Hair Removal laserHair Removal laser

Dr. Alireza Vaez Dr. Alireza Vaez ShooshtariShooshtari

DermatologistDermatologist

Hair RemovalHair Removal

•ElectrolysisElectrolysis

•CreamsCreams

•LaserLaser

Laser Hair ReductionLaser Hair Reduction

Epidermis: 40 - 150 microns

Dermis: 140 - 400 microns

E & D: 180 >/= 550 microns

1.Papilla: neurovascular tuft

2. Bulge: at Erector Pili

3.Matrix cells:>= 2 mm

Anagen> Catogen> Telogen

Target IsolationTarget Isolation

• Can we target over other similar targets?Can we target over other similar targets?

(Can we seek melanin in hair over skin?)(Can we seek melanin in hair over skin?)

Selective Selective PhotothermolysisPhotothermolysis

What is the Target ?What is the Target ?

• EumelaninEumelanin: : brown or black hairbrown or black hair Best absorption of lightBest absorption of light

• PheoPheomelaninmelanin: : red or blond red or blond hairhair

Poor absorptionPoor absorption

• Gray hairGray hair: : pigment-freepigment-freeWhite hair White hair

No absorptionNo absorption

Hair Removal LasersHair Removal Lasers

• Nd:YAGNd:YAG 10641064 nm nm• FlashlampFlashlamp575/ 515-1200575/ 515-1200 nmnm• DiodeDiode 800/810800/810 nmnm• AlexandriteAlexandrite 755755 nmnm• RubyRuby 694694 nmnm

Relative Absorption of Laser Relative Absorption of Laser LightLight & Competing Chromophores & Competing Chromophores

1064nm

FeaturesFeatures

Wavelength: Wavelength: nmnmPower: Power: wattswattsFluence:Fluence: power/cm2power/cm2Spotsize: Spotsize: mmmmOverlap: Overlap: %%Pulsetime: Pulsetime: msmsPulse interval: Pulse interval: ms or ms or freqfreq

Keys for successKeys for success

•Wavelength: >690 nm (>wavelength=depth)Wavelength: >690 nm (>wavelength=depth) (shorter -> competing (shorter -> competing

chromophores)chromophores)

•Spot size: at least 5 millimetersSpot size: at least 5 millimeters

•Pulse time: 18 or > millisecondsPulse time: 18 or > milliseconds

•Pulse interval of 35 or > millisecondsPulse interval of 35 or > milliseconds

When do you treat?When do you treat?

• During Anagen cycleDuring Anagen cycle

• Not during telogenNot during telogen

• Cycle time determined by Cycle time determined by

Richard-Merhag chartRichard-Merhag chart

Richards-MerhagRichards-Merhag

Fitzpatrick TypesFitzpatrick Types

OK: Fitzparick IV/VI: Nd-YAG

non-confluent scanner

>15 ms

Continuous cooling

ConsultationConsultation• Patient history( mense, PCO, Patient history( mense, PCO,

other sign)other sign)

• Any previous hair methodsAny previous hair methods

• ExpectationsExpectations

• Treatment Treatment explanationexplanation3-6 session, 1-2 month apart3-6 session, 1-2 month apart

20-30% reduction per session 20-30% reduction per session

70-80% long term reduction70-80% long term reduction

• Photographs & ConsentPhotographs & Consent

ContraindicationsContraindications

• PregnancyPregnancy

• Recent sun exposureRecent sun exposure

• Sun tanSun tan

• Suspicious lesionsSuspicious lesions

Before TreatmentBefore Treatment

• Shave 1-3 days before Shave 1-3 days before treatment treatment (stubble) (stubble)

• Avoid other methods for 30 Avoid other methods for 30 daysdays

• SPF 15+ for 4-6 weeksSPF 15+ for 4-6 weeks

• Avoid tanning creamsAvoid tanning creams

• Hydroquinone if necessaryHydroquinone if necessary

What is the endpoint ?What is the endpoint ?

• Small contact spark/flashSmall contact spark/flash

• Smell of burnt hair Smell of burnt hair

• Perifollicular edemaPerifollicular edema

• Sensation of light sunburnSensation of light sunburn

• One in three hairs extrudeOne in three hairs extrude

After treatmentAfter treatment

• Redness: 4-6 hours after treatmentRedness: 4-6 hours after treatment

• Hair appears to grow for several daysHair appears to grow for several days

• Hair falls out: day 10-14Hair falls out: day 10-14

• Hair reappears, next phase: >3-6 Hair reappears, next phase: >3-6 weeksweeks

• Treat again: >= 6 weeks laterTreat again: >= 6 weeks later

Complications of Laser Hair Complications of Laser Hair RemovalRemoval

• BlisteringBlistering

• HypopigmentationHypopigmentation

• HyperpigmentationHyperpigmentation

• ScarringScarring

• Koebner Koebner phenomenon in phenomenon in psoriasis , vitiligopsoriasis , vitiligo

• Temporary or Temporary or permanent permanent leukotrichialeukotrichia

Complication (cont.)Complication (cont.)

• Found conversionFound conversion of fine vellus hair of fine vellus hair to dark, to dark, coarse terminal haircoarse terminal hair or or induction of growth of long fine hair induction of growth of long fine hair from repetitive low fluencefrom repetitive low fluence