American Journal of Clinical Dermatology

, Volume 3, Issue 2, pp 107–115 | Cite as

Laser Hair Removal

Guidelines for Management
Review Article

Abstract

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.

References

  1. 1.
    Richards R.N., Meharg G. Electrolysis: observation from 13 years and 140,000 hours of experience. J Am Acad Dermatol 1995; 33: 662–6PubMedCrossRefGoogle Scholar
  2. 2.
    Wagner R.F., Tomich J.M., Grande D.J. Electrolysis and thermolysis for permanent hair removal. J Am Acad Dermatol 1985; 3: 441–9CrossRefGoogle Scholar
  3. 3.
    Gorgu M., Aslan G., Akoz T., et al. Comparison of Alexandrite laser and electrolysis for hair removal. Dermatol Surg 2000; 26: 37–41PubMedCrossRefGoogle Scholar
  4. 4.
    Anderson R.R., Parrish J.A. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220: 524–7PubMedCrossRefGoogle Scholar
  5. 5.
    Boulnois J.L. Photophysical processes in recent medical laser development: a review. Lasers Med Sci 1986; 1: 47–66CrossRefGoogle Scholar
  6. 6.
    Anderson R.R., Parrish J.A. The optics of human skin. J Invest Dermatol 1981; 77: 13–9PubMedCrossRefGoogle Scholar
  7. 7.
    Solomon M.P. Hair removal using the long-pulsed ruby laser. Ann Plast Surg 1998; 41: 1–6PubMedCrossRefGoogle Scholar
  8. 8.
    Liew S.H., Grobbelaar A.O., Gault D.T., et al. Ruby laser-assisted hair removal: repeated treatments and clinical efficacy. Eur J Plast Surg 2000; 23: 121–6CrossRefGoogle Scholar
  9. 9.
    Raulin C., Greve B. Temporary hair loss using the long-pulsed alexandrite laser at 20 milliseconds. Eur J Dermatol 2000; 10: 103–6PubMedGoogle Scholar
  10. 10.
    Grossman M.C., Dierickx C., Fanelli W., et al. Damage to hair follicles by normalmode ruby laser irradiation. J Am Acad Dermatol 1996; 35: 889–94PubMedCrossRefGoogle Scholar
  11. 11.
    Gault D.T., Grobbelaar A.O., Grover R., et al. The removal of unwanted hair using a ruby laser. Br J Plast Surg 1999; 52: 173–7PubMedCrossRefGoogle Scholar
  12. 12.
    Bjerring P., Zacharia H., Lybecker H., et al. Evaluation of the free-running ruby laser for hair removal-a retrospective study. Acta Derm Venereol (Stockh) 1998; 78: 48–51CrossRefGoogle Scholar
  13. 13.
    Lask G., Elman M., Slatkine M., et al. Laser-assisted hair removal by selective photothermolysis: preliminary results. Dermatol Surg 1997; 23: 737–9PubMedCrossRefGoogle Scholar
  14. 14.
    Williams R., Havoonjian H., Isagholian K., et al. A clinical study of hair removal using the long-pulsed ruby laser. Dermatol Surg 1998; 24: 837–42PubMedCrossRefGoogle Scholar
  15. 15.
    Polderman M.C.A., Pavel S., Le Cessie S., et al. Efficacy, tolerability, and safety of a long-pulsed ruby laser system in the removal of unwanted hair. Dermatol Surg 2000; 26: 240–3PubMedCrossRefGoogle Scholar
  16. 16.
    Williams R.M., Christian M.M., Moy R.L. Hair removal using the long-pulsed ruby laser. Dermatol Clin 1999; 17: 367–72PubMedCrossRefGoogle Scholar
  17. 17.
    Wimmershoff M.B., Scherer K., Lorenz S., et al. Hair removal using a 5 msec long-pulsed ruby laser. Dermatol Surg 2000; 26: 205–9PubMedCrossRefGoogle Scholar
  18. 18.
    Finkel B., Eliezri Y.D., Waldman A., et al. Pulsed Alexandrite laser technology for non-invasive hair removal. J Clin Laser Med Surg 1997; 15: 225–9PubMedGoogle Scholar
  19. 19.
    Connolly C.S., Paolini L. Study reveals successful removal of unwanted hair with LPIR laser. Cosmet Dermatol 1997; 10: 38–40Google Scholar
  20. 20.
    Garcia C., Alamoudi H., Nakib M., et al. Alexandrite laser hair removal is safe for Fitzpatrick skin types IV-VI. Dermatol Surg 2000; 26: 130–4PubMedCrossRefGoogle Scholar
  21. 21.
    Nanni C., Alster T.S. Long-pulsed alexandrite laser assisted hair removal at 5, 10 and 20 millisecond pulse durations. Lasers Surg Med 1999; 24: 332–7PubMedCrossRefGoogle Scholar
  22. 22.
    McDaniel D.H., Lord J., Ash K., et al. Laser hair removal: a review and report on the use of the long-pulsed alexandrite laser for hair reduction of the upper lip, leg, back and bikini region. Dermatol Surg 1999; 25: 425–43PubMedCrossRefGoogle Scholar
  23. 23.
    Goldberg D.J., Ahkami R. Evaluation comparing multiple treatments with a 2 msec and 10 msec Alexandrite laser for hair removal. Lasers Surg Med 1999; 25: 223–8PubMedCrossRefGoogle Scholar
  24. 24.
    Lou W.W., Quintana A.T., Geronemus R.G., et al. Prospective study of hair reduction with diode laser (800 nm) with long-term follow-up. Dermatol Surg 2000; 26: 428–32PubMedCrossRefGoogle Scholar
  25. 25.
    Campos V.B., Dierickx C.C., Farinelli W.A., et al. Hair removal with an 800 nm pulsed diode laser. J Am Acad Dermatol 2000; 43: 442–7PubMedCrossRefGoogle Scholar
  26. 26.
    Goldberg D.J., Littler C.M., Wheeland R.G. Topical suspension-assisted Q-switched Nd:YAG laser hair removal. Dermatol Surg 1997; 23: 741–5PubMedCrossRefGoogle Scholar
  27. 27.
    Nanni C.A., Alster T.S. Optimising treatment parameters for hair removal using a topical carbon-based solution and 1064-nm Q-switched Neodymium:YAG laser energy. Arch Dermatol 1997; 133: 1546–9PubMedCrossRefGoogle Scholar
  28. 28.
    Liew S.H., Gault D.T. Laser-assisted hair removal at 1064 nm without added chromophore. Br J Plast Surg 1999; 5: 419–20Google Scholar
  29. 29.
    Goldberg D.J., Samady J.A. Evaluation of a long-pulsed Q-switched Nd:YAG laser for hair removal. Dermatol Surg 2000; 26: 109–13PubMedCrossRefGoogle Scholar
  30. 30.
    Gold M.H., Bell M.W., Foster T.D., et al. Long-term epilation using the epilight broad band, intense pulsed light hair removal system. J Dermatol Surg 1997; 23: 909–13CrossRefGoogle Scholar
  31. 31.
    Fitzpatrick R.F., Goldman M.P., Sriprachyaanut S. Hair removal utilising the ESC Epilight device abstract]. Am Soc Laser Med Surg 1997; 9 Suppl.: 36Google Scholar
  32. 32.
    Weiss R.A., Weiss M.A., Marwaha S., et al. Hair removal with a non-coherent filtered flashlamp pulsed light source abstract]. Am Soc Laser Med Surg 1998; 10 Suppl.: 40.Google Scholar
  33. 33.
    Smith S.R., Tse Y., Adsit S.K., et al. Long-term results of hair photo-epilation abstract]. Am Soc Laser Med Surg 1998; 43 Suppl.: 43Google Scholar
  34. 34.
    Tse Y. Hair removal using a pulsed-intense light source. Dermatol Clin 1999; 17: 373–85PubMedCrossRefGoogle Scholar
  35. 35.
    Schroeter C.A., Raulin C., Thurlimann W., et al. Hair removal in 40 hirsute women with an intense laser-like light source. Eur J Dermatol 1999; 9: 374–9PubMedGoogle Scholar
  36. 36.
    Nanni C.A., Alster T.S. Efficacy of multiple hair removal sessions using the Qswitched Nd:YAG, long pulsed ruby and long pulsed alexandrite laser systems abstract]. Lasers Surg Med 1998; 10 Suppl.: 40Google Scholar
  37. 37.
    Kilmer S.L., Chotzen V., Calkin J. Hair removal study comparing the Q-switched Nd:YAG and long pulsed ruby and Alexandrite lasers abstract]. Lasers Surg Med 1998; 10 Suppl.: 43Google Scholar
  38. 38.
    Liew S.H., Gault D.T. Clinical comparison of the ruby, Alexandrite and Nd:YAG (Medlite IV) lasers in removing unwanted body hair-a preliminary report. Cosmetic Dermatol 2000; 13: 17–9Google Scholar
  39. 39.
    Dover G.F., Shepard R.S., Paul B.S., et al. Organelle-specific injury to melanin-containing cells in human skin by pulsed laser irradiation. Lab Invest 1983; 49: 680–5Google Scholar
  40. 40.
    Polla L.L., Margolis R.J., Dover J.S., et al. Melanosomes are a primary target of Q-switched ruby laser irradiation in guinea pig skin. Soc Invest Dermatol 1987; 89: 281–6CrossRefGoogle Scholar
  41. 41.
    Dover J.S., Margolis R.J., Polla L.L., et al. Pigmented guinea pig skin irradiated with Q-switched ruby laser pulses: morphologic and histologic findings. Arch Dermatol 1989; 125: 43–9PubMedCrossRefGoogle Scholar
  42. 42.
    Hruza G.J., Dover J.S., Flotte T.J. Q-switched ruby laser irradiation of normal human skin: histological and ultrastructural findings. Arch Dermatol 1991; 127: 1799–805PubMedCrossRefGoogle Scholar
  43. 43.
    Kopera D., Hohenleutner U., Stolz W., et al. Ex-vivo quality-switched ruby laser irradiation of cutaneous melanocytic lesions: persistence of S-100, HMB-45 and Masson-positive cells. Dermatology 1997; 194: 344–50PubMedCrossRefGoogle Scholar
  44. 44.
    Liew S.H., Ladhani K., Grobbelaar A.O., et al. Ruby laser-assisted hair removal: success in relation to anatomical factors and melanin content of hair follicles. Plast Recons Surg 1999; 103: 1736–43CrossRefGoogle Scholar
  45. 45.
    Lin T.Y.D., Manuskiatti W., Dierickx C.C., et al. Hair growth cycle affects hair follicle destruction by ruby laser pulses. J Invest Dermatol 1998; 111: 107–13PubMedCrossRefGoogle Scholar
  46. 46.
    Liew S.H., Cerio R., Sarathchandra P., et al. Ruby laser-assisted hair removal: an ultrastructural evaluation of cutaneous damage. Br J Plast Surg 1999; 52: 636–43PubMedCrossRefGoogle Scholar
  47. 47.
    McCoy S., Evans A., James C. Histological study of hair follicles treated with a 3 msec pulsed ruby laser. Lasers Surg Med 1999; 24: 142–50PubMedCrossRefGoogle Scholar
  48. 48.
    Omi T., Honda M., Yamamoto K., et al. Histological effects of ruby laser hair removal in Japanese patients. Lasers Surg Med 1999; 25: 451–5PubMedCrossRefGoogle Scholar
  49. 49.
    Anderson R.R. Laser tissue interactions. In: Goldman M.P., Fitzpatrick R.E., editors. Cutaneous laser surgery: the art and science of selective photothermolysis. St. Louis: Mosby Year Book Inc., 1984: 1–18Google Scholar
  50. 50.
    Liew S.H., Grobbelaar A.O., Gault D.T., et al. The effect of ruby laser light on ex-vivo hair follicles: clinical implications. Ann Plast Surg 1999; 42: 249–54PubMedCrossRefGoogle Scholar
  51. 51.
    Liew S.H., Grobbelaar A.O., Gault D.T., et al. The effect of ruby laser light on cellular proliferation of epidermal cells. Ann Plast Surg 1999; 43: 519–22PubMedCrossRefGoogle Scholar
  52. 52.
    Tong A.K.F., Tan O.T., Boll J., et al. Ultrastructure: effects of melanin pigment on target specificity using a pulsed dye laser (577 nm). J Invest Dermatol 1987; 88: 747–52PubMedCrossRefGoogle Scholar
  53. 53.
    Kolinko V.G., Littler C.M., Cole A. Influence of the anagen: telogen ratio on qswitched Nd:YAG laser hair removal efficacy. Lasers Surg Med 2000; 26: 33–40PubMedCrossRefGoogle Scholar
  54. 54.
    Liew 6S.H., Grobbelaar A.O., Gault D.T., et al. Ruby laser-assisted hair removal correlation of efficacy with the growth cycle of human hair. Eur J Plast Surg 2000; 23: 127–31CrossRefGoogle Scholar
  55. 55.
    Haedersdal M., Egekvist H., Efsen J., et al. Skin pigmentation nd textural changes after hair removal with the normal mode ruby laser. Acta Derm Venereol 1999; 79: 465–8PubMedCrossRefGoogle Scholar
  56. 56.
    Manuskiatti W., Diereckx C.C., Gonzalez S., et al. Laser hair removal affects sebaceous glands and sebum secretion: a pilot study. J Am Acad Dermatol 1999; 41: 176–80PubMedCrossRefGoogle Scholar
  57. 57.
    Liew S.H., Grobbelaar A.O., Gault D.T., et al. Ruby laser hair removal: clinical efficacy in Fitzpatrick skin type I-V and histological changes in epidermal melanocytes. Br J Dermatol 1999; 140: 1105–9PubMedCrossRefGoogle Scholar
  58. 58.
    Menon I.R., Persad S., Ranadive N.S., et al. Role of superoxide and hydrogen peroxide in cell lysis during irradiation of in-vitro Ehrlich ascitic carcinoma cells in the presence of melanin. Can J Biochem Cell Biol 1985; 63: 278–83PubMedCrossRefGoogle Scholar
  59. 59.
    Sarna T., Sealy R.C. Free radicals from eumelanin: quantum yields and wavelength dependence. Arch Biochem Biophysics 1984; 232: 574–8CrossRefGoogle Scholar
  60. 60.
    Chedekel M.R., Agin P.P., Sayre R.M. Photochemistry of pheomelanin: action spectrum for superoxide production. Photochem Photobiol 1980; 34: 553–5CrossRefGoogle Scholar
  61. 61.
    Marks F., Furstenberger G., Heinzelmann T., et al. Mechanisms in tumour promotion: guidance for risk assessment and cancer chemoprevention. Toxicol Lett 1995; 82/83: 907–17PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Institute of Plastic SurgeryMount Vernon Hospital, NorthwoodMiddlesexUK

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