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Laser Hair Removal

Conference Paper · November 2014

DOI: 10.13140/2.1.2589.0887

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Sandeep Arora Arora Gulhima

Army College of Medical Sciences Mehektagul Dermaclinic, New Delhi, India
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 Laser Hair Removal

Gp Capt Sandeep Arora1, Dr Gulhima Arora2

Author affiliations
1. Senior Advisor (Dermatology), Base Hospital Delhi Cantt
2. Consultant dermatologist, Primus Superspecialty Hospital, New Delhi

Introduction
Human hair plays a defining role in our day-to-day life. Dermatologists are uniquely placed
as they manage both sparse as well as excess hair growth. This excessive hair growth
may either be a reflection of the individuals’ race or may be organic in nature. Those
seeking removal of these hair usually have excess growth in undesirable locations, or have
issues arising out of abnormal hair growth patterns on normal skin. Darker skin types such
as ours are more predisposed to complications and hence a thorough understanding of
pathophysiology of excess hair growth as well as their modalities of their treatment must
be understood.

Historical aspects
Traditional hair removal methods of shaving, epilation, waxing and tweezing have been
around for a long time. Radiograph machines were used in the early twentieth century for
removal of facial hair, however with attendant complications. Electrolysis was used for a
fairly long time and has served well depending upon the expertise of the treatment giver.
Advent of medical lasers led to increased research in management of skin disorders
including hair removal. Ohshiro et al1 initially noted the incidental effect of ruby lasers on
hair growth while managing nevi. CO2 laser, Ruby, Alexandrite, Q switched Nd:YAG,
continuous-wave Nd:YAG, long pulse Nd:YAG, Diode and intense pulse light in similar
wavelengths have since then all been used.
Laser and Hair removal - what we need to know
Removal of excessive hair using laser requires an understanding of optical and
physiological (hair cycle) properties of skin. Selective-photothermolysis2 ensures laser
absorption only by the target chromophore and subsequent microscopic damage to the
concerned tissue. The colour of skin and hair as well as hair shaft characteristics play a
role in successful laser hair removal.
Lasers used in hair removal include Ruby, Alexandrite, Diode, long pulse Nd:YAG as well
as Intense Pulse Light sources (not a laser). The treating dermatologist should be aware of
the terms: thermal damage time, thermal relaxation time of the target tissue and
wavelength, pulse, pulse duration, spot size and fluence of the laser in use. The choice of
laser depends upon the skin type and availability of the laser machine, as it may not be
possible to offer all in one centre.
The general rules to follow in laser hair removal are:

• Determine the cause of hirsutism/ hypertrichosis

• Laser hair removal may be initiated along with the above and you do not need to
complete the work up.

• Observe the skin colour type. Longer wavelengths are better suited to darker skin types.

• Consent as in any cosmetic procedure is a must and parameters including photographs

for initial and all follow up sessions must be recorded3.

• Although it is good to start with a low fluence/ test patch, avoid an over cautious
approach/ lower fluencies to prevent compensatory hypertrichosis 4.

• Dark thicker terminal hair are easier targets compared to finer hair. White and grey hair
cannot be targeted by laser alone unless an additional chromogen is used.

• Achieve your realistic end point and stop!

Hair removal devices were required to demonstrate a 30% reduction in hair growth at the
end of three months5. This does not strictly correlate with hair cell cycle, which may differ
in different sites of the body. Although a definite reduction in hair growth is seen with early
sessions, follow up sessions are needed every few weeks to synchronise the anagen
phase, overcome the telogen and the catagen phase as well target the follicles not treated
with single sessions. Seven to ten or more sessions may be needed in selected patients.
Indications of laser hair removal the author has encountered included hirsutism especially
on account of polycystic ovarian syndrome, hypertrichosis, pseudofolliculitis, and recurrent
pilonidal sinus and faun tail nevi apart from the usual cosmetic indications.
Contraindications include strong history of post inflammatory hyper-pigmentation, history of
keloid or hypertrophic scarring, herpes simplex infections, photosensitive disorders or on
intake of known photosensitizing drugs. It is best deferred during pregnancy.
Complications of laser hair removal include pain, pigmentary changes both hypo-
pigmentation and hyper-pigmentation, burns, scarring and textural changes.

Infrastructure and Setup

Procuring and installing a laser hair removal device must be done after preparing a set up
fit to receive the machine6. A stand-alone room/ chamber with opaque partitions is a must.
A fire point must be handy. In an Armed Forces setup the following issues must be
addressed:

• Since the treatment offered is free, who all will be offered treatment? Cosmetic
indications may soon outweigh those on treatment for hirsutism in whom laser hair
removal has been offered as an adjunct.

• Whole body hair removal session can last anywhere between two to three hours! Will
laser hair removal be offered only for face/neck/arms or exposed areas; etc need to be
specified in a standard operating protocol depending upon the patient load of the centre.

• Who is going to administer the laser session? Typically in a civil set up the trained and
certified laser technician should administer based on parameters provided by the
dermatologist/ aesthetic medicine provider under their supervision. The authors over the
past six years has trained female attendants (nursing staff) provided to his laser centres
for administering the sessions. The author himself treats face.

Conclusion
Laser hair removal is no longer a forte of ‘state-of-the-art’ centres. All dermatology centres
may soon be equipped with facilities of laser hair removal. However, despite our
theoretical knowledge about laser hair removal, issues remain unresolved. Treatment
parameters laid out are generalized and need to be more patient specific rather than
machine specific. This fact is complicated in darker skin types where the chances of side
effects are more. The same patient may respond variably to same parameters in different
 sessions since hair follicle energy absorption may vary with the phase of hair cycle. The
paper at this conference shall attempt to clear the air and put forth recommendations
based on the author’s experience.

References
1. Ohshiro T, Maruyama Y. The ruby and argon lasers in the treatment of naevi. Ann
Acad Med Singapore. 1983;12:388-95
2. Patil Uddhav A, Lakshyajit D. Dhami. “Overview of Lasers.” Indian Journal of Plastic
Surgery  : Official Publication of the Association of Plastic Surgeons of India 2008;
41. S101–S113.
3. Goldberg DJ. LASERS and the LAW: what the dermatologist needs to know. Semin
Cutan Med Surg. 2013;32:205-8.
4. Desai S, Mahmoud BH, Bhatia AC, Hamzavi IH. Paradoxical hypertrichosis after
laser therapy: a review. Dermatol Surg. 2010;36:291-8
5. Goldberg DJ. Laser hair removal. Dermatol Clin 2002;20:561-7
6. Buddhadev RM. Standard guidelines of care: Laser and IPL hair reduction. Indian J
Dermatol Venereol Leprol 2008;74, Suppl S1:68-74

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