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Abstract
To investigate the safety and effectiveness of a long pulsed Nd:YAG (1064nm) laser compared to a shorter wavelength intense pulse light system for assisted hair removal in volunteers with skin type 1V, V and VI.
Eleven patients of Fitzpatrick skin type IV-VI were recruited into the study. The area treated included the face (upper lips, chin and jaw area), axillae and legs. One half of the body was treated with the long pulse Nd:YAG laser and the other half was treated with the IPL system randomly under topical anesthesia. Degree of pain experienced during treatment, the treatment outcome and any complications were observed. Patients were reviewed at 2 weeks and 6 weeks post-treatment.
Volunteers generally described pain from the IPL system as "prolonged burning sensation" but tolerable. Pain from Nd:YAG laser treatment was described as "pinprick" and more intense but tolerable. "Slowing of hair growth"was reported with IPL and Nd:YAG, but with a greater effect from Nd:YAG. Sixty-four percent and 73%(8/11) noticed hair reduction <20% after 6 weeks on IPL and Nd:YAG treated side respectively (ns). Post-inflammatory pigmentation occurred in some volunteers on the IPL treated sides whereas this was not seen on any Nd:YAG treated side, and three of these patients experienced blistering, followed by post-inflammatory pigmentation.
In our experience the long pulse width 1064 nm Nd:YAG laser, which can penetrate 5-7 mm into the dermis depths to reach the whole length of the hair follicle, would be expected to produce sufficient follicular injury with less epidermal damage in patients with darker skin type compared to shorter wavelength laser and light system.
... All studies comparing IPL and Nd:YAG systems in terms of pain have used therapies for purposes of epilation. However, since the systems used differ, it is not possible to perform any direct comparison between them, although, in contrast to our findings, studies have generally reported that IPL systems caused less pain than Nd:YAG procedures [37][38][39][40][41] . ...
... Goh CL reported that patients described a prolonged burning sensation with the IPL system, but a transient stinging sensation with Nd:YAG 41 . ...
... In contrast, a greater incidence of bullae and post-inflammatory hyperpigmentation has been reported with IPL used for epilation purposes than with Nd:YAG laser 41 . Complications developed in only 3 patients in our study (vesicles in 2, and atrophic scar in 1), all of which occurred after Nd:YAG laser application. ...
Background and Design: The aim of this study was to evaluate the efficacy and safety of neodymium-doped yttrium aluminum garnet (Nd: YAG) laser and intense pulsed light (IPL) systems, and the variety of indications involved.
Materials and Methods: First-year treatments in our clinic were evaluated retrospectively. Results were classified according to improvement rates: 75% as excellent improvement.
Results: One hundred thirty-three patients aged 3-79 years (mean: 35.91) with 14 different indications were treated. Pigmented lesions were treated with IPL, and vascular lesions with IPL and/or Nd: YAG. Combined therapy with IPL and Nd: YAG at two-week intervals resulted in excellent improvement in 70.21% of vascular lesions (34 rosacea, 8 nevus flammeus, and 5 hemangioma), and moderate improvement in the rest. Telangiectasia and angiomatous lesions exhibited excellent improvement in 93.65% of patients with Nd: YAG, and moderate improvement in the rest. IPL resulted in excellent improvement in 78.49% of cases of solar lentigo, and moderate improvement in the rest. Moderate improvement was observed in 66.67% of patients with melasma using IPL, and mild improvement in the rest. Pain scores were significantly lower with Nd: YAG than IPL (p
... Studies done by Goh (75) and Lanigan (76) have shown that Nd:YAG laser has been used successfully to treat abnormal hair in patients with skin types V and VI. In both studies, no risk of serious adverse side effects has been noted with the Nd:YAG laser (75,76). However, pain is the most prominent side effect of Nd:YAG laser (62,75,76). ...
... In both studies, no risk of serious adverse side effects has been noted with the Nd:YAG laser (75,76). However, pain is the most prominent side effect of Nd:YAG laser (62,75,76). Good cooling during treatment and proper choice of laser parameters can reduce the perception of pain. ...
... It is very effective in hair removal, treating vascular lesions, for skin rejuvenation and as surgical ablation device. No risk of serious adverse side effects has been noted with the Nd:YAG laser (75,76). Palesty et al have used it in pilonidal cystectomy. ...
... However, since the systems used differ it is not possible to perform any direct comparison between them, although, in contrast to our findings, studies have generally reported that IPL systems cause less pain than Nd:YAG procedures 37-41 . Goh CL reported that patients described a prolonged burning sensation with the IPL system, but a transient stinging sensation with Nd:YAG 41 . We thing that with its own cooling headpiece, the Nd:YAG system used in our study was effective in overcoming pain by cooling the area before treatment. ...
... The risk of post-inflammatory hyperpigmentation and atrophic scar formation is higher in patients with skin types 4 and 5. Studies comparing IPL and Nd:YAG in terms of complications have reported a higher incidence of hyperpigmentation development in vascular lesions with Nd:YAG 43 . In contrast, greater development of bullae and post-inflammatory hyperpigmentation has been reported with IPL used for epilation purposes than with Nd:YAG laser 41 . Complications developed in only three patients in our study (vesicles in two, and atrophic scar in one), all of which occurred after Nd:YAG laser application. ...
... 29 In a comparative study on long-pulsed Nd: YAG laser and intense-pulsed light system in skin types 4-6, the former device was found to be more effective than the latter for hair removal with fewer side effects. 30 Similarly some recent studies have demonstrated superior hair reducing efficacy of Nd: YAG laser over intense-pulsed light system in dark skin. 10,30 ...
... 30 Similarly some recent studies have demonstrated superior hair reducing efficacy of Nd: YAG laser over intense-pulsed light system in dark skin. 10,30 ...
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.
... There are numerous studies done to compare Nd:YAG versus IPL in patients with Fitzpatrick skin types I-III, but there is a dearth of literature looking into the efficacy of laser and IPL in skin types IV-VI (13,14,15). Moreover, there are no studies done in Indian population comparing the effectiveness of laser and IPL. ...
... After 6 weeks of treatment, the percentage of patients who noticed a considerable hair reduction in the Nd:YAG side was 73 % and on IPL side 64%. Statistical analysis was not performed (14). In our study, the mean hair reduction in IPL group was 25.70% (p < 0.001) and mean hair reduction in Nd: YAG group was 24.12% (p < 0.001) after 8 weeks post-treatment. ...
Background and objectives:
There are no large volume comparative studies available to compare the efficacy of lasers over lights for hair removal in Fitzpatrick V and VI skin types. This study is designed to compare the efficacy of Nd:YAG Laser versus IPL in the darker skin types.
Study design/materials and methods:
Thirty nine patients included in Group-1 were treated with Nd:YAG and 31 in group-2 with IPL. Both groups received 5 sessions of treatment. The hair counts were assessed using digital photography and manual counting method before and after treatment and results were analysed. Patient satisfaction scores and pain scores were recorded in each session and compared.
Results:
Mean hair reduction in the IPL group was 25.70 and Nd:YAG group was 24.12 (95% CI). In the Nd:YAG group, 59% of subjects had burning sensation while the figure was 32.3% in IPL group. Burning was less in IPL group (p<0.023). There were no statistically significant difference noticed regarding hyperpigmentation in both the groups (p<0.115).
Conclusion:
Both Nd:YAG and IPL are equally effective for epilation of the darker skin types. Nd:YAG is associated with mild burning sensation in a significant number of patients. Patient satisfaction scores were comparable in both the groups.
... Often, repeated treatments are required to obtain satisfactory results. [3][4][5][6][7] Although the clinical efficacy of these treatments has been reported, their effects on surrounding tissues are not well known. ...
... In summary, even if our results show that a single IPL treatment causes local damage to the hair matrix that does not always extend to the dermal papilla, clinical data indicate that between 45% and 70% reduction of hair density may be reached, depending on the subject, following multiple IPL treatments. [3][4][5][6][7] For subjects with dark hair and pale skin, our results suggest that IPL epilation is a good and safe method to reduce the number and the size of hairs, without compromising bulge epithelial stem cell integrity. Thereafter, recalcitrant hairs can be removed using a complementary technique such as electrolysis. ...
Background
Hair follicles house a permanent pool of epithelial stem cells. Intense pulsed light (IPL) sources have been successfully used for hair removal, but long-term hair reduction may require several treatments. Many questions remain regarding the impact of IPL treatment on the structure of the hair follicle, more specifically on hair follicular stem cells and dermal papilla cells, a group of specialized cells that orchestrate hair growth. Objectives
To characterize the destruction of human hair follicles and surrounding tissues following IPL treatment, with more attention paid to the bulge and the bulb regions. Methods
Human scalp specimens of Fitzpatrick skin phototype II were exposed ex vivo to IPL pulses and were then processed for histological analysis, immunodetection of stem cell-associated keratin 19, and revelation of the endogenous alkaline phosphatase activity expressed in dermal papilla cells. ResultsHistological analysis confirmed that pigmented structures, such as the melanin-rich matrix cells of the bulb in anagen follicles and the hair shaft, are principally targeted by IPL treatment, while white hairs and epidermis remained unaffected. Damage caused by heat sometimes extended over the dermal papilla cells, while stem cells were mostly spared. ConclusionsIPL epilation principally targets pigmented structures. Our results suggest that, under the tested conditions, collateral damage does not deplete stem cells. Damage at the dermal papilla was observed only with high-energy treatment modalities. Extrapolated to frequently treated hairs, these observations explain why some hairs grow back after a single IPL treatment.
... They concluded that long pulse width of 1064 nm Nd: YAG laser, which can penetrate five to seven millimetres into the dermis depths to reach the whole length of the hair follicle, would be expected to produce sufficient follicular injury with less epidermal damage in patients with darker skin type compared to shorter wavelength laser and light system giving better results in this regard. 20 We studied response after the three sessions on two sides of the face with each modality and found no statistically significant difference on both the sides. ...
Objective: To compare the efficacies of intense pulse light (IPL) versus diode laser in the removal of unwanted facial hair among female patients. Study Design: Case series. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2019 to Mar 2020. Methodology: A total of 38 female patients with hirsutism diagnosed by a consultant dermatologist were included in this study. Intense pulse light therapy was applied on one half of the face while diode laser was used on the other half of the face for three sessions one month apart. A consultant dermatologist assessed the reduction in hair count on both sides of the face after the last session. Any adverse effects experienced by the patients were also recorded. Results: Out of 38 patients with 76 responses (both sides of the face) were included in the study. 14(17.9%) patients had less than 25% hair reduction, 24(30.7%) had 25-50% reduction, 27(34.6%) had 50-75% and 11(14.1%) had more than 75% reduction of the unwanted hair. Transient erythema 9(11.5%) and moderate pain 9(11.5%) were the common side effects experienced by the patients overall on both sides. Results of the chi-square test revealed that hair reduction, adverse effects and patient satisfaction were not statistically significant in both the groups (p-value>0.05). Conclusion: This comparative study revealed that intense pulse light and diode laser treatment have been equally efficacious and tolerable in managing unwanted hair among females suffering from hirsutism.
... In a comparison study of diode lasers and IPL for axillary hair removal conducted in 30 patients with Fitzpatrick type II-III, both diode and IPL were found to result in effective reductions at one-year follow-up (69.2 and 52.7% respectively) [38]. However, two studies comparing IPL to longpulsed alexandrite and Nd:YAG noted inferiority of IPL [39,40]. IPL devices are also marketed for home use. ...
Excessive unwanted hair has a significant psychological effect for children and adolescents. Laser hair removal (LHR) is best suited for darkly pigmented hair in light‐skinned individuals. Importantly, darker skin may absorb emitted light along with the hair follicles and incur skin damage. It is important to screen patients carefully. However, with careful choice of laser parameters including wavelength, pulse duration, energy fluence, spot size, and repetition rate, LHR may be safely and effectively utilized in darker skin types. Long‐pulsed Nd:YAG is often considered safest for use in darker skin types. Depending on the source consulted, long‐pulsed diode or long‐pulsed alexandrite laser may also be suggested for use in darker skin types. Current knowledge of lasers for hair removal in the pediatric population is limited by a dearth of studies. LHR has the potential to decrease the emotional burden of children and adolescents suffering with hirsutism and hypertrichosis and should be considered where appropriate.
... 11 Hirsutism represents a severe cosmetic disturbance and causes great social and psychological embarrassment including anxiety, social avoidance and confusion of gender identity. 12,13 Idiopathic hirsutism is identified in 10%-15% of women who are apparently hirsute, with normal levels of serum androgen levels and normal ovulatory and hormonal functions. [14][15][16] In the present study, we aimed to evaluate whether the combination of physical "(long pulsed Nd-YAG laser) and pharmacological (topical capislow)" method would be superior to long pulsed Nd-YAG laser alone in the treatment of idiopathic hirsutism. ...
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.
... [27]. Interestingly, a study using IPL for 34 patients FST II-V showed no statistical difference in occurrence of side effects between the 4 skin types, however, a split body study in 2003 comparing Nd: YAG and IPL in patients FST IV-VI found post-inflammatory hyperpigmentation in 45% of IPL sites and no side effects in the Nd: YAG treated sites [28]. Another comparative evaluation of 100 patients with FST IV-VI skin types was performed with Nd: Yag, Alexandrite, and Diode lasers; all three lasers had comparable results at 12 month follow-up with 35% reduction for the Nd: YAG, and 40% for the Alexandrite and Diode. ...
... In addition to determining optimal parameters, clinicians should also consider additional methods to reduce the laser induced adverse effects including test shots, epidermal cooling and advice of minimizing sun exposure before and after laser treatment to prevent potential complications. 8 In this study, at 8 weeks after the last treatment, hair reduction was 86% and 96% in sides treated with IPL and alexandrite laser, respectively. The results showed that both systems are effective, with the alexandrite laser shown to have result in more significant reduction of axillary hair than IPL. ...
... -Overall, complications are rare in case of adequate, skin type-adapted parameter selection. -Side effects are more common when treating darkskinned individuals (Fitzpatrick IV-VI) [ 86 ] . -Depending on the wavelength employed, the most common side effects include erythema, burns, blistering/crusting, hypopigmentation, hyperpigmentation, and scarring [ 87 ] . ...
Recent developments (new wavelengths, treatment concepts, and combinations) in the field of lasers, intense pulsed light (IPL), LED, as well as new energy and light sources have opened up new therapeutic options that extend beyond mere aesthetic indications. Thus, while fractional lasers used to be employed to merely treat wrinkles, the same devices – in the context of laser-assisted drug delivery – have now become important tools in the treatment of scars, field cancerization, and epithelial tumors. The requirements posed to physicians, both with respect to establishing the indication and conducting treatment, have been growing along with the increase in technological complexity as well as the rising number of comorbidities and comedications in a patient population that continues to age. At the same time, home-use devices have been introduced for a variety of indications. These devices are characterized by low power and special safety features aimed at preventing accidents, risks, and side effects. Despite the reduced efficacy of such self-treatment devices, there is an increased risk of misuse, given that the basic prerequisite for adequate treatment cannot be ensured, to wit, the exact diagnosis and therapeutic indication. Consequently, during hair removal or anti-wrinkle treatment, pigmented lesions and cutaneous neoplasms may be altered, thus giving rise to expected, unexpected and new side effects and complications. In the aforementioned setting, it is important that all potential users of these new technologies be properly trained in a manner that ensures those treated a maximum of safety and efficacy in accordance with the guiding principle “diagnosis certa – ullae therapiae fundamentum”.
... This process combines selective absorption of light energy by the melanin in hair follicles with suitable fluences and pulse durations that are equal to or less than the thermal relaxation time of targeted follicles in human skin (10-100 ms). 2,4,5 Laser and intense pulsed light (IPL) sources with wavelengths in the red or nearinfared region (600-1200nm) are potentially capable of irradiating the entire length of anagen hair follicles, which typically extend 2 to 5 mm into the dermis. Laser systems and IPL sources currently approved by the Food and Drug administration for the reduction of hair include the long-pulsed ruby (694 nm), alexandrite (755 nm), diode (800 nm), Nd:YAG (1064 nm) lasers and IPL (590 to 1200 nm) sources. ...
Chaopatipharn P, Rojanamatin J. Background: Long-Pulsed 1064-nm Nd:YAG is an effective and well-accepted treatment for hair removal, especially thick dark hair. For fine hair ,which has less melanin content and less depth of hair follicle, need more powerful energy to destroy the follicle. When using higher fluences, smaller spot size should be considered for prevent the side effects from over-heating in dermis. Objective: To determine the efficacy and optimal parameters of Long-Pulsed Nd:YAG laser for fine hair reduction. Materials and Methods: This study was side-by side, comparative study. Twenty-six female patients with Fitzpatrick skin type III-IV were enrolled. The Long-Pulsed Nd:YAG laser was employed with two different spot size on each half of upper lip, with 3-ms pulse duration. Fluence of 30-46 J/cm 2 was used with12-mm spot size and 35-60 J/cm 2 was used with 8-mm spot size. Treatment were performed at 4-week interval for five sessions. Patients were followed up for 12 weeks after the last treatment. Hair count and clinical photographs were taken before each treatment session, 1 and 3 months after the last treatment. The assessment of patient improvement score and pain score were obtained. Results: Prior to treatment there was no significant difference in mean hair count between both sides (p-value = 0.129). On the side with 12-mm spot size, mean hair counts decreased 90.95% (p<.001) and 82.16% (p<.001) at 1, 3 months after the last treatment, respectively. On the side with 8-mm spot size, mean hair counts decreased 91.11% (p<.001) and 82.70% (p<.001) at 1, 3 months after the last treatment, respectively. There was no significant different of hair counts as well as patient's satisfaction between both sides. Our data demonstrated a trend toward increased hair reduction with higher fluences. Additionally, on the side with 8-2 mm spot size was found to be significant lesser degree of immediate pain. Increase fluence setting was generally correlated with greater degree of immediate pain. The adverse effects were mild and reversible. Conclusion: Both 12-mm spot size and 8-mm spot size Long-Pulsed Nd:YAG are effective in fine hair reduction with low incidence of side effects. However, 8-mm spot size showed lesser degree of immediate pain and was more tolerable.
... None of our patients reported blistering, crusting or scarring. for the Treatment of Hair Removal and Vascular Lesions DISCUSSION Nd:YAG lasers have emerged as the most effective laser for the treatment of hair removal and leg veins in patients of darker skin types [6][7][8][9][10]. Although Ruby and Alexandrite lasers have been shown to be much more efficacious in hair removal due to better absorption by melanin their use in darker skinned patients is limited due to their side effect profile [11]. ...
In recent years, there has been an increasing trend toward a more or less hairless body as an ideal of beauty not only among women but also increasingly among men. The desire for permanent hair removal is therefore being increasingly approached by dermatologists. Laser epilation is particularly suitable for large-area hair removal. In practice, alternative methods such as needle epilation can only be used for smaller areas, since the needle has to be placed in each individual follicle in order to damage the hair root with an electrical impulse. For this reason, needle epilation is very time-consuming and is no longer performed in medical practices. However, some specialized cosmetic studios still offer this service.
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.
The current study aims to evaluate the dependence of laser-induced optical breakdown (LIOB) on skin types by using 1064-nm picosecond laser with micro-lens arrays (MLA) and diffractive optical elements (DOE). Both black and white skin tissues were examined to comparatively assess the LIOB effects in the skin in terms of laser-induced vacuolization. The black skin irradiated at 3.0 J/cm² demonstrated that MLA yielded a deeper distribution (180~400 μm) of laser-induced vacuoles with an size of 67 μm, compared to DOE (180~280 μm; 40 μm in size). However, the white skin presented that MLA created larger vacuoles (134 μm in size) in a smaller number at deeper distributions (125~700 μm) than MLA with the black skin. DOE generated no laser-induced vacuolization in the white skin. The white skin tissue with inherent higher scattering could be responsible for deeper vacuolization after the picosecond laser treatment. Further investigations are expected to determine the optimal treatment conditions for various skin types.
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Background
The use of intense pulsed light sources has been booming in the world of cosmetic dermatology. Despite advances in technology and benefits for a wide range of skin conditions, complications do occur.
Objective
To assess complications associated with intense pulsed light sources in cosmetic dermatology to provide clinicians with reference to achieve better patient outcomes.
Methods
A literature review of complications associated with intense pulsed light sources.
Results
Notable complications include pigmentary changes, crusting, burns, zebra appearance, folliculitis, acne, leukotrichia, paradoxical hypertrichosis, scarring, infection, and ophthalmic injury.
Conclusion
Clinicians using intense pulsed light sources should be aware of complications associated with their use to take precautions and implement preventative strategies to avoid adverse effects and long‐term consequences.
The advancement of laser and light therapies have allowed patients of all races and ethnicities access to different methods for removing unwanted hairs that can cause emotional distress and impact one's quality of life. Despite their effectiveness, these technologies are not without their risks, such as the well‐known side effects of blister formation, erythema, crusting, and postinflammatory hypo‐ and hyperpigmentation. However, one adverse effect that seems to remain a clinical mystery is paradoxical hypertrichosis. Paradoxical hypertrichosis is the growth of fine, dark hair in treated areas or untreated areas close to the area treated on the face and neck, more frequently affecting those with darker skin (Fitzpatrick III‐VI) and darker hair color, and most associated with those having undergone the intense pulsed laser and long‐pulse alexandrite laser, although, this adverse reaction is likely common to all current and laser and light hair removal devices, despite the unknown prevalence and varying incidence rates. This phenomenon is not well understood, although explanations include the activation of dormant hair follicles by the intense pulse light flashlamp's suboptimal fluences and the synchronization of hair growth cycles caused by direct light stimulation.
The goal of achieving a satisfied patient implies, beyond an accurate treatment, wise patient selection and management. While some patients will be satisfied with basically any result, others will need special attention and guiding before achieving a satisfying result. In both cases, the physician’s attitude plays a key role and can avoid bad reviews, complaints and lawsuits. At the end of the spectrum are patients who need psychiatric care rather than cosmetic treatment. Recognizing and denying treatment to these patients, as well as those who do not harmonize with your team, can save you a lot of trouble. This chapter offers a comprehensive description of what an ideal as well as a difficult patient means and gives tips and tricks to how a physician should manage these patients.
The rapid development of IPL technique has led to improvement in the safety of professional and of home-use devices. Covering such a large array of treatments in the medical office as well as at home, IPL devices prove to be a relatively safe technique. Some adverse effects can still be encountered, most with minor consequences. The complications caused by IPL treatments may be divided into two groups: those which are due to errors in handling of the device and those which are patient-dependent. Improper training of operators and insufficient experience may lead to undesirable results. The second type of complication which is related to the patient’s skin reactivity is harder to anticipate. Major complications are permanent pigmentary changes, paradoxical effect, leukotrichia, uveitis, iritis and scarring. Minor complications are erythema and purpura which last more than 3 days, blisters, temporary pigmentary changes and temporary hair discoloration. In this chapter we will describe the most common side effects as well as the methods of avoiding and treating them when they occur.
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.
Background:
Due to concerns regarding maternal and fetal safety and the absence of evidence to the contrary, laser treatment during pregnancy has traditionally been limited to situations of absolute necessity.
Objective:
This review seeks to examine the available evidence to determine the safety of laser therapy during pregnancy.
Methods:
Medical databases were searched for relevant reports from all specialties regarding the use of lasers during pregnancy from 1960 to 2017. A legal case review was also performed.
Results:
Twenty-two publications in the literature reported the use of various laser wavelengths in 380 pregnant women during all trimesters. Other than 1 case of premature rupture of membranes questionably related to the laser treatment, there were no cases of maternal or fetal morbidity or mortality, premature labor, or identifiable fetal stress.
Conclusion:
The available evidence, limited to low evidence level case reports and series, indicates cutaneous laser treatment during pregnancy is safe for both mother and fetus. Furthermore, laser physics and optics dictate there should theoretically be no risk of fetal laser exposure from commonly used cutaneous lasers.
In den letzten Jahren ist ein zunehmender Trend zu einem „haararmen“ Körper als Schönheitsideal nicht nur bei Frauen, sondern in steigendem Maße auch bei Männern zu beobachten. Der Wunsch nach dauerhafter Haarentfernung wird daher immer häufiger an Dermatologen herangetragen. Insbesondere bei großflächiger Haarentfernung bietet sich die Laserepilation an. Alternative Methoden wie die Nadelepilation sind in der Praxis nur für kleinere Areale einsetzbar, da die Nadel in jeden einzelnen Follikel gebracht werden muss, um dort durch einen elektrischen Impuls die Haarwurzel zu schädigen. Aus diesem Grund ist die Nadelepilation sehr zeitintensiv und wird in ärztlichen Praxen nicht mehr durchgeführt. Um all diese Aspekte geht das folgende Kapitel.
Unwanted facial and body hair presents as a common finding in many patients, such as females with hirsutism. With advances in laser and light technology, a clinically significant reduction in hair can be achieved in patients with light skin. However, in patients with darker skin, Fitzpatrick skin types (FST) IV–VI, the higher melanin content of the skin interferes with the proposed mechanism of laser-induced selective photothermolysis, which is to target the melanin in the hair follicle to cause permanent destruction of hair bulge stem cells. Many prospective and retrospective studies have been conducted with laser and light hair-removal devices, but most exclude patients with darkly pigmented skin, considering them a high-risk group for unwanted side effects, including pigmentation changes, blisters, and crust formation. We reviewed the published literature to obtain studies that focused on hair reduction for darker skin types. The existing literature for this patient population identifies longer wavelengths as a key element of the treatment protocol and indicates neodymium-doped yttrium aluminum garnet (Nd:YAG), diode, alexandrite, and ruby lasers as well as certain intense pulsed light sources for safe hair reduction with minimal side effects in patients with FST IV–VI, so long as energy settings and wavelengths are appropriate. Based on the findings in this review, safe and effective hair reduction for patients with FST IV–VI is achievable under proper treatment protocols and energy settings.
The proper use and administration of laser procedures in darker skinned patients differ from that in those with lighter skin types in several ways. Largely, the higher epidermal melanin content introduces a constant competing chromophore and increases the risk for complications. Consequently, it is a challenge for physicians when treating darker skin types to temper effective treatment with minimal risk to the patient. However, with proper physician training, appropriate laser and laser parameter selections, and suitable patient selection, excellent results can be obtained. Laser procedures can be safely used for a wide variety of conditions including vascular lesions, hair removal, pigmentary disorders, photoaging, and scars.
Die Entwicklungen im Bereich dermatologischer Laser, hochenergetischer Blitzlampen, LED und neuer Energie- und Strahlquellen der letzten Jahre haben gezeigt, dass mit neuen Wellenlängen, Konzepten und Kombinationen zusätzliche, zum Teil über den ästhetischen Bereich hinaus gehende therapeutische Optionen für den Dermatologen erschlossen werden konnten. Wurden bisher zum Beispiel mit fraktionalen Lasern Falten behandelt, sind eben diese Systeme heute in Kombination mit Medikamenten wichtige Werkzeuge bei der Behandlung von Narben, bei Feldkanzerisierung und epithelialen Tumoren. Die Anforderungen an den die Indikation stellenden und vorzugsweise therapierenden Arzt steigen mit der immer komplexer werdenden Technik und den zunehmenden Komorbiditäten und Komedikationen einer älter werdenden Patientenklientel. Parallel etabliert wurden, zunächst für einige wenige Indikationen, Geräte für die Heimanwendung, die sich durch geringe Leistung und spezielle Sicherheitsvorkehrungen zur Vermeidung von Unfällen, Risiken und Nebenwirkungen auszeichnen. Trotz der reduzierten Effizienz solcher Selbstbehandlungsmaßnahmen steigt die Wahrscheinlichkeit einer Fehlanwendung, da die Grundvoraussetzung für eine korrekte Therapie, nämlich die exakte Diagnose und Indikationsstellung, nicht vorausgesetzt werden kann. Bei einer Haarentfernung können so Pigmenttumoren, bei einer Faltentherapie neoplastische Hautveränderungen adressiert und zu erwartende, unvorhergesehene und neue Nebenwirkungen und Komplikationen induziert werden. In diesem Szenario ist es wichtig, alle potenziellen Anwender dieser neuen Technologien vor deren Einsatz so zu qualifizieren, dass den Therapierten maximale Therapiesicherheit bei höchster Effizienz unter dem Leitbild diagnosis certa – ullae therapiae fundamentum garantiert wird.
Background:
Photothermal destruction of hair shaft melanin with intense pulsed light (IPL) and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has become an effective treatment of hair removal.
Aims:
Our aim was to compare efficacy, satisfactory levels, safety, and side effects of Nd:YAG and IPL in hair reduction.
Methods:
This was a prospective randomized intrapatient, right-left, assessor-blinded comparison of Nd:YAG vs IPL. There were 38 volunteers recruited. Seven sessions were performed. Hair count, efficacy, and side effects were compared before and after each treatment and 6 months after the last treatment. In respect of 12 volunteers, we have examined the reduction in hair after 18 months.
Results:
Initially, there was no significant difference between the numbers of hair follicles. There was significant hair reduction after each treatment on the Nd:YAG-treated side. The hair reduction became significant after the third treatment with IPL. Comparison of the efficacy of the two devices on each visits showed no significant difference. There was statistically lower pain score on the IPL-treated side and statistically higher erythema, burning sensation, and edema on the Nd:YAG-treated side. Statistically lower side effect score was observed on the IPL-treated side. Eight months after the last treatment, there was significant hair reduction both on the Nd:YAG and on the IPL-treated side, and there was no difference between the efficacy. The patient satisfaction scores were higher with the IPL.
Conclusion:
Unwanted hair can be reduced by both systems safely and effectively; however, IPL has less side effects and higher satisfaction scores.
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.
Der Erfolg von Laser- und IPL-(″intense pulsed light″-)Behandlungen zur Haarentfernung ist von der vorhandenen Melaninmenge im Haarschaft abhängig. Der ideale Patient für die lasergestützte Haarentfernung hat helle Haut mit schwarzen, dicken Haaren. Die Beweislage für die Wirksamkeit der Laser- und Photoepilation ist sehr umfangreich; Anfang 2009 lagen 43 kontrollierte Studien dazu vor. Laserbehandlung und Photoepilation sind den herkömmlichen Methoden wie Rasur, Wachsbehandlung und Elektrolyse überlegen. Wiederholungsbehandlungen verbessern den Wirkungsgrad der Laser- und Photoepilation. Für den Rubin-, Alexandrit- und Diodenlaser sowie den Neodymium:Yttrium-Aluminium-Granat-Laser (Nd:YAG-Laser) und für IPL-Geräte konnte mehrfach eine kurzfristige Wirksamkeit bei der Haarentfernung für einen Zeitraum von bis zu 6 Monaten nachgewiesen werden. Des Weiteren liegen Beweise für eine langfristige Wirksamkeit von Wiederholungsbehandlungen mit Alexandrit- und Diodenlasern sowie langgepulsten Nd:YAG-Lasern vor, die länger als 6 Monate anhielt. Weiße, graue und rote Haare sprechen nicht ausreichend auf Standardbehandlungen an. Eflornithin, topisches Melanin und die photodynamische Therapie können jedoch neue Behandlungsoptionen für diese schwierig zu entfernenden Haartypen darstellen, obwohl es bisher noch an maßgeblicher Evidenz dazu mangelt. Zum jetzigen Zeitpunkt gibt es keine Evidenz für eine vollständige und dauerhafte Haarentfernung. Die Patienten sollten vor der Behandlung mit Laser und IPL über das zu erwartende Ergebnis aufgeklärt werden, um eine realistische Erwartungshaltung zu ermöglichen. Geräte für den Hausgebrauch, die von den Patienten selbst bedient werden können, sind auf dem Vormarsch.
As with any other medical technology, side effects and complications can occur after IPL treatment. Some complications can be prevented by knowing the principles of therapy and treatment strategies, and from having experience with the device. The complications caused by IPL treatments may be divided into two groups: those which are due to errors in handling of the device and those which are patient-dependent. Improper training of operators and insufficient experience may lead to undesirable results. Not infrequently there are “profit motivated “cosmetic centers” where IPL technology is used by people with minimal training and background. The second type of complication which is related to the patient’s skin reactivity is harder to be anticipated. The major complications are permanent pigmentary changes, hair stimulation, paradoxical effect, leukotrichia, uveitis and iritis and scarring. The minor complications are erythema and purpura which last more than three days, blisters, temporary pigmentary changes and temporary hair discoloration.
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.
The skin is composed of three layers: epidermis, dermis and subcutaneous tissue. The thickness of the layers varies with different anatomical regions. The epidermis is thickest on the palm and soles, and very thin on the eyelids, while the dermis is thickest on the back. Keratinocytes are the main component of the epidermis. Melanocytes are the cells located in the epidermis whose function it is to produce pigment. The ratio is about one in every ten basal keratinocytes. Differences in skin color according to race are explained by the number of melanosomes. Langerhans cells represent 3-5% of the cells of the stratum spinosum where they are situated between the keratinocytes. The dermis consists of a supporting matrix (ground substances) in which polysaccharides and proteins act to produce proteoglycans. The protein fibers inside the dermis are represented by collagen, elastin and other components, such as fibrillin and microfibril proteins. The blood supply to the skin comes from the deep plexuses located at the fascia and subcutaneous level. With aging, there is a decrease in total collagen content in the skin, an increased amount of type III collagen, decreased number and diameter of elastin fibers, and a lack of interaction between water and surrounding molecules which contribute to the dry and wrinkled aspect.
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.
Hirsutism is defined as the excessive growth of terminal hairs in androgen-dependent areas in females, while hypertrichosis is defined as the generalized excessive growth of hair that is not limited to androgen-dependent hair. An effective management of hirsutism should aim to diagnose and treat any underlying hormonal disease while reducing excessive hair. Evidence-based data regarding the use of systemic treatments for hirsutism is lacking. As idiopathic hirsutism is mainly a cosmetic problem, topical treatments and hair removal methods are preferred. Combined oral contraceptives are a first-line therapy for hirsute women with polycystic ovary syndrome (PCOS). Eflornithine hydrochloride cream is an FDA-approved topical treatment indicated for the reduction of unwanted facial hair in women. Different cosmetic and hair removal methods include chemical depilation, bleaching, physical methods, electrolysis, thermolysis, and laser hair removal. An interdisciplinary approach comprising a dermatologist, an endocrinologist, and/or a gynecologist may provide optimal management to the hirsute woman.
This chapter discusses melanogenesis in skin and hair follicle, how melanin granules or melanosomes are formed, some basic thermal principles describing how hair follicles respond to heat, the relevance of using the Fitzpatrick scale, various cooling systems designed to protect the epidermis, and the efficacy and safety of various lasers and IPL systems for darker skin types. Laser hair removal allows a physician or trained professional to treat large areas of the body quickly, with long-lasting or permanent reduction in hair growth. These reductions in growing hair are caused by the interaction of the laser with the hair melanin. While initially developed for the ideal contrast of dark hair against a fair skin background, an increasing demand is foreseen to treat all individuals regardless of base skin color, particularly in the United States, where the population is becoming more ethnically diverse. Significant hair growth reduction has been reported in people with darker skin types; however, the interaction of the laser with skin melanin must be taken into account to prevent long-lasting side effects. Permanent changes in pigmentation and skin texture, focal atrophy, and scarring are some of the adverse effects that have been reported with improper laser use. As the understanding of the variations in response in people of color to the laser grows, these side effects associated with laser hair reduction can be reduced.
Background:
Nonsurgical procedures for facial rejuvenation vastly outnumber surgical procedures among board-certified plastic surgeons; interest in nonsurgical cosmetic procedures is rapidly growing for patients and physicians, with less down time, less scars, and potentially less cost. Nonsurgical procedures are often a gateway for patients into more invasive surgical procedures. Providing patients with a comfortable, pleasant experience increases the chance of referrals and return for future procedures, surgical and nonsurgical.
Methods:
In this review article, we describe basic principles for providing patients with a pleasant, minimal pain experience during nonsurgical facial rejuvenation procedures. The procedures are grouped into injectables, noninvasive devices, and minimally invasive devices, and basic guidelines for pain management are provided.
Results:
A review of each nonsurgical facial rejuvenation procedure is provided with typical patient perception of discomfort and methods to reduce or eliminate pain. This article covers the most popular procedures performed in many plastic surgery offices but is not inclusive of all devices and technologies available on the market.
Conclusions:
A wide range of nonsurgical options exist for rejuvenation, and there is nearly as much variety in pain associated with these procedures. As with any procedure that potentially may lead to pain or anxiety for a patient, it is important to assess patient's pain tolerance preprocedurally to determine the level of intervention needed. Providing a relaxed, calm environment and satisfactory pain control helps to reduce anxiety and improve the overall perception of the procedure and provider.
Objective:
Multiple lasers and light sources are currently available for hair removal and many studies comparing efficacy and safety exist. SHR mode IPL is a technique that gives the total energy in divided doses with fewer side effects. We compared a SHR mode IPL system with alexandrite and Nd: YAG lasers for leg hair reduction.
Material and methods:
Twenty-five female participants with skin types II-IV, underwent treatment of unwanted hair on the cruris. Three selected areas were randomly treated with the SHR mode IPL system, Alexandrite laser and Nd: YAG laser in three sessions. Hair reduction was evaluated with digital photography by a blinded assessor every 6 weeks and 6 months after the last session. Pain severity, side effects and patient satisfaction analysis were also investigated.
Results:
Twenty-one participants completed the trial. The mean hair reductions in 6 weeks after the last treatment were 50% for the IPL system, 53% for Alexandrite and 39% for the Nd: YAG lasers. However after 6 months; 40%, 49% and 34% hair reduction was observed, respectively. The Alexandrite laser was the least painful system.
Conclusion:
Although there is no obvious advantage of one laser system over the others in terms of treatment outcome, the Alexandrite laser is still the most efficient and reliable way of hair removal in fair skinned individuals.
Today, most do not go a day without practicing or hearing about new hair removal methods. However, little is discussed about the history of hair removal and the development of most hair removal methods since the period of cavemen. Avoiding decapitation and fitting in with society are two of many reasons for the development of this now normative practice. Knowledge of the hair growth cycle is vital in understanding the efficacy of various hair removal methods as well as the difference between epilation and depilation. While laser hair removal (LHR) is one of the most common cosmetic procedures practiced in the world, according to the FDA, the only current permanent form of hair removal is electrolysis. These two methods as well as various other ones are discussed in this article. Further developments are being made every day to better treat the removal of blonde and white hair as well as to diminish the pain of hair removal. With these developments, dermatologists will better understand the advancement of hair removal methods and the reasons why patients may seek treatment.
Safe and effective laser treatments are crucial, especially in darker-skinned individuals. Herein, we report our experience treating Fitzpatrick skin types IV to VI with a long-pulsed, 1,064-nm neodymium-doped yttrium aluminum garnet laser. With the right treatment settings, darkly pigmented individuals can undergo laser hair removal effectively.
J Drugs Dermatol. 2013;12(3):366-367.
Im dermatologischen Alltag begegnet uns Licht auf vielfältige Weise. Die biologischen und physikalischen Interaktionen des
Lichtes mit der Haut machen Licht bei gezielter Anwendung zu einem potenten Diagnostikum und Therapeutikum. Diese Arbeit soll
die Einsatzmöglichkeiten von Lichtdioden und hochenergetischen Blitzlampen in der Dermatologie beleuchten. Beide Lichtquellen
finden erst seit jüngerer Zeit Anwendung in der Dermatologie und bereichern neben Breitband-UV-(Ultraviolett-)Lichtquellen,
Hochdruckgasentladungslampen und Halogenlampen das Armamentarium der inkohärenten Lichtquellen.
In the everyday practice of dermatology, we encounter light in many ways. The biological and physical interactions between
light and skin make light a potent diagnostic and therapeutic tool when well directed. This contribution intends to illuminate
the possible uses of light-emitting diodes and high-energy flashlamps in dermatology. Both sources of light have only recently
been employed in dermatology and in addition to broadband ultraviolet (UV) light sources, high-pressure gas discharge lamps,
and halogen lamps enrich the armamentarium of incoherent light sources.
Laser and IPL treatments for hair removal depend on the presence of melanin in the hair shaft. The ideal patient for laser
hair removal has light skin with black, coarse hair. There is substantial evidence for laser and photoepilation with a total
of 43 identified controlled trials in the beginning of 2009. Laser treatment and photoepilation are superior to conventional
treatments such as shaving, waxing, and electrolysis. Repetitive treatments improve the efficacy from laser and photoepilation.
A short-term hair removal efficacy up to 6 months after treatment is well-documented for ruby, alexandrite, diode, and Nd:YAG
lasers, as well as intense pulsed light. Evidence exists for a long-term hair removal efficacy beyond 6 months after repetitive
treatments with alexandrite, diode, and long-pulsed Nd:YAG lasers. White, grey, and red hairs do not respond sufficiently
to standard treatments but eflornithine, topical melanin, and photodynamic therapy may offer new treatment options for these
difficult-to-treat hair types although substantial evidence today is lacking. Today, there is no evidence for complete and
persistent hair removal. Patients should be preoperatively informed of the expected treatment outcome from laser and IPL hair
removal procedures in order to gain realistic expectations. Consumer-based home devices are evolving.
Intense pulse light (IPL) with square pulse technology is one of the latest hair removal technologies to be marketed in India. However, there is no literature on use of IPL in Indian skin.
A preliminary descriptive study to ascertain the efficacy of an IPL device with square pulse technology for hair removal in Indian patients. Materials and methods: The IFL i200 system (Cyden Ltd, Swansea, UK) was used for hair removal on 12 patients of skin type III, IV and V up to a maximum of six sessions. Hair removal efficacy (HRE) was calculated and photographs taken after each session.
Treatment was done for 12 patients. Mean HRE was 69.6%; 83% were satisfied with the procedure; 66% had excellent results; 16% had good results. No permanent adverse effects were seen.
With standard precautions, IPL is a safe and effective tool for hair removal in Indian patients. Further studies to compare square pulse technology with traditional IPL systems and lasers are required.
Although several lasers meet the wavelength criteria for selective follicular destruction, the treatment of darker skin phototypes is particularly challenging because absorption of laser energy by the targeted hairs is compromised by an increased concentration of epidermal melanin.
To compare satisfaction level, safety and effectiveness of a long-pulsed Nd:YAG laser and intense pulsed light (IPL) in axillary hair reduction in subjects with dark skin.
The study design was a within-patient, right-left, assessor-blinded, comparison of long-pulsed Nd:YAG laser and IPL. Fifty women (skin phototypes IV-VI) volunteered for removal of axillary hair. Five sessions at 4- to 6-week intervals were performed. Hair counts at both sides were compared at baseline and 6months after the last session. Final overall evaluations were performed by subjects and clinician at the end of the study. Satisfaction was scored for both devices.
Thirty-nine women completed the study. At 6months, the decrease in hair counts on the laser side (79·4%, P<0·001 vs. pretreatment) was significantly (P<0·01) greater than that on the IPL side (54·4%, P<0·01 vs. pretreatment). Only temporary adverse effects were reported at both sides. Higher pain scores and more inflammation were reported with Nd:YAG laser; however, it was preferred by 29 volunteers (74%). Volunteers reported higher satisfaction score with Nd:YAG laser (P<0·01).
Dark skin can be treated by both systems safely and effectively; however, long-pulsed (1064 nm) Nd:YAG laser is more effective as reported by both subjects and clinician.
Hair removal with optical devices has become a popular mainstream treatment that today is considered the most efficient method for the reduction of unwanted hair. Photothermal destruction of hair follicles constitutes the fundamental concept of hair removal with red and near-infrared wavelengths suitable for targeting follicular and hair shaft melanin: normal mode ruby laser (694 nm), normal mode alexandrite laser (755 nm), pulsed diode lasers (800, 810 nm), long-pulse Nd:YAG laser (1,064 nm), and intense pulsed light (IPL) sources (590-1,200 nm). The ideal patient has thick dark terminal hair, white skin, and a normal hormonal status. Currently, no method of lifelong permanent hair eradication is available, and it is important that patients have realistic expectations. Substantial evidence has been found for short-term hair removal efficacy of up to 6 months after treatment with the available systems. Evidence has been found for long-term hair removal efficacy beyond 6 months after repetitive treatments with alexandrite, diode, and long-pulse Nd:YAG lasers, whereas the current long-term evidence is sparse for IPL devices. Treatment parameters must be adjusted to patient skin type and chromophore. Longer wavelengths and cooling are safer for patients with darker skin types. Hair removal with lasers and IPL sources are generally safe treatment procedures when performed by properly educated operators. However, safety issues must be addressed since burns and adverse events do occur. New treatment procedures are evolving. Consumer-based treatments with portable home devices are rapidly evolving, and presently include low-level diode lasers and IPL devices.
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.
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.
Laser-assisted hair removal is the most efficient method of long-term hair removal currently available. Several hair removal systems have been shown to be effective in this setting: ruby laser (694nm), alexandrite laser (755nm), diode laser (800nm), intense pulsed light source (590 to 1200nm) and the neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1064nm), with or without the application of carbon suspension. The parameters used with each laser system vary considerably. All these lasers work on the principle of selective photothermolysis, with the melanin in the hair follicles as the chromophobe. Regardless of the type of laser used multiple treatments are necessary to achieve satisfactory results. Hair clearance, after repeated treatments, of 30 to 50% is generally reported 6 months after the last treatment. Patients with dark colored skin (Fitzpatrick IV and V) can be treated effectively with comparable morbidity to those with lighter colored skin. Although there is no obvious advantage of one laser system over another in terms of treatment outcome (except the Nd:YAG laser, which is found to be less efficacious, but more suited to patients with darker colored skin), laser parameters may be important when choosing the ideal laser for a patient. Adverse effects reported after laser-assisted hair removal include erythema and perifollicular edema, which are common, and crusting and vesiculation of treatment site, hypopigmentation and hyperpigmentation (depending on skin color and other factors). Most complications are generally temporary. The occurrence of hypopigmentation after laser irradiation is thought to be related to the suppression of melanogenesis in the epidermis (which is reversible), rather than the destruction of melanocytes. Methods to reduce the incidence of adverse effects include lightening of the skin and sun avoidance prior to laser treatment, cooling of the skin during treatment, and sun avoidance and protection after treatment. Proper patient selection and tailoring of the fluence used to the patient's skin type remain the most important factors in efficacious and well tolerated laser treatment. While it is generally believed that hair follicles are more responsive to treatment while they are in the growing (anagen) phase, conflicting results have also been reported. There is also no consensus on the most favorable treatment sites.