2 From Razor to Laser Methods of hair removal Shaving Waxing / plucking Depilatories and creams (bleaches)Electrolysis / electrothermolysisLaser/light-based hair removal
3 Benefits of Laser Hair Removal Treats a large area quicklyLow risk of side-effectsTemporary hair reduction for all hair typesLong-term growth delayPermanent hair reduction
4 Absorption Spectrum of Major Chromophores in Skin Cheveux™ Diode Laser
5 How Laser Hair Removal Works Laser energy is selectively absorbed by the melanin in the hair follicle and converted to heat, injuring the follicle.Most hair is permanently removed. Hair that does regrow is finer and lighter than before.
6 Appropriate Pulse Durations Pulse duration: key in destroying the follicle without excessive damage to the epidermisWith a pulse duration and energy chosen properly for a particular skin type, the follicle can be destroyed with minimal heat damage to the epidermis (selective photothermolysis).The larger the target, the longer the thermal relaxation time (defined as the time required for an object to cool to 50% of the temperature achieved immediately following laser exposure).Finer hair has shorter TRT.Coarser hair has longer TRT.Longer pulses allow heat to safely spread from the epidermis, especially important with darker skin types (e.g. 100ms, 400ms).
7 Who is a Candidate?The Cheveux™ is safe and effective on all skin types and tanned skinWorks best on darker hairRed or light brown hair may take more treatments to be effectiveBlonde, gray and white hair do not contain melanin so treatments are not recommendedCan treat any area of the bodyFor safety avoid treating within ocular socket/orbit or on mucous membrane
8 Number of Treatments Three phases of normal hair growth: Anagen (active)Catagen (regression)Telogen (resting)Follicle most susceptible during anagen phase1/3 to 2/3 of hair is in Anagen phase at any timeHair has most melanin in the bulb during Anagen phase and absorbs the most energy to disable stem cellsMultiple treatments required 4 to 6 weeks apart3-6 treatments for lighter skin patients4-8 treatments for darker skin patientsDuring initial treatment, only 1/3-2/3 hair will be effectedPermanent reduction typically 50-90% following multiple treatments
9 Pre-TreatmentPt. cannot wax, pluck or undergo electrolysis for 6 weeks beforehandCan shave or trimAvoid active tanning in area to be treated for 4 weeks prior to treatmentNo self-tanning products 2 weeks prior to treatmentObtain photographs
10 Pre-Treatment Patient selection Gray or blond hair not good candidates Avoid treating if history of pronounced keloidsAvoid treating over tattoos or permanent make-upHistory of herpes simplex virus (HSV) - pretreat with antiviral medicationStop Accutane for at least 6 monthsCaution if patient on photosensitizing medicationsCaution if history of hyper- or hypopigmentation
11 Eye Safety Can cause severe retinal injury No treatment within bony orbit of eye (outer canthus). Treatment of eyebrows not recommended.Ocular Hazard Zone:164 feet / 50 mUse occlusive goggles when treating the face
12 Safety Enclosed room, windows covered Laser safety sign posted outside doorLaser in standby when not actively usedKey removed when not in useLaser beam directed only at target or calibration port
13 Safety Footswitch clean and out of way when not in use Do not treat over paper or clothDo not store flammables in the roomAvailable fire extinguisherFollow ANSI standards for Class IV laserContact Laser Institute of America (LIA) (800) 34LASER for current ANSI and OSHA standards
14 Laser Hair Removal Technique Treatment is simple and straightforwardSet patient expectationsObtain health historyInformed consent signedArea clean and shaved prior to treatmentIf desired, topical anesthetic cream applied minutes before treatmentCaution if lidocaine allergySettings chosen based on skin type and hair densityLook for the presence of a tanTest spotting recommended
15 Fitzpatrick Skin Type Classification Scale Skin ColorCharacteristicsIWhite; very fair; red or blond hair; blue eyes; frecklesAlways burns, never tansIIWhite; fair; red or blond hair; blue, hazel, or green eyesUsually burns, tans with difficultyIIICream white; fair with any eye or hair color; very commonSometimes mild burn, gradually tansIVBrown; typical Mediterranean Caucasian skinRarely burns, tans with easeVDark Brown; mid-eastern skin typesVery rarely burns, tans very easilyVIBlackNever burns, tans very easilyThe Fitzpatrick Classification Scale was developed by Harvard Medical School dermatologist, Thomas Fitzpatrick, MD, PhD. This scale classifies a person's complexion and their tolerance of sunlight. It is used by many practitioners to determine how someone will respond or react to facial treatments.
16 Suggested Treatment Parameters Fitzpatrick Skin TypeStarting Fluences (Test Spots)Tolerated FluencesPulse WidthI35J/cm2Wait at least minutes.Observe epidermal response,increase or decrease by 2-5 J/cm2.15-60 J/cm2Auto30 ms – highhair density areasII350J/cm2III25J/cm210-45 J/cm2Auto – finer hair30 ms – coarser hair or high hair density areas
17 Suggested Treatment Parameters Fitzpatrick Skin TypeStarting Fluences (Test Spots)Tolerated FluencesPulse WidthIV20 J/cm2 for 100 ms10-45 J/cm230 ms – finer hair100 ms – coarser hair or high hair density areas1-10 J/cm2 for 400 ms1-10 J/cm2100 ms for coarse hairWait at least minutes.Observe epidermal response,increase or decrease by 2-3 J/cm2.
18 Suggested Treatment Parameters Fitzpatrick Skin TypeStarting Fluences (Test Spots)Tolerated FluencesPulse DurationV15-20 J/cm2 for 100 ms1-35 J/cm2100 ms1-10 J/cm2 for 400 ms1-10J/cm2400 msWait at least hours.Observe epidermal response,increase or decrease by 1-2 J/cm2.VI10-20 J/cm2 for 100 ms10-20 J/cm2
19 Suggested Treatment Parameters Fitzpatrick Skin TypeStarting Fluences (Test Spots)Tolerated FluencesPulse DurationAll Skin Types – Tanned SkinUse low range of fluences recommended for one skin type darker than patient’s skin type (e.g. treat tanned skin type III as skin type IV).Perform test spots on areas with same degree of tan as area to be treated.n/a100 ms
20 Operator Technique Secure wrist strap! Apply water-based gel on area to be treated (this may be kept refrigerated)Apply gel in no bigger than 12 inch square area as it tends to dry outSpot size is 9mmX9mm – laser spreads under skinOverlap 10%Larger spot sizes – deeper penetration in skinApply slight compressionKeep chilled tip flat on the skin surface at a 90o angle-Surface skin is cooled by chilled tip (4° C)to minimize heating of skinInspect and clean tip frequently during treatment!Caution if treating over moles or suspicious lesionsOperator Technique
21 Expected Sequelae and Tips Observe skin for unwanted effects such as excessive erythema, blisteringPerifollicular edema is to be expected – resolves in 2 hoursPerform a test spot behind ear to ensure safety to skin – wait 24 hoursDo not overlap over 10% or treat area twiceMake sure tip is always in contact with skin when treatingPlace wet gauze under lip when treatingDo not try to sculpt eyebrowsNever treat inside orbital rimUse goggles when treating glabellar area to protect eyesPlace cotton ball in ears when treating tregusPlace white sponge behind ear when treating pinnaStop treatment If greying or separation
22 Positive Clinical Endpoints Perifollicular erythema and edemaBumps around follicle several minutes after treatmentLess pronounced on darker skin typesCourtesy C. Dierickx M.D.
23 Post-Treatment Sunburn sensation is normal Takes 2 weeks for hair to shedIf desired, cold compress, aloe or hydrocortisone cream applied after treatmentGently clean area twice dailyStop glycolics, retinoids etcSunscreen for 6 weeks over the areaDescribe singed hair and shedding processPatient returns in 4-8 weeks for next treatmentAfter completion of initial treatment touch-up treatments at 6 month intervals may be required to disable resistant hairs in treatment area
24 Potential Risks Perifollicular edema/erythema Favorable post-treatment responseUsually resolves w/in 24 hoursLocal blisters - too high fluence, dark skinHyper/HypopigmentationTransient, should clear within 6-12 months,Fluence and skin type dependentScarring – Extremely rare
25 Ideas For Getting Started PromoteGood idea to treat staff so they can speak knowledgeably about procedureMention availability to patientsBrochuresPosters in waiting room, office bathrooms, exam roomsOn-hold message introducing laserPhone staff should be able to answer basic questions