Summary
Hirsutism is the abnormal growth of terminal hair in women in male-pattern (androgen-dependent) sites, such as the face and chest. Hypertrichosis refers to excess hair growth in any body area that is not androgen-dependent. Although hypertrichosis is often a primarily cosmetic problem, it may also represent a cutaneous sign of an underlying systemic disease. To ensure long-term hair reduction in these conditions, we combine three technology, light, laser, and radiofrequency. Electro-Optical Synergy (ELOS) or, in short, E-light technology combines electrical (conducted radiofrequency (RF)) and optical (laser/light) energies. The general idea of this method is to reduce the intensity – and thus, the potential side-effects of optical power (laser or light) by combining it with bipolar radiofrequency (RF). Based on this combination, E-light technology is more tolerated in all skin phototypes and more effective in removing lightly pigmented hair and thin hair. The large spot size of the light energy makes it easy to treat large surface areas such as the back, chest, and legs. The result is long-term hair reduction,” meaning, after four to six laser treatments, the total amount of hair is significantly reduced, generally from seventy to ninety percent, and hair that does grow is often much more delicate and lighter in color. You can expect that this hair reduction might last for many years.
Consultation with Prof Moawad
Despite the cosmetic nature of LHR, a complete medical history, physical examination, and informed consent, including setting realistic patient expectations and potential risks, should be performed before any laser treatment. The physical exam should evaluate the patient’s Fitzpatrick skin phenotype. This will help determine which lasers and light sources are safe to use for that patient because the epidermal melanin in darkly pigmented patients can compete with the melanin within the hair follicles as the target chromophore.
Importantly, every patient should always be evaluated for the presence of a tan. If present, you should delay laser treatment or the treatment parameters appropriately adjusted until the tan has faded. Finally, the patient’s hair color should be noted as the chromophore for LHR is melanin. Black and brown hair hold enough amounts of melanin to serve as a chromophore for LHR. In contrast, the lack of melanin, paucity of melanin, or presence of eumelanin in the hair follicle, which clinically correlates to white, gray, or red/blonde hair, is predictive of an inadequate response to laser hair removal.
Any patient with evidence for endocrine or menstrual dysfunction should be appropriately worked up. Similarly, patients with an explosive onset of hypertrichosis should be evaluated for paraneoplastic etiologies. Treatment of a pregnant woman for non-urgent conditions is discouraged, although there is no evidence suggesting a potential risk to expectant women undergoing LHR.
I should review the past medical history to find patients with photosensitive conditions, such as autoimmune connective tissue disorders or disorders prone to the Koebner phenomenon (vitiligo). A history of recurrent cutaneous infections (herpes) at or in the vicinity of the treatment area might call for the use of preventative medications.
Earlier methods for hair removal, including any past laser treatments, will be reviewed with Prof. Any history of gold intake is a contraindication for laser therapy. You should elicit any history of keloid or hypertrophic scar formation as well. It would be best to stop topical retinoids used in the treatment area 1–2 days before treatment. The use of any photosensitizing medications or over-the-counter supplements should also delay treatment until you can safely drop these medications.
Laser hair removal is a gentle, three-step process. First, we gently cleanse the area to be treated. Next, we shave the area. Then the area is scanned with the laser. Having a vacuum device on hand during treatment can minimize each laser pulse’s plume and unpleasant odor. Because the retina has melanin, which all LHR devices can damage, proper eye protection is critical for both the patient and laser surgeon. Each device requires the use of protective goggles that are unique to the device’s wavelengths. I cannot interchangeably use glasses with laser or IPL devices of other wavelengths. Furthermore, because of the risk of retinal damage, the authors’ strong opinion is that one should never treat a patient for LHR within the bony orbit.
Treatment can last from a few minutes to a few hours, depending on the size of the areas being treated. Fewer treatments are needed when the hair is dark and the skin is light-colored. It takes four to twelve weeks for the next crop of hair roots to become active and develop pigment, which is the target for the laser. Therefore, for treatment to be most effective, there should be a minimum of four to twelve weeks between treatments, depending on the area treated.
To summarize, the long-pulse Nd: YAG laser provides effective and permanent hair loss in darker skin types (skin phototypes IV-VI). The Nd: YAG laser is considered the best to treat darker pigmented skin, such as skin phototypes IV to VI. The diode (810nm) lasers are more suitable for skin types 1-V. The IPL and alexandrite (755 nm) laser, which do not penetrate as deeply, are ideal for lighter skin types I to III because there is a higher risk of epidermal melanin activation with shorter wavelengths.
Am I a Good Candidate for elos & Laser Hair Removal?
The presence of four laser/light/Radiofrequency systems at MSI allows treatment of all skin types, hair colors in both sexes effectively and safely, including less pigmented or even white hairs., Laser helped hair removal is not just for cosmetic problems. Patients with excess body hair due to medications (e.g., organ transplant patients taking cyclosporine) can benefit from laser hair removal, as can patients with dark skin who are prone to ingrown hairs. Children with congenital nevus can also be treated.
What Areas of the Body are Treated?
I can treat all areas of the body. Areas of concern for women are hair on their upper lip, chin, neck, cheeks, underarms, bikini line, legs, and around the navel, and for men, it’s usually the unsightly hair on their back and shoulders. And, while it is technically possible to treat even eyelashes and eyebrows, we do not treat those areas. The top of the eyebrows can be treated when the forehead is treated.
Is elos & Laser Hair Removal Painful?
The laser emits only light. You may feel a tingling or snapping sensation like a rubber band. There is no bleeding, and no open wound is created. Some patients find their first treatment uncomfortable, more so than the following treatments, which may be due to more hair roots being destroyed by the first treatment or because the patient is apprehensive, not knowing what to expect. Some patients find minor discomfort if they shave the area to be treated a few hours before treatment. While areas like the upper lip and pubic hair area are more sensitive than others, many patients report little or no discomfort.
The need for topical anesthesia is variable among patients and anatomic sites. Various topical anesthetics, including lidocaine, lidocaine/ prilocaine, and other amide/ester anesthetic combinations, can be used to diminish the procedural discomfort and should be applied 30 minutes to 1 hour before treatment under occlusion. Care should be taken when using lidocaine or prilocaine to administer these medications to a limited area to diminish the risk of lidocaine toxicity or methemoglobinemia, respectively.
Cooling gel pads are usually applied at once before and after treatment, and a soothing gel is used during the procedure. In addition, our lasers have a specific cooling device to maximize the patient’s comfort. If there is excellent discomfort, we can often apply more cooling or adjust the settings on the laser accordingly.
How Can I Obtain the Best Results?
The professionals at MSI are experts in laser technology, treating thousands of patients yearly. Following consultation with Prof Moawad, or one of his team of professionals, I will advise you of your options for the best possible results. I will provide the given instructions. Any methods of Epilation, such as waxing or tweezing, that entirely remove the target chromophore render LHR ineffective for at least two weeks. Although there is little evidence for the time frame a patient must wait after complete Epilation of the hair shaft and laser treatment, we recommend a minimum of 2 weeks of facial hair. You can use up shaving and depilatory creams on the day of the laser treatment as they do not remove the entire hair shaft.
Patients should avoid tanning, sunless tanner, or the use of makeup on the areas to be treated (all can diminish the effectiveness of laser treatment by absorbing the laser energy). Makeup could heat up during the procedure and irritate or burn your skin. Patients with a dark or very tanned surface may be pre-treated with bleaching agents. Areas to be treated should be protected with broad-spectrum sunblock with SPF 30 before and after laser treatment.
What Can I Expect Following elos & Laser Hair Removal?
Hair follicles may appear slightly more visible and pinkish for the first one to two days. There will be some redness, which will subside within an hour or so. You can apply a topical antibiotic cream, and you should recommend your physician. Following treatment, hair shafts will be released from hair follicles in treated areas for one to two weeks. It is permissible to gently exfoliate, shave, or use depilatory cream in the areas should you feel the need.
You will be provided detailed instructions on post-treatment care and given a kit having an ultra-gentle cleanser, moisturizer, chemical-free sun protection cream, and topical antibiotic cream with a mild steroid to decrease redness, should it be needed. Shaving, depilatory creams, or bleaching is permissible between laser treatments; however, you should avoid plucking, waxing, and sugaring since these procedures could reduce the effectiveness of your subsequent laser treatment.
Why Does My Hair Look like it’s Growing After elos and Laser Hair Removal?
The laser destroys active hair roots at the time of treatment but will not instantly remove hair shafts. Hair shafts in treating hair follicles will fall out or be shed within the first week following treatment; all treated hairs fall out within two to three weeks. It is expected that some hairs in treated areas may not fall out within two to three weeks, and these will be treated in the next session.
Patients will often find that a single treatment of LHR with shorter pulse durations results in nearly total Epilation of the hair follicles in the treatment area. It is important to counsel the patient that most hairs will regrow, which isn’t considered a treatment failure. Permanent hair removal with a complete drop out of follicles is achieved in only 15% to 30% of treated hairs at each treatment at best parameters. More commonly, temporary hair loss occurs through the induction of a theologian-like state in which the hair follicles are at “rest,” and no hair growth occurs.
On the other hand, LHR treatments with longer pulse durations may leave behind many hairs that appear to “grow” following treatment. It is vital to reassure the patient that these “growing” hairs are dislodged from the hair follicle and require 1–2 weeks to be completely shed. You can use nearly any method of Epilation to hasten their removal. The importance of strict sun precaution following LHR treatments cannot be overemphasized. This can be achieved using topical sunscreens, ultraviolet light impermeable garments, and sun avoidance.
How Much Hair Will Grow Back? How Soon Will It Grow Back?
It was seen that hair reduction depended on the hair color, skin type, and the number of treatment sessions (i.e., the more treatment sessions, the higher the hair reduction). It was easier to treat fine hair than coarse hair because coarse hair often has a thick layer of keratin and requires a higher energy level for removal. Blond-haired person- and gray-haired patients required a more significant number of treatments than dark-haired patients. Blond hair has less melanin compared with darker hair. Consequently, the light source can target less chromophore, and hence, the response is less reliable.
The laser works by destroying active hair roots at the time of treatment and which have enough pigment to absorb enough laser energy. Hair shafts in the treated hair follicles will fall out or be “shed” one to three weeks after treatment. After the first treatment, hair regrowth may resume within a few weeks or anywhere from two to four months. The amount of hair reduction increases with multiple treatment sessions. Patients notice a decrease in the number, thickness, and color of hair. However, unwanted hair may appear after successful removal, possibly the result of hormone stimulation.
Is elos and Laser Hair Removal “Permanent”?
“Permanent” hair removal implies that all the hair is gone for good! However, no method or treatment to date (including lasers) can guarantee permanent hair removal. The most realistic description that does apply following laser treatment is “long-term hair reduction,” meaning, after four to six laser treatments, the total amount of hair is significantly reduced, generally from seventy to ninety percent and, hair that does grow is often much more delicate and lighter in color. After having between four to six laser sessions, it is essential to note that it likely results in a substantial reduction in hair, thickness, and color in the treated areas. You can expect that this hair reduction might last for many years.
