laser hair reduction

1. Presenter: Dr. Nahida Nabi
POSTGRADUATE DEPARTMENT OF
DERMATOLOGY, VENEREOLOGY AND LEPROSY,
GMC SRINAGAR

2.  The first operating laser, a red beam
generated by the excitation of Ruby crystal by
intense pulses of light from a flash lamp was
produced by Maiman in 1960.This was the
first laser of clinical significance.
 Leon Goldman, father of laser medicine, was
first to use Ruby laser in 1960 for benign
pigmented lesions.

3.  In 1961, first gas laser using mixture of
helium and neon was developed.
Subsequently, in 1961, Nd: YAG laser and in
1962, Argon laser were developed.In 1964,
Patel developed CO2 lasers.
 The use of lasers (photo epilators) as hair
removal first started in 1960s. However,
probably the first therapeutic use was
treatment in patients of trichiasis

4. The first FDA-approved hair removing Nd :
YAG Laser landed up in the United States
market in 1995 which used carbon based
lotion as chromophore.

5.  Depilation and epilation are two ways of hair
removal.
 Epilators remove the hair from their roots
hence have a long lasting effect. Whereas,
depilators though relatively painless but
removes hair from the surface hence lasts for
a shorter duration.

6.  A laser is a device that controls the way that
energized atoms release photons.
 “Laser” is an acronym for light amplification
by stimulated emission of radiation, which
describes how a laser works.

7.  Laser hair removal is the top third most
popular nonsurgical procedure
 Women had more hair removal procedures in
compared to men, however, hair removal still
ranked top third nonsurgical procedure in
both men and women. Men accounted for
about 12% of the total laser hair removal
procedures that were performed.
 Furthermore, individuals 35–50 years of age
had the most number of laser or pulsed light
hair removal procedures.

8.  Mono chromaticity : It contains one specific
wavelength of light
 Coherent: The light released is organized,
 Collimated: The light is uni directional.
 High intensity

10. The basic laser device has following
components :
An active medium or lasing medium,
An optical cavity or resonator, and
An energizing source

11.  The active medium in lasers may be a solid,
liquid, or gas. Different active media emit
different energies or wavelengths of light.
However, they all operate with the same basic
principles.
 The resonator contains an active medium. At
each end of the resonator, parallel reflectors
or mirrors are placed facing each other. The
front of the output mirror is designed to be
partially reflective.

12.  It reflects only a portion of the light
impinging on it, allowing some portion of the
light energy to escape. The rear mirror is a
total reflector that reflects the entire energy
impinging on it.
 The energizing pump provides the energy
(thermal, electrical, or optical) for absorption
by the active medium. When the active
medium is pumped with sufficient energy, a
population inversion occurs, thus causing
spontaneous emission of photons.

15.  There are various chromophores in the skin that
are able to absorb light. The three main
endogenous chromophores in the skin are
melanin, haemoglobin and water. Each of this
chromophore has its own absorption spectrum
and absorption peak.
 Melanin shows a decreasing absorption spectrum
curve ranging from 400 to 1100 nm. The
absorption spectrum of hemoglobin is from 400
to 600 nm, with three absorption peaks. These
absorption peaks can be targeted so as to
minimize absorption by competing
chromophores.

16.  Water shows increasing absorption, starting
from near infrared to far-infrared reaching
maximum absorption peak at 2,940 nm with
another peak close to 10,600 nm
 Ultraviolet and visible light are mainly
absorbed by melanin and hemoglobin, while
infrared light is mainly absorbed by water.

17. Selective Photothermolysis
 The laser for skin treatment works on the
concept of "selective photothermolysis“ that
describes site specific, thermally mediated
injury of microscopic tissue targets by
selectively absorbed pulses of radiation,
where the target and the chromophore
occupy the same area.

18.  At times the target absorption is not uniform
and part of target exhibits no or minimal
absorption whereas other parts exhibit high
absorption. In this case the weakly absorbing
part has to be destroyed by the heat diffusion
from highly absorbing part called the heater
or the absorber.

19.  This principle is used in laser photo epilation.
Here the weak target is the hair follicle and
the highly absorbing areas consist of the
melanin bearing structures like the hair shaft
and matrix cells. It is this theory which
revolutionized the use of laser in hair
removal.

20.  The melanin captures energy from the laser
and dissipates it to the surrounding follicular
tissue destroying the hair matrix and the
bulge area rich in stem cells without
damaging the structure of the skin.
 This is only possible when the hair is in the
anagen stage as the melanosomes are
present maximum during anagen stage

21. The clinical target of laser therapy is the
chromophore, however, in hair reduction the
chromophore and the target are not the
same. The target chromophore in hair
removal is melanin present in hair matrix and
shaft which, can be destroyed by direct
heating, but the stem cells present in the hair
bulge do not contain pigment and are found
at a distance from the pigment containing
target chromophore.

22. If laser light is delivered for nanoseconds,
only melanosomes are targeted leading to
fragmentation of melanin but not hair
reduction. In order to destroy nonpigmented
stem cells, and achieve hair reduction, the
heat must diffuse from the pigmented area
(hair) to the target (bulge).
 The clinical target will therefore be destroyed
by heat diffusion rather than by direct
heating.

23.  TRT is defined as the time required for the
target chromophore to dissipate 63% of its
peak temperature. TRT is directly
proportional to square of the diameter of the
chromophore.

24. This is defined as the time required for the
entire target, including the primary chromo
phore (e.g.,melelanin) and the surrounding
target (e.g., hair follicle), to cool by about
63%

25.  Hair growth has three phases
 Anagen (active)
 Catagen
(regression)
Telogen (resting)
 Growth cycle
 depends on the body part,
 lasts anywhere from 4 to 12 months.
 Hair reduction is considered permanent when a
significant amount of hair does not return for longer
than the complete growth cycle

26.  Power : Watts = joules/seconds
 Energy :Joules = watts × seconds
 Irradiance :Power density = watts/cm2
 Fluence: Joules/cm2
 Wavelength: Nanometers
 Pulse duration: Milliseconds, nanoseconds
 Spot size: Millimeters
 Frequency: Hertz = pulses per second

27.  Wavelengths of laser energy
 Fluence
 Spot size
 Pulse duration or pulse width
 Cooling
 Number of sittings/sessions
 Time interval between treatments

28.  Several wavelengths of laser energy have
been used for hair removal, from visible light
to near infrared radiation depending upon the
lasing medium.
 Ruby laser: 694 nm
 Alexandrite laser: 755 nm
 Nd: YAG laser: 1064nm
 Pulsed Diode array : 810nm

29.  The ideal wavelength is 690-1000 nm as
absorption by competing chromophores for
melanin like water and oxyhemoglobin is less
in this wavelength. Though melanin absorbs
energy at lower wavelengths but greater the
wavelength better the penetration which will
help target melanin in hair follicles rather
than targeting epidermal melanin. Hence,
higher wavelengths should be used in darker
skin types.

32.  Fluence (amount of energy per unit area of target
tissue—joules/cm2) should be high enough to
cause maximum destruction of follicular tissue,
but simultaneously low enough to prevent
epidermal side effects like pigmentary changes,
tissue scarring and burns.
 Thereby an optimal tolerable limit of fluence has
to be used. Fluence can be increased by effective
cooling before, during and after the pulse. Since
lasers with higher wavelength will give better
penetrance, more fluence can be used.

33.  Larger the spot size deeper the penetration.
Spot size determines the area to penetration
to be treated and the depth of penetration.
 At least 5-10 mm size is required for
effective hair removal.
 This means the more effective hair removal,
less is the thermal damage.

34.  Smaller spot sizes are still useful as it gives
higher fluence. The larger the spot size of the
laser beam, the more fluence must be used to
achieve the same result.
 Lasers have limits as to the amount of energy
that can be used with the larger spot sizes.
Also, higher the spot size lesser the time
required for the procedure.

36.  Pulse duration or pulse width is the amount
of time laser energy is applied (ns, ms) or the
duration of exposure of the target to the
EMR.
 Q switched laser's short pulses may induce
thermal destruction of melanosomes, but
may not effectively damage follicular tissue.

37.  Longer pulses will not only heat the
melanosomes gently but also allow thermal
conduction from melanosomes to the
surrounding follicular structure thus ensuring
the effective follicular destruction.
 Thus a longer pulse duration ensures less
epidermal melanosome damage, but more of
follicular damage .The ideal pulse duration in
laser hair removal is approximately 10-50
ms, which lies between the TRT for the
epidermis (3-10 ms) and that for the hair
follicle (40-100 ms).

39.  Better the cooling less the chances of
epidermal injury, more fluence can be used
and thus increasing the efficacy. There are
many cooling options with "in built" cooling
mechanisms like cooled sapphire or copper
window or air cooling to external application
of cryogen spray, cooling jellies, ice pack,
and so on.

40.  Precooling is carried out before laser
treatment in order to reduce or prevent
excess heating of the epidermis during
treatment. It is usually performed by a
cryogen spray, an air cooling device, contact
cooling, or even ice.
 Parallel cooling is performed simultaneously
with laser treatment, by cooling sapphire tips
within the handpiece.

41.  Postcooling helps to extract excess heat from
the tissue in order to prevent post
inflammatory hyperpigmentation. Cooling at
any stage of the treatment reduces pain and
edema.
 Too much cooling of the epidermis may
render laser treatment ineffective. Cryogen
burns or postinflammatory
hyperpigmentation because of aggressive
cooling is a possibility. Hence the proper
balance between the laser energy and cooling
is desirable.

42.  It is the anagen hair that is thought to contain
maximum melanin, hence, a number of
sittings may be required to achieve near
desire results as many hair are present in the
catagen or the telogen stage depending on
the anatomic site. Though there has been no
consensus in spite of numerous studies, a
general rule, 6-10 laser sessions may be
required to achieve longterm epilation.

43.  Wait for re growth
 1 month/2 months (dependent on body location
- face will have shorter time between treatments
than body)
 Take hair growth cycles into consideration

45.  Hair color
 Skin type
 Type of hair
 Hormonal status
 Site of Hair Removal

46.  Light skin (Fitzpatrick skin type I-IV) and
dark hair are an ideal combination for
effective hair removal. Since the chances of
epidermal melanin absorption are less with
higher fluence, short pulse duration can be
used. The absorption is more at the level of
follicular melanin rather than epidermal
melanin thus reducing the chances of
epidermal damage.

47. The anagen hair is more prone to laser
therapy since melanin is present only in
anagen hair. At any given point of time,
almost 10%-15% hair may be catagen or
telogen stage, hence treatment has to be
extended for many months to cover as many
hair follicles in its anagen stage. Terminal
hair being more pigmented respond better
than vellus hair.

48.  Patient should be evaluated for hirsutism by
doing various hormonal assay, especially for
testosterone levels, these may influence the
response to laser therapy

49.  Since there are differences in anagen telogen
ratios in various anatomic sites, hence there
may be difference in response rates.
 Axillae and belt areas respond better than
legs, arms and chest.

50.  Hirsutism and hypertrichosis: Unwanted hair
in women in androgen or non androgen
dependent areas may warrant treatment in
areas like upper lip, chest, and chin.
 Cosmetic: Many individuals have hair
distribution which would be considered
normal, however they may be considered for
hair removal for cosmetic or social
indications.

51.  Therapeutic: for treatment of
pseudofolliculitis barbae, pilonidal sinus,
acne kelodalis nuchae.
 Grafted hair bearing flaps used for
reconstruction may require hair removal for
cosmetic and medical purposes.

52.  Age less than 15 years.
 Patients with history of hypertrophic and
keloidal scarring. This is relative
contraindication and patient can be treated
carefully with lesser fluences.
 Herpes simplex and staphylococcal Infections
in the local site. Patients with a history of
herpes simplex may be given prophylactic
therapy prior to the procedure.

53.  Drugs: patients on aspirin or other
anticoagulant therapy. They may be treated
cautiously by stopping the therapy 10 days
prior to the procedure,
 Patients with too high expectations and
unwilling to cooperate.
 Superficial wounds in the procedure area.
 Patients with psoriasis and vitiligo for the risk
of koebnerization.

54. Preprocedure and Patient Selection
 Adequate history to be taken to rule out
infections like Herpes simplex, hypertrophic
scars, keloidal tendencies, drug intake like
aspirin, anticoagulants, retinoids. Topical
retinoids used in the treatment area should
be stopped 1-2 days prior to laser therapy.
 Physical examination to determine skin type
and hair types to determine the type of
suitable laser and parameters.

55.  Take an informed consent.
 Clinical photographs to keep a record for
evaluation of efficacy of treatment.
 Help patients remember density and diameter of
hair before treatment.
 To quanity hair, modified ferriman galleway scoring
is used.
 One into one cm cardboard window is made,to
calculate the number of hair follicles.
 Mark area to be treated.
 Shave the area a day prior to the procedure.

57.  Counseling the patient is very important to
reduce the high and unrealistic expectations.
The notion of permanent hair removal be
substituted with temporary hair removal or
permanent hair reduction.
 A test patch may be carried out prior to the
procedure to determine appropriate
parameters and to be prepared for any
unwarranted side effects.

58.  Hormonal evaluations should be done in
case.
 Sunscreens can be prescribed 4-6 weeks
prior to procedure, especially in exposed
sites.
 Though bleaching of hair should be avoided,
however hydroquinone can be used in darker
skin types.
 Plucking, waxing or electrolysis of hair for 6
weeks prior to the procedure should be
avoided.

59. Clean the local area with soap and water to
remove other creams, ointments, or makeup.
 Position the patient in a treatment chair or
table so that the desired area is easily
accessible.
 Though the procedure may not be too
painful, but depending upon patient EMLA
cream may be used 30 minutes to one hour
under occlusion prior to the procedure.

60.  The need for topical anesthesia is variable
among patients and anatomic sites. Various
topical anesthetics including lidocaine,
prilocaine, can be used.
 Care should be taken when using lidocaine or
prilocaine to apply these medications to a
limited area to diminish the risk of lidocaine
toxicity or methemoglobulinemia,
respectively.

61.  Deaths have resulted from lidocaine toxicity
resulting from occlusion of the back as well
as lower extremities with topical lidocaine.
 Likewise, systemic toxicity can occur with the
use of any topical anesthetic in large

62.  Secure wrist strap
 Slide and glide
 Allows more rapid coverage on larger areas
 Thin (< 1 mm) layer of gel enables friction-free
movement
 Pattern in gel enables tracking of treated areas
Keep the ChillTip flat on the skin surface and
at a 90o angle
 Inspect and clean tip frequently during
treatment

63.  Selection of appropriate parameters is the key
to success of the therapy. Hence, these
parameters should be individualized
depending upon the skin and hair types and
the type of laser machine.
 The manufacturer provided parameters may
also be referred for this purpose. A record of
the parameters should be kept for
subsequent use in the same patient.

64.  Though latest lasers have in built adequate
cooling mechanism, however, cooling jellies,
ice packs, cryogens should be used during
the procedure.
 Manufacturer provided safety goggles should
be used both for patient as well as operator.
 Presence of metallic/reflecting objects should
be avoided in the near vicinity of the laser
beam so as to avoid any untoward side
effects.

65.  The hand piece should be pressed gently but
firmly perpendicular to the skin so as to
decrease the blood supply to the local area
and also to bring the follicles closer to the
surface.

66.  The patient may be expected to have
perifollicular erythema and edema in the
treatment area and also that the hair may
appear to grow up to weeks even after
treatment.

67.  Look for laser-tissue interaction,
Perifollicular erythema: Initial redness from ChillTip
and pressure decreases, Erythema around treated
hair increases after a few minutes

68.  Perifollicular edema
 Swelling around the follicle (bumps) several minutes
after treatment

69.  It is important to counsel the patient that a
majority of these hairs will likely regrow, and
this isn’t considered a treatment failure.
 Generally, only about 15% of hairs are
permanently removed with each laser
treatment. On the other hand, LHR treatments
with longer pulse durations may leave behind
many hairs that appear to ‘grow’ following
treatment.
 It is important to reassure the patient that
these ‘growing’ hairs are dislodged from the
hair follicle and require 1–2 weeks to be
completely shed.

70.  Topical steroids can be used for a short
duration in case of local erythema and
swelling.
 Use icepacks to minimize local swelling and
pain
 Topical antibiotics may be used in case of any
epidermal injury.
 Avoid sun exposure and use of sunscreens to
be advocated to all patients.

71. Local side effects may be seen post procedure
which includes:
General
 Occular hazard
 Fire hazard
 Electric hazard
 Plume hazard
 Teeth hazard

72.  The 755 nm alexandrite laser, 810 nm diode,
laser and the 1064 nm Nd :YAG laser can
damage the lens and the retina. 2940 nm
Erbium :YAG laser may damage the cornea
and the lens.
 Q-switched alexandrite and Q- switched Nd:
YAG lasers can cause thermal damage as well
as mechanical damage due to photoacoustic
waves. Injury resulting from photoacoustic
waves may culminate in retinal perforation

73.  Ocular injury is a serious complication which
should be prevented. Laser beam cannot be
shielded by the eyelid blink reflex. Laser light
can inflict injury on the cornea and the lens.
 Lasers operating in the infrared spectrum do
not emit visible light necessary to elicit a
blink reflex.
 No treatment within bony orbit of eye (outer
canthus). Treatment of eyebrows not
recommended.

74.  Laser fires may result from ignition of
combustible material in the laser room.
Inflammable materials used during laser
surgical procedure include gauze, towels or
drapes, respiratory devices such as face
masks and nasal cannula. Flammable
materials such as makeup and hair spray
should be washed out prior to the laser
procedure. Alcohol being inflammable should
never be used to clean a laser surgical field.

75.  Ocular protection is mandatory during laser
surgery. Protective eyewear is based on the
wavelengths of light emitted by the laser.
Each pair of laser safety eyewear is
designated with a central wavelength of
rejection, as well as the optical density (OD)
afforded by the lens.
 The OD parameter is defined by the log of
the attenuation of light transmitted through
the lens. Protective laser goggles with an OD
of 4 allow 1/104 of the laser energy to
penetrate. Thus higher the OD value, the
greater is the protection.

76.  Proper wiring and quality electrical fittings
should be used to withstand the high voltage
required by lasers. Regular maintenance and
repairs by trained personnel helps to avoid
the hazard of electrocution.

77.  Surgical smoke or plume is produced when
tissues interact with a heat producing device.
Electrosurgical units and lasers are common
heat generating devices used in dermatology.
Evaluation of plume as a hazard has centered
on its mutagenic capacity and disease
transmission. Plappert et al have found
substances released in CO2 laser pyrolysis of
tissue to be cytotoxic, genotoxic, clastogenic
and mutagenic.

78.  Chemical substances that have been detected
in the laser plume include carbon monoxide,
hydrogen cyanide, ammonia, formaldehyde,
acrolein, toluene, and benzene. Some of
these are respiratory irritants in laboratory
animals, resulting in the development of
pulmonary and bronchiolar inflammation.
Laser procedures using lower irradiance
energies carry the risk of liberating cellular
clumps and red blood cells in the laser
plume. It is believed that laser plume may
harbor greater infectious potential as
compared to electrosurgical smoke.

79.  Dental enamel is vulnerable to ultraviolet and
infrared light. CO2 and Er :YAG pose a
particular threat. Melting and resolidification
of enamel at high fluences and cracking,
charring, flaking, and discoloration at lower
fluences has been reported. This can be
prevented by keeping the mouth closed or by
covering it with a moistened gauze or a
protective mouth piece.

80. Epidermal
 Hyperpigmentation
 Hypopigmentation
 Blister formation
 Milia
 Crusting
Dermal
 Scarring
 Delayed wound healing
 Contact dermatitis
 Purpura
 Postoperative erythema
 Chrysiasis
 Allergic reactions

81.  Provides Permanent Hair Reduction
 Safe and effective on all skin types
 Effective on a broad range of hair colors
 Effective on a broad range of hair diameters

82.  Laser systems include Epilaser/E2000,
Epipulse Ruby, Rubystar. They deliver red
light at a wavelength of 694 nm in the visible
light spectrum through synthetic ruby
crystals.
 It is more effective for light skinned
individuals with dark hair because of high
melanin absorption at this wavelength.

83.  Laser systems include Apogee, Epitouch,
Alex, Gentlelase. With a wavelength of 755
nm, it has greater penetrance and considered
relatively safe in darker skin types.
 Though melanin absorption is relatively less
as compared to the ruby laser, its better
penetrability leads to more energy deposition
at the dermal level leading to better bulbar
destruction.

84.  Many of these complications can be
prevented with adjustment of parameters like
fluence, spot size, wavelength, and use of
appropriate cooling methods.
 Burning, pigmentary changes, erythema ,
and edema can be treated with topical
steroids.

86. The Diode laser systems include SLP 1000, F1
Diode, Light Sheer, MeDioStar, LaserLite,
Epistar, and Apex 800.
It has a longer wavelength (810 nm) than
Ruby and Alexendrite, enabling the light to
penetrate deeper, deliver better fluence, and
also cause less epidermal damage. This is
relatively safer in darker skin type individuals
(V and VI).

87. Before 5 months after 3 Tx

88.  The laser systems include Lyra, CoolGlide,
Yaglase, Image, VascuLight. Though 1064 nm
wavelength delivered by this laser achieves
better penetrability but the melanin
absorption is relatively less.
 With the use of higher fluence and cooling
mechanisms this is an effective hair removal
laser with significantly lesser epidermal
complications. It can be more effectively used
in darker skinned individuals.

90. Before
46 months after last treatment
2 treatments at 30 J/cm2, 30 ms
2 treatments at 40 J/cm2, 30 ms

91. Before 24 months after last treatment
40 J/cm2
Treatments 1-3: 30 ms

92. Before 3 months after last treatment
22 J/cm2
Treatments 1-4: 30 ms

93. Before 4 months after last treatment
22-24 J/cm2
Treatments 1-3: 30 ms

94.  Commonly referred to as “razor bumps”
 Not a true “folliculitis”as name implies.It is
Inflammatory foreign body response to a sharp
hair shaft

95. Study by Fran E. Cook-Bolden, MD
Ethnic Skin Specialty Group
New York, NY, USA
79%
86%0.86
0.84
0.82
0.8
0.78
0.76
0.74
Male Female
Mean % Reduction of Lesions fromBaseline
Female
Male
51

96.  These are high intensity pulses of non coherent
light in a range of 500-1200 nm. Though IPL
works on the same principle as lasers the
difference is the use of monochromatic, coherent
ligh of laser and polychromatic noncoherent light
in IPL.
 With the use of different filters the depth of the
penetration can be altered depending o the
target chromophore. Thus, it may be used in
darker skinned individuals, larger areas can
covered, owing to its larger spot size and has an
advantage of altering the pulse duration to
varying extent.

97. Before 4 months after 3 Tx

98.  Most of the women seeking laser therapy for
unwanted facial hair may suffer from
hirsutistm. It is imperative in such patients
that underlying problem is addressed before
jumping on to the laser therapy. Androgenic
cause can be address to by pharmacological
therapy or surgical modality.

99.  Whereas the removal of unwanted facial hair
can be lone by physical methods like
electrolysis, mechanical methods, laser or
light assisted along with pharmacological
methods. The most common cause of
androgen excess is polycystic ovary
syndrome PCOS), with other causes like
adrenal hyperplasia, androgen secreting
tumors and androgenic drug intake.
 Pharmacological treatment consists of anti
androgens like spironolactone, flutamide
and/or oral contraceptives.

100.  Besides, systemic therapy may also help
reduce unwanted hair even when androgen
levels are normal. Unwanted facial hair can
also be managed with topical eflornithine
cream, which is an irreversible inhibitor of L
ornithine decarboxylase, an enzyme that
catalyzes the conversion of ornithine to
putrescine resulting in slowing the rate of
hair growth.
 The combination of eflornithine with laser is
recommended for patients to achieve faster
and better results, for patients with light hair
and dark skin or for areas like periorbital
where laser is not suitable

101.  Expert working group guidelines suggests
unwanted facial hair in cases which may be
treated with eflornithine in combination with
laser therapy include resistant hirsutism,
paradoxical hypertrichosis, resistant
hypertrichosis, postmenopausal
hypertrichosis, pseudofolliculitis barbae, and
facial hirsutism resulting from PCOS.

102. Laser hair removal is based on targeting
melanin absence of melanin or decreased
melanin often results in failure of treatment.
Goldberg et al have used combined Light
bipolar radiofrequency devices along with the
use of photosensitizers with some success,
suggesting that photosensitizers augment the
effects of combined radio frequency devices in
non pigmented hair reduction.

103.  A recent alternative approach has been
external application of melanin to the hair
through the use of liposomal technology.
 Meladine, a topical melanin chromophore,
has been studied in Europe with interesting
results.

104.  The liposome solution dye, which is sprayed on,
is selectively absorbed by the hair follicle and not
theskin. This gives the follicles a temporary
boost of melanin to optimize laser hair removal
treatments.
 Clinical studies in Europe have shown vast
permanent hair reduction in patients who used
Meladine prior to treatment. However, others
tudies have found Meladine to only offer a delay
of hair growth as opposed to permanent hair
reduction

105.  Pneumatic Skin Flattening is a technique of
reducing pain during the procedure. It works
on gate theory of pain transmission wherein
immediately prior to laser pulse it stimulates
pressure receptors with the help of a vacuum
chamber by generating a negative pressure
and flattening the skin.

106.  Other than laser alternative technologies are
like photodynamic therapy with
aminolevulinic acid and ELOS.
 Photodynamic therapy (PDT) with
aminolevulinic acid (ALA) has been shown in a
small pilot study to result in up to 40% hair
reduction with a single treatment, although
wax epilation was performed prior to
treatment in this study.

107.  Electro optical synergy technology combines
electrical and optical lights. Here first the hair
shaft is heated by laser/light energy, which
then is thought to concentrate the bipolar
radiofrequency energy to the surrounding
hair follicle.
 This has an advantage of the use of lesser
fluence hence less epidermal damage and can
also be effective in poorly pigmented hair.

108.  A new evolution in photoepilation involves
removing nonpigmented hairs such as “peach
fuzz” which the previous lasers fail to
remove. A combination of radiofrequency (RF)
and lasers have been used for white or
blonde hair, but with low efficacy.
 Studies have shown that the combined use of
RF and optical energy has been found to be
successful, though various mechanisms have
been proposed to explain the success

109.  A Traser is not a laser; it is fundamentally
different, and, in many ways, much simpler in
design.
 A Traser utilizes the energy from, for
example, a flashlamp to induce the
spontaneous emission of photons from a
fluorescent dye in solution, or ions
impregnated in a crystal structure. The light
generated can be tuned from UVA to near
infrared (NIR).

110.  Response of hair follicles to this mode of
energy delivery has been studied wherein the
follicular structures were targeted with dye
cell switched to sulphorhodamine 640
chloride, producing a narrow peak of 654nm.
 Single 20ms pulses with a 12mm spot size
and fluences from 14 to 20J/cm2, were fired.
Chest hair was treated with contact cooling.

111.  Clinical and histological punch biopsy at
30mins after hair treatment observations
reflected a clinical end point of perifollicular
edema and transient erythema. Histologically,
the damage was shown to limited to the
target structures.
 Clinical and histological acute phase changes
associated with the use of TRASER has shown
important observations, thus it can be used
as an novel and effective method of hair
removal.

112.  Vacuum gently draws skin into the handpiece,
skin is stretched thin and target is pulled
closer to the energy source.
 Energy is applied to target in which
melanocytes are spread apart and blood flow
is constricted.
 Target is damaged and skin is released.

113.  Advantages Of High-Speed Vacuum Assisted
Technology
 Efficacy: reduction in competing chromophores
enables delivery of laser energy more efficiently.
 Safety: less energy is absorbed by the epidermis
and lower fluence is required since the target is
closer to the energy source.
 Decreased pain: The unique vacuum mechanism
activates tactile and pressure skin receptors to
inhibit the transmission of pain sensation.

115. Skin is cooled before and during
treatment.
Skin is compressed. Laser
beam applied to skin and
target is damaged

116.  Safety: superior epidermal protection is
achieved through ChillTip contact cooling.
 Patient comfort: by continuously cooling the
skin, pain and discomfort are significantly
reduced.
 Efficacy: Compression of the skin rotates
follicle closer to the surface, blenches blood
vessels and reduces competing
chromophores. High fluence enables
treatment of areas requiring precision and
thin, light hair.

117.  Vectus (palomer) is a hair removal system
that uses a diode laser
 It has a large spot size which makes large
areas like back of legs easier to treat
 Large spot size provides efficacious hair
removal due to photon recycling and
increased depth of penetration.
 In a study, 18mm spot size was found more
effective than 12mm spot size.

118.  The original concept of Progressive Photothermolysis is
included in the operation of the diode laser SHR for
photo-epilation
 During treatment, pulse repetition of the laser system SHR
is of 10Hz. Depilation is performed through the
continuous movement of the handpiece over the skin
surface while delivering laser pulses, which prevents
energy from concentrating on a particular point and thus
generating burns due to overheating.
 The relatively long-duration pulse of the laser SHR and its
high repetition frequency, the laser energy penetration is
secondarily increased and reaches deeper into the skin
through a thermal propagation mechanism.

119.  Presently, lasers have been widely accepted
as a hair removal modality and many
publications have reviewed the method,
efficacy, safety of it. Since, there is no
permanent hair removal with lasers, the word
permanent hair reduction has been approved
by the FDA defining it as significant reduction
in number of terminal hairs after a given
treatment, which is more stable for a period
of time longer than the complete growth
cycle of hair follicles at the given body site.

120.  Though a large number of laser systems exist
and there have been different reports as to
the outcome of the procedure, but laser hair
reduction have proven and stood the test of
time in last one decade.
 The results may vary from one patient to the
other and also from one operator to the
other.

121.  The selection of the machine and setting up
of various parameters depending upon the
patient play a major role in the final outcome
of the procedure.
 Advancement in technology may soon find
newer hand held laser devices finding their
way from the markets to patients homes.
How effective will these be and will lasers be
used like razors in the near future, a question
which is probably waiting to be answered.

122.  ROOKS TEXT BOOK OF DERMATOLOGY
 IADVL TEXT BOOK OF DERMATOLOGY
 FITZPATRICK BOOK OF DERMATOLOGY