Tuesday 22 January 2019

Laser Hair Removal

 

I have become a passionate therapist for both electrolysis & laser hair removal due to my past experience as a client for electrolysis, laser & IPL hair removal. I had got epidermal burn once from IPL hair removal resulting in hypopigmentation in that area for about 5 yrs. [ https://hairtell.com/forum/t/hypopigmentation-after-laser-treatment-burns-photo/51382/6 ]


For any light therapies including diode, IPL & laser hair removal, I think not only therapists but also clients need to be well informed about it before deciding to have the treatment. I had got skin burn from IPL hair removal because back then I didn’t know what I should have felt during and after the treatment as my therapists hv never provided any proper consultations!!!


Therefore, everyone should read and understand the following info before they start laser (diode, or IPL) hair removal treatment. To achieve the most successful result you could possibly get, compliance is required from both therapists and clients, especially timing between treatment sessions.



Ask yourself what do you want your ultimate result to be?

-- If you are happy with significant hair reduction (ending up with peach fuzz which is short, fine, lightly pigmented hair) and you may require maintenance sessions in later years (4-6 yrs after the initial LHR course), Laser/IPL may be your preferred choice.

Please note you may end up with either good results as expected, patchy hair in certain areas, more hair or the combinations of these after series of Laser (Diode, or IPL) treatments.

-- If you want to achieve completely and permanently “gone forever” removal of every single unwanted hair, electrolysis is the only solution.

 


Electrolysis vs Laser Hair Removal

The Difference Between Laser Hair Removal and Electrolysis :




//////////////////////////////////////////

Laser Hair Removal (LHR)


When LHR should be avoided? Who should avoid LHR?




(The list is not meant to be exhaustive but is a good starting point for issues that are contraindicated for LHR)


• Individuals who can't stay out of the sun

• history of skin cancer, such as melanoma

• raised moles, suspicious lesions, hypertrophic/keloid scar formation, healing problems, active infections, open lesions, wounds, open skin, hives, herpetic lesions, cold sores, autoimmune diseases such as lupus, psoriasis, scleroderma or vitiligo

• Individuals with a known history of frequent Herpes Simplex Virus (HSV) 1 or 2 lesions should begin prophylaxis prior to treatment as prescribed by their physician. Clients are advised to take the antiviral medications (examples: acyclovir or valacyclovir) at least one day before and continue after each treatment session strictly as directed until you finish the prescription, even if you feel better. If you stop taking medication too soon or skip doses, your infection may not be completely treated or may become more tolerant and difficult to treat.

• history of photosensitivity – drug induced or something to do with genetic inheritance

• Current uses of photosensitising/photosensitive medications that induce photosensitivity and can make your skin sensitive to light including laser light and sunlight

Exposure to light, these medication may induce hyper-, hypo-pigmentation, dermatitis, blister or burn.

LHR can be performed when clients stay off such medication for at least its 1/2 life or longer when it is out of their body system.

Clients are advised to consult their doctors before stop the medication. Clients are also advised to stay off such medication 7 days after each LHR.

For ex, isotretinoin, such as Accutane, wait at least 6 months after the completion of such therapy before starting/resuming LHR. Isotretinoin temporary decreases the production of sebum and reduces the size of sebaceous glands. Some of the side effects of isotretinoin are dry skin, chapped lips, a weakened ability to heal wounds. Therefore, it is not advisable to do LHR while on Accutane as this could increase the risk of burn or scarring from the laser/IPL treatments.

• Hydroquinone, skin brightener, skin lightening or bleaching agent – Stay off them for at least 7 days prior to and after each LHR due to higher risk of pigmentation complications

• Pregnancy, trying to get pregnant, or during breastfeeding

• Seizure disorders including light-triggered seizures


• Intramuscular gold therapy

• Individuals who r currently taking anticoagulants, blood thinners, iron supplements, herbal supplements such as ginkgo, ginseng or garlic may bruise more readily.

• Individuals with implanted medical devices such as Pacemakers, cardioverters, and other implantable devices or fillers, please consult your physician.

• Here, we do NOT treat clients with recently tanned skin or fake tan. Blisters, burns, hyperpigmentation or hypopigmentation may occur. Allow tan to fade prior to treatment. When in doubt, compare treatment area with limited sun exposure area such as your bum

Natural tanning or artificial tanning products darken the surface of the skin. When the surface of the skin darkens, more laser energy will be absorbed by the skin's surface rather than by the hair - our main target. When too much light energy is absorbed at the skin surface, not only it posts higher risk for burn, but also less result in hair reduction.

Other places can treat tan skin because they use low settings to lower risks of over treatments such as burn. But this will ruin clients' ultimate results to have the uttermost hair reduction in the long run.

• For clients with sensitive skin and histamine, or have a history of allergy, hay fever, asthma, eczema, prolonged erythema or edema, taking oral anti-histamine 12-48 hours before & after laser treatment is optionally recommended. Prescribed topical corticosteroids may also be another option. Click here for possible adverse effects of corticosteroid creams.

• For optimal hair removal results, wait around 6 - 8 weeks (not earlier and not later) after waxing, plucking, threading, epilation cream or other methods that affect or disturb hair underneath the skin, before having LHR.

• Between each LHR session => NO waxing, plucking, threading, epilation cream and/or other methods that affect or disturb hair underneath the skin => No No No

• After you finish course of multiple laser sessions, NO waxing, plucking, threading, epilation cream or other methods that affect or disturb hair underneath the skin => No No No

• Avoid any heating devices including LHR 2 weeks prior to or after Botox.

• Avoid laser treatments at least 2-4 weeks or longer prior to or after filler. Consult with your provider for their specific recommendations.



Electrolysis is the only solution for permanent hair removal for individuals with the following cases:
• blond, red, grey and white hair
• sparse, thin hairs or individual/isolated/patchy coarse hair
• tattooed sites & permanent makeup
• cold sensitivity including Raynaud phenomenon

 

 


If you have any concern or questions, you are more than welcome to contact us for more information.


What you need to know & expect?

////////////// IPL, diode & Laser are different. //////////////

Both IPL, diode & laser are lights. But they have totally different properties.

Click here for video.


IPL refers to machines that send out a band of spreading (or divergent) & noncoherent (photons are travelling in random directions but all are travelling forwards) light of around 400 - 1200 nm wavelengths. Therefore, it require direct skin contact, else the lost of energy is very high and only a small portion of the light intensity will ineffectively reach the target. Because IPL light is noncoherent, it cannot be focused, or collimated like laser and laser diode. IPL is less effective than laser and diode in removing hair due to different properties stated above.

a sample VDO for an IPL for hair removal

 

Diode or laser diode refers to a low-energy device that uses semiconductors to generate light beams of a single wavelength of spreading light, thus requires directly skin contact during treatment to counteract its spreading property of light. Due to its properties of spreading, noncoherent light beam, diode cannot be concentrated/focused into pulse width shorter than what crystal laser machines can offer, so diode is less effective than crystal lasers in treating residual fine hair after many treatment sessions.

To create a triple-wavelength hand-piece (for an example, one that emitting light of wavelengths of 755, 808 & 1064 nm), a manufacture installs three different sets of diodes, each emitting a single wavelength, in the hand-piece. The problem that arises here is that each wavelength of diode requires a unique technical specification. The manufacture then creates an environment that will be as suitable as possible for all three, but not optimised for any one of the three. This means that the optimal performance and lifetime of the hand-piece are reduced.

VDO explaining diode lasers from around Minute 9.26

Click to see vdo ;         Another VDO hair purging out of follicles as light beam hit


Laser refers to a device using crystals, such as alexandrite (emitting ligth of a wavelength of 755 nm) or Nd:YAG (emitting ligth of a 1064-nm wavelength), as its laser sources. It is made to produce a single wavelength of light which has more concentrated (coherent & collimated) energy than that of IPL and diode. A laser or diode device with one wavelength is more specific to a given target but less versatile than IPL with multiple wavelengths. Therefore laser is more effective than IPL in removing hair and laser has fewer side effects and less complications than IPL. However, many lasers and diodes now can fire multiple wavelengths simultaneously.

Click here for a VDO sample for a laser machine ;        Another VDO for a different laser machine;       Third sample from other business


Any superior machines become useless if there's no signs of perifollicular oedema 5-15 min after being hit by light beams and hair doesn't fall out within few weeks post each treatment session.

Any inferior machines can work effectively when hair follicles become inflamed soon after the treatment procedure and hair fall out in 1-2 weeks after each session.

Superior machines can help clients achieve ultimate greatest reduction result long-term at the right hand, for instance more than 90% permanent hair reduction, instead of less than 75-80%. Therefore hire the right therapists with the right machines for LHR when majority of your hair is in anagen.

You can get treated by the most expensive, top notch machine with highest output power in the world (which isn’t necessary but at least a decent machine is still required), but if your therapist use insufficient settings, you won’t achieve greater reduction results.
 
One of the significant factors in achieving optimised result is not only the right machine, but the therapist’s knowledge, experience and understanding of the technology and the machine he or she is working with.
 

 

 

When u r talking about light, you are also talking about colours.

colour = wavelength => They are the same thing in different contexts. Each colour has different wavelength.

Please see the image below and apply the principle of light absorption & reflection for objects of different colours. Please note many lasers are invisible to human eyes. But the principle holds true even if we can see it or not with our naked eyes.

 

Objects of different colours absorb different colours (aka wavelengths) of light, but will reflect similar colours of light.

 


 
The wavelength of light indicates the energy level of the photons.

The shorter wavelength has lower-energy of photons.

At the same power or watts, lasers with higher-energy photons (aka shorter wavelengths) can cause more cellular/tissue damages. It means lasers with longer wavelengths, having lower energy photons, require more power supply.

Because laser is light, to remove hair by laser we need to consider colours (aka wavelengths) of both laser beam & the natural colours of hair underneath the skin we wish to be removed. Target dictates which wavelengths we must use.

Colour of our hair & skin comes from pigments called melanin.

Melanins aren't only found in hair. They are also inside the skin cells (AKA keratinocytes) & inside melanocytes locating in the bottom-most of epidermis => [[[Thus complication can happen. For example, damaged melanocytes may cause temporary or permanent hypo-pigmentation of the nearby keratinocytes. Mitosis of melanocytes or differentiation of the precursors of melanocytes which occur naturally may later solve this skin lightening problem.]]]

 

melanin locations of anagen hair
Melanin Locations in Anagen Hair

 

Hair get destroyed by laser according to the following process. Any dark thingies (such pigments including brown & black melanins) present in the skin & hair shaft absorb light of only certain wavelengths emitted by certain light-emitting devices. Any dark-colour matters (in this case, dark melanin inside hair shaft & epidermis) turn laser light into heat and give off such heat to surroundings that have no dark pigments such as colourless hair follicles containing colourless hair stem cells and etc.

 

 
When light reaches/hits the skin, some photons immediately either reflect back, scatter, or get absorbed by some chromophores. (A chromophore is a molecule which absorbs light at a particular wavelength.)
When light energy is absorbed by some things, this causes their molecules to vigorously vibrate & this in turn causes friction and some of that energy will be converted into heat, which raises the temperature of the chromophores.




//////// Not all current diode, IPL & laser devices work effectively and are suitable to remove hair ///////


LHR uses dark melanin pigments present inside the hair as elements to heat and destroy the surrounding colourless stem cells found from the bulge to dermal papilla. It is not the hair but the colourless stem cells causing hair growth that needs to be destroyed. If the stem cells aren't completely destroyed, hair will eventually regrowth. Thus,

hair can be permanently reduced/retarded only when the appropriate wavelengths of light are used for the sufficient period of time (aka pulse duration) so that the sufficient light is absorbed by dark colours and converted to sufficient heat enough to destroy hair FOLLICLES while minimal energy is transferred to the surrounding skin. If this can occur then there is high possibility that hair may reduce/remove permanently, and less chance of hair regrowth in the future.


There are things to consider:

-- Wavelengths (in 'nm' for hair removal devices)
Light of shorter wavelengths can only penetrate shallow into the skin and cannot reach any deeper.
Thus it cannot effectively treat some hair that roots deeper.

Dark melanins locating within the skin cells and hair shaft absorb more light of shorter wavelengths, but less of longer wavelengths.

Light of longer wavelengths can penetrate skin deeper, allowing sufficient light energy to reach those follicular vessel supplies locating at the bottom of hair follicles. Consequently, t
he hair follicles starve to death when their blood supplies have been destroyed.





 Chromophore Absorption of Various Wavelengths:  VDO I      VDO II

 




Penetration Depths of Various Wavelengths:

 

 

 


 

Melanin, hemoglobin, fat cells and water molecules are main chromophores in our skin.

-- Melanin can absorb light of wavelengths between 400 - 1,200 nanometers. However, it absorbs more light of shorter wavelengths and less as wavelengths become longer.

-- Hemoglobin absorbs more light of wavelength 418, 532, 577 & 585-595 nm and less of 1064 nm

-- Fat cells absorb light of wavelengths between 1,200 - 1,700 nm.
 
-- Water absorbs light of wavelengths longer than 1,000 nm.


 

Lights of longer wavelengths can penetrate deeper into our skin, 

but lights whose wavelengths are longer than 1,300 nm cannot penetrate deeper beyond stratum corneum because most of them get absorbed by water molecules present in all the skin cells, thus blocking those light to reach deeper.

 

 

Sources:

 


-- Skin colours (aka skin phototypes)
755nm is safe to be used for Fitzpatrick Skin Type 1, 2 & 3 only. Diode is safe to be used for Fitzpatrick Skin Type 1, 2, 3 & 4 only. 1064nm is suitable for all skin types but less efficacy.

It is safer to use a laser with a longer wavelength for very dark-skinned individuals. The longer wavelength is needed to avoid the laser energy absorption by dark melanin pigment locating in the epidermis layers as would occur with the shorter wavelength laser. Dark melanins poorly absorb longer wavelength, thus decreasing the risk of blisters or burns on the surface of the skin.
 

 
 
 
-- Pulse Duration or Pulse Width [in 'millisecond (ms)' for hair removal]
Pulse width/duration means cooking time or how long each laser beam is allowed to work on target, in this case hair follicles. It needs to match the size/diameter of the targets. The longer pulse duration is for the thicker hair diameter. Longer pulse shouldn't be used for thinner hairs to prevent damage to adjacent tissue.
 
Longer ms for thicker hair having larger diameters; shorter ms for finer and residual hair.
 
Hair with thinner diameter requires high fluence with shorter pulse duration.
Our machine, Duetto MT EVO from Quanta System allow us to drop pulses as short as 0.3 milliseconds to effectively treat finer hair that other machines struggle with because they are not capable to produce shorter pulse duration of high fluence, thus losing efficacy to treat fine hair.
 
For the same fluence, a longer pulse will generate lower temperature.
Assuming all else is the same, if we fire the same fluence (= same amount of photons) at the same hair in half that time (reduce ms by 1/2), then such hair become hotter. This is not quite that because photons become more concentrated due to same amount of photons being emitted for shorter/quicker pulse, but the photons are fired at the hair in a short time, not much heat will escape (away from dark melanin inside the hair shaft to surrounding) during the pulse. Thus the hair becomes hotter. In a longer pulse, there is more time for the heat to escape during the pulse. That means that the hair cannot be as hot since more of the heat is lost to the surroundings before the pulse has finished.

For example, an Alexandrite-crystal laser delivering 10 Joules in a 5ms pulse, will generate higher temperatures in a target than the same fluence delivered by a diode laser or IPL in a 10 or 20 or 50ms pulse. In fact, the shorter the pulse, the higher the peak (maximum) temperatures attained in the targets. 
As a consequence, crystal lasers can induce more thermal damage, compared with diodes and IPLs. This is due to crystal lasers are capable of emitting pulse shorter of higher fluence than do diodes and IPLs. Given that hair removal is a photothermal process, these higher temperatures result in better clinical outcomes.
 
Too short/quick pulse width will only bleach hair but won't kill/destroy/damage hair follicles. Read Picosecond and Q-switched lasers below.

VDO I;         VDO II



Laser devices operate as continuous or pulsed modes (e.g. single or repetitive pulsed).
 
Two main types for pulsed systems are called/termed or marketing in various terms/names:
 
1. single pulsed system, single shot or static mode (1 Hz) - For hair removal devices, each shot (1 Hz) delivers high energy enough to damage hair follicles.

2. repetitive pulsed, SHR or dynamic mode (above 1 Hz) - Rather than deliver a single shot, the machines deliver multiple shots/Hz to build up energy and heat designing for less pain.

Some machines are manufactured to be able to work in both modes (1 Hz or more), but some aren't.
 
 
Examples of multi-pulsed (aka, repetitive-pulsed) laser devices are Short Pulsed, Long Pulsed, Q-switched and Pico for different treatment purposes.

Long-pulsed lasers (in ms) with wavelengths from 694 to 1064 nm have proved to be effective in removing hairs.

Picosecond, Q-switched (in nanosecond) & other short-pulsed lasers, which emit laser beam in much shorter duration than long-pulsed lasers (in millisecond), do not allow enough time for light to be absorbed by dark melanin, not long enough for heat to dissipate from dark melanin inside hair shaft to destroy surrounding colorless hair follicles. They are designed to emit much much higher fluence in much much quicker pulse duration that can violently shatter pigments into smaller fragments. Thus they won't do anything to your hairs except bleaching hair colours. Both the amount, density & size of your hairs will remain exactly the same. The follicles will remain intact & but dark melanin has been destroyed. Remember! Once hair get bleached, any current light-based therapy won't be effective for lighter hairs. :-( 😭

 
 
In other words, if the pulse duration is too short or too long this can result in unanticipated results.

 

 

-- Repetition Rate (Hz) is the number of laser pulses per 1 second.

0.5 Hz means 1 shot every 2 seconds, each shot emits the set Fluence for the set Pulse duration
1 Hz = 1 shot per 1 second
2 Hz = 2 shots per second or 1 shot per ½ second
2.5 Hz = 1 shot every 0.4 second

The higher Hz the faster the treatment and to achieve greater hair reduction/destruction results, this (higher repetition rate) is only enable by machines with high power output.


-- No. of passes/passages -- Passes is different from Hz. It refers to repeating action of a therapist to deliver light beams over the same spot of your body area to build up energy and heat. Follicles might not be effectively damaged if therapist do it too fast and too little passage number.

 

Click here to see Static vs Dynamic Modes and Passes in action.


 


Fluence = J/cm2 = watts/cm2 × ms

-- Fluence means energy (in Joules) of each laser beam per 1 squared centimetre of treated area. Clients achieve must better results with higher fluence.

One shot of higher fluence is more efficacious than multiple shots of lower fluence. Click here for explanation.


Energy (Joules) = Power (watts) x time (millisecond) => This means that joules (energy) can be adjusted either by adjusting the power (watts) or cooking time (ms). Unfortunately, output power is fixed by manufacturers.


-- Power (watts)

Some machines of different brands with higher output powers (higher watts) require lower Hz and less passes, working efficiently faster to effectively damage hair follicles. Some other brands require higher Hz and multiple passes for lower powers (lower watts) to work longer (longer pulse duration).

As abovementioned, the longer the pulse, the lower the peak (maximum) temperatures attained in the targets and less outcome. Thus, less effective.

More info regarding "power vs energy": Click here

More read regarding "power": Click here


Some professionally-claimed machines and many home devices with low powers cannot supply enough energy to damage hair follicles.

 

For an example, a hair dryer with 2200 watts can heat and dry hair much faster/more efficient than a 750-W one.

 

That is the reason why our business has upgraded to a brand new, medical-grade, Class-IV laser device with output power of 8200 watts using both Alex (755nm) and Nd:YAG (1064nm) crystals that can deliver non-spreading, concentrated, more powerful short pulses (as short as 0.3 milliseconds) with higher fluence, which is more efficacious for difficult to treat residual fine hair that other laser, IPL and diode machines struggle with. This model has been used and trusted by medical professionals worldwide. It can fire both Alex & YAG at the same time or separately.


Our model has been approved by Australian TGAUSA FDA, European EMA and also by other regulatory bodies around the world as the medical laser device indicated for long term or permanent hair reduction/removal and for treatment of pseudofolliculitis barbae (PFB), for all skin colours, Fitzpatrick I-VI. Click the links for verification.

 

Comparison Table of Different Machines with our LHR machine


 

Source: USA FDA approved medical devices

 

With a skilled therapist and low power machine, clients will observe good results for the first few treatment sessions and less on subsequent treatment sessions. Thereafter, the results will plateau as it is beyond the machine's capacity to be able to provide any further reductions.

As clients progress with subsequent LHR treatment sessions, their hair becomes finer and lighter and locates shallower, thus absorbing less light, requiring shorter pulse widths and concentrated beams of higher fluence (energy) than does initial hair which is denser, thicker, coarser & darker. In order to achieve beyond 80% - 98% long-term/permanent hair reduction, ensure the power output of a LHR machine is over 2000 watts to ensure the machine can perform this.



-- Spot Size (mm) is the size of laser aperture.


-- Depth of Penetration

is dependent upon the wavelength, fluence, and the spot size.

In general, the longer the wavelength the deeper the penetration into skin. The bigger the spot size the deeper the penetration into the skin.

 
 
 
The setting must match the depth of the target to be destroyed. If the setting is for deeper penetration, this won't be so effective for the target locating shallower.


This VDO summarises IPL, laser & diode technology => click to see

The following article also summarises settings for LHR => click to read

The following VDO summarises settings for LHR => click to see



Settings of different parameters [i.e., Wavelength, Spot Size, Fluence, Pulse Duration (ms) & Repetition Rate (Hz)] to be applied are according to different recommendations among different brands. They can be increased or decreased depending on the previous results and clients' feelings during different sessions.

Aim is to raise the temperature to fully coagulate the hair FOLLICLES and that temperature is above 75 °C just like when egg white starts to change from fresh clear liquid to cooked cloudy solidified.
So how can customers feel painless if the treatment is meant for efficacy?

Aim is to raise the temperature to destroy as much as possible, if not completely, hair stem cells and FOLLICLES. This mean
s that the treated hair follicles must show the sign of inflammation – angry red bumps few minutes after the firing.
Ask yourself how can your hair follicles get destroyed if there is no sign of follicle inflammation!

Please note that inflammation sign won't appear as soon as the laser beams hit you, so does the over-treated sign of blistering or burning, but few minutes or longer after that. That's why all the clients should do patch test initially to find the proper energy settings which are different among individuals & different body parts.
 
 

 

-- Pre- and Post-Cooling: Click here to read

to reduce pain and to cool skin surface and prevent burning/overtreatment of top skin layer.

 

 

///////////// The efficacy of LHR also significantly depends on: /////////////////////


-- The colours of hair underneath the skin
Current IPL & laser are ineffective for blond, red, grey and white hair, but they are effective for natural brown & black hairs.

-- Density & diameter of DARK hair underneath the skin
The treatments are more effective on dense, thick, coarse & dark hair because they have more dark pigment that can absorb more light. The higher density of dark hair the better result. Either sparse or fine hairs cannot absorb enough light to destroy the follicles. Thus, LHR lose efficacy on either scattered hair or very thin, vellus hair.
 

 
 -- The colour of the skin vs. the colours of hair underneath the skin
If the surrounding skin is lighter than the colour of the hair, the energy of the laser is concentrated mainly in the hair shaft, effectively destroying it without much affecting the skin.
If the skin contains dark melanin, melanin in both skin & hair will absorb laser light, thus less heat concentration in the hair.
The less pigment in the skin and the more darker pigment in the hair, the better result.

The darker the skin colour the higher risk of skin damage or burning, thus the lower energy setting and the less efficiency and less results.


-- Hairs of different areas & hormones

Results also vary among different areas and among different individuals.
Areas that aren't controlled by hormones, such as underarms, groin area, lower arms & lower legs, usually respond well to LHR.

For some individuals, hair of certain areas that are controlled by hormones, such as face, upper arms, chest, abdomen, back & inner thighs can become patchy after LHR.

Additionally, there have been cases LHR can stimulate hair of those areas that are controlled by hormones by turning fine, vellus hairs into coarse, terminal ones. Some individuals can end up looking harrier in some areas after LHR. Examples of reported cases: Case A, Case B, Case C

https://www.lasercollege.org/diode-laser-hair-removal-or-hair-growth-stimulation/

 

However, results vary among different individuals & different areas can have different results.


-- Phase of the hair growth cycle
The most effective result is when hairs are in the anagen phase. Why?
Any dark-colour objects (in this case, dark skin & hairs of all growth cycle including anagen) absorb light from laser and turn the light into heat and give off such heat to surroundings that have no dark pigments. Any colourless, red, blond, grey & white objects don't absorb light produced by current LHR devices.
Only hairs in anagen phase are still in contact with the parts of colourless hair follicles containing colourless stem cells. Even though hairs in other growth phases absorb light from laser and give off heat to surrounding but they have lost contact with stem cells. If the stem cells aren't destructed, hairs will eventually grow back.
 


Candela Gentle series and Cutera machines can only emit a single wavelength, but our laser machine, Duetto MT EVO by Quanta System, can emit both wavelengths allowing us to treat multiple targets & depths at the same time. 755 nm treats shallower part of hair follicles while 1064 nm treats deeper part.
755 targets dark pigments, such as dark melanins, thus more effective to treat hair with light colours than 1064 nm.
1064 nm targets oxyhaemoglobin and water in the blood, thus cutting off nutrients and hormones supplies and starving the follicles.




Reference:

Image Gallery: Intravital visualization of the dynamic changes in human hair follicle cycling

 

At any given time, not all hairs are in anagen phase. Therefore, multiple treatments are required to achieve the optimal appearance.


///////////// Types & Quantity of melanins (colours) found in human skins & hairs significantly affect efficacy of LHR: /////////////


Types of melanin found in human skins & hairs:

Eumelanin is found in the hair, skin, eyes and dark areas around the nipples. It is particularly abundant among black populations.

There are two types of eumelanin—brown eumelanin and black eumelanin—which chemically differ from each other.

Black melanin produces black colours when it is present in large quantities. A small amount of black eumelanin in the absence of other pigments causes grey hair.

Brown eumelanin may produce brown hair colours when it is present in abundance. A small amount of brown eumelanin in the absence of other pigments, hair may be blonde/yellow.
Eumelanin is present in the Caucasian and Negroid races, therefore in subjects with dark skin and dark hair.


Pheomelanin is also found in the eyes, hair and skin. This type of melanin provides pink and red colors and is the main pigment found among red-haired individuals. Pheomelanins are particularly concentrated in the lips, nipples, glans of the penis, and vagina. When a small amount of brown eumelanin in hair, which would otherwise cause blond hair, is mixed with red pheomelanin, the result is red hair. Pheomelanins is typical in the Celtic race, with pale skin, numerous freckles and auburn or carrot coloured hair.


Trichochromes (formerly called trichosiderins) are pigments found in red hair.



Our hair colour is determined by varying amounts of melanin, the pigment type, the density and distribution of the pigment granules. Different types of melanin, and the ratio of these pigments produces different hair colours. The mixture varies not only from one person to another, but also across one person’s body.

Although people with dark hair may still produce the yellow-orange pheomelanin, it is largely masked by the dark eumelanin pigment and cannot easily be seen. However, the red-yellow pheomelanin is believed to cause the warm, golden, or auburn tones found in some types of brown hair. The range of colours produced by melanin is limited to shades of yellow, brown, red, and black. Grey hairs contain only a few melanin granules, spread out through the hair. White hairs contain no melanin at all.

The whiter the skin colour and the more dark pigment there is, so the darker the hair colour the higher efficacy of LHR treatment. The less pigment in the skin and the more darker pigment in the hair, the better result.

The darker the skin colour the higher risk of skin damage or burning, thus the energy settings must be lowered and the less efficiency of LHR treatment.


Much like the difference in the heating of a car in sunlight, the darker car is hotter at the end of the day than the white car. This principle also holds true for laser hair removal.






All of the following 6 conditions must STRICTLY be followed in order to obtain optimum results from LHR:


1. Marquee clinical End Points which determine that the device settings are effective
The settings must be high enough that 
your follicles become inflamed after being hit by the light. That is when you see treated hair follicles become red & swollen.

The more pronounced follicle inflammation, the better & the sign to indicate some damages to your hair follicles. But the setting shouldn't be too high that can blister or burn you, therefore patch test is very important. Some hair purge out from follicles as soon as they get hit by the light. Generally, hair should fall out within a week or two after the treatment. If this isn't the case, it's not working.

The photos below show the signs of what effective treatments should look like:


 


 

 

The photos below show the signs of unwanted results from laser & IPL hair removal:


2. Your hair must be at the anagen phase
Timing between each treatment is very crucial for ultimate results from LHR. Any light-based therapies are effective to remove hair only in anagen phase of growth.
Different body areas have different hair growth cycles. In order to catch the most hair in the anagen phase during your LHR sessions, as soon as a significant percentage of the hair starts emerging from your skin, resume for the next session. For optimal results, it is recommended that your initial 1st & 2nd sessions are done at 6-8 week intervals to catch each cycle of hair growth. Then the subsequent 3rd to 6th sessions are between 6 weeks - 6 months apart. For majority of clients, it would take 4-6 sessions. Some people may be satisfied with their results sooner. Some may require more sessions. Results vary among different individuals & different areas can have different results. Following these guidelines should result in the greatest reduction of hair.


Under the skillful & experienced therapists coupled with appropriate type of powerful devices (sufficiently high output watts) & the proper settings, clients should definitely see significant difference in their hair reduction after each session.

Even if diode, IPL & laser tend to have unpredictable results among different individuals, initially up to around 4-6 treatments within 1 ½ – 2 yrs are typically required to achieve maximum hair reduction (of at least 85-95% hair reduction), and I believe that further treatments can induce hair growth.

Once desired results are achieved after the initial course/series of LHR treatments (around 2 yrs initially), some clients will have permanent hair reduction/removal for the rest of their lives, some still require maintenance sessions around 1-2 treatment sessions, additionally, 4-6 yrs after their last LHR session. While in the maintenance phase, the ideal time to get a touch-up session is when you notice there are times when hair growth seems to be more aggressive. This is, as hair in the anagen phase, most effectively targeted.

Unfortunately, not all the unwanted hairs will be permanently removed by LHR. After prolonged dormancy, some unwanted hair can regrow even many years (say 4-6 years) after a successful initial LHR course. If u want to have every single unwanted hair gone forever, Electrolysis is the only solution.

Another recommended alternative would be to START WITH LASER. Multiple (around 4-6) LHR sessions will be required initially in the first 2 yrs. Once desired results are achieved by laser, then you may choose to FINISH WITH ELECTROLYSIS. This is the fastest way to achieve the optimal appearance (be it total removal or just thinning of the hair, permanently).


3. Avoid under-treatments of LHR or avoid application of low Fluence

Under-treatment or insufficient fluence can:

3.1 stimulate hair growth

3.2 undermine ultimate/final results – You will get less ultimate results. Why?

Light properties, such as reflection and absorption, are SOLELY based on COLOR. This principle also applies to virtually all light technology & devices including laser, IPL, LED & diode.

LHR is most efficacious during your very first few sessions while your hair is still the most dense, thick, coarse & dark because they have more darker pigment that can absorb more light. Based on this principle, it is essential to apply the most effective energy settings, especially during very first few initial treatment sessions to obtain the most ultimate reduction result. (The higher density of darker hair the better result).

Every time you received treatment, dark pigments (AKA melanins) within your hairs are destroyed & weaken. Less reduction results in later sessions because less dark melanins absorb less light. When hair becomes finer & lighter, it is more difficult to treat and LHR becomes less effective. Thus, initial patch tests are important to ensure your therapist can use high settings and avoid overtreating/burning you.

 

LHR lose efficacy on lighter, sparse, fine or thin hairs because they cannot absorb much light insufficient to kill hair stem cells. Cells that contain DARK melanin, such as hair & skin cells, are destroyed. But hair follicles & hair stem cells that lack colour may remain intact. Thus some hairs will eventually grow back after some time, but such hairs will be lighter and finer (of course cells containing dark melanin have been destroyed).


Your chances of ultimate good reduction increase when the moral therapists use proper & high settings. If lower settings are kept applying on you, you may obtain final less reduction results or you may also end up with more hair.


4. Avoid LHR treatments when majority of hairs are not in anagen

Thus as soon as a significant percentage of the hair starts emerging out of your skin, return for the next treatment. Do not resume the next treatment too early when hair isn't dense enough or do not wait until your hair is growing out too long because these can ruin your final result.

Alternatively, it is recommended to WAX around 6-8 weeks prior to the appointment, expecting ALL hair that emerging out of your skin post waxing are in anagen.


5. Stop waxing, plucking, threading & other epilation methods that pull/tear/disturb/weaken hair underneath the skin and stop using any epilation creams that affect hair underneath the skin at least 6-8 weeks before your very first session, after and in between each sessions.

Shaving with shaving cream that doesn't disturb/weaken hair under the skin is ok. Clients can shave as often as they like when their skin is no longer inflamed/irritated while waiting to resume their next session.

Do NOT use hair removal creams or any other products that affect/disturb/weaken hair, such as Nair, Veet and other hair removal creams/chemicals.

6. Why age is important to your result?
It's recommended that the client should have completely gone through puberty before commencing laser hair removal, so that it allows enough time for full pattern of hair growth to be completely developed. That is around mid 20's for female and mid 30's for male.

Why wait? Remember laser (or IPL) works most efficaciously when hair is the most dark, dense, thick & coarse.

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The risk of hair stimulation is higher when:

 under-treated => To avoid being undertreated, ensure that your HAIR FOLLICLES become inflamed few minutes after light beams hitting u. The more pronounced follicle inflammation the better & the sign indicates some damages to hair follicles. Treatment can b painful at the time only when the lights hit, with no lingering pain & heat longer than FEW SECONDS after each hit. Effective treatment is painful (with no lingering pain & no lingering heat)!


Some clients r not happy with temporarily follicular inflammation (angry red bumpy follicles and sometime scabbing around 48 hrs post session), even if this indicates effective result. Clients need to understand this. No follicle inflammation = no result


There are studies showing evidences that treatment series of low levels or low doses of light therapy (LLLT & LED) significantly increase hair stem cells, reversed the miniaturisation process of the hair follicles and stimulated hair growth.

It usually takes at least 6-12 months to start seeing hair regrowth for the combined treatment series of topical minoxidil + LLLT for non-scarring alopecia. Doesn’t this imply that multiple sessions of under-treatments of hair removal by low settings of light therapy can also stimulate hair growth, instead of removing/reducing it?

https://www.lasercollege.org/diode-laser-hair-removal-or-hair-growth-stimulation/


 colour, diameter & density of hair is too light or too sparse => Avoid having any LHR treatments over area where there is no hair or where there is vellus, fine hair in order to minimise the hypertrichosis risk. Low energy settings can turn fine, vellus hairs into coarse terminal ones.

As mentioned above, fine, light hair requires shorter pulse width and higher fluence (energy) than does dense, thick, coarse & dark hair. Ensure the power output of a LHR machine isn't lower than 2000 watts to ensure the machine can perform this.


 too early or waiting far too long between each session => Timing is essential, not only to obtain the best reduction result but also to minimise hypertrichosis risk. Good time to have treatment is when majority of hair is in anagen, only then u will get the most ultimate reduction result. Thus as soon as significant percentage of hair starts emerging out of your skin, this is a good time to resume treatment. Do not resume the next treatment too early when hair isn't dense enough or do not wait until your hair is too long because these can ruin your ultimate result.





///////////// Why patch test is so important? ///////////// 


Please note that follicular erythema (redness) & perifollicular edema (swelling) won't appear as soon as the laser beam/pulses hit you but few minutes or longer after that, so does the over-treated sign of blistering or burning. That's one of the reasons to do patch testing to find the efficacious energy settings which are different among different individuals & different body parts.

When laser beams hitting your skin, you will feel like a hot rubber-band snap, without any lingering pain or heat. Your skin should cool down almost immediately. If it feels extremely hot and is not cooling down you MUST alert your therapist immediately. The heat & pain should go away almost immediately as soon as the pulse stopped & moved away from that treated spot => Otherwise blisters or burn.

The similar situation is when you have extended sun exposure, such as when you go to the beach, you will only feel lingering heat but you won't see any skin reactions yet. Then within a day or two after that skin reaction either tanning, blistering, peeling or sun burn will start to appear.

Please do not shave when you come for patch test. I need to see your hair.



LHR vs Electrolysis for Hair Removal -- Which Method?

The fact that laser, diode & IPL retard hair growth & it is semi-permanent hair removal,…

Based on my experience:
After I had my hair in certain areas removed by 
electrolysis and other areas by laser (Trade name of the laser device: Candela Gentle …. both 755 & 1064 nm) and IPL. I also had got epidermal burn once from IPL hair removal resulting in hypopigmentation in that area for about 5 yrs. Some hair regrew 3-5 yrs after last LHR treatment session; some hair has been permanently removed.

I have had all of every single hair permanently removed from my underarms and from knees down to lower legs & ankles via Electrolysis during 1998-1999. 
This took less than 2 yrs provided my regular commitments. Since then not even a single hair came back.

How much will hair regrow & how long does it take for hair to regrow after the 
initial series of LHR treatments? This varies among individuals and varies among different body areas.

(As long as you received perifollicular oedema after being hit by LHR and those treated hair falls within few weeks post treatment session, those follicles should be destroyed, if not then hair should become much lighter & finer.)


If u hv been treated with laser/diode/IPL before, electrolysis will still 100% permanently remove every single hair. If the therapist is skillful it only takes a single treatment per follicle but the hair need to be there to be treated. LHR retards hair growth, so some hair may take 
5-6 years longer to regrow.

What I can conclude by this? => I warn consumers if they want to get a fast result/look they may choose to start with laser hair removal for 4-
8 sessions then finish it with electrolysis. BUT
 

BUT, and it’s a big ‘but’, the customers may get hair free for some yrs & some hair may regrow yrs after this because laser/diode/IPL retards hair grow. However, with this choice, you should achieve clean skin look within the first few months after starting of the journey, provided that you are a good candidate for LHR (a person with very fair skin colour with thick, dark, coarse & dense hair)

But if you choose to do only electrolysis since the start of your journey, it should take upto around 1 ½ – 2 yrs for average persons to have every single hair permanently cleared by electrolysis, depending on your commitment and the amount & density of your hair.


Why our Laser Hair Removal services are better?



● All of our new clients receive initial consultation & patch tests for all different areas they wish to have LHR. 

● Ever since I started offering LHR services I have never treated anyone more than 6 sessions for their 2-yr initial course provided that clients are good candidates for laser that their original hairs were starting with dark, dense, coarse and thick hair with light skin colors. Majority of my clients achieved more than 80-95% permanent hair reduction within only 4th session, but some may require upto 6th session. 

● I honestly advise my clients upfront if they are not good candidates for LHR; such clients can still try LHR but if their hair doesn't fall out within a week or two post treatment any current light/optical therapies (diode, IPL or laser) won't be effective for them, but only electrolysis is the only permanent solution.

 

 

Better Results with Fewer Treatments & Least Total Costs


Your ultimate final result in the years to come depends on how effective therapists have delivered your results from the very first and every LHR session you have had. After treatment series, the higher reduction results can be achieved when the moral therapists use proper & high settings. If lower settings are kept applying on you, not only you get less ultimate result, but you may end up with more hair that being stimulated by low levels of light exposure.

Here we find the proper laser settings for individual clients from the start because we are all different & we provide patch testing for different body areas so to help our clients achieve the optimal results within the minimum time period.

Provided that they are good candidates for LHR, our clients see significant change since their first session even if more sessions are required to meet satisfaction. Even if laser (diode & IPL) tends to have unpredictable results among different individuals, up to around 6-8 treatments within 1 ½ – 2 yrs are typically required initially to achieve maximum hair reduction, and it is believed that further treatments can induce hair growth.

We highly recommend that your initial 1st and 2nd sessions are between 4 to 8 weeks apart.Then the subsequent 3rd to 6th sessions are between 6 weeks to 6 months apart. Following these guidelines should result in the greatest reduction of hair.


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Examples of Case Studies for Non-Compliance

Case 1: Skin inflammation because the client went to the gym too early after LHR

 

Source: https://imgur.com/gallery/7KeWfN6


Case 2: Post Inflammatory Hyperpigmentation (PIH) because the client sunbathed 2 weeks (too early) after LHR


Source: the medical textbook “Laser Hair Removal” by David J Goldberg, M.D. 2000 ISBN: 1 85317 831 4


Case 3: LHR on recent tanned skin

The client came to the laser clinic with her skin looking normal. There were no obvious signs of skin damaged from sun exposure prior to commencing LHR. Who was to blame, the therapist or the client?

Had the therapist seen any signs, the therapist wouldn’t have treated the client until after the client’s skin healed and tan faded.




 

 

 

 

 

 

Source: the medical textbook “Laser Hair Removal” by David J Goldberg, M.D. 2000 ISBN: 1 85317 831 4


Remember! After sun exposure, you won't see any signs and your skin can still look normal until after a day or two post-sun exposure. It can take a day or 2 after sun exposure for your skin to show any damaged signs, such as redness, tanning, blistering, peeling and/or sun burn.


< LHR can be treated on tanned skin, but lower settings should be used, thus less efficiency in hair reduction/removal. If you would like to receive the ultimate & most reduction result, it is better to avoid lower settings >


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*** My services are for customers who are seriously looking to get permanent results in hair removal, whether it is totally hair removal or just a significant hair reduction. I provide result guarantee in permanent hair removal/reduction. Thus, ALL customers need to understand the following information: Customers Beware




For more info regarding Laser Hair Removal, please visit => https://www.facebook.com/upweylaser/




Other topics:

-- Client Information: LHR

-- When to book or resume your next LHR session?

 

-- Burns or other over-treatments by Laser/IPL

-- Care after Electrolysis/Laser Hair Removal Treatment (aloe vera gel containing no alcohol)

-- Quick fix for Post Inflammatory Hyperpigmentation (PIH) after laser hair removal


-- Age Restrictions for Laser & Electrolysis Hair Removal


-- Electrolysis PERMANENT Hair Removal (or Needle Epilation)

-- Diathermy or Removal of Superficial Red Capillaries, Telangiectasia, Spider Veins, Thread Veins, Cherry Angiomas, Red Moles & Vascular Blemish via Electrolysis

 

-- Before Booking and Coming for the Appointment

-- Basic Ways to Protect Yourself during COVID-19 Pandemic

 

-- How do you know if such laser treatment session is effective?

-- How can you tell whether your electrolysis hair removal is effective?

 

--  Treating Unwanted Hair From the Root Cause


-- About Us & Why us?

-- Our Prices

-- Our Payment Terms and Conditions

-- Any GPS will give you wrong directions => Our Address

-- Opening Hours

-- Book an appointment

 

9 comments:

  1. More info regarding Laser (or IPL) Hair Removal => https://www.linkedin.com/pulse/all-client-need-know-laser-hair-removal-nora-tang/

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  2. https://mikemurphyblog.com/2022/08/04/why-we-should-not-reduce-the-fluence-when-treating-darker-skins/?fbclid=IwAR3lQxX4F5n8WWNMFt6WU86bSm2qv9YlymC6_2Dt-wwtdmQwLbUndz3lXAs

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  3. https://mikemurphyblog.com/2022/09/27/ipl-hair-removal-how-to-achieve-good-results-from-an-expert-marlon/?fbclid=IwAR2vV6zQ2ewUGwoBG4BvAfoB8t7iAQRCqHgvGgEE88u00rkkCMVDCDgtIA0

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  4. https://www.medestheticsmag.com/treatments/article/21232169/optimizing-and-reducing-risks-in-your-hair-removal-treatments?fbclid=IwAR1RO_9rz2z8vEZO_JfFZXoyKcBTbn27TpyJ6qhfL8_uJAWNsAxAvlz2q-E

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  5. https://medestheticsmag.texterity.com/medesthetics/january_february_2021/MobilePagedArticle.action?articleId=1652662&app=false#articleId1652662

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  6. https://www.physics-and-radio-electronics.com/physics/laser/differenttypesoflasers.html

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  7. https://gembared.com/blogs/musings/how-deep-does-red-and-near-infrared-wavelengths-penetrate-into-the-body-marketing-vs-science

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  8. settings: https://hairtell.com/forum/t/for-laser-hair-removal-is-cryogenic-cooling-in-gentlemax-pro-more-effective-than-contact-cooling-chilltip-in-other-lasers/51837/5

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