laser hair removal. is it permanent?

Prof. Osama B Moawad

Energy Based Hair Removal

Human hair growth patterns convey social information about sex,

age, and racial background

Excess Hair

The presence of

excessive hair can be a

source of distress that

can lead to such

psychological problems

as anxiety, depression,

and reduced quality of

life.

Excess Hair

Excess Hair

Hypertrichosis Hirsutism

Hypertrichosis

Hypertrichosis is

defined as hair growth

that is abnormal for the

age, sex, or race of an

individual at any body

site that is not

androgen dependent

Hirsutism

Hirsutism is defined as the abnormal growth of terminal hair in women in male-pattern (androgen-dependent) sites, such as the face and chest

Temporary Methods of Hair

Removal

Bleaching does not

remove the hair follicle,

but it serves to lighten the

color of the external hair

shaft so that it is less

noticeable

Temporary Methods of Hair

Removal

Trimming

Trimming of hair is the

treatment of choice for

young children with

either localized or

generalized

hypertrichosis. It is safe

and does not accelerate

hair regrowth

Temporary Methods of Hair

Removal

Shaving is one of the

oldest and most frequently

used methods of hair

depilation. Contrary to

popular belief, shaving

does not affect the width or

rate of regrowth of

individual hairs

Shaving

Temporary Methods of Hair

Removal

Tweezing or plucking is a

temporary method of

epilation that is used for

small areas of excess hair.

Drawbacks include treatment

discomfort and risk of

folliculitis, pigmentation,

redness, follicular distortion

(which makes subsequent

treatment difficult), and

scarringTweezing

Temporary Methods of Hair Removal

provide

inconsequential

transmission of

electric current

into the follicle

with subsequent

rapid hair

regrowthElectronic

tweezers

Chemical Depilatory

Agents

• act to separate the hair

from its follicle and the

surrounding skin surface

through reduction of

disulfide bonds

• chemical depilatories are

most appropriate for

weekly hair removal from

small areas.

Temporary Methods of Hair Removal

Mechanical epilation

Threading

This method is used extensively in Arabic countries and may produce folliculitis , erythema, andsepigmentary changes

Temporary Methods of Hair Removal

Temporary methods of hair removal

Six weeks of relatively hair-free skin is typically

achieved

SugaringThe non-Western

technique of sugaring is

another temporary hair

removal method.

Sugaring is similar to

waxing except that a

sticky paste isapplied to

the skin instead of

melted wax or acold

polymer. Sugaring is

often preferred for large

surface areas, such as

the back or legs

Temporary Methods of Hair Removal

Energy Based Hair Removal- MSI

Energy Based Hair Removal

Types

Laser

Light

Radiofrequency

Energy Based Hair Removal

Action on Hair

Photothermal destruction through local heating

Photomechanical destruction through the

generation of schock waves

Photochemical destruction through the creation of singlet oxygen radicals

Electrolysis and

Thermolysis

Permanent Methods of Hair Removal

Electrolysis, thermolysis, and a

combination of both are three

popular procedures used for

epilation or permanent hair

removal

All three methods involve the

insertion of a small needle or

probe into the hair follicle

through which an electric

current is delivered, resulting in

the production of a microscar

that s is barely perceptible at the

skin surface

Electrolysis is more effective

on anagen hairs; therefore,

shaving within a few days

before electrolysis greatly

increases its efficacy because

it ensures that only growing

anagen hairs are epilated

Although the combination

treatment is slower, it is

significantly more effective

than the individual use of

each method and is less

painful .

Permanent Methods of Hair Removal

Electrolysis and

Thermolysis

Recently, a home used device

(no, no hair ) uses the principles

of thermal transference to heat

the hair shaft through a

thermodynamic wire. .

Permanent Methods of Hair Removal

Electrolysis and

Thermolysis

Fine Black

Fine Brown

Fine Blond

Thick White

The Radiofrequency (RF) Current is less painful than

waxing or traditional ways of removing hair.

Radiofrequency

It induce micr-scars

Radiofrequency

However these micro-scars with good technique may

be imperceptible

Radiofrequency

Magic Bullets!!

Factors affecting Laser HR

Laser and IPL

Wavelength

Fluence

Pulse duration

Spot size

Cooling

The Recipe of Permanent Hair Removal

1.Appropriate wavelength

.2 Adequate energy (fluence) destroy the follicle

3.Pulse durations 10ms-400ms

4.Spot sizes that maximize laser parameters

5. Sufficient surface cooling

The target chromophore in laser-assisted hair removal is the

melanin rich hair shaft and bulb.

Melanin

Melanin is Major Chromophore

Hair follicles that are less pigmented (blond) as well as

those pigmented with pheomelanin-containing (red)

instead of eumelanin-containing (dark) hair are less

susceptible to photoepilation procedures

Effective Not Effective

Long pulsed alexanadrite 755nm

Long Pulsed and Superlong Pulsed 810nm Diode

Long Pulsed 1064nmNd YAG Laser

Wavelength: The Longer the Safer

Lasers/ light sources with wavelengths of about 600–

1100 nm are absorbed by melanin

The ability to remove hair without damaging the surrounding

skin is based on selective photothermolysis.

Pulse Width: The Shorter the Safer

Q switched Nd:YAG laser, with or without topical carbon

suspension, destroy hair mechanically temporary

No Cooking with ultrashort pulse width

Plus Width: Shorter for thinner, lighter

Shorter pulses, with equivalent fluence, have

achieved superior LHR, particularly when the

hair shafts are lighter and thinner.

Pulse Width: Longer for thicker, Darker

However, to achieve permanent hair reduction, the heat

must diffuse through the entire surrounding tissue of the hair

follicle. The durations in the milliseconds are necessary

To achieve permanent hair

reduction, the heat must

diffuse to the entire

surrounding tissue of the

hair follicle.

Thermal damage to the hair

follicle and surrounding

stem cells reaches its peak

at a pulse duration of 400

msec.

New Recipe for Hair Cooking

Super-long-pulse technology is more safer for the dark skin

New Recipe for Hair Cooking

Super-long Pulsed Technology

The Larger Spot Size

Faster

Deeper

More energy

Comfort Safety Efficacy

Effective Cooling is a Must

Non-laser light sources

Flashlamp-generated intense pulsed light at wavelengths longer than 590 nm

lasers and IPL devices both work quite well for hair removal.

The decision to use an IPL or laser determined by the physician’s bias and familiarity with a specific device

Intense Pulsed Light (IPL)

12/18/2009Hair Removal

40

elos (electro-optical synergy). E. Light

Pulses of bipolar radiofrequency and

pulsed visible light delivered within

the same pulse to reduce intensity

and thus potential side effects.

Skin compression

Pain Reduction

Expels blood

Increasing the amount of light

reaching this region

Pneumatic Skin Flattening (PSF)

Non-laser light sources

A novel, low-

energy, pulsed-light

device for home-

use hair removal

(Silk’n™)

(Silk’n™)

Home Use LHR

Am I a Good Candidate for LHR?

A medication history

screening for hormonal

conditions

Prior staphylococcal or

herpes simplex

keloids or hypertrophic

scars

Endocrine dysfunction

Anatomical region

skin pigmentation

Hair color, thickness

Hair growth cycle

Depth of follicles

Individual Skin or Hair characteristics

Factors affecting LH Results

What Body Area Can Be Treated?

Treatment of Light Hair

The use of elos has cleared 52% of blond hair and a

44% clearance of white hair after four treatments the

18-month follow-up

Photodynamic therapy may provide another option.

Melanin in the epidermis competes with the hair follicle as a

chromophore, potentially leading to side effects

Treatment of Dark

Skin types (IV–VI)

Longer wavelengths

Longer pulse width

Lower Energy

Efficient Cooling

Treatment of Dark Skin Types ( IV–VI)

The Long Pulsed Nd:YAG 1064nm is considered

to be the safest hair removal device in patients

with dark skin

Treatment of Dark skin (IV–VI)

Combined Hair Removal Therapy

Prof Moawad believe that combining two different technology such as E-light

(effective in treating lighter hair) and long pulsed Nd YAG 1064nm (effective in

treating deeper hair follicle in darker skin) is very promising

Avoid plucking, Waxing, or

Electrolysis 2 weeks before

laser therapy .

Shaving and bleaching are

allowed.

Depilatory creams may be

used because the hair shaft

is not absolutely necessary

to hair removal

Prior Your Laser Hair Removal

Session Remember!!!

Is Laser Hair Removal Painful?

Laser treatments for hair removal are generally well

tolerated except in large or sensitive areas topical

anesthetic cream may be applied

Preparation of Laser Hair

Removal

Skin should be cleaned and all makeup and skin

creams removed

The hair is shaved so that the thermal damage occurs in the

follicle as opposed to on the surface of the skin.

All lasers and IPLs used for hair

removal are potent eye hazards

therefore, protective eyewear

should be given to all persons

It is prudent to treat the “unibrow”

away from the eyes.

Lasers and IPLs should not be

used to remove the lower eyebrow

What Areas of the Body

Can be Treated?

Area of unwanted hair is precisely marker

Patient Education

The Recipe for Hair Cooking

Treatment parameters are individualized

Pulses are delivered in a slightly overlapping mode.

The highest tolerable fluence and the largest spot size are used

Vaporization of the hair shaft, perifollicular edema and erythema are good end points

The ideal treatment parameters are individualized for each patient Pulses are delivered in a slightly overlapping mode using

the highest tolerable fleunce with the largest spot size

Patient Education

What Do I Expect Immediately after LHR Light Hair?

The ideal immediate response is vaporization of the hair shaft, is followed a few minutes later by the appearance of perifollicular

edema and erythema.

•Laser-induced perifollicular erythema and edema generally last for minutes to a few hours.

Moderate to severe pain is another indicator that the fluency

may be too high.

The discomfort is described as feeling like a small rubber band snapping against the skin, insertion of fine needles or pin-point heating

IS LASER HAIR REMOVAL PAINFUL?

Cooling mechanisms such as a cooling

plate, spray, or gel protect against

thermal damage of darker skin.

Hair epilation with minimal epidermal

damage is achieved by balancing

thermal destruction with cooling.

Efficient Cooling is essential for safe

laser hair removal in dark skin

Patient Education

Comfort Safety Efficacy

After therapy, patients

should be given ice to

decrease pain and

reduce swelling. Patients

may also be given a mild

corticosteroid cream to

decrease erythema.

Patient Education

Postoperative care

Postoperative care

Antibiotic ointment is

recommended if

epidermal injury is

noted and makeup

may be applied the

Day after

Patient Education

What Can I Expect After ……?

Patient Education

Hair casts will shed the first week of therapy, and this shedding

should not be confused with hair growth

Avoid Sun Exposure and Tanning

Postoperative Care

Patient Education

Before

During

After

Avoid Sun Exposure or Tanning, apply Sunblock, Bleaching ,

Mild steroids and Antibiotics

Patient Education

•Expect 20– 30% hair loss per treatment; as low as a 4% and

as high as a 70% per-treatment

Patient Education

How Much Hair Will Grow Back?

Treatments are spaced 1-3 months apart,

although shorter treatment interval may be more effective

Patient Education

How Soon Will It Grow Back?

Patient Education.

Significant permanent hair reduction according to FDA

definition , may require at least 5-7 treatments

How Many Sessions Do I Need?

Patient Education.

• After

An average, (75% -905) reduction in hair after 5-7 treatment in

patients with dark hair and light skin and may be reduced in

patients with dark skin or with light hair

How Many Sessions Do I Need?

count Color Thickness

Patient Education

How Do My Hair Look after finishing my laser treatment?

What are the Potential Side Effects of LHR?

Pain

Erythema

Perifollicular edema

Pigmentary alterations

Blistering, Crusting and Erosions

Superinfection, and Folliculitis

Pruritis and Urticaria

Poor Technique

Skipped Areas

No Overlapping

Thermal Epidermal Injury

Blisters

High Energy

Thermal Epidermal Injury

High Energy

No Efficient Cooling

Pigmentary Changes

Pigmentary change

Thermal Epidermal Injury

Overlap more than 25%

Conclusion

Rather than being a

simple physics

problem of targeting

pigmented structures

and heating them until

they or adjacent

structures are

destroyed, laser hair

removal relies on a

complex set of

biologic events

following laser

treatment.

Conclusion

‘‘only with a better

understanding of

hair biology and the

histologic evidence

of laser induced

changes that we

will begin to truly

understand the

mechanism of laser

induced hair

removal

Conclusion

Studies have found diode, ruby, and alexandrite

lasers as well as the IPL to be of similar efficacy

Conclusion

The overall cosmetic outcome is determined not only by the

absolute number of hairs, but also by the diameter, length

and color of hairs in the treated area.

ThicknessColor Count

Today there is no evidence for a complete and persistent hair

removal efficacy after laser and photo-epilation.

Additional studies are needed to assess the appropriate

number and timing of treatment sessions in order to obtain

even longer and perhaps permanent hair removal

Moawad Skin

Institute

189

In the end, growth delay is easy, but permanent hair removal is hard, Persistent is Impossible with

Current Technologies