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Laser epilation. Efficient hair removal with long-pulse alexandrite laser (Clinical Report No. 02/03-10).

Laser epilation. Efficient hair removal with long-pulse alexandrite laser (Clinical Report No. 02/03-10).

28.01.2011

Dr. Jean Luc Levy, MD, Laser Dermatology Center, Marseille, France


Introduction

Laser hair removal is still the most popular laser cosmetic procedures worldwide. Now a broad assortment of devices for hair removal is available on the market. 

There is a large number of working protocols with the peculiarities of the procedures on different areas of the body with different skin phototypes and the different hair characteristics. This clinical report will not include a statistically significant amount of samples, but will be restricted by the only specific area of treatment, the axillary area.
Laser hair removal is often associated with the procedure of removing unwanted hair, but it is also an integral part of hirsutism and hypertrichosis treatment.
The main objectives of laser hair removal are well pigmented and thick terminal hairs, with a dense keratinized melanocytes column. It is well known that hair growth cycle consists of 3 phases: anagen, catagen and telogen. Laser hair removal should be handled during the anagen phase, a phase of active growth.

Hair follicles vary even on the same area of skin, which affects the subsequent transfer of heat. Hair follicles are usually located at a depth of 1 to 6 mm, the papilla, located more surfactant than hair bulb. Both dermal papilla and hair bulb are the targets for laser hair removal.

The theory of selective photothermolysis is the basis of laser hair removal procedure, when the laser beam is focused on the melanin in the hair shaft, as the main chromophore for laser hair removal, perifollicular dermis of the surrounding tissue remains unaffected. In order to avoid undesirable side effects after laser hair removal pulse duration should be shorter than the thermal relaxation time of hair follicle (between 20 and 80 ms).


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Dr. Jean Luc Levy, MD, Laser Dermatology Center, Marseille, France


Introduction
Laser hair removal is still the most popular laser cosmetic procedures worldwide. Now a broad assortment of devices for hair removal is available on the market.
There is a large number of working protocols with the peculiarities of the procedures on different areas of the body with different skin phototypes and the different hair characteristics. This clinical report will not include a statistically significant amount of samples, but will be restricted by the only specific area of treatment, the axillary area.
Laser hair removal is often associated with the procedure of removing unwanted hair, but it is also an integral part of hirsutism and hypertrichosis treatment.
The main objectives of laser hair removal are well pigmented and thick terminal hairs, with a dense keratinized melanocytes column. It is well known that hair growth cycle consists of 3 phases: anagen, catagen and telogen. Laser hair removal should be handled during the anagen phase, a phase of active growth.

Hair follicles vary even on the same area of skin, which affects the subsequent transfer of heat. Hair follicles are usually located at a depth of 1 to 6 mm, the papilla, located more surfactant than hair bulb. Both dermal papilla and hair bulb are the targets for laser hair removal.

The theory of selective photothermolysis is the basis of laser hair removal procedure, when the laser beam is focused on the melanin in the hair shaft, as the main chromophore for laser hair removal, perifollicular dermis of the surrounding tissue remains unaffected. In order to avoid undesirable side effects after laser hair removal pulse duration should be shorter than the thermal relaxation time of hair follicle (between 20 and 80 ms).

While wavelength is increasing, absorption of laser light by melanin decreases. Additionally, during the procedure of laser hair removal, the ray dispersion mechanism reduces depending on the wavelength, which leads to deeper penetration into the dermis. The increasing during laser hair removal spot size ensures improving of the optical penetration into skin 1,5,6. Alexandrite Long-pulse Laser with a wavelength of 755 nm is the best choice for an effective procedure of laser hair removal. Its distribution and recognition in the market began in 1996. Excellent absorption in melanin and low absorption in oxyhemoglobin makes it an ideal wavelength for laser hair removal of Fitzpatrick I-IV skin phototypes. 

Additionally, the side effects of alexandrite laser with a properly regulated cooling system using is minimal, even for dark skin phototypes 5,8.

Quanta System is one of a few alexandrite laser manufacturers. Laser Light A platform and Domino, produced by Quanta System - is a modern alexandrite platform, which guarantee the highest success degree of laser hair removal procedures. During this clinical study we used the Light A laser. Nevertheless, the alexandrite laser can also be found among other Quanta System laser platforms, such as Light A *, Light 4V, Matisse HR, Q-Plus * 2, DaVinci A and Duetto MT

Purpose 
In this research effectiveness of the laser hair removal of the underarm area procedures with laser Light A is evaluatesd The aim of the procedure of laser hair removal was to evaluate the number of hair rods in the underarm area reducing.

Methods
The procedure of laser hair removal system on the Light A in the axillary region was performed with the following options, selectable on the touch screen platform: spot size of 14 mm, repetition rate 1.5 Hz, pulse width 20 ms and the energy flux density in the range of 14-22 J/cm2 .

Selected options provided 2.3 cm2 per sec. speed of procedure. The laser handpiece has built in contact skin cooler preloaded with 4 ° C to protect the epidermis.

To provide the most comfortable laser hair removal procedure the ratio between the repetition rate and cooling system requires the maximum 1.5 Hz pulse repetition frequency during it. In alive research 16 women aged between 21 and 55 years (mean age of patients was 41 years) were involved, while four patients had Fitzpatrick skin photo type II, 10 - skin photo type III and 2 patients had skin photo type IV. Two patients with skin phototype IV had laser hair removal with the energy flux density 14Dzh/sm2 in order to avoid potential side effects from laser hair removal procedure. In addition, 2 patients were treated with the following epicutaneous application of corticosteroid. All patients were healthy with normal endocrine function. For all patients it was the first procedure of axillary laser hair removal.

Armpit hair was shaved or trimmed up to 1 mm immediately before the procedure of laser hair removal. A local anesthetic cream was not applied prior the procedure of laser hair removal. Afterprocedure care included the application of a cream with zinc oxide, immediately after the laser hair removal procedure. The procedure of laser hair removal performed to these patients for 5 times with 4-5 week intervals. Reduction of hair after laser hair removal procedures has been noted on standardized images by a single independent observer and one operator during the study after 3 months (which coincide with the duration of telogen phase of the axillary hair), and 6 months after the first laser hair removal procedure. We used the classic quartile scale for assessment of hair reduction (1: 0-25%, 2: 26-50%, 3: 51-75%, 4: 76-100%). Patients evaluated the results of laser hair removal as an excellent, good, average or bad.

Laser hair removal. Results and conclusions
All patients during the procedure of laser hair removal have experienced a low level of discomfort during Light A laser procedures. The pain level was 3.6 on a visual analogue scale from 1 to 10. After the laser hair removal procedure, the mild perifollicular erythema and slight edema were observed, it persisted up to a maximum of 1 day after the laser hair removal procedure, depending on the color, thickness and density of hair. Two patients with skin phototype IV had not experienced any complications, such as temporary hyperpigmentation, or other changes in epidermal pigmentation after laser hair removal procedures. No one patient has not observed hypopigmentation or scarring. Pulse duration of 20 ms that was used to influence the follicles of terminal hair in all patients, is safe for exposure to epidermal melanosomes, which are only sensitive to very short pulses.

The Check visits after 3 and 6 months after the first laser hair removal procedure demonstrate a progressive decrease in the amount of hair with a partial re-growth in 3 sessions of laser hair removal. This was due to the timing of phases of hair growth after 2 sessions of laser hair removal. The 6 months later check after the last session of laser hair removal has demonstrated definitive and stable results. All patients with terminal black-brown hair, demonstrated more than 79% hair reduction. The remaining hair was thinner and lighter, and required another session of laser hair removal or additional treatment with one session of electrolysis to get 100% reduction in the amount of hair.

Patients evaluated the results of laser hair removal procedures as excellent and their estimate was always higher than observer and operator estimates. The average armpit hair removal processing time was 7 minutes, including shaving and cleaning before the laser treatment.
All 16 patients were satisfied with the results of laser hair removal, in general, they stated that laser hair removal procedures were virtually painless. Two patients with skin phototype IV and two other patients with skin phototype III (25% of patients) needed all 5 treatments of laser hair removal to achieve a satisfactory reduction of all hair amount.

 Even nine of the patients, three of whom had skin phototype II and 6 - skin phototype III (56% of patients), with dark and thick terminal hair achieved satisfactory results after only 3 treatments of laser hair removal.
In conclusion we can say that the axillary region is not hormone-sensitive zone. This cosmetic laser hair removal procedure demonstrated considerable reduction of hair growth without significant epidermal side effects. It can be concluded that the procedure of laser hair removal using laser platform Light A company of Quanta System is one of the safest and most effective laser hair removal procedures when they are synchronized with the cycle of hair growth, typical of the treated anatomical area. The 6 month later check visit demonstrated a high degree of the procedures success. Further research should focus on determining the optimal parameters with respect to various thickness and color of the hair shaft. Will also assess the procedure of laser hair removal to other areas such as bikini line or face area, with the same laser.

LINKS
1. Levy J.L., Trelles M. A. and de Ramecourt A. (2001) Epilation with a long-pulse 1064 nm Nd:YAG
laser in facial hirsutism. Journal of Cosmetic and Laser Therapy, 3(4), p. 175-179.
2. Sanchez L. A., Perez M. and Azziz R. (2002) Laser hair reduction in the hirsute patient: A critical
assessment. Human Reproduction Update, 8(2), p. 169-181.
3. McDaniel D.H., Lord J., Ash K., Newman J. and Zukowski M. (1999) Laser hair removal: a review
and report on the use of the long-pulsed alexandrite laser for hair reduction of the upper lip, leg, back, and
bikini region. Dermatologic Surgery
1999, 25(6), p. 425-430.

4. Anderson R. R. and Parish J.A. (1983) Selective photothermolysis: Precise microsurgery by elective
absorption of pulsed radiation. Science 1983, 220, p. 524-527.
5. Khoury J.G., Saluja R. and Goldman M. P. (2008) Comparative evaluation of long-pulse Alexandrite
and long-pulse Nd:Yag laser systems used individually and in combination for axillary hair removal.
Dermatologic Surgery 2008, 34(5), p. 665-670.
6. Olsen E.A. (1999) Methods of hair removal. Journal of the American Academy of Dermatology, 40, p.
143-155.
7. Garcia C., Alamoudi H., Nakib M. and Zimmo S. (2000) Alexandrite laser hair removal is safe for
Fitzpatrick skin types IV-VI. Dermatologic Surgery 2000, 26(2), p. 130-134.
8. Ono I. and Tateshita T. (2000) Histopathological changes in the hair follicle after irradiation of long-
pulse Alexandrite laser equipped with a cooling device. European Journal of Dermatology, 10(5), p. 373-
378.

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