Tips and Considerations for Laser Hair Removal (iStockphoto)

As a medical aesthetician, I frequently perform laser hair removal treatments.  I wanted to share some of my insights with all of you.

Over the course of several treatments, the process of “laser hair removal” will effectively diminish hair growth in a specified treatment area.  So – YES, it does work.  The reduction of hair is gradual and cumulative with each treatment.  Probably the most important consideration regarding this procedure – because of the fact that there are so many millions of follicles that can potentially grow hair on one’s body – it’s not realistic to expect every single follicle in a treatment area will permanently be disabled from producing hair.  This means there can be no promises or guarantees that “all hair is gone forever”. Perhaps the process would be more accurately termed “laser hair reduction”.

Selective photothermolysis is the primary principle at work in the treatment of removing unwanted body/facial hair utilizing optical energy/lasers.  Briefly – a laser beam at a specific wavelength is applied to the desired treatment area.  The optical energy is absorbed by the melanin in the hair shaft and converted to thermal/heat energy.  This heat travels down the hair shaft and dissipates in the follicle.  For effective treatment to occur, the hair must be in the actively growing anagen stage (the root and bulb of the hair is attached at the base of the follicle during this phase).  By traveling to the root of the hair/base of the follicle this heat destroys the anatomical structure of the hair follicle but does not destroy the tissue surrounding the hair follicle.

With that simple overview in mind, here are some additional essential considerations:

• Due to the nature of selective photothermolysis, optical energy (at ideal wavelengths for hair removal) is basically converted to thermal energy when the presence of pigment/melanin is detected.  Therefore, ideal candidates for laser hair reduction have darker hair and lighter skin. In some cases, various lasers can treat individuals with darker, more pigmented skins (like Candela’s GentleYAG) or lighter hair (blonde, gray, or white).  However, it is important to note that the BEST results are observed with the greater contrast of darker hair on lighter skin.
• As briefly mentioned earlier, the hair must be in the actively growing anagen stage to be effectively treated. All the hair in a specific treatment area is at various stages within the hair growth cycle – either anagen (actively growing phase – hair bulb attached at root of follicle), catagen (transitional phase – hair bulb has detached from the root), or telogen (resting phase – no bulb is present and hair is shed).  Because the hair is attached with a bulb at the root of the follicle in only anagen stage – that is the only time the thermal energy is able to reach the root of the hair and the base of the follicle.  Growth cycles vary between areas of the body as well.  This means that treament for for long term hair reduction requires multiple sessions at various intervals in one area in order to achieve the desired clearance of hair.  The average number of sessions required to effectively clear hair in a desired area is approximately 6-8. The number of treatments required can vary from one individual to another.  Sessions are on average spaced at 4-6 week intervals. The time between treatments can also vary based on the individuals response or the specific area of the body being treated.  In the final few treatments, when very little untreated hair remains – sessions may be placed even further apart – as much as 16 weeks.
• The treatment area should be shaved prior to treatment. When hair is not shaved prior to treatment, the laser is passed over the treatment area and hair is typically singed at the surface (creating that unappealing burnt hair smell).  This typically generates more heat at the surface of the skin – which can also create more discomfort.  More importantly, the thermal energy is often absorbed by the hair above the surface of the skin – rather than traveling all the way to the root of the root of the hair at the base of the follicle.  This can cause the treatment to be less effective.  Patients may even shave the day of the treatment.  Please consult with your specific technician regarding their preferred protocol.  In some areas, technicians may want to see the hair first and mark the area they will be working in before shaving then treating the area.
• Avoid tanning – especially in the treatment area. We all know that UV exposure ages our skin, but tanning also produces more melanin/pigment in the skin.  This diminishes the contrast between hair and skin.  This also increases the thermal energy/heat absorbed by the skin – which can increase the level of discomfort and the risk of burn.  Some laser hair reduction providers may have to turn you away (until you “lighten up”) if you have too much sun exposure.
• Hair does not immediately disappear after treatment.  It takes approximately 2 weeks for hair to be shed from the follicle post treatment. Stubble will appear in the days following laser treatment – the hair is being pushed to the surface.  Do not wax or tweeze these hairs – allow them to shed naturally.
• DO NOT wax or tweeze the treatment area prior to treatment or during the course of treatment. Again, consult with your specific provider – they will give you a detailed explanation of dos and don’ts.  Waxing and tweezing remove hair by the root – this prevents effective treatment.  As weird as it may sound, that means shaving only during the course of your treatment…and that includes areas like the lip and chin for women.  I know, I know – I hear many moans, groans, questions and concerns when I tell a female patient she can only shave or nothing between treatments.  We’ve all heard the myth that shaving makes the hair grow back thicker and darker, but it’s simply not true.  Because shaving leaves the root intact and cuts hair off mid shaft – when stubble appears it is thicker/darker than the finer/lighter tip of a hair.  This can give us the impression that hair is indeed thicker and darker – but it really is not and the growth of hair is unaffected.
• The body can convert inactive or dormant follicles to grow hair later in life as a result of many factors: hormone imbalance, pregnancy, menopause, disease, medication, obesity, etc. Most individuals and areas respond in a predictable fashion to the laser hair process.  However, in some areas hair growth may be more hormonally driven.  A common example of this is the chin for women.  Laser treatments can effectively treat hair follicles in this area – however, the treatments are not affecting the underlying issue causing the growth – the hormones.  Hormones will continue to recruit dormant follicles to produce hair in some stubborn areas.  Areas where hair is growing due to hormone levels may not respond as well or may require an additional number of treatment sessions than other areas.  Also, when patients present conditions such as hirsutism (excessive and increased hair growth in females) or hypertrichosis (hair growth amount that is considered abnormal) the response to laser hair reduction is less predictable and may require more treatments.
• Does it hurt? This is really hard question to answer – as the answer varies widely.  Everyone’s pain tolerance is different.  Some patients feel nothing at all, but some find the process bearable but quite uncomfortable.  I have experienced a full range of pain tolerances while delivering the exact same treatment protocols.  Most patients receiving laser hair removal say the sensation feels like a rubber band snap, a pinch, or a little flash of heat.  In addition to the variance in individuals pain tolerance – no two individuals hair growth is exactly the same.  When hair growth is more dense or more than one hair grows from a follicle in a particular area, more sensation can usually be felt.  Generally, the more pigment/melanin present by way of hair or skin in a given area – the more thermal heat will be generated.  The more thermal heat – the increased chance for discomfort.  Some providers recommend or utilize numbing sprays/creams for individuals that find them helpful during treatment.  As for my personal experience and opinion, I find the treatment way more comfortable than waxing and infinitely more rewarding.
• Please know that effectiveness can vary based on the skill of the technician and/or the equipment being used. Hopefully, these tips will give you a lot of the information you need to have successful treatments.  My personal experience has led me to determine that my preferred equipment (as both a patient and a technician) for laser hair reduction is created by Candela (either a Candela GentleLASE, GentleYAG, or GentleMAX).  I feel their equipment is specifically designed for the purpose of hair reduction, offers premium results, and I feel it offers great comfort during treatment.  That being said there are many other manufacturers and types of lasers that offer satisfactory results with regards to hair reduction.  (Please see this article for more technical info on lasers and effective wavelengths for hair reduction.  Also, please reference this useful chart that compares various laser, the technology/wavelength used, and their relative effectiveness for hair reduction.)  Generally speaking, Alexandrite, Nd:YAG, or Diode laser technologies work best for hair reduction.  When becoming a patient for laser hair reduction, please speak with your provider regarding the type of laser they use – do your research to evaluate if the equipment being used offers optimum results for you.  Also, various equipment calls for different treatment protocols.  With some equipment the area is covered with a thin layer of gel but not with others.  Also, it’s my recommendation that IPL (Intense Pulsed Light) does not provide a satisfactory result for permanent hair reduction.  IPL operates at multiple wavelengths and is not as effective as equipment operating at one single wavelength.

Please feel free to leave comments with additional concerns or questions.  You may also email me directly (see my email address in the EMAIL tab of the main control center box located in the upper right hand of the page).