Laser Hair Removal

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Hair removal, also known as epilation, is the intentional removal of body hairs. Various forms of hair removal have been practised in almost all human cultures as early as the stone age, for various cultural, sexual, medical or religious reasons. 

Methods used to remove hairs have varied in different times and regions, including bleaching, plucking, shaving, waxing, threading, chemical depilatories and electrolysis. These methods of hair removal are far from ideal due to the limited and short-term efficacy. There is, therefore, a great demand in the market for efficient long-term hair removal systems.

Since the first FDA-approved laser hair removal device was introduced in 1995, Laser Hair Removal has become one of the most commonly performed cosmetic procedures with over 1 million treatments annually, according to statistics from the American Society for Aesthetic Plastic Surgery. Much of the popularity surrounding Laser hair Removal can be attributed to its efficacy and excellent safety profile, with minimal discomfort and downtime..

Indications for laser hair removal

Most individuals seek laser hair removal for purely aesthetic purposes. Almost everyone has unwanted hair somewhere on their body, that they have grown tired of shaving and/or waxing. Shaving can be a time consuming process, and it has to be done rather regularly. Waxing on the other hand can be downright uncomfortable. These individuals may eventually seek a longer lasting solution that requires much less time and effort, while being more comfortable.

Hirsutism is defined as an androgen-dependent, male pattern of hair distribution in women and is a common disorder estimated to up to 15% of women of reproductive age in the general population. It is a distressing condition, and more than half of hirsute women feel that the unwanted hair growth has an impact on their self esteem. 

Hirsutism can be induced by several drugs, but usually it is a sign of an underlying hormonal disorder such as in the case of Polycystic Ovarian Syndrome. It can also appear without any cause (idiopathic hirsutism) and therefore the treatment approach to hirsutism must be a two-pronged approach, treating the underlying cause and reduction of visible hair.


Certain medical indications like Pseudofolliculitis barbae, pilonidal sinus, and acne keloidalis nuchae can also be addressed with laser hair removal. Over the years, a number of dermatological conditions associated with hair follicular pathology as the primary dysfunction have been successfully treated with Laser hair Removal. These include chronic inflammatory disorders such as pilonidal sinus disease (PSD), hidradenitis suppurativa (HS), dissecting folliculitis, pseudofolliculitis barbae (PFB), and others. These diseases are thought to result from occlusion, rupture, and inflammation of the follicular unit. 

How does laser hair removal work?

The theory of Selective Photothermolysis

Lasers for skin treatment work on the theory of “selective photothermolysis.” This term implies a site-specific, thermally mediated injury of microscopic tissue targets by the selective absorption of pulses of radiation by the targets and the chromophores. The natural or artificial chromophores absorb monochromatic or broadband electromagnetic radiation of specific wavelengths. The chromophore employed in laser hair reduction is melanin. Melanin absorbs light in the range of 690 to 1000 nm, and lasers in this range of wavelengths can be effectively used for hair reduction.

An Extended Theory of Selective Photothermolysis

Target absorption may not always be uniform. In these cases, the weakly absorbing parts may have to be destroyed by heat diffusion from the highly absorbing parts. This is the extended theory of selective photothermolysis. This principle is applied to laser photoablation. Melanin content is much higher in melanin-bearing structures like the hair shaft and matrix cells than in the hair follicle. Thus melanin captures energy from the laser and distributes it to the surrounding follicular structures. This results in the destruction of the hair matrix and hair bulge stem cells.

Can i really expect permanent hair removal?

Candidates for Laser Hair Removal should expect to undergo several treatments in order to achieve optimal results. Because hair growth is asynchronous and laser hair removal is mostly effective for hair follicles in the anagen phase, patients can expect, on average, 20% to 30% permanent hair reduction after one treatment and up to 90% reduction after completing a treatment series. 

Prolonged hair loss can be observed 12 months after the final laser treatment (70%-90% hair reduction)

Puri, N., 2015. Comparative study of diode laser versus neodymium-yttrium aluminum: garnet laser versus intense pulsed light for the treatment of hirsutism. Journal of cutaneous and aesthetic surgery, 8(2), p.97.

How many treatments do i need?

Typically, fair skinned individuals (Fitzpatrick skin types I to III) require a series of six sessions, whereas darker skin (Types IV and V) require eight sessions or even more because treatment fluences are increased more slowly and conservatively over time with darker skin types to minimize the risk of complications.

The hair matrix being sensitive to laser treatment in the anagen phase necessitates multiple treatments to treat all hairs during this most sensitive phase. In the initial phase, 4 to 6 treatments spaced 4 to 6 weeks apart are a minimum to achieve adequate results. Subsequently, patients may be maintained with repeat treatments once every 6 to 12 months as small vellus hair may grow back.

What are the options for laser/light hair removal?

The diode lasers (800-810 nm) are solid-state laser devices that have been very well received over the past several years because of their reliability and their ability to penetrate even deeper into the skin, thus, allowing even darker and perhaps tanned individuals to be successfully treated for epilation of unwanted hair. A comparative study was done of different types of lasers and it was seen that best results were obtained with diode laser followed by alexandrite laser.

The long pulse Neodymium-yttrium aluminum — garnet laser (Nd:YAG laser) can be safely used in all skin types, including tanned patients. Large coverage areas and fast repetition rates allow large areas to be treated quickly. It causes more discomfort during treatment. It is also less effective for fine and light hair than other lasers.

Long Pulsed Alexandrite 755-nm laser is also used worldwide. It is an effective laser with more depth of penetration in comparison to IPL and Nd: YAG lasers. It exerts effect on the hair follicle by applying the principle of selective photothermolysis.

Intense Pulsed Light (IPL) is not actually a laser treatment. IPL energy is produced by a lamp, a little like a light bulb, that produces a spectrum of light waves, meaning that it is more diffuse and less powerful. It is usually limited to use on fairer skin types. The key benefit of the IPL system is its cost-effectiveness. However, compared to laser hair removal treatments, IPL is far less effective for laser hair reduction.

How do I prepare for treatment?

  1. If hormonal changes are suspected, a hormonal evaluation may be necessary to assess causes of hirsutism.
  2. Avoid hair epilation by plucking or waxing for at least 6 weeks before the procedure.
  3. Sunscreens may be prescribed 4 to 6 weeks before the procedure, especially on sun exposed areas.
  4. Shave the area before the procedure. This should be done a day prior to the treatment.

Are there any side effects?

The most common cutaneous reactions include redness, swelling, discomfort and pain. Severe side-effects such as thermal burns, blisters, hyperpigmentation, hypopigmentation and scarring may manifest more frequently in darker-skinned patients but can be avoided or minimised by the selection of safer parameters and an effective cooling process during the session. 

‘Paradoxical hypertrichosis’ is a rare side-effect observed when the laser stimulates the growth of more hairs through a photoactivation of dormant hair follicles into terminal anagen hair phase. It is characterised by the appearance of new hair follicles surrounding the treated areas. This side-effect could be induced by overly conservative treatment parameters, and therefore it can be easily solved by selecting more aggressive parameters during the subsequent sessions

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