The need for a rapid, noninvasive method for hair removal has led to the development of various light sources for hair removal. These include ruby, alexandrite, diode, and Nd:YAG lasers and an intense pulsed light source. These devices target either an endogenous chromophore (eg, melanin) or an exogenous chromophore (eg, carbon suspension). This article discusses the basic principles of laser hair removal, examines the attributes of specific laser systems, and focuses on patient selection and treatment protocols for the various systems designed to ensure safe and effective treatment.
Hair removal is a vague term that has recently been defined. Temporary hair reduction is defined as a delay in hair growth, which usually lasts 1-3 months, consistent with the induction of telogen. Permanent hair reduction refers to 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. It has recently been suggested to add another 6 months to this posttreatment observation time (ie, the time necessary for a damaged follicle to recover from the laser injury and reenter a normal growth cycle).
Laser-assisted hair removal is a relatively new method available for long-term hair reduction. The different lasers available for hair removal are the ruby laser (694 nm), alexandrite laser (755 nm), diode laser (800 nm), and Nd:YAG laser (1064 nm). These lasers target melanin and subsequently produce selective photothermolysis of the hair follicles. The longer wavelengths are safer for darker skin types.
Laser hair removal is not a painless procedure. Most patients experience some discomfort during and immediately after treatment. One can use a topical or local anesthetic before performing the treatment.
Perifollicular erythema and edema are expected in all patients treated at the threshold fluence. The intensity and duration depend on hair color, hair density, and fluence. The reaction usually lasts 1-3 days (see Table ).
Epidermal damage occurs if excessive fluence is used. It is also more common in patients with a tan.
Herpes simplex outbreaks are uncommon but may occur. In patients with a previous history of herpes simplex and in those receiving treatment to the perioral, pubic, or bikini area, the risk is increased.
The laser beam used in the laser hair removal device is directed at the hair follicles. The dark pigments in the follicle absorb the laser light energy. Her white skin does not absorb the light energy; in fact, energy dissipates. The follicle absorbs more and more energy; the follicle dies and can no longer grow hair.
The risk of bacterial infection is extremely low; however it may occur following epidermal damage.
Transient pigmentary changes (eg, hypopigmentation, hyperpigmentation) can be prevented if the ideal patient and treatment fluence are chosen. Dyspigmentation of skin is seen most often in patients with darker skin types or in patients with a recent tan.
Permanent pigmentary changes are unlikely except in dark-skinned individuals.
Scarring is unlikely except in cases of overaggressive treatment or postoperative infection.
Lightening of tattoos and loss of freckles or pigmented lesions is not uncommon. Patients should be aware of this possibility.
Short-term side effects may include a slight reddening of the skin or local swelling which typically lasts less than an hour and may, on occasion, a bit longer. Long wavelength lasers like CoolGlide are less likely to cause prolonged irritation, pigment changes or blistering.
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