Treatment Approach

Peruvian Hair Loss Treatment

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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 tory pigmentary changes are still to be expected in individuals who have darker complexions.

All of the lasers and intense pulsed light sources described in this chapter, when used with almost all fluences, can lead to temporary hair loss at all treated areas. However, choosing appropriate anatomic locations and using higher fluences will increase the likelihood of permanent hair reduction after multiple treatments. Even though permanent hair loss is not to be expected in all individuals, lessening of hair density and thickness is an expected finding.

The ideal treatment parameters must be individualized for each patient, based on clinical experience and professional judgment. For individuals who have darker complexions, the novice might consider delivering the laser energy in several individual test pulses at an inconspicuous site with lower energy fluences. The delivered energies are then slowly increased. Undesirable epidermal changes such as whitening and blistering are to be avoided.

Prolonged and permanent hair loss may occur following the use of all the aforementioned described millisecond systems. However, great variation in treatment results is often seen. Most patients with brown or black hair obtain a 2- to 6-month growing delay after a single treatment. There is usually only mild discomfort at the time of treatment. Pain may be diminished by the use of topical or injected anesthetics.

Transient erythema and edema are also occasionally seen and irregular pigmentation of

1- to 3-months duration is often noted. These changes are far less common after treatment with an Nd:YAG laser. Permanent skin changes, depigmentation, or scarring is rare.

Finally, it is true for all hair removal lasers that the higher the delivered fluences, the better the results. The fluence chosen should be as high as can be tolerated without creating an epidermal blister.

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