A-Z of Laser Hair Removal
Written by our team here at the clinic, here is the A to Z of everything you could ever want to know about Laser Hair Removal.
Alexandrite laser – this operates at a specific wavelength of 755 nanometres and is widely recognised, along with the Diode laser at a wavelength of 810 nanometres, as the lasers of choice for skin types 1-3 with dark hair. All lasers must carry CE marking http://ec.europa.eu/enterprise/policies/single-market-goods/cemarking/index_en.htm, this is irrespective of where the laser was manufactured.
If you visit any registered medical facility, all lasers must be PAT (Portable Appliance Testing) tested on an annual basis http://www.hse.gov.uk/electricity/faq-portable-appliance-testing.htm. Operators of Class 4 medical grade lasers have a legal duty of care to comply with the necessary Electricity at Work Regulations. These regulations state that operators are responsible by law, for the prevention of any harm coming to employees, tenants or customers when using electrical equipment provided within an organisation. There are also insurance implications of not having an up to date PAT programme in place. Failure to carry out the necessary testing can result in insurance companies refusing to pay out after an accident or a fire.?Any item that has a mains voltage plug attached to it should be tested.
The largest installed base of Alexandrite lasers in the UK are from the manufacturers, Cynosure Inc http://www.cynosure.com/ and Candela Inc http://www.syneron-candela.co.uk/. These are both US based laser manufacturers from the Boston, Massachusetts area. There are other manufacturers, some of which are entirely legitimate and there are also low-cost machines, coming from the likes of China and Taiwan which are poor quality, some with falsified CE markings. A good question to ask any operator, clinic or beauty salon is how much did they pay for their machine? The lasers that we referred to previously by Cynosure and Candela will be in the price bracket of £50-60,000. A further point of information is that both Cynosure and Candela have a laser on the market that incorporates not only the Alexandrite laser but also the Long Pulsed Nd:YAG which we will come to later (the Cynosure Elite and the Candela Gentle Max Pro).
Burns – this is not a subject that most people want to talk about. Unfortunately, it is a very common experience when unqualified, inexperienced operators using cheap and/or replica lasers and IPL (Intense Pulsed Light) machines carry out treatments such as laser/IPL hair removal. The selection of an experienced and qualified laser technician is detailed more under “Operators”. However, if you are offered laser or IPL hair removal treatments without having a series of test patches carried out in advance, DO NOT GO AHEAD WITH TREATMENT AND LOOK AT OTHER PROVIDERS. Continued…. (the rest doesn’t need to be shown on the page, can click on “Continued”).
For laser hair removal to be successful, the laser light needs to be absorbed by the melanin (this is the brown pigment in your hair) for it to be destroyed. All skin reacts differently and therefore it is essential at any consultation to let the operator know if you have had any sunbeds or you are carrying a sun tan prior to any test patches being carried out. In a perfect world, you would have no tan, would come along, your test patch would be done on three different power settings, the laser operator would gage the tissue response on each of those test patches, then you would then be sent away for a period of five days and then would return and if no adverse reaction had occurred, the laser therapist would be able to carry out the first treatment. The question an experienced operator will ask you every time is: have you been on sunbeds and have you got a tan since your last treatment. The reason for this is that exposure to sun beds and the sun produces an increased level of melanin in the skin and this is what the laser light targets. Increased melanin (colour) means more laser light will be absorbed into your skin. This can cause a burn.
How do I tell if I have been burned? It is normal for skin to feel hot during laser and IPL treatments but you should expect the skin to cool down quickly. The laser technician can give you an idea of how long you should expect the skin to feel hot. For example, if you are having a laser hair removal treatment, your skin should cool down almost immediately. You should feel something like a hot rubber band snap without any lingering pain or heat. If it feels extremely hot and is not cooling down, you should alert your technician as they are carrying out the treatment. This will allow the technician to adjust the treatment setting. Your technician can also take immediate action to cool the skin and possibility even prevent a burn or reduce the severity. If you suspect that you have been burned, be sure to discuss it with your laser technician before you leave the clinic. Make sure you understand what to expect and how to treat your skin at home. Then make an appointment for a post-treatment follow-up and never hesitate to call the clinic if you have any questions or concerns. Usually, you will know almost immediately if you have a burn. In some cases, however, the skin may not feel hot until you go home. As soon as you suspect a burn, you should telephone and speak to the laser technician that carried out the treatment. If you are not satisfied or confident with the post-treatment care, ask to speak to the Medical Director. (Hopefully the medical facility has a Medical Director who is a doctor). You should first make every attempt to work with the staff at the clinic, where the laser treatment was provided and if you are not satisfied level of care, then seek a second opinion. You should obtain professional treatment as soon as possible. The information provided here or anywhere else on the internet, cannot replace personal treatment by experienced skin professionals.
I have a burn, what do I do? The recommended treatment for burns will depend on the degree of the burn. In most cases, the burn from an aesthetic laser or IPL is a first degree burn. A second degree burn can also occur from laser/IPL treatment but third degree burns are not likely. If you suspect that you have been burned severely and find the pain intolerable or if the burn covers a large portion of the body, you may want to go to Accident and Emergency at your local hospital. In most cases, it is not necessary to make a trip to A&E. However, in rare cases, you may need some medical attention. Be sure to let the laser technician know as soon as possible. They should be aware so that they review the treatment settings and assess whether there is an issue with the equipment. They should ask you to return to the clinic as soon as possible so that they can give you post-treatment instructions. You may also be scheduled to see the doctor if one is attached to the clinic, or a clinic nurse if necessary. It is the patient’s responsibility to communicate with the provider and return to the clinic and follow post-treatment instructions.
First-Aid Tips (actual first aid treatment will depend on the type of burn):-
Cool the skin as quickly as possible (within the first few hours). This is critical!
While driving home after the treatment, aim the air conditioner toward the treated area if possible
When you get home, soak a washcloth in a bowl of ice water, ring out the excess water and apply the cold wash cloth to the treated area. Switch out the cold cloths every couple minutes. When you feel the wash cloth become warm, it is time to switch it out
Do not apply ice directly to the skin, and do not leave cold packs on the skin for an extended period of time. On for ten minutes, off for ten minutes
Do not apply an occlusive ointment such as Aquaphor or Vaseline, unless instructed by your laser technician or doctor, as it can trap in the heat. After the skin has had time to cool, and the skin begins to heal you may then be instructed to use an ointment to protect the skin.
Do not open or pop blisters. Opening the blisters will make the area more vulnerable to infection
It may be recommended to loosely wrap the area in gauze
You can apply a topical hydrocortisone cream and/or antibiotic cream to the burn
Watch the skin for signs of infection
After the burns have healed:-
Once the burns have healed, the concern becomes how to treat and prevent scars. The most important thing you can do is protect the area from further injury, this includes avoiding sun exposure. Be sure to use a Physical SPF 35 or higher with Zinc Oxide. You can also prevent and treat hyperpigmentation (dark skin discoloration) by using a 4% Hydroquinone cream and Tretinoin (Retin-A). Topical Serums that contain Vitamin C, and products with growth factors (TNS Recovery Complex) can aid in collagen production, improve skin healing and reduce inflammation. If the burn marks are old you may need something like a medium depth chemical peel, to treat the scars. http://bestofbothworldsaz.com/
Cooling – cooling of the skin is very important during laser/IPL treatments and it comes in various formats. There are cold air chillers http://www.zimmerusa.com/cryo_6.html (where the cold air is blown onto the skin immediately prior to the treatment), Cryogen sprays and contact cooling (the latter could be a sapphire tip or aluminium plate). The cryogen of choice for laser dermatological indications is DuPont http://www.dupont.com/. All laser manufacturers will have some sort of skin cooling system for laser hair removal, whether it be an integrated part of the laser machine or a separate stand-alone unit. One of the most advanced systems is from Asclepion Laser Technologies in Germany http://www.asclepion.com/root_corporate/overview_corporate_ENG_Corporate.aspx. This is contact cooling with what is called a Peltier Cooling System. This is built into the hand piece and is in constant contact with the skin (albeit through a disposable membrane). This cools the skin immediately ahead of the laser firing. From our knowledge, we would believe that this is one of the most effective cooling mechanism available.
Diode Laser – These operate mainly on a wavelength of 810 nanometres and are used primarily for laser hair removal in skin types 1-3 and sometimes 4.
The Lightsheer Diode from Lumenis http://www.aesthetic.lumenis.com/lightsheerduet was introduced in the late 1990’s and was the laser used by Boots the Chemist www.boots.com when they were in the laser hair removal business. All manufacturers claim that they can treat skin types 1-6 with diode lasers. As a general rule of thumb, we would have to disagree with this.
The Alexandrite laser at 755 nanometres is the laser of choice for white skin types with dark hair. The Diode laser at 810 nanometres, is not far away on the light spectrum from 755 nanometres and as such, is more suited to skin types 1-3 and possibly 4.
The laser of choice for dark skin types, 4, 5 and 6, is the Long Pulsed Nd:YAG, operating at 1064 nanometres and we will come to this later.
Diode laser technology has moved on a long way since the 1990’s. Today’s diode lasers from reputable manufacturers have a raft of advanced features. The main feature that everybody is talking about is the pain-free laser hair removal. One of the best systems on the market is the Asclepion MeDioStar Diode Laser http://www.asclepion.com/root_corporate/overview_corporate_ENG_Corporate.aspx
Education – you would not buy a car without adequate research. The same applies to choosing a reputable treatment provider http://www.oprah.com/style/The-Facts-About-Laser-Hair-Removal
Fitzpatrick Skin Scale – clearly identifies the skin type that you are:
Felix von Luschan Skin Colour Chart:
If you are unsure of what skin type you are, please look at both of these websites
Ground-breaking Technology – the lasers available for hair removal continue to develop.
The latest diode laser from Asclepion, the MeDioStar NeXT, http://www.asclepion.com/root_corporate/mediostar_corporate_ENG_Corporate.aspx comes with two blended simultaneously-emitted wavelengths of 810 and 950 nanometres. This not only targets the melanin in the hair shaft but also the vessels supplying blood to the hair follicle. This specifically targets the thin, downy hair, known as “vellus hair” and operates in basic, professional and smooth pulse modes.
Hair – Those who have it, want to get rid of it, those who have lost it, want it back! http://en.wikipedia.org/wiki/Hair_removal
Intense Pulsed Light (IPL) Machines – these are not lasers. An IPL uses short blasts of a polychromatic high-intensity light to penetrate just below the skin’s surface. A laser is more invasive and has a precisely calibrated laser beam set on a narrower specific wavelength which is targeted at one specific problem condition and penetrates deeply into the skin. http://www.youtube.com/watch?v=nghvc5ryITU
A word of warning, IPLs come in all shapes and sizes, with quite a lot from China and Korea, some with and some without CE markings. You can actually buy an IPL machine online which comes with a training manual and self-certification for you to complete. These can be purchased for £4-5,000!!! This is not recommended!
J Joules per cm2 – this is the measurement that is used to describe the power output of a laser http://www.medaphile.com/medical-dictionary/joule-per-square-centimeter
Keratin – Keratin is the key structural material making up the outer layer of human skin, hair and nails.
Laser – LASER means Light Amplification by Stimulated Emission of Radiation.
In 1917, Albert Einstein established the theoretical foundations for lasers. http://en.wikipedia.org/wiki/Laser. In 1960, Theodore H Maiman operated the first functioning ruby laser at the Hughes Research Laboratories in Malibu, California http://en.wikipedia.org/wiki/Theodore_Maiman
The big advantage of skin lasers is that the laser light can be accurately focussed into small spots with very high energy values. To date, a huge array of lasers are available for all sorts of uses, these include gas lasers, chemical lasers, excimer lasers, solid-state lasers, fibre lasers, photonic crystal lasers, semi-conductor lasers, dye lasers and free electron lasers. They have become ubiquitous in finding utility in thousands of highly varied applications in every sector of modern society, including consumer electronics, information technology, science, medicine, industry, law enforcement, entertainment and the military
Melanin – also called pigment, melanin is the substance that gives the skin and hair its natural colour
Basically, the more melanin you have in your hair, the darker the colour and therefore, the better the capability to absorb more laser light
Nanometre (nm) – A unit of length in the International System of Units equal to one billionth of a metre
Operators – a total minefield. Class 4 lasers were de-regulated in October 2010. This basically means that anybody can buy a Class 4 laser or an IPL, put it in their house and start treating people. Due to the problems that have been encountered and at the time of writing, we are waiting for Sir Bruce Keogh, Medical Director of the NHS to issue his report into the cosmetic healthcare sector. This might or might not require the registration of all Class 4 lasers and IPL machines.
A few questions that you should ask any potential provider:
Are they registered with the Care Quality Commission (CQC)?
Has the laser operator obtained the Core of Knowledge certification?
Has the operator been signed off by the laser or IPL manufacturer in the use of that particular laser/IPL?
How long have they been carrying out these treatments?
How many patients have they treated?
Do they have a Class 4 medical grade laser or an IPL which they are trying to pass off as a laser?
Do they carry out test patches prior to treatment?
Can they treat people with a sun tan?
If an operator answers yes to these last two questions, look elsewhere for treatment!
Price – if it sounds too good to be true, it probably is. A high quality Class 4 medical grade laser for hair removal is going to cost in the region of £50-60,000. Accordingly, treatments need to be priced to reflect the cost of this technology. Having said that, hair removal prices have reduced substantially over the years, in part due to the competitive nature of the sector, ie. number of providers, but also the technology has improved dramatically in relation to spot size and speed of treatments.
What can you expect to pay? Most operators offer single treatment prices and then a discounted price for pre-paid courses. The most popular areas are bikini line and underarms. Expect to pay between £80-90 for a single treatment. If you buy a package of 6 treatments, the treatment price will drop to circa £55.
Q-Switched Ruby Laser – if during you research for lasers using hair removal, you come across the Q Switched Ruby laser, do not be surprised. This was the first laser that was used for laser hair removal back in the mid 1990’s. So the story goes, a tattoo removal patient was being treated with this laser and noticed that after his treatment session, the hair did not grow back on his arm in the location of the tattoo. As with many great discoveries, this was purely by accident but has led to one of the popular cosmetic treatments worldwide. The Q Switched ruby laser has been taken over by the likes of the Alexandrite, Long Pulsed Nd:YAG and Diode lasers
Radiation – laser radiation predominantly causes injury by thermal effects. Even moderately powerful lasers can cause injury to the eye. High powered lasers can also burn the skin. Some lasers are so powerful that a diffuse reflection from a surface can be hazardous to the eye. Laser warning signs should be displayed and all clients made aware of the dangers. Clients must wear protective eyewear during the laser treatment
Spot size – this refers to the diameter of the laser beam on such lasers as the Alexandrite and Long Pulsed Nd:YAG and is also known as a Gaussian beam http://en.wikipedia.org/wiki/Gaussian_beam. Ideally, the larger the spot size you can get, the better. Just be aware that some of the really large spot sizes that have been advertised by different providers are not necessarily a true statement, as the power levels need to be decreased. Diode lasers come with either a square or rectangular beam profile and come in a variety of sizes. Again, one needs to be careful about the actual power levels that are available on really large spot sizes
Tanned skin – if you have a sun tan, basically you have increased the melanin content of your skin. It is essential that you wait a few weeks to let the tan fade before considering any laser treatment. The reason being, that increased level of melanin in your skin will absorb more of the laser light. This can lead to problems such as burns and hyperpigmentation. Be very wary of anybody that says that they can treat you with a tan
Ultra-violet light – is emitted by tanning machines, it can penetrate your clothing (ie. bikini) and change the melanin content of your skin. Again, do not consider laser treatment until tan has faded
Vellus hair – this is fine, short hair that is usually no longer than 2mm, normally light coloured or translucent and non-pigmented that has developed from childhood that can be found on most areas of the body. This is the technical term for “peach fuzz” which is what it is called in the Urban Dictionary. Vellus hairs can be more prominent in women and children as they don’t have as many terminal hairs as adult males, which tend to obscure vellus hairs
What is Wavelength? – Most so-called “single wavelength” lasers actually produce radiation in several modes having slightly different frequencies (wavelengths). Our eyes are sensitive to light which lies in a very small region of the electromagnetic spectrum labelled “visible light”. This visible light corresponds to a wavelength range of 400-700 nanometres (nm) and a colour range of violet through to red. The human eye is not capable of “seeing” radiation with wavelengths outside the visible spectrum. The visible colours from shortest to longest wavelength are: violet, blue, green, yellow, orange and red. Ultraviolet radiation has a shorter wavelength than the visible violet light. Infrared radiation has a longer wavelength than visible red light. The white light is a mixture of the colours of the visible spectrum.
X-ray Laser – An X-ray laser (or Xaser) is a device that uses stimulated emission to generate or amplify electromagnetic radiation in the near X-ray or extreme ultraviolet region of the spectrum, that is, usually on the order of several of tens of nanometers (nm) wavelength.
YAG (Yttrium Aluminium Garnet) – The Long Pulsed Nd:YAG operates at a wavelength of 1064 nanometres and is widely regarded as the laser of choice for skin types 5 and 6
Zap – slang term used to indicate the firing of a laser