Laser Hair Removal

by D.M. Murdock

Laser hair removal or "photo-epilation" is a highly popular treatment used by both women and men to remove unwanted hair and to give the skin a smooth and youthful look. Superior to most other procedures, laser hair removal is a long-term treatment that destroys the hair follicle and its stem cells, preventing re-growth. Other hair removal procedures include depilatory creams and lotions, electrolysis, intense pulsed light, plucking, radio frequency, shaving, sugaring and waxing. At $150-200 per 15-minute session, laser hair removal can be expensive, and some people have adverse reactions to it. Nevertheless, in certain instances laser hair removal has been a necessary treatment to improve the quality of life and increase health, at least psychologically and emotionally. Unwanted facial hair, for example, "can cause embarrassment and result in a significant emotional burden,"1 "can be a source of distress" and "can lead to psychological problems such as anxiety, depression and a reduced quality of life."2

First approved by the FDA in 1995, laser hair removal is today considered well tolerated, safe and effective, as the methods have improved, with hundreds of millions of procedures using laser and light surgery having been performed since that time. Using the "Fitzpatrick Pigmentation Scale" skin type is determined, and different pulses or laser lengths are used for different hair and skin colors, with longer-pulsed lasers utilized on darker-skinned individuals,3 Long-pulsed (1,064 nm) laser hair removal  is painful, so topical anesthetics such as lidocaine are recommended.4

Studies done on dark-skinned patients show that repeated laser-hair removal treatments increase the rate of hair reduction.5 Such repeat treatments are necessary since dark-skinned patients are "the most challenging hair-removal patients because of the melanin found in both the hair and the skin."6 Repeat treatment is also recommended for Asian skin and hair types.

Laser hair removal works best on individuals with light skin and coarse dark hair. It does not work on blond, gray or white hair, and dark-skinned and tanned people may experience discoloration. Recommendations for difficult cases include using laser or intense pulse light (IPL) along with a depilatory cream such as Eflornithine.

At present, repeated laser hair removal treatments are between 70 and 90% effective in the long term, lasting six to 12 months. The success rate with laser hair removal is as follows:

"From substantial clinical experience, it becomes apparent that in the ideal subject with fair skin and dark hair, a single treatment can reduce hair by 10-40%; three treatments by 30-70%; and repeated treatments by as much as 90%. These results persist for as long as 12 months."7

The recommended three-treatment procedure is only "partly permanent."8

Conditions indicated for laser hair removal treatment

In addition to cosmetic purposes such as hormonally induced facial hair on women or hairy backs on men, there are medical reasons for laser hair removal:

• facial hair due to polycystic ovary syndrome (PCOS), adrenal hyperplasia and Cushing's syndrome
• hirsutism
• hypertrichosis
• pilonadal disease
• pseudofolliculitis barbae (razor bumps)
• recalcitrant folliculitis decalvans
• transsexualism

Pseudofolliculitis barbae or "razor bumps" is a condition caused by ingrown hairs that mainly effects black people who shave their faces.9 These ingrown hairs can lead to keloid scar formation. Laser treatments can relieve this syndrome, but it may also leave the patient beardless.

Facial hirsutism due to polycystic ovary syndrome (PCOS) "can lead to high levels of depression and anxiety," and facial hypertrichosis and hairiness may further cause "severe cosmetic and psychologic problems."10 Hirsutism is the term designating the excess-hair condition suffered specifically by women and is "associated with social and psychological difficulties including anxiety, social avoidance and a confusion of gender identity..."11

A British study published in May 2005 concluded, "Laser treatment appeared to reduce the severity of facial hair and time spent on hair removal as well as alleviating depression and anxiety in women with PCOS."12 Laser hair removal may thus provide psychological and emotional benefits. The anxiety, depression and hostility that may be produced in hirsute individuals is detrimental not only to themselves but to others, including their families, teachers and society at large.

Laser hair removal contraindications and side effects

Side effects from laser hair surgery include the following:

• blisters
• cataract formation
• crusting
• discoloration (hyperpigmentation or hypopigmentation)
• erosions or skin ulceration
• folliculitis
• hair induction/regrowth
• iris atrophy
• pain
• paradoxical hypertrichosis or increased hair regrowth
• purpura
• reticulate erythema
• scarring
• skin reddening (transient erythema)
• swelling around hair follicle (perifollicular edema)

Laser hair removal done on the eyebrows may cause "irreversible cataract and iris atrophy."13 Most of the other side effects are temporary. Darker-skinned patients tend to experience certain of side effects more often than lighter-skinned individuals. Previous drawbacks and complications such as discoloration and pigmentation problems have been largely, although not entirely, overcome with newer technology and procedures.

Laser hair removal is contraindicated in areas with tatoos, as such a procedure may leave a scar or "black crust."14

Laser hair removal should not be performed by unqualified and unapproved individuals, as such practice may increase complications and side effects. Patch testing for the effects on the skin tone is recommended.

Laser hair removal alternatives

Laser hair removal has been proved to be safe, effective and beneficial to psychological and emotional health. Because of its cost and complications, however, laser hair removal may not be an option for many people. There are alternatives to laser hair removal that are more effective, including intense pulse light system or IPL(S) and radio frequency or RF.

A study published in 2000 by Danish doctors Bjerring, Egekvist, et al., concluded that "IPL was found to be 3.94 times more effective than the ruby laser for hair removal."15 Because dark skin tends to be more difficult to penetrate with light source treatments, radio frequency hair removal has been utilized successfully in conjunction with IPL, with good results.16 The combined IPL and radio frequency (RF) treatment may be effective in removal of blond, gray and white hair as well.17 Another study concluded:

"The combined IPL (680-980 nm)/RF light source with contact cooling is a safe and effective method of long-term hair reduction in patients of diversified skin types and varied hair colors and is associated with excellent patient safety."18

Another study showed that this IPL/RF combination was very effective on white terminal hairs, the growth of which is affected by hormones as found in adults, but not on unpigmented vellus hair, referring to the fine, downy hair that covers the body in children and adults.19 

In early 2006, a study was published which concluded that IPL is a "safer and more effective" hair removal treatment for Asian women.20 Another study published in 2005 concluded that "IPL is an ideal hair-removal method because of the credible effect, simple operation, rapid treatment and no serious complications." Although fewer and more minimal complications and side effects are reported with IPL than with laser, side effects with IPL treatment include blisters, superficial burns, crust formation, pain, paradoxical hair growth, skin redness and discoloration. Intense pulsed light therapy can also be used for other purposes, including dermatological concerns such as port-wine stains, psoriasis, scars, tatoos, tumors and wrinkles.