Hair Today…Gone Tomorrow

Body hair…not a fan. Shaving…not a fan. Waxing, also, Not. A. Fan. When I was about 23 years old, laser hair removal was becoming more and more of a popular option for reducing unwanted hair. In its infancy, it was considered a luxury treatment, and was quite expensive. Laser treatment chains like American Laser Centers (my very first job as a laser tech. BTW) started popping up across the US offering packages with payment options so that everyone could take advantage of permanent hair reduction via laser light therapy.

History of Laser Hair Removal

Originally developed in the 1960’s, laser hair removal has revolutionized the way we remove hair. Lasers are differentiated by the wavelength of light used to accomplish their goals. The first laser for hair follicle destruction was a ruby laser (wavelength of 694.3nm) developed in 1960. It was slow and could only treat a small number of follicles at once, but most concerning was that it was dangerous leaving burns and tissue damage in its wake. Next, came the YAG (1064nm) laser in 1964 which was very safe, but unable to produce permanent results. Then the first alexandrite laser came into play in 1970’s. The alexandrite (755nm), which is the optimal wavelength for treating hair, was safer but wasn’t immensely powerful, so it required too many treatments to be considered a great option.  After time and experimentation though, scientists learned that laser power was tunable, and the Alexandrite became the gold standard for hair reduction. As treatment continued, it became apparent that skin color and genetics also played a part in successful treatment of unwanted hair via laser. A dermatologist by the name of Dr. Thomas B. Fitzpatrick developed a system for phototyping human skin that is still used today. We use the Fitzpatrick skin typing method to determine wavelength, power, and pulse duration settings to treat unwanted hair safely and effectively with laser.

More Like Laser Hair Reduction!

What is commonly referred to as laser hair removal should actually be called laser hair reduction because there is no way to guarantee the total and complete destruction of every hair follicle within an area. Follicles can begin producing hairs at any point throughout your life even after laser treatment, but follicles that have previously been destroyed will not regrow a hair. Laser hair reduction works on the principle of selective photothermolysis. That is the conversion of light energy into heat when it finds the correct target chromophore. In the case of hair reduction, the target chromophore is melanin or pigment. You may have heard that blonde, gray, white and red hair can not be treated with lasers. That’s because there isn’t enough target chromophore to attract the amount of energy required to disable the follicle. Unfortunately, if your patient has any of these hair colors, they are stuck with shaving, waxing, tweezing, threading, electrology, or making peace with their inner feminist hippie.

When the correct amount of laser energy is applied, in the proper pulse duration (measured in milliseconds,) to the target chromophore, during the anagen phase of growth, the follicle has been disabled. In other words, laser hair removal is hard. All the stars have to be aligned in order for it to work. To be honest, a lot of it is trial and error. While education and experience give us guidelines for treatment, every body is different. Every hair growth cycle is different. Therefore, every treatment could also be different! Successful hair reduction happens when patients are consistent with treatments. For areas from the shoulders up, treatment should happen every 4-6 weeks. For treatment of areas from the shoulders to the groin, every 6-8 weeks, and the legs are every 10 weeks. The number of treatments will vary from person to person based on, Fitzpatrick skin type, scheduling compliance, hormonal activity, certain medications, pain tolerance, and sun exposure avoidance (or lack thereof). When someone gets tan the melanin in the skin becomes the target chromophore and can result in burns, scarring and long-term or even permanent pigmentation issues. Many of my patients will tell me they aren’t tan, even when its obvious that they are. Now, I’m not saying they are lying, but maybe they just forget that visible tan lines mean they are, in fact tan.  You should always deny treatment if this is the case. Don’t negotiate. If they are ok with looking like a zebra, then I’m sure there is a laser center that will ignore this contraindication. For the sake of preserving your professional reputation and licensure, you should not.

What to know about Laser Hair Reduction Treatment

Still not entirely sure you understand? That’s because we haven’t gone over the mechanics. Hair grows in phases. The anagen phase of growth is the period of time that a hair is attached to and feeding off of the small capillaries at the base of the follicle. Cells rapidly divide and multiply to add to the hair shaft. There is a concentration of melanin at the root or bulb of the hair that attracts laser energy. That energy converts to heat and cauterizes the small capillaries feeding that follicle. With no nutrition source, the follicle is incapable of producing new hairs. The existing hair pushes through the remaining phases of growth, falls out and no new hairs can grow in its place. At any given time, only about 15-20% of body hair is in its anagen phase of growth, so we have to treat multiple times to get the results we are looking for. If your patient is taking hormones of any kind, it can affect our ability to treat. If they are on antibiotics, it is not safe to treat you until they’ve finished them and been off of them for at least 72 hours. Most antibiotics cause skin to become extremely sensitive to photo stimulation meaning that skin can easily burn if the medication is not out of their system. Darker skin will require lower power levels and longer pulse durations, to ensure that the targeted melanin is in the hair, and not the skin. This unfortunately equates to more treatments.

Scheduling is also a consideration. If your patient wants to have laser treatment so they can enjoy smooth, hair-free skin during bathing suit season, they’ll need to plan ahead. They should expect at least six treatments (no guarantees that it won’t be more, and sometimes it is less). Each treatment will be between 4 and 10 weeks apart depending on the location of the hair. If they do the math, they may need to start in October or November. Be sure that they don’t wax or tweeze prior to their appointments. If they do, there is no point in treating as there is no hair there to target. Do direct patients to shave before they come in for treatment. Laser energy won’t get the job done if it is wasted above the surface of the skin. We need all of the energy to concentrate at the base of the follicle, so clean shaven is best. This includes facial hair. Hair will not come back darker and thicker if you shave it. That is an old wives’ tale. If you need to see where your patient’s hair growth remains, ask him/her not to shave, and supply them with a razor to shave after you’ve seen what still needs to be treated. Some areas are extra sensitive and can be numbed prior to treatment, but make sure your patient doesn’t have lidocaine allergies and plans extra time for the numbing cream to become effective. Taking the time to educate your patient on laser hair reduction will undoubtedly result in their happiness and less frustration for you as their provider.

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