Laser-Assisted Hair Removal
The use of lasers for hair removal is a technique that may offer some benefit to selected patients. In most cases, however, hair removal is temporary, and claims of "permanent" hair removal must be interpreted with caution. Long-term comparative data on a variety of available laser devices as well as the outcome of treatment for large numbers of patients is still being accumulated. The American Society for Aesthetic Plastic Surgery (ASAPS) believes it is important for the public to understand that multiple treatments are necessary, not all individuals are potentially good candidates, and there are risks associated with laser-assisted hair removal.
What are lasers?
Laser is an acronym that stands for Light Amplification by the Stimulated Emission of Radiation. Lasers produce intense, concentrated beams of light energy of a single specific wavelength (color) traveling in one direction. Laser systems control and vary the intensity of the light (measured in joules or watts) as well as its duration (measured in pulses). The use of lasers for hair removal is a new application of technology which has been used for more than 20 years by plastic surgeons.
How the laser works to remove hair
Hair reacts to light only during the active "anagen" phase of its growth cycle. For this reason, the laser is effective in causing hair loss only when it penetrates and interrupts the hair follicle during this phase. Hair in other phases of growth (telogen or catagen) will enter its growth cycle later. Therefore, multiple treatments are necessary. The effect of the laser is to reduce the size of the follicle, thwarting hair growth. When regrowth does occur, it is usually thinner, finer, and lighter in color than the original hair. There are two types of laser systems: one targets the body's natural pigment, melanin, found in the hair shaft, and the other targets a laser-absorbing preparation that is applied to the skin being treated.
Ruby, alexandrite, and flashlamp are the three types of energy that are effective upon melanin in hair. All supply a wave length of light that is absorbed by melanin. They are most effective on light-skinned individuals with dark hair. If used on individuals with dark skin, normal skin pigment may be damaged. The primary drawback with these lasers is the lack of effectiveness on very light or white hairs and the limitations of treating tanned or dark skin. Some long-term (2 years or more) hair loss has been reported with some of these systems.
A number of available systems utilize ruby lasers with various methods of delivery. Although these systems are designed to deliver maximum light energy to the follicle with minimum impact on the epidermal skin, there are potential risks of short-term loss of skin color (hypopigmentation) and blistering. Patients with light skin and dark hair have the best outcomes. Patients with light-colored hair are not good candidates for this laser.
In addition to melanin, these lasers also allow absorption by hemoglobin (a red pigment in the red blood cells). One system has the capability to deliver rapid pulses with lengths as short as 20 milliseconds, offering the potential for a more focused hair reaction with decreased injury to the skin.
This system applies a broad band of energy directed to the tissue, generated by a flashlamp rather than a single wavelength of a laser. There have been reports of clinical success with individuals who are not good candidates for other laser treatments because of dark skin pigment or light hair.
Lasers using absorbing preparations
This system requires the application of a carbon-based cream before performing the laser treatment. Because this laser does not act upon the melanin in the hair, light or white hair and moderately dark skin can be treated. Hair reduction has been reported for a period lasting three to six months.
The Nd:YAG utilizes a carbon-based cream to loosen hair from the follicle and was the first type of laser to be FDA-approved for hair removal. Initially, waxing of the area to be treated was thought to enhance the long-term result, but data has not borne this out, and a second-generation device is being developed for use without pretreatment waxing.
The back, shoulders, arms, and legs are areas typically treated with laser light. Areas of the face, such as the upper lip and chin, and the Abikini@ area are other parts of the body that may be "lasered" to remove unwanted hair. Certain areas of the shoulder (deltoid region) and chest (presternal region) should be avoided due to the increased risk of scarring and keloid formation. To protect sensitive areas such as the patient's eyes, appropriate shielding is used.
Localized trauma such as blistering after treatment and short-term hypo- or hyperpigmentation, which usually resolves, may occur. Other rare risks include scarring, keloid formation, and infection (viral, fungal, or bacterial).
Research to determine the safety and efficacy of laser-assisted hair removal continues. It is anticipated that technologic advances ultimately will allow for more uniform application of light energy and more success in treating a wider range of patients (ie those with dark skin and/or light hair).
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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