Laser Hair Removal important facts

Depending on the laser or light used, you and therefore the technician will got to wear appropriate eye protection. it’ll even be necessary to guard the outer layers of your skin with a chilly gel or special cooling device. this may help the laser light penetrate the skin.

Next, the technician will provides a pulse of sunshine to the treatment area and watch the world for several minutes to form sure the simplest settings were used and to see for bad reactions.

When the procedure is completed, you’ll tend ice packs, anti-inflammatory creams or lotions, or cold water to ease any discomfort. you’ll schedule your next treatment four to 6 weeks later. you will get treatments until hair stops growing.

The demand for safe, long-lasting, and effective hair reduction for aesthetic also as medical indications is on the increase . a spread of options for hair removal are available, like epilation by plucking or waxing, depilation by shaving, chemical depilatories, electrolysis, eflornithine cream, and laser and intense pulsed light (IPL) systems. a spread of lasers and IPL systems are available and are the simplest option for long-term hair reduction. This activity describes the various lasers, their indications, contraindications and complications and highlights the role of the inter professional team in educating patients who want to undergo hair removal.

Objectives:

• Describe the various lasers used for hair removal.
• Review the indications for laser hair removal.
• Summarize the complications of laser hair removal.
• Outline inter professional team strategies for improving care coordination and communication to advance care bundle approaches for hair removal with the laser and improving outcomes.

Introduction

The demand for safe, long-lasting, and effective hair reduction for aesthetic also as medical indications is on the increase . a spread of options for hair removal are available, like epilation by plucking or waxing, depilation by shaving, chemical depilatories, electrolysis, eflornithine cream, and laser and intense pulsed light (IPL) systems. a spread of lasers and IPL systems are available and are the foremost effective options for long-term hair reduction. The mechanism of action of those systems is that the targeting melanin within the hair shaft, follicular epithelium, and hair matrix by emitting light with wavelengths starting from 600 to 1200 nanometers (nm), because those wavelengths are selectively absorbed by melanin.

Anatomy and Physiology

Lasers for skin treatment work on the idea 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 therefore the chromophores. The natural or artificial chromophores absorb monochromatic or broadband electromagnetic wave of specific wavelengths. The chromophore employed in laser hair reduction is melanin. Melanin absorbs light within the range of 300 to 1200 nm, and lasers during this range of wavelengths are often effectively used for hair reduction.

An Extended Theory of Selective Photothermolysis

Target absorption might not always be uniform. In these cases, the weakly absorbing parts may need to be destroyed by heat diffusion from the highly absorbing parts. this is often the “extended theory of selective photothermolysis.” This principle is applied to laser photoablation. Melanin content is far higher in melanin-bearing structures just like the hair shaft and matrix cells than within the follicle . Thus melanin captures energy from the laser and distributes it to the encompassing follicular structures. This leads to the destruction of the hair matrix and hair bulge stem cells.

Indications

1. Hirsutism and hypertrichosis
2. Aesthetic purposes
3. Medical indications like pseudofolliculitis barbae, pilonidal sinus, and acne keloidalis nuchae

Equipment

Lasers for hair reduction include the following:

1. Ruby Laser (694 nm) – Red light is delivered through synthetic ruby crystals, simpler for lighter skin types with dark hair (skin types I-III*)
2. Alexandrite Laser (755 nm) – Greater penetrance, good for lighter hair (skin types I-III)
3. Diode Laser (810 nm) – Penetrates deeper, delivers better fluence, less epidermal damage, safer in darker skin (skin types I-V)
4. Neodymium-doped Yttrium-Aluminium-Garnet (Nd: YAG) Laser (1064 nm) – Better penetration, less epidermal damage, relatively less melanin absorption (skin types I-VI)
5. Intense Pulse Light (IPL) or Broadband Light (BBL) (500-1200 nm) – High-intensity pulses of polychromatic, non-coherent light are delivered by a flash-lamp; various filters allow the narrowing of the emitted wavelength band, are often used on darker skin, larger areas are often covered thanks to its larger spot size, less costly than a real laser but not as effective.

* Fitzpatrick Skin Types

• I- Pale white skin, blue/green eyes, blond/red hair; always burns, doesn’t tan
• II- Fair skin, blue eyes; burns easily, tans poorly
• III- Darker white skin; tans after the initial burn
• IV- brown skin; burns minimally, tans easily
• V- Brown skin; rarely burns, tans darkly easily
• VI- Dark brown or black skin; never burns, always tans darkly

Preparation

1. Detailed clinical history to rule out infections, drug intake, etc.
2. Hormonal evaluation to assess causes of hirsutism.
3. Counsel the patient to manage expectations. It must be stressed that the procedure provides permanent hair reduction instead of removal.
4. Evaluate skin and hair types to settle on the proper laser and parameters.
5. Avoid hair epilation by plucking or waxing for six weeks before the procedure.
6. Sunscreens could also be prescribed 4 to six weeks before the procedure, especially on exposed areas.
7. Pre-procedure photographs, with due consent, to take care of a record for evaluation of treatment response.
8. Shave the world long enough before the procedure to permit a small stubble to develop; this may provide enough of a target for the laser without absorbing an excessive amount of energy within the hair shaft itself.
9. Obtain an consent .
10. If need be, a local anesthetic cream could also be applied one-half to at least one hour before the procedure

Technique

1. Clean the world to get rid of oils from the skin
2. Position the patient comfortably.
3. Use eye protection for both the operator and therefore the patient.
4. Avoid reflecting surfaces or metallic objects near the laser.
5. Individualize the parameters to every patient’s skin and hair type and therefore the sort of laser getting used .
6. Place the handpiece perpendicular to the skin. make sure that it’s pressed down gently but firmly to bring the follicles on the brink of the surface and temporarily decrease the blood supply to the treatment area.
7. Perifollicular edema and erythema is an expected side effect, and this must be explained to the patient before the procedure.

Post-Procedure Care

1. Although most machines have inbuilt cooling systems, ice packs or cooling agents could also be used post-procedure to attenuate pain and swelling.
2. just in case of inadvertent epidermal injury, topical antibiotics could also be used.
3. Strict sun protection and therefore the use of sunscreens may be a must.
4. Topical steroid creams could also be prescribed to attenuate erythema and swelling.

The hair matrix is merely sensitive to laser treatment during the anagen phase of the hair growth cycle; therefore multiple treatments are going to be necessary so as to deal with all hair follicles once they are most sensitive to treatment. within the initial phase of hair removal therapy, 4 to six sessions spaced 4 to six weeks apart are the minimum required to realize adequate results. Subsequently, patients may have maintenance treatments once every 6 to 12 months as small vellus hair may grow back.

Various factors may affect the result , such as:

1. Hair location (axillary and bush respond better than hair on the extremities and chest)
2. Skin and hair color (light skin of Fitzpatrick skin types I-IV with dark hair achieve the simplest results thanks to the shortage of melanin within the skin and therefore the abundance of melanin to soak up laser energy within the hair follicles)
3. Hair growth stage (anagen hair being most sensitive)
4. Laser type
5. Hormonal status
6. Treatment plan

Complications

Adjacent epidermal structures aside from melanin within the hair bulb can compete for absorption, and should cause laser energy to be absorbed by pigment within the epidermis. This hampers the effectiveness of the treatment and causes adverse effects thanks to adjacent epithelial damage.

Common adverse effects of laser or IPL-based hair removal include post-treatment erythema, pain, and burning.

More severe adverse effects include blistering, crusting, dyspigmentation, purpura, and sometimes scarring. Ocular complications thanks to injury could also be seen. Paradoxical hypertrichosis may rarely occur, more commonly in skin type III and with the utilization of IPL systems.

Clinical Significance

Selecting the right lasers with the acceptable parameters, individualized to every patient, is extremely important, particularly in patients with intrinsically dark skin. Most complications are preventable when adequate precautions are crazy adjustment of the fluence, spot size, wavelength, and therefore the use of appropriate cooling. Thus, it’s all the more important that trained personnel with a radical knowledge of the mechanisms, techniques, and complications perform these procedures.

Enhancing Healthcare Team Outcomes

Laser hair removal is performed by many healthcare workers including nurses, dermatologists, plastic surgeons, medical care providers and other cosmetic surgeons. Unfortunately, due to lack of oversight, complications are common during this procedure. to form matters worse, patients are often given unrealistic expectations. The key’s to use the right laser, especially in dark skinned individuals. Common adverse effects of laser or IPL-based hair removal include post-treatment erythema, pain, and burning. More severe adverse effects include blistering, crusting, dyspigmentation, purpura, and sometimes, scarring. Ocular complications thanks to injury could also be seen. Paradoxical hypertrichosis may rarely occur, more commonly in skin type III and with the utilization of IPL systems.

Overall, lasers can remove hair but rarely does the procedure provide a permanent cure for hair growth. retouch maintenance treatments are required for many patients within the future .