7 Laser Hair Removal How does it work? Targets the pigment in the hair follicle.Heat is absorbed and destroys the cells lining the hair follicle specifically around the bulb, bulge, and vascular supply.
8 Permanent Hair Reduction The FDA allows us this definition:“long-term stable reduction in the number of hairs re-growing after a treatment regime”This is the FDA’s definition of “Permanent Hair Reduction.” Electrolysis is the only methodology that can claim “Permanent Hair Removal” although those who wrote the regulations do not differentiate between the two terms. Setting patient expectations is the key, as “Permanent Hair Reduction” or “Removal” does not mean 100% elimination of hair forever.
9 How Effective is it?Studies have shown up to 80% reduction in hair after a series of treatmentsThe 755nm & 1064nm wavelengths will NOT treat white, blonde, or gray hairs!Some reds hairs will not achieve desired efficacy.Patients should be informed of all possible outcomes prior to treatment
10 **Bulb/bulge are critical structures responsible for hair re-growth Hair AnatomyFollicleEpidermisSebaceous GlandBulgeVascular Supply (Matrix)BulbStill, these lasers are primarily hair removal lasers and should be purchased on the basis of their hair removal capabilities.So how does laser hair removal work? Current research suggests the two critical areas of the hair follicle that need to be destroyed to demonstrate permanent hair reduction are the the bulge area (located mm deep in the skin) and the bulb/vascular supply area of the hair follicle (located 3-5 mm deep within the skin).**Bulb/bulge are critical structures responsible for hair re-growth
11 What are the 3 cycles of hair growth? Anagen: Hair is actively growingCatagen: Hair is dormantTelagen: Hair is falling out
13 How Many Treatments?Different areas have different percentages of hair in the Anagen phase.Face, Axilla, Bikini have approximately 20-35%Trunk and Extremities have approximately 10-20%
14 Time to Retreat? As a rule: Face/Axilla/Bikini: 4-6 weeksTrunk: 8-10 weeksArms & Legs: weeksOr within 7 days of when regrowth is observed.
15 Hair Growth Information Body Area% Anagen Hair% Telogen HairTelogen DurationFolliclesDensity/ cm²Depth of follicleAxillae30%70%3 months65mmBrow and Ears10-15%85-90%502-2.5 mmBeard10 weeks5002-4 mmUpper Lip65%35%6 weeks1-2.5 mmScalp80-90%13%3-4 months3503-5 mmTrunk10-20%4 months702-4.5 mmPubic Area20-30%Arms20%80%18 weeks80Legs & Thighs6 months602.5-4 mmBreast3-4.5 mm
16 Bottom Line For best results, multiple treatments will be needed. For most areas 4-6 treatments are necessary to achieve desired hair clearance.One may need more or less than 6 treatments depending on hair type, previous methods of hair removal, and skin color.Results may vary from patient to patient and to various degrees of efficacy.
17 Pre-Treatment Instruction BeforeShave hair hours prior to treatmentIf the patient has a history of cold sores/fever blisters, an anti-viral can be prescribedIf there is concern over pigmentary changes, a prophylactic bleaching cream can be used weeks prior to treatment
18 Pre-Treatment Instruction NO Plucking – 6 weeks prior or afterNO Waxing – 6 weeks prior or afterNO Tweezing – 6 weeks prior or afterPatients should only shave
19 Clinical Endpoints PFEs Perifollicular erythema: The treatment area should appear redPerifollicular edema: There should be swelling around each hair follicleSome patients will experience a hive like responseLighter hairs may not respond as significantly
20 Post-Treatment Instruction AfterCool compresses can be used to reduce patient discomfort & swellingAloe veraTopical Cortisone creamSun block of 30+ SPF
21 Treatment Technique 3 Things to ALWAYS remember while treating: FLUSH: The distance gauge should be flat and in contact with the skin’s surfacePERPENDICULAR: The hand piece should be 90° to the skin’s surfaceOVERLAP: Pulses should be overlapped at 20-30%. Think of the Olympic Rings
22 ComplicationsThere are risks and complications that can occur from laser treatment.Use of conservative DCD settings are important.Complications are rare!Heat rashBruisingScarringInfectionHyper-pigmentationHypo-pigmentationSwellingWelting
24 Pigmented LesionsA pigmented lesion is caused by an abnormal production of melanin which makes it visible on the skins surface
25 Pigmented LesionsThe following benign pigmented lesions can be treated with the 755nm wavelength:Mottled or hyperpigmentationLentiginesEphelides (freckles)Epidermal melasmaCafé’ au lait
26 Pigmented Lesions Lentigines: Are small, tan to medium brown lesions that are located on the skins surfaceUsually caused by excessive sun exposureNeed to be differentiated from the potential skin cancers. (i.e., have it checked off by a physician)
32 Pigmented LesionsRemember that this will treat Epidermal pigmentation issues.NOT LIKELY TO RESPONDNevi of Oto or ItoMelanocytic NeviShould only be treated by dermatologistBlue Nevi
33 Pigmented Lesions Method of Treatment: Treat only on Skin Types I-III (and Asian skin)No DCD is used.May require multiple treatments (2 – 3 TX)For treatment of smaller lesions a small spot size should be used.
34 Pigmented LesionsSome factors that could possibly trigger a re-ecurrence of pigmented lesions are:Hormonal inbalancePregnancyMedicationsMenopauseSun Exposure
35 Pigmented Lesions Potential Side Effects: Infection Scarring Lesion RecurrenceSide effects are quite rare!Potential Side Effects:DiscomfortBruisingSwellingScabsHyper-pigmentationHypo-pigmentation
36 Pigmented Lesions Clinical Endpoint Single Pulse Only! You may hear a “Snap” while treating.The darker the lesion, the louder the “Snap”It is not uncommon to see a “Frosting” of the lesionSingle Pulse Only!
37 Pigmented Lesions Clinical Endpoint: The lesion will darken within minutes after treatment and may remain so until the lesions forms a micro-crust. Use of an ointment is recommended. Aquaphor, bacitracin or even vaseline can be used to keep area moist until the crust falls off. The skin underneath will be pink. There is a gradual return to normal skin color over time.
38 Pigmented LesionsAvoidance of direct and indirect sun exposure for at least 2 weeks before & after the laser treatment is advisable.Sunblock of at least SPF 30 on the treated area daily. Sun exposure may contribute to hyperpigmentation in treated area.
39 Vascular Lesions & Linear Telangiectasia 755nm & 1064nm Wavelengths
40 Which Does What? 755nm 1064nm Facial Vessels Leg Veins Hemangiomas Resistant PWS1064nmFacial VesselsLeg Veins40
41 Leg Telangectasia or Spider Veins Sclerotherapy is the GOLD STANDARD for the treatment of leg veinsThe 755nm & 1064nm wavelengths can clean up what Sclerotherapy does notVeins < 3mm in size are treatable
42 Special Considerations Vitamin E, Aspirin, Ibuprofen, Fish Oils or other Blood thinners may increase the likelihood of bruising. Avoid for several days if possible, if not, practitioners should perform test spotsWhen treating lower extremities diabetic patients should have clearance from their primary physiciansDarker Skin Types should only be treated with the 1064nm wavelength42
43 Pre-Treatment Squeaky clean skin! No tanned skin! No Topical anestheticsTopical Alpha-hydroxyCan be used for 1-2 weeks prior to treatmentMeasure vessel sizeTanned skin and high fluences DO NOT MIX……..may scab/blister/hypopigment.43
44 Clinical Endpoints – 755nm Facial Vessels & Leg VeinsStructure will vaso-spasm or darkenPeri-vascular erythema is normalHemangiomasTransient purpuraResistant PWSTransient gray color that evolves into deep purpura44
45 Clinical Endpoints – 1064nm Facial VesselsONLY the 1.5mm spot size should be used on the faceVessels should disappear and erythema the end resultLeg VeinsVessels should disappearWheal & Flare or Cat Scratch appearance after about 5minutes45
46 Post treatment Apply pressure to treated area after a few pulses Cool CompressesTopical Cortisone CreamEncourage sun block 30+ SPFAvoid activities that cause vasodilatation or increase blood pressure for 3-5 days
48 What’s The Difference? 755nm 1064nm Thermal Injury stimulates the body’s response to create collagen1064nmBulk deposition of heat can cause both collagen contraction & collagen stimulation48
49 Use of 755nm Treatment of skin types I-IV Requires a series of treatments performed once a monthTechnique is similar to LHRClinical endpoints are slight edema & erythema49
50 Use of 1064nm Treatments can be performed on all skin types Requires a series of treatments performed once a monthSeveral techniques to choose fromClinical endpoint is achieving a surface skin temperature of 40-43º C50
51 1064nm for Skin Tightening Three different techniques *New Taylor18mm, 50ms, 18 J/cm² with the DCD turned off – 3 PassesKeys10mm, 50ms, 20 J/cm², DCD off, Double Pulse/3 PassesPainting8-10mm, ms, 12 J/cm², DCD off, 5-7HzAll deliver bulk heating into the dermal layer of skin
52 Clinical Endpoint?The use of an Infra-Red Thermometer allows us to achieve a surface temp of 40°-44° CThis translates to an approximate dermal temp of 65° CThis is the temperature that can cause collagen contracture
53 GentleMAX User Interface How to choose wavelengthHow to adjust parametersUsing the Guided Mode
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