Hair Removal laser

Dr. Alireza Vaez Shooshtari

Dermatologist

Hair Removal • Electrolysis • Creams • Laser

Laser Hair Reduction Epidermis: 40 - 150 microns Dermis: 140 - 400 microns E & D: 180 >/= 550 microns 1.Papilla: neurovascular tuft 2. Bulge: at Erector Pili 3.Matrix cells:>= 2 mm Anagen > Catogen> Telogen

Target Isolation • Can we target over other similar targets?

(Can we seek melanin in hair over skin?) Selective Photothermolysis

What is the Target ?

• • • Eumelanin : brown or black hair Best absorption of light Pheo melanin : red or blond hair Poor absorption Gray hair : pigment-free White hair No absorption

Hair Removal Lasers • • • • • Nd:YAG Flashlamp Diode Alexandrite Ruby 1064 575/ 515-1200 800/810 755 694 nm nm nm nm nm

Relative Absorption of Laser Light & Competing Chromophores

1064nm

Features Wavelength: Power: Fluence: Spotsize: nm watts power/cm2 mm Overlap: Pulsetime: % ms Pulse interval: ms or freq

Keys for success •Wavelength: >690 nm (>wavelength=depth) (shorter -> competing chromophores) •Spot size: at least 5 millimeters •Pulse time: 18 or > milliseconds •Pulse interval of 35 or > milliseconds

When do you treat?

• • • During Anagen cycle Not during telogen Cycle time determined by Richard-Merhag chart

Richards-Merhag

Fitzpatrick Types

OK: Fitzparick IV/VI: Nd-YAG non-confluent scanner >15 ms Continuous cooling

Consultation • Patient history( mense, PCO, other sign) • • Any previous hair methods Expectations • Treatment explanation 3-6 session, 1-2 month apart 20-30% reduction per session 70-80% long term reduction • Photographs & Consent

Contraindications • • • • Pregnancy Recent sun exposure Sun tan Suspicious lesions

Before Treatment • • • • • Shave 1-3 days before treatment (stubble) Avoid other methods for 30 days SPF 15+ for 4-6 weeks Avoid tanning creams Hydroquinone if necessary

What is the endpoint ?

• • • • • Small contact spark/flash Smell of burnt hair Perifollicular edema Sensation of light sunburn One in three hairs extrude

After treatment • • • • • Redness: 4-6 hours after treatment Hair appears to grow for several days Hair falls out: day 10-14 Hair reappears, next phase: >3-6 weeks Treat again: >= 6 weeks later

Complications of Laser Hair Removal • • • • • • Blistering Hypopigmentation Hyperpigmentation Scarring Koebner phenomenon in psoriasis , vitiligo Temporary or permanent leukotrichia

Complication (cont.) • Found conversion of fine vellus hair to dark, coarse terminal hair low fluence or induction of growth of long fine hair from repetitive