Natural Hair Reduction

Need No Hair

Need No Hair is a comprehensive guide to getting rid of unwanted body hair. One of the important aspects to getting rid of unwanted body hair for good lies in identifying certain key ingredients and blending them together in such a way as to create a Natural, Safe And Effective Remedy. The results are rooted in scientific principles and these are explained in the guide. Need No Hair shows you how to remove body hair safely but equally as important it shows you how to ensure that the problem will stay away for good. Forget corrosive and potentially harmful bleaches and other nasty chemical concoctions. Need No Hair shows you the best way of getting rid of body hair without having to deal with all that stuff. It shows you how to produce your own easy, totally natural and totally effective way of getting rid of unwanted body hair.

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Physical Basis of Laser Hair Removal

Successful treatment of unwanted hair is dependent on an understanding of the optical properties of the skin. It is these properties that determine the behavior of light within the hair shaft and bulb, including the relative amount of absorption of incoming photons. Different physical factors including delivered fluence, wavelength, pulse duration, and spot size diameter play an important role in maximizing the efficacy and safety of laserassisted hair removal. For optimal laser hair removal, one needs to use an optimal set of laser parameters based on anatomic and physical principles. This is determined by a time-temperature combination with the ultimate effect being transfollicular denaturation. The theory of selective photothermolysis led to the concept of a laser-induced injury confined to microscopic sites of selective light absorption in the skin, such as blood vessels, pigmented cells, and unwanted hair with minimal damage to the adjacent tissues. To achieve this selective...

Currently Available Lasers and Light Sources Used for Hair Removal

In the USA, the Food and Drug Administration (FDA) has traditionally used electrolysis results as a benchmark to evaluate laser treatment efficacy, despite the near lack of significant scientific data about electrolysis. In the initially submitted studies, all hair removal devices were required to show a 30 decrease in hair growth at 3 months after a single treatment (Tope et al. 1998). This criterion clearly does not equate with permanent hair loss, as a delay in hair growth, which usually lasts for 1-3 months, is simply consistent with the induction of the telogen stage. Permanent hair reduction results should be based on the cyclic growth phases for hair follicles, and should refer to a significant reduction in the number of terminal hairs after a given treatment. There must be a reduction that is stable for a period of time longer than the complete growth cycle of hair follicles at any given body site. Multiple laser systems are currently available and approved by the FDA for hair...

Operative Consent Laserlight Source Hair Removal

I am aware that laser light source hair removal is a relatively new procedure. My doctor has explained to me that much of what has been written about these methods in newspapers, magazines, television, etc. has been sensationalized. I understand the nature, goals, limitations, and possible complications of this procedure, and I have discussed alternative forms of treatment. I have had the opportunity to ask questions about the procedure, its limitations and possible complications (see below). Although complications following laser light source hair removal are infrequent, I understand that the following may occur Fig. 4.2. Before alexandrite laser hair removal Fig. 4.2. Before alexandrite laser hair removal Fig. 4.4. Before alexandrite laser hair removal Fig. 4.4. Before alexandrite laser hair removal

Table 28 Stages of Sexual Development Male

Hair Pubic hair thicker and coarser in most it ascends toward umbilicus in typical male pattern axillary hair increases, facial hair increases overlap and upper cheeks. Hair Pubic hair thick, curly, heavily pigmented, extends to thighs and toward umbilicus adult distribution and increase in body hair (chest, shoulders, and thighs) continues for more than another 10 years baldness, if present may begin.

Normal Puberty Physical Changes

Puberty is the maturational process of the reproductive endocrine system that results in final adult stature and adult body proportions, as well as final development of the genital organs and the capacity to reproduce. In this maturation of the hypothala-mic-pituitary-gonadal axis, the levels of gonadotropins increase and the production of sex steroids rise, leading to gonadal development and the development of secondary sexual characteristics. In boys, the first physical signs of puberty are an increase in testis volume and penis size, at a mean age of approx 11.5 yr in most Western countries. Testis volume increases from prepubertal values of 1-2 mL to 3-8 mL even before pubic hair appears, and reaches 20-30 mL in adulthood (1). Development of mature spermatogenesis is called spermarche (as opposed to menarche), at which time mature spermatozoa are found in the urine. This hallmark of gonadal maturation occurs at mean age of 13.5 years, when the mean testis volume reaches 11.5 mL...

Growth Centers of Hairs

Long-term hair removal has been traditionally thought to require that a laser or light source impact on one or more growth centers of hair. The major growth centers have always been thought to be in the hair matrix. However, research evaluating growth of new hair has revealed that the matrix is not the only growth center. New hairs may evolve from the dermal papilla, follicular matrix, or the bulge. These stem cells are usually found in a well-protected, highly vascularized and innervated area, often in close proximity to a population of rapidly proliferating cells. They always remain intact and, in fact, are left behind after hair plucking. Stem cells are relatively undifferentiated both ultrastructurally and biochemically. They have a large proliferative potential, and are responsible for the long-term maintenance and regeneration of the hair-generating tissue. They can be stimulated to proliferate in response to wounding and certain growth stimuli.

Androgen Replacement Therapy

Testosterone therapy results in a more male phenotype, with increases in facial and pubic hair, muscle size and strength, libido, and bone mineral density, and improved mood (21,47,52,53). We recommend testosterone therapy beginning at the time of puberty to allow boys with KS to experience pubertal changes in tandem with their peers. In addition, this approach may allow for optimal enhancement of bone mineral density. Even if testosterone therapy is delayed until adulthood, it is still associated with beneficial improvements in mood, behavior, and sense of well-being (53). Testosterone therapy has no beneficial effect on infertility or gynecomastia, which is best treated with surgical resection if bothersome.

Male Pseudohermaphroditism Often Results From Resistance to Androgens

A pseudohermaphrodite is an individual with the gonads of one sex and the genitalia of the other. One of the most interesting causes of male reproductive abnormalities is an end organ insensitivity to androgens. The best characterized syndrome is testicular feminization, an X-linked recessive disorder caused by a defect in the testosterone receptor. In the classical form, patients are male pseudohermaphrodites with a female phenotype and an XY male genotype. They have abdominal testes that secrete testosterone but no other internal genitalia of either sex (see Chapter 39). They commonly have female external genitalia, but with a short vagina ending in a blind pouch. Breast development is typical of a female (as a result of peripheral aromatization of testosterone), but axillary and pubic hair, which are androgen-dependent, are scarce or absent. Testosterone levels are normal or elevated, estradiol levels are above the normal male range, and circulating go-nadotropin levels are high....

Laser Tissue Contouring And Restructuring

The target chromophore is follicular melanin. Selective photothermolysis of the hair follicles is achieved without damaging the skin. It is unknown at present whether the bulge, dermal papilla (nonvascular core elevations of tissues associated with irritation or immuno-logical challenge), or both have to be destroyed to achieve permanent hair removal. Also, it is currently debatable if the hair removal achieved is permanent. Table 13.2 lists the dermatological applications of skin resurfacing (a more popular form being wrinkle removal), hair removal, and tattoo removal. The lasers and their parameters used for these procedures are also listed. Hair removal 2. Goldberg, D. J., Unwanted Hair Evaluation and Treatment with Lasers and Light Source Technology, Adv. Dermatol. 14, 223-248 (1999). 3. Goldberg, D. J., ed., Laser Hair Removal, Dunitz, London, 2000. 2. Goldberg, D. J., Unwanted Hair Evaluation and Treatment with Lasers and Light Source Technology, Adv. Dermatol. 14,...

Consent For Levulan Photodynamic Treatment

Anticipated side effects of Levulan treatment include discomfort, burning, swelling, blistering, scarring, redness and possible skin peeling, especially in any areas of sun damaged skin and pre-cancers of the skin, as well as lightening or darkening of skin tone and spots, and possible hair removal. The peeling may last many days, and the redness for several weeks if I have an exuberant response to treatment.

Androgens Are Responsible for Secondary Sex Characteristics and the Masculine Phenotype

Androgens effect changes in hair distribution, skin texture, pitch of the voice, bone growth, and muscle development. Hair is classified by its sensitivity to androgens into nonsexual (eyebrows and extremities) ambisexual (axilla), which is responsive to low levels of androgens and sexual (face, chest, upper pubic triangle), which is responsive only to high androgen levels. Hair follicles metabolize testosterone to DHT or androstenedione. Androgens stimulate the growth of facial, chest, and axillary hair however, along with genetic factors, they also promote temporal hair recession and loss. Normal axillary and pubic hair growth in women is also under androgenic control, whereas excess androgen production in women causes the excessive growth of sexual hair (hirsutism).

Case Study for Chapter

The pediatric endocrinologist is called in to consult on the case of a 1-week-old girl. The baby was born at home and is now in the emergency department because she appeared listless and has not nursed during the past 24 hours. On physical examination, the baby exhibits signs of virilization (growth of pubic hair) and volume depletion, and laboratory results indicate hyponatremia and hyperkalemia. 1. A reasonable initial hypothesis is that the baby has a form of congenital adrenal hyperplasia. The virilization (appearance of pubic hair) suggests the presence of excess androgen production by the adrenal gland. The hyponatremia, hyperkalemia, and volume depletion suggest a salt wasting syndrome.

Tissue Engineering with Light

This chapter covers three main types of laser-based tissue engineering (i) tissue contouring and restructuring, (ii) tissue welding, and (iii) tissue regeneration. Two specific examples of tissue contouring and restructuring covered in this chapter are used in dermatology and ophthalmology. Dermatological applications discussed here are (i) the treatment of vascular malformations, such as port-wine stains, (ii) the removal of pigment lesions and tattoos, (iii) skin resurfacing (wrinkle removal), and (iv) hair removal. Appropriate lasers used for these applications are presented.

QSwitched NdYAG Laser

Q-switched Nd YAG lasers have been used to target topically applied carbon particles that have previously been applied to the hair follicle. This method was one of the first available laser hair removal techniques. This short term hair removal technique has also been used without the prior application of carbon. Different studies have compared the effectiveness of Q-switched Nd YAG laser hair removal with ruby and alexandrite laser treatments. Millisecond pulse ruby and alexandrite lasers showed greater hair reduction than was seen with Q-switched Nd YAG lasers. Relatively weak absorption by the innate target chro-mophore melanin of Q-switched Nd YAG laser energy translates into less energy available to damage the follicle. Therefore, a lesser hair removal effect is seen. Several studies have examined the 1064-nm Q-switched Nd YAG laser with and without a topically applied chromophore. However, in one controlled study (Nanni et al. 1997), using a single Q-switched Nd YAG laser...

Selective Photothermolysis

This new extended theory of selective thermal damage of nonuniformly pigmented structures in biological tissue postulates that the target is destroyed by heat diffusion from the absorbing chromophore to the target but not by direct heating from laser irradiation, as is seen with selective photothermolysis. This theory has now been applied to the treatment of unwanted hair. Ultimately, the use of hair removal lasers expanded rapidly with the subsequent development of appropriate cooling devices that minimized epidermal injury.

Diana M Zuckerman PhD

Consumers show their confidence in the safety of medical devices when they spend the equivalent of more than 200 billion worldwide annually 1 . Nevertheless, consumers are not necessarily familiar with the term 'medical device' and might not be able to name any if asked. Virtually every consumer uses medical devices, and many have friends and family members with implanted medical devices. In recent years, the number of men, women, and even children with implanted medical devices has increased dramatically, as artificial knees, hips, heart valves, and shunts have become increasingly common 2,3 . Medical implants come in a very wide range of shapes, sizes, and substances, including the increasingly popular oils and gels that are injected into millions of faces every year to fill wrinkles and scars 4 . The use of implanted devices, either to replace aging body parts or to help people look younger, will certainly continue to increase as the baby boomers age. Lasers are also widely used...

Intense Pulsed Light Systems

Several studies have demonstrated the long-term efficacy of IPL hair removal devices (Gold et al. 1997 Weiss et al. 1999). In one study of 67 subjects of Fitzpatrick skin phototypes I-IV, mean hair loss was 48 at 6 months or more after a single treatment. In another study, after a single treatment, hair reduction ranging from 33 to 60 was observed at 6 months after treatment. Further studies of 14 subjects treated with this technology and followed for 12 months after their last treatment showed a mean of 83 hair reduction was obtained after two to six treatments. As would be expected, repeated treatments appear to improve outcome. Despite this, some have suggested that more than three IPL treatments do not appear to increase the success rate. Not all would agree with this. Finally, treatment with IPL, with and without bipolar radiofrequency, has been said to be useful for the treatment of light-colored hair. Generally, more treatments are required and the results are not expected to...


In general, higher-delivered laser fluences lead to better laser hair removal results. However, the higher the utilized fluence, the greater the discomfort and risk of complications. The effective fluence for any one area of hair is determined mainly by hair color, whereas the tolerated fluence is determined mainly by skin color.

Hair Color

Most individuals demonstrate greater melanin density in their hair as compared to their skin epidermis such that the absorption coefficient of the hair shaft and bulb is roughly 2-6 times that of the epidermis. Thus, hair will generally absorb more of the melanin-absorbing wavelengths emitted from today's laser and light source hair removal systems.

Diode Lasers

Diode lasers (800 nm) used for hair removal include In a prospective controlled trial, the 810-nm diode laser demonstrated a significant reduction in hair growth (Lou et al. 2000). Overall, clinical studies with the diode laser system have reported variable success rates ranging from 65-75 hair reduction at 3 months after one to two treatments with fluences of 10-40 J cm2. This was increased to 75 hair reduction in 91 of subjects 8 months after three to four treatments at 40 J cm2 (Williams et al. 1999). As


The theoretical explanations behind laserassisted hair removal seem logical. However, questions do remain. It is very difficult to predict the ideal patient and ideal treatment parameters for each patient. Even the same patient may respond differently to the same parameters on two different treatment sessions.

Alexandrite Laser

Most individuals are no longer using ruby lasers. However, the same general approach to alexandrite laser treatments would apply if the ruby laser was used for hair removal in lighter skin types. We have found the alexandrite lasers to be very helpful in treating Fitzpatrick I-III skin phenotypes (Figs. 4.2-4.14). Although it has been suggested that alexandrite lasers, with their longer 755-nm wavelength, are safer in treating darker complexions than are ruby lasers, we have not consistently found this to be the case. It would appear that the ability to treat darker complexions with alexandrite lasers may be more related to the longer pulse durations emitted by some of these systems. It should be noted that unless appropriate cooling is utilized, some Fitzpatrick skin phenotype III and even sun-tanned type II complexioned individuals tend to have postinflammatory pigmentary changes after laser treatment.

Diode Laser

Six months after five alexandrite hair removal sessions Fig. 4.3. Six months after five alexandrite hair removal sessions Fig. 4.5. Six months after five alexandrite hair removal sessions Fig. 4.5. Six months after five alexandrite hair removal sessions As a general rule, somewhat lower fluences are required for effective hair removal than are required with the ruby lasers. This may be related to the deeper penetration of the 800-nm wavelength.


The incidence of cutaneous adverse effects after laser hair removal is both patient and laser parameter related. Patients with darker-colored skin, especially skin types V and VI, are more likely to experience cutaneous adverse effects, related to the abundance of melanin in their epidermis. However, such complications are not limited to patients with genetically determined dark skin. This may also be seen in patients with darker skin due to other reasons, such as sun-tanning and lentiginous photoaging. The incidence of adverse effects will be modified by utilized wavelength, fluence, pulse duration, and associated cooling.


These early studies showed that the pulsed dye laser not only improved rhytides but also caused histological changes in the dermis consistent with improvement of sun-damaged collagen. Similarly, the Q-switched Nd YAG laser used in combination with a topical carbon suspension for laser hair removal was noted to diminish fine lines, most likely due to a photomechanical effect. Lasers with an affinity for water absorption were then investigated for their effects on wrinkle improvement. These lasers, which include the 1320-nm and 1450-nm systems, deliver heat into the dermis to trigger a wound-healing response. In these cases, epidermal damage was avoided by a concomitant cooling mechanism. Laser-induced histological changes showed increased fibroblast activity and new collagen deposition. These changes were similar to those seen with both the pulse dye and Q-switched Nd YAG lasers. Over time, there has been an ever-increasing surge in patients demanding a no downtime wrinkle treatment...

Plastic Surgery

Plastic surgery suites vary considerably, depending on the focus of the practice (cosmetic or reconstructive) and whether there is an intention to provide skin care or spa services (a recent trend). Skin care spa services may include microdermabrasion skin resurfacing, chemical peels, permanent hair removal by a diode laser, facials, body and cellulite treatments, as well as makeup tattooing of eyeliner or brows. These procedures are explained in greater detail, and room requirements discussed, in the Dermatology section of this chapter and at the end of this section.


A dermatologist treats diseases of the skin. It is not uncommon to find a one-physician practice. Since dermatologists rarely make hospital rounds or emergency house calls, their appointment schedule is strictly adhered to without the sort of interruption that plagues many other physicians. A one-physician suite would be composed of three examination or treatment rooms, a waiting room to accommodate eight to ten persons, a small lab, a toilet room, a business office, a consultation room, a minor surgery, and a large storage closet for drug samples (Figure 4-107). Larger practices may include a surgery facility, as well as offer ancillary services such as laser hair removal, chemical peels, facials, Botox (botu-linum toxin) injections, sclerotherapy, Endermologie , and massage. The reader is referred to Chapter 6 for a decentralized plan of a group-practice dermatology suite and to Figure 4-108 for a centralized plan. Figure 4-109 shows the relationship of rooms.


There are three different types of hair. Fine long lanugo hairs cover the fetus but are shed about I month before full-term. They are replaced by fine short vellus hairs, which cover much of (he body surface. Terminal hairs then replace vellus hairs on the scalp. At puherty. the vellus hair of the pubic region is replaced by darker, coarser and curlier hair. This begins earlier in girls (average age 11.5 years) than in boys (average age 13.5 years). The development of pubic hair is related to adrenal androgen production (adrenarche). This occurs in the absence of gonadotropin secretion. Thus patients with isolated gonadotrophs deficiency may have pubic hair but no other signs of pubertal development. Axillary hair appears about 2 years after the start of pubic hair growth and, in boys, coincides with the development of facial hair. Last of all, body hair develops, and its extent increases throughout the years of sexual maturity though there is a wide variation in its pattern.

Leydig Cell Tumors

Leydig Cell Testosterone

LCTs are found at all ages from 2 to 90 yr, with a peak occurrence in the fifth decade of life. In boys, these tumors typically occur between the ages of 4 and 10 yr and account for approx 10 of cases of precocious puberty (122). They are uniformly benign hormonally active tumors that present with macrogenitosomia (a syndrome that is characterized by precocious enlargement of the genitals), including an enlarged phallus and or prostate, and premature growth of pubic hair (120). Adult men with LCTs often present with a painless testicular mass, usually associated with gynecomastia, infertility, decreased libido, and other feminizing features. Gynecomastia is bilateral in 90 of the cases (123,124).

Alexandrite Lasers

Several long-pulsed alexandrite lasers (755 nm) are being used for hair removal, including There are a number of advantages in using long-pulsed alexandrite lasers for hair removal. Some of the long-pulsed alexandrite laser systems are compact and can be used in small rooms if adequate ventilation is available. Their flexible fiberoptic arm is easy to manipulate and provides access to hard-to-reach body areas. The large spot sizes and frequency (1-5 Hz) improves the possibility of rapidly treating large body areas. The reported hair removal success rate using an alexandrite laser has ranged from 40 to 80 at 6 months after several treatments (Gorgu et al. 2000) In a controlled randomized study using a single 20 J cm2, 5- to 20-ms alexandrite laser on various anatomic sites, investigators reported a 40 reduction in hair growth 6 months after treatment. This increased to 50 (on the upper lip) if a second treatment was performed after 8 weeks. In another study, one treatment with a...

NdYAG Laser

Switched Yag Laser Treatment

Nine months after three alexandrite hair removal sessions Fig. 4.9. Before alexandrite laser hair removal Fig. 4.9. Before alexandrite laser hair removal Fig. 4.12. Before alexandrite laser hair removal Fig. 4.12. Before alexandrite laser hair removal Fig. 4.13. Six months after three alexandrite hair removal sessions Fig. 4.14. Nine months after three alexandrite hair removal sessions Fig. 4.14. Nine months after three alexandrite hair removal sessions temporary short-term hair removal. Skin cooling is not required when a nanosecond laser is used. This contrasts with the requisite need for some form of epidermal cooling with virtually all millisecond hair removal lasers. Fig. 4.17. Before diode laser hair removal hair removal Fig. 4.17. Before diode laser hair removal hair removal Fig. 4.19. Before Nd YAG laser hair removal Fig. 4.19. Before Nd YAG laser hair removal Millisecond Nd YAG laser systems are the safest laser hair removal systems for Fitzpatrick skin types V-VI...

Near Birth

In females, increasing levels of LH and FSH at puberty stimulate the ovaries to begin producing the female sex hormones. The increased circulating levels of these hormones initiate the development of the traits of a sexually mature woman enlarged breasts, vagina, and uterus, broad hips, increased subcutaneous fat, pubic hair, and the initiation of the menstrual cycle.

The Onset of Puberty

Physiology Puberty

Pubic hair About 2 years after the appearance of pubic hair About the same time as axillary hair growth Growth of testes Pubic hair Body growth Growth of penis Growth of larynx (voice lowers) Facial and axillary (underarm) hair Eccrine sweat glands and sebaceous glands acne (from blocked sebaceous glands) Same time as growth of penis About 2 years after the appearance of pubic hair About the same time as facial and axillary hair growth

Facial and body hair

Pituitary Tumour

Hirsutism is an excessive growth of coarse hair in the female on the face, trunk and limbs in the pattern normally seen in males. The pubic hair spreads from its normal Hat-topped distribution up towards the umbilicus, this being described as a male escutcheon. Mild hirsutism is a common condition, often associated with higher than average levels of testosterone. In some subjects it may be a cause of considerable psychological distress. Some increase in facial hair is common after the menopause.

Whole Body Perfusion

Perfusion Fixation

Mice are anesthetized using a mixture of ketamine xylazine. When adequately anesthetized, the mouse is secured with tape in the supine position in a custom-built mold designed to maintain the mouse's natural body shape after fixation (Figure 5.8). The hair on the chest wall is removed with a chemical depilatory hair remover (Nair, Church and Dwight Co., Princeton, NJ, U.S.A.). Ultrasound gel is spread over the precordial region and the ultrasound biomicroscope with a 30-MHz transducer is used to visualize the left ventricle (Figure 5.9a). When the cross-section with the largest left ventricular chamber dimension is located, an i.v. catheter with needle is placed at the precordial area on the chest wall, with the longitudinal axis of the needle in the ultrasound imaging plane (Figure 5.9b). Under real-time image guidance, the needle is inserted into the left ventricle (Figure 5.9c). The needle is then removed, and the catheter secured in place by tape (Figure 5.9d) and connected to a...

Pulse Duration

Laser pulse width seems to play an important role in laser-assisted hair removal. Thermal conduction during the laser pulse heats a region around each microscopic site of optical energy absorption. The spatial scale of thermal confinement and resultant thermal or thermome-chanical damage is therefore strongly related to the laser pulse width. Q-switched laser nanosecond pulses effectively damage individual pigment cells within a hair follicle by confinement of heat at the spatial level of melano-somes (Zenzie et al. 2000). They can induce leukotrichia and cause a temporary hair growth delay, but do not inactivate the follicle itself.


Individuals may seek laser hair removal because of excess hair induced by genetics or associated medical conditions. More commonly, laser hair removal patients simply have unwanted hair that would be considered normal in distribution and density. Yet, these individuals for emotional, social, cultural, cosmetic, or other reasons want the hair to be removed. Also, individuals with pseudofolliculitis barbae, a relatively common disorder seen with coarse, curly hairs that occurs in glabrous skin, often seek laser hair removal. The ideal candidate for laser hair removal is a dark-haired, fair-skinned individual with little melanin within the overlying epidermis. Such patients tolerate the use of more effective higher fluences and relatively shorter wavelengths. In darker-skinned individuals it may be preferable to utilize a longer wavelength laser device. Epidermal protection is also afforded by utilizing longer pulse durations and active cooling.

Pigmentary Changes

There is a remarkable variation in the reported incidence of postoperative pigmentary changes after laser hair removal. Unfortunately most studies have not been carried out under standardized conditions. In different studies, varied laser parameters have been used, follow-up periods have varied from 90 days to 2 years, and the preoperative skin characteristics were not standardized (hair color, skin pigmentation, anatomical region). Finally, the majority of studies estimate the incidence of side effects by subjective clinical evaluation.

Ruby Lasers

Ruby lasers (694 nm), used for hair removal includes The RubyStar (Aesculap-Meditec) is a dualmode ruby laser that uses a contact skin cooling method. It can operate in the nanosecond Q-switched mode for the treatment of tattoos and pigmented lesions and in the normal millisecond mode for hair removal. Its integrated cooling device consists of a cooled contact hand-piece which precools the skin before laser pulse delivery. Because of its comparatively short ruby laser wavelength, this hair removal system is best suited for the treatment of dark hair in light skin. It also may be more efficacious than longer wavelength devices for the treatment of light hair or red to red-brown hair (Ross et al. A number of reports have documented the efficacy of ruby laser hair removal in varying types of skin using different laser parameters. The published hair reduction rates have ranged from a 37 to 72 reduction 3 months after one to three treatments to a 38 -49 hair reduction 1 year after three...

Treatment Approach

The hair removal treatment technique with all lasers and intense pulsed light sources commences with preoperative shaving of the treatment site. This reduces treatment-induced odor, prevents long pigmented hairs that lie on the skin surface from conducting thermal energy to the adjacent epidermis, and promotes transmission of laser energy down the hair follicle. A small amount of posttreatment crusting and erythema is to be expected. In darkly pig-mented or heavily tanned individuals, it may be beneficial to use topical hydroquinones and meticulous sunscreen protection for several weeks prior to treatment in order to reduce inadvertent injury to epidermal pigment. Individuals with recent suntans should not be treated until pretreatment hydroquinones have been used for at least 1 month. Postinflamma- Fig. 4.24. Six months after three IPL hair removal sessions All of the lasers and intense pulsed light sources described in this chapter, when used with almost all fluences, can lead to...

Hair Cycle

Although reports of anagen duration, telo-gen duration, and the percentage of telogen hairs represent an inexact science, most discussions of laser hair removal take into account different anatomic areas in terms of anagen and telogen cycles. tiveness of hair removal with each consecutive treatment. Another explanation might be that the follicle is not destroyed immediately, but shows a growth arrest after only one (shortened) anagen cycle. Some have questioned the assumption that effective laser hair removal is determined solely by treating hairs in the anagen cycle. These investigators suggest that melanin within a hair follicle may be more important than the actual time of treatment.

NdYAG Lasers

Millisecond Nd YAG lasers (1064 nm) used for hair removal include The longer Nd YAG laser wavelength provides deeper penetration, a necessary factor in the attempt to achieve optimal laser hair removal results. In addition, the 1064-nm wavelength is relatively less absorbed by epidermal melanin than are the 694- to 810-nm wavelengths. It is this decreased melanin absorption that leads to the greater pigmented epidermal safety seen with these systems. Although the 1064-nm wavelength is less well absorbed by melanin than shorter wavelengths, the absorption appears to be enough to achieve the selective photothermolysis of the pigmented hair follicle (Lin et al. 1998). The use of appropriate fluences and effective epidermal cooling devices leads to an effective hair removal device with little risk of complications when such lasers are used correctly. Although the relatively low melanin absorption would appear to be a disadvantage in the treatment of pigmented hair, the Nd YAG laser's...