recent years, due to traditional factors, fashion, sport, wellbeing and health requirements. Some of the most popular options include laser and intense pulsed light (IPL) treatments, which are often administered by aesthetic practitioners. This article will discuss the hair growth cycle, as well as treatment options, parameters and outcomes.
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Hirsutism is represented by excessive growth of the coarse hairs in women, distributed in a male-like pattern. Hypertrichosis is represented by excessive growth of coarser and longer hair than is normal for the age, sex and race of the person. The hair growth cycle has three phases: anagen, catagen and telogen. The anagen phase is the growth phase, the catagen phase is the regression phase and the telogen phase is the rest phase. The hair follicle is the most susceptible to IPL treatment during the anagen phase. The melanin is the target chromophore for hair removal. There are three types of melanosomes present in the hair. Erythromelanin granules are present in red hair while eumelanin and pheomelanin granules are found in varying proportions in blond and dark hair. The targets for hair removal are the dermal papilla and the bulge area. The heat-induced destruction of the hair shaft leads to hair “dropout”. The partial injury to the germinative zone leads to telogen-shock response, prolonged telogen dropout, and development of dystrophic hairs which are thinner in texture and have variable pigmentation. Multiple IPL treatments are usually needed. If no improvement is obtained after 5–6 sessions, interrupting the treatment should be considered. The darker the skin and the brighter the hair (Fig. 7.1), the less effective the treatment will be.
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To determine the most effective treatment parameters for laser-assisted hair removal using a Q-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Prospective study to determine the effectiveness of Q-switched ND:YAG laser-assisted hair removal under varying pretreatment protocols. Hair growth was assessed after laser treatment, and the results were compared with those of wax epilation at 4, 12, and 24 weeks. A private ambulatory laser facility and academic referral center. Laser-assisted hair removal was performed under 4 different pretreatment conditions. Eighteen areas of unwanted body and facial hair from 12 study subjects were divided into 4 quadrants. Wax epilation followed by application of a carbon-based solution and exposure to Q-switched Nd:YAG laser radiation was performed on 1 quadrant. A second quadrant was wax epilated and exposed to Q-switched Nd:YAG laser radiation without prior carbon solution application. A third quadrant was exposed to laser radiation alone, and a final quadrant was wax epilated to serve as the control. Follow-up evaluations at 1, 3, and 6 months consisted of photographic documentation, manual hair counts, and patient hair-density estimates. Percentage of hair regrowth as assessed by objective hair counts and patient subjective evaluations. Mean percentage of hair regrowth at 1 month was 39.9% for the wax-carbon-laser quadrant, 46.7% for the wax-laser quadrant, 66.1% for the laser-alone quadrant, and 77.9% for the wax control quadrant. The percentage of hair regrowth approximately doubled by 3 months but was significantly delayed in all laser-treated quadrants regardless of pretreatment protocol. Full hair regrowth in all anatomic locations was observed by month 6. Patient subjective evaluations of hair density closely approximated hair count data. No adverse effects or long-term complications were observed. A single hair-removal treatment with the Q-switched Nd:YAG laser is safe and effective in delaying hair growth for up to 3 months. Although the combination of pretreatment wax epilation and topical carbon solution application was effective, laser irradiation alone, with or without wax epilation, also provided a significant delay in hair growth.
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Promising clinical results have been obtained with the normal mode ruby laser for removal of unwanted hair. Melanin within the hair follicles is thought to act as target for the ruby laser pulses, whereas epidermal melanin is thought to be a competitive chromophore, responsible for potential side effects. This study aimed (i) to objectify postoperative changes in skin pigmentation and texture and (ii) to evaluate the importance of variations in preoperative skin pigmentation for the development of side effects 12 weeks after 1 treatment with the normal-mode ruby laser. A total of 17 volunteers (skin types I-IV) were laser-treated in the hairy pubic region (n = 51 test areas). A shaved test area served as control. Skin reflectance spectroscopical measurements, 3-dimensional surface contour analysis and ultrasonography objectified postoperative changes in skin pigmentation and texture. Blinded clinical assessments revealed postoperative hyperpigmentation (2% of test areas) and hypopigmentation (10%), whereas no textural changes were seen. Reflectance spectroscopically-determined pigmentary changes depended on the degree of preoperative skin pigmentation, fairly pigmented skin types experiencing subclinical hyperpigmentation and darkly pigmented skin types experiencing subclinical hypopigmentation. Three-dimensional surface profilometry documented similar pre- and postoperative surface contour parameters, indicating that the skin surface texture is preserved after laser exposure. Ultrasonography revealed similar skin thicknesses in laser-exposed and untreated control areas. It is concluded that normal-mode ruby laser treatment is safe for hair removal in skin types I-IV.
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The main purpose of this clinical study was to compare the effectiveness of an intense pulsed light irradiator system (IPL) and a normal mode ruby laser for hair removal. Thirty-one patients were treated 3 times with a new IPL system on one side of the chin and neck and with a normal mode ruby laser on the other side. After 6 months, nine of the patients received 3 additional IPL treatments and 11 patients received 3 additional ruby laser treatments. All treatment intervals were 2 months. Hair reduction was measured by hair counts on close-up photographs. Hair reduction was obtained by 93.5% of the patients after 3 IPL treatments and by 54.8% after 3 ruby laser treatments. The average hair count was reduced by 49.3% after IPL treatments and by 21.3% after ruby laser treatments. Three additional IPL treatments following 3 IPL treatments resulted in only 6.6% further hair reduction--in total 55.9%, whereas 3 IPL treatments following 3 ruby laser treatments resulted in an additional 35.5% hair reduction--in total 56.8%. The IPL was found to be 3.94 times more effective than the ruby laser for hair removal. In the chin and neck region, more than 3 treatments with the IPL did not improve the therapeutic result significantly.
Article
Background. Unwanted hair growth is a common, usually physiologic phenomenon.Objective. In this study the efficacy and tolerability of a long-pulsed ruby laser system was compared with needle electrolysis and hot wax on three parts of the body.Methods. Thirty volunteers were treated three times on the forearm (n = 10), on the face (n = 10), or in the pubic area (n = 10) with 25 J/cm2 laser, 40 J/cm2 laser, needle electrolysis, and hot wax therapy.Results. The 25 J/cm2 and 40 J/cm2 laser treated sites showed a statistically significant decrease (38% and 49%, respectively) in the number of hairs at the first visit after the last treatment compared to the pretreatment hair counts. No significant decrease was observed in the needle electrolysis and hot wax treated sites. Laser therapy yielded better results on the forearm than on the face or pubic area and was scored as the least painful.Conclusion. The long-pulsed ruby laser is a promising, well-tolerated method of epilation.
Article
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.
Article
Background: Unwanted hair growth is a common, usually physiologic phenomenon. Objective: In this study the efficacy and tolerability of a long-pulsed ruby laser system was compared with needle electrolysis and hot wax on three parts of the body. Methods: Thirty volunteers were treated three times on the forearm (n = 10), on the face (n = 10), or in the pubic area (n = 10) with 25 J/cm2 laser, 40 J/cm2 laser, needle electrolysis, and hot wax therapy. Results: The 25 J/cm2 and 40 J/cm2 laser treated sites showed a statistically significant decrease (38% and 49%, respectively) in the number of hairs at the first visit after the last treatment compared to the pretreatment hair counts. No significant decrease was observed in the needle electrolysis and hot wax treated sites. Laser therapy yielded better results on the forearm than on the face or pubic area and was scored as the least painful. Conclusion: The long-pulsed ruby laser is a promising, well-tolerated method of epilation.
Article
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.
Article
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.
Article
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.
Article
Despite widespread demand for efficient, reliable methods of eliminating unwanted hair from the face and body, available options were limited until the recent development of laser-assisted hair removal systems. This is a review of the various types of hair removal methods available today with an emphasis on laser-assisted hair removal.
Article
Background: Multiple laser systems are available for the purpose of hair removal. Objective: The purpose of this study was to determine the safety and long-term efficacy of the 800 nm, pulsed diode laser at reducing hair count. Methods: Fifty volunteers, primarily Fitzpatrick skin types II and III, with dark brown or black hair, were treated with a diode laser (800 nm, 10-40 J/cm2, 5-30 msec, 9 mm 9 mm, 5 degrees C chilled handpiece). Each subject had eight treatment sites at varying fluences and pulse durations, as well as a varying number of treatments and pulses. Hair counts were obtained at each site at baseline, 1, 3, 6, 9, and an average of 20 months after treatment. Results: After one treatment, hair regrowths ranged from 22 to 31% at the 1-month follow-up visit, then remained stable between 65 and 75% from the 3-month to the averaged 20-month follow-up. After two treatments there were relatively longer growth delays, with hair regrowths plateauing beginning at 6 months after treatment and ranging from 47 to 66% for the remainder of the follow-up evaluations. Side effects were limited to pigmentary changes, transient in subjects with skin types II and III. Conclusions: This 800 nm diode laser with a chilled sapphire tip and variable pulse duration is safe and effective for long-term hair reduction in individuals with skin types II and III.
Article
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.
Article
Suitably brief pulses of selectively absorbed optical radiation can cause selective damage to pigmented structures, cells, and organelles in vivo. Precise aiming is unnecessary in this unique form of radiation injury because inherent optical and thermal properties provide target selectivity. A simple, predictive model is presented. Selective damage to cutaneous microvessels and to melanosomes within melanocytes is shown after 577-nanometer (3 x 10(-7) second) and 351-nanometer (2 x 10(-8) second) pulses, respectively. Hemodynamic, histological, and ultrastructural responses are discussed.
Article
Although many temporary treatments exist for hirsutism and hypertrichosis, a practical and permanent hair removal treatment is needed. Our purpose was to study the use of normal-mode ruby laser pulses (694 nm, 270 microseconds, 6 mm beam diameter) for hair follicle destruction by selective photothermolysis. Histologically assessed damage in ex vivo black-haired dog skin after the use of different laser fluences was used to design a human study; 13 volunteers with brown or black hair were exposed to normal-mode ruby laser pulses at fluences of 30 to 60 J/cm2, delivered to both shaved and wax-epilated skin sites. An optical delivery device designed to maximize light delivery to the reticular dermis was used. Hair regrowth was assessed at 1, 3, and 6 months after exposure by counting terminal hairs. Fluence-dependent selective thermal injury to follicles was observed histologically. There was a significant delay in hair growth in all subjects at all laser-treated sites compared with the unexposed shaven and epilated control sites. At 6 months, there was significant hair loss only in the areas shaved before treatment at the highest fluence. At 6 months, four subjects had less than 50% regrowth, two of whom showed no change between 3 and 6 months. Transient pigmentary changes were observed; there was no scarring. Selective photothermolysis of hair follicles with the normal-mode ruby laser produces a growth delay consistent with induction of prolonged telogen with apparently permanent hair removal in some cases.
Article
Some randomised controlled trials (RCTs) done in German-speaking Europe are published in international English-language journals and others in national German-language journals. We assessed whether authors are more likely to report trials with statistically significant results in English than in German. We studied pairs of RCT reports, matched for first author and time of publication, with one report published in German and the other in English. Pairs were identified from reports round in a manual search of five leading German-language journals and from reports published by the same authors in English found on Medline. Quality of methods and reporting were assessed with two different scales by two investigators who were unaware of authors' identities, affiliations, and other characteristics of trial reports. Main study endpoints were selected by two investigators who were unaware of trial results. Our main outcome was the number of pairs of studies in which the levels of significance (shown by p values) were discordant. 62 eligible pairs of reports were identified but 19 (31%) were excluded because they were duplicate publications. A further three pairs (5%) were excluded because no p values were given. The remaining 40 pairs were analysed. Design characteristics and quality features were similar for reports in both languages. Only 35% of German-language articles, compared with 62% of English-language articles, reported significant (p < 0.05) differences in the main endpoint between study and control groups (p = 0.002 by McNemar's test). Logistic regression showed that the only characteristic that predicted publication in an English-language journal was a significant result. The odds ratio for publication of trials with significant results in English was 3.75 (95% CI 1.25-11.3). Authors were more likely to publish RCTs in an English-language journal if the results were statistically significant. English language bias may, therefore, be introduced in reviews and meta-analyses if they include only trials reported in English. The effort of the Cochrane Collaboration to identify as many controlled trials as possible, through the manual search of many medical journals published in different languages will help to reduce such bias.
Article
To assess the permanence of hair removal by normal-mode ruby laser treatment. Hair removal was measured for 2 years after a single treatment with normal-mode ruby laser pulses (694 nm, 270 microseconds, 6-mm beam diameter). Six test areas on the thighs or backs of 13 volunteers were exposed to normal-mode ruby laser pulses at fluences of 30 to 60 J/cm2 delivered to both shaved and wax-epilated skin. In addition, there was a shaved and wax-epilated control site. Terminal hairs were manually counted before and after laser exposure. Transient alopecia occurred in all 13 participants after laser exposure, consistent with induction of telogen. Two years after laser exposure, 4 participants still had obvious, significant hair loss at all laser-treated sites compared with the unexposed shaved and wax-epilated control sites. In all 4 participants, there was no significant change in hair counts 6 months, 1 year, and 2 years after laser exposure. Laser-induced alopecia correlated histologically with miniaturized, velluslike hair follicles. No scarring and no permanent pigmentary changes were observed. Permanent, nonscarring alopecia can be induced by a single treatment with high-fluence ruby laser pulses. Miniaturization of the terminal hair follicles seems to account for this response.
Article
This study was designed to evaluate the effect of selective photothermolysis on dark pigmented hair follicles treated with a normal-mode ruby laser (694-nm wavelength, pulse duration 0.5 ms, fluence 20 J/cm2, spot size 2 mm). In 15 volunteers, four test areas each were selected. After shaving, the first area was irradiated once, the second twice, the third three times and the fourth served as control area. A punch biopsy was taken from each volunteer immediately after the first laser treatment. Four weeks after the last irradiation, no effect was found in six cases and little effect in another six cases (50-90% regrowth). Hair regrowth of less than 30% was observed in only three cases. Eight weeks after the last session, no effect was found in 11 cases, little effect in 2 cases (10%) and less than 30% regrowth in only 2 cases. Twelve weeks after the last treatment, no difference could be detected between the areas untreated and treated by laser. The laser parameters applied in this study do not result in effective epilation of body hair. In some cases, a delay in growth of several weeks was noticed.
Article
The methods of hair removal vary between simple inexpensive means of home treatment (shaving, plucking, depilatories) to expensive and potentially time-consuming means used by paraprofessionals, nurses, and/or physicians (electrolysis, lasers, x-ray). The ways in which these different methods induce hair removal, the duration of such removal, and the nuances between devices within the same category of methods are discussed. (J Am Acad Dermatol 1999;40:143-55.) Learning objective: At the completion of this learning activity, participants should be cognizant of the different control mechanisms for hair growth and how the different means of hair removal affect these. Readers will also become familiar with the different types of electrolysis and lasers currently used for hair removal and the advantages and disadvantages of each.
Article
Laser-assisted hair removal has been reported previously with the Nd:YAG laser, the long-pulse ruby laser, the long-pulse Alexandrite laser, and the short-pulse Alexandrite laser. Results with all these lasers have been successful; however, it has been postulated that the long-pulse Alexandrite laser would have a lower complication rate and greater efficacy at identical fluences than the short-pulse Alexandrite laser. The authors chose to compare directly the pulsed Alexandrite lasers for speed of application, complications, and results. Eighteen patients who desired hair removal were entered into the study. There were 10 female and 8 male patients, with a mean age of 36 years. All skin types from Fitzpatrick classes I through VI were treated. The body areas treated consisted of the face, ears, neck, back, arms, upper thighs, bikini lines, legs, and breasts. One side of the body was treated with the short-pulse (2-msec) Alexandrite laser (Sharplan Epitouch 5100). The other half was treated with a long-pulse (20-msec) Alexandrite laser. Both lasers were set at the same fluence for each patient. Patients reported a 60% to 80% reduction in hair growth at 6 months. Both sides were identical with regard to return of hair growth and complications such as hypopigmentation. Both the long- and short-pulse Alexandrite laser systems yielded an effective method of hair reduction with minimal complications. Equal results and complications were obtained with the two systems. The only exception was that the length of the procedure was shorter with the short-pulse Alexandrite laser.
Article
The tremendous demand for removal of unwanted hair has led to the development of a wide range of noninvasive, user-friendly laser and light source systems; however, despite considerable advances in this field, these devices still have the potential to cause injury when used improperly. It is important to follow precise treatment guidelines in order to attain optimal results. This article gives an overview of the currently available lasers and light sources. It focuses on the practical aspect of laser hair removal by discussing patient selection, safety precautions, techniques using the different systems, pre- and post-laser treatment care, proper treatment endpoints, expected outcome, and possible side-effects and complications.
Article
Several laser systems with varying wavelengths, pulse durations, and energy fluences are currently utilized for hair removal. However, the ideal laser parameters and treatment candidates for photoepilation remain largely unknown. The medical literature lacks a wealth of experimental data to sufficiently document the long-term safety and efficacy of laser-assisted hair removal. This study examines the clinical efficacy and side effect profile of long-pulsed alexandrite laser-assisted hair removal utilizing laser pulse durations of either 5, 10, or 20 milliseconds (ms). Laser-assisted hair removal was performed on 36 subjects with a long-pulsed alexandrite laser. Areas of unwanted hair growth on the face, back, and legs were divided linearly into four 1 cm2 or 2 cm2 quadrants. Experimental regions included a control quadrant and three additional quadrants, which were treated with the alexandrite laser using an average fluence of 18 J/cm2, with a 10 mm spot size at either a 5, 10, or 20 ms pulse duration. Hair counts and photographs were obtained before treatment, immediately following irradiation, 1 week and 1, 3, and 6 months postoperatively. All laser-treated quadrants displayed a significant delay in hair regrowth compared to control nontreated quadrants at postoperative week 1 and months 1 and 3. Hair counts were reduced by 66% at 1 month, 27% at 3 months, and 4% at 6 months. No significant differences in clinical efficacy or side effect profiles were observed between treatment quadrants, yet a trend towards less post-treatment erythema and hyperpigmentation was noted with the 20 ms pulse duration. Equivalent long-term hair removal for up to 6 months was achieved with the long-pulsed alexandrite laser at 5, 10, and 20 ms pulse durations at an average fluence of 18 J/cm2. Side effects were limited and transient.
Article
There are a variety of different laser hair removal systems currently available. There are also systems with identical emitted wavelengths; yet their emitted pulse durations vary. There are few data comparing these systems in an objective manner. Fourteen subjects received three treatments with two different pulse duration 755-nm alexandrite lasers. Paired anatomic sites were treated three times with both a 2-msec and a 10-msec system. Subjects were evaluated prior to laser treatment and 6 months after the three treatments with manual hair counts and incidence of complications. The average percentage of hair reduction was 33.1% for the 2-msec-pulse duration and 33.9% for the 10-msec-pulse duration alexandrite laser. No cutaneous pigmentary changes or scarring was noted 6 months after the final treatment. The alexandrite laser is effective in removing unwanted hair. There was no difference in response between a 2-msec and a 10-msec alexandrite laser.
Article
Fifty-one patients of skin type I to IV with facial hirsutism received treatment with the normal-mode ruby laser (950-micros pulse; 4-mm spot; mean fluence, 49 J/cm(2); maximum fluence, 66 J/cm(2)). For each patient, one site was treated once only, and a second site was treated 4 times at 4-week intervals. After 48 weeks, 46 patients were available for assessment. After a single treatment, hair counts were reduced to a mean of 45% at 4 weeks (pretreatment median of 63 hairs down to 26), increased to 80% (median, 51 hairs) at 12 weeks, were 65% (median, 41 hairs) at 24 weeks, and were 59% (median, 35 hairs) at 48 weeks. Four weeks after 3 treatments, the hair counts had reduced to a mean of 30% (pretreatment median of 68 hairs down to 15). Twelve weeks after 4 treatments, the hair counts had increased to 45% (median, 24 hairs) and were 39% after 36 weeks (median, 22.5 hairs). No anesthesia was needed. Treatment tolerance improved with consecutive visits, allowing higher fluences to be used. Hyperpigmentation developed in 9 patients, which had faded completely in 8 patients at the end of the study. One patient showed hypopigmentation. Depressions in the skin below the jaw line developed in 5 patients, which resolved completely within 4 to 32 weeks. We conclude that normal-mode ruby laser treatment is well tolerated and leads to significant improvement of facial hirsutism, which is maintained for at least 48 weeks. Repeated treatments result in greater clinical effects.
Article
The use of lasers for removal of unwanted hair has been shown to be effective in temporarily controlling hair growth. Several lasers are currently utilized for this purpose. This study evaluates the short-term effectiveness and discomfort levels of the long-pulsed alexandrite laser and the topical suspension-assisted Q-switched Nd:YAG laser in a side-by-side comparison. Fifteen subjects were treated in the bilateral hair-bearing axilla, using one treatment with the alexandrite laser for the right and two treatments with the topical suspension-assisted Nd:YAG laser for the left. Reduction in hair regrowth was measured at 2 and 3 months following the first treatment by comparing the terminal hair count to the baseline values. Patients rated their pain on a scale of 0-10 immediately following the first treatment at each site. The mean percentage reduction in hair regrowth 2 months following alexandrite laser treatment was 55% and 73% for the Nd:YAG laser-treated regions. After 3 months, alexandrite laser-treated patients showed a reduction of 19%, while Nd:YAG laser-treated patients showed a 27% reduction. Patients reported average pain values of 8 and 4 for the long-pulsed alexandrite and Nd:YAG laser sites, respectively. All differences were significant. While the design of this study makes it difficult to compare the relative effectiveness of the lasers, both systems evaluated were shown to delay hair growth and provide patients with a satisfactory treatment.
Article
The hair removal market is evolving rapidly. The goal has always been long-term epilation. Success is dependent on understanding hair biology and physiology and on knowledge of laser physics, skin optics, and tissue preservation with respect to these emerging laser technologies. These topics will be reviewed, as will specific categories of laser systems in the hair removal arena and the clinical aspects of laser hair removal today.
Article
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.
Article
Numerous lasers are currently available for hair removal, yet there are still few studies that have examined the role of fluence, light dose, hair color, and treatment number in laser hair reduction. To demonstrate the efficacy and safety of a scanning 800 nm diode laser for hair reduction. An 800 nm scanning diode laser was used to deliver 24, 38, or 48 J/cm2 to a 3 cm x 3 cm area of skin located on the back, groin/bikini area, or thigh in 36 adult patients with varying shades of brown or black hair. Patients received one to four treatments during the course of the study. Hair loss was evaluated at both 30 and 90 days after final treatment. Biopsies were obtained from 20 consenting patients. Significant fluence-dependent hair reduction was demonstrated between treatment and control groups. At 48 J/cm2, the highest dose, a mean hair reduction of 43% was achieved 30 days after the final treatment, and 34% was achieved 90 days after the final treatment. Darker hairs were more effectively treated than lighter hairs. Hair reduction can be safely and effectively achieved using a scanning 800 nm diode laser.
Article
The purpose of this study was to determine whether there were differences in outcome between patients treated by a trained physician and patients treated by a trained, supervised nurse. A total of 100 patients were treated for unwanted body hair using the Cynosure long-pulsed alexandrite laser: 50 patients were treated by a physician and 50 by a nurse. The measured average reduction in hair counts was 74 +/- 8% in the physician-treated group and 70 +/- 6% in the nurse-treated group (NS). Transient skin changes (i.e. pigmentation changes and blistering) were comparable between the two groups. Patient satisfaction measured by an assessment scale of 1 (excellent) to 5 (poor) was 1.6 +/- 0.3 and 1.4 +/- 0.3 in the physician- and nurse-treated groups respectively (NS). Using treatment efficacy, complication rate, and patient satisfaction as variables, this study concluded that properly trained physicians and nurses achieved parallel results in laser hair removal.
Article
As laser epilation has become a widely accepted method for hair removal, questions regarding timing and frequency of treatments have arisen. To determine whether a structured treatment protocol for laser hair removal improves clinical results in reducing hair growth. A group of 100 patients (Group A) underwent laser epilation with four regularly spaced treatments; a group of 100 patients (Group B) determined their own treatment plan with respect to timing and frequency (not exceeding four treatments). Group A experienced a 78 +/- 8% reduction in hair with four treatments per patient while Group B experienced a 48 +/- 12% reduction with an average of 2.5 +/- 0.5 treatments per patient. These differences were statistically significant (P < 0.05). Patient satisfaction was significantly improved in Group A compared with Group B (P < 0.05). A positive linear relationship was identified in Group B between treatment frequency and hair reduction (r = 0.94) and between treatment frequency and patient satisfaction (r = 0.89). This study concludes that patients who participate in a structured treatment protocol note superior clinical results following laser hair removal.
Article
This study aimed to evaluate the safety and efficacy of a 3.5 ms Nd:YAG laser for the removal of hair in subjects with Fitzpatrick skin types I-IV. Thanks to a pulse shorter than the hair Thermal Relaxation time (TRT), photothermolysis was thus achieved. This study assessed the percentage of hair reduction at 1 month and at 3 months after a single Nd:YAG laser treatment (Athos; Quantel Médical, France); 3.5 ms pulse, single shot to 3 Hz, a maximum fluence of 80 J/cm2, 4 mm spot, no cooling system, no anaesthesia. The treatment sites consisted of three adjacent squares (optimum fluence, no treatment, -20% optimum fluence). Computerized hair counting was realized on digital pictures. The phototype, pain, side effects and patient's satisfaction were noted. Biopsies were performed 15 min after treatment. The enrolment consisted of 17 women, 22-60 years old, phototypes I-IV, with a follow-up at 1 month and 3 months of 25 sites. Counting at 1 month and at 3 months revealed a significant hair reduction compared with the control sites: 60% at 1 month (P < 0.001) and 24% at 3 months (P < 0.05) for optimal fluence (25-80 J/cm2), compared with 31% and 0% on the control sites; values similar to those published for Nd:YAG or diode lasers. There were no adverse effects at all. Biopsies showed lesions from necrosis coagulation of the root sheaths and hair disruption to isolated apoptotic cells in the outer root sheath, depending on the fluence applied. Results from this study show that the Athos Nd:YAG is efficient and safe for removing pigmented hair in phototypes I-IV.
Article
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.
Article
Photo-epilation has become an accepted modality for the removal of unwanted hair. However, adverse effects may occur in darker skin patients. Treatment with the ruby laser is generally advised for skin types I-III. Treatment of over 3000 patients (skin types I-III) in our clinic has resulted in a minimal percentage (approximately 3%) of adverse effects. Increasing pulse duration should allow the epidermis to cool and thus minimize thermal damage so that treatment can be extended to dark skin patients. The purpose of our study was to compare tissue reaction in dark skin patients (skin type IV) after treatment with a long-pulse (20 msec) ruby laser and compare the reaction with a 1 msec ruby laser treatment. Hair removal efficacy was determined to be similar with both pulse durations, but tissue reaction was more severe, including eschar and hypopigmentation, following treatment of dark skin patients with the 1 msec protocol. Increasing the pulse duration to 20 msec appears to result in safe and efficacious ruby laser treatment even for darker skinned patients.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.