The ABC's of plastic surgery:
Laser Hair Removal: Goodbye Razor, Hello Laser?
By Dr. Mathew C. Mosher

Unwanted dark hair has been a cosmetic problem for men and women for centuries. Today, this problem fuels a multi-billion dollar hair removal industry in North America alone.

Until a decade ago, the only long-lasting method of hair removal was electrolysis. Now laser hair removal is available nearly everywhere with business owners making bolder claims every day. Advertisements promising easy and permanent removal of unwanted hair sound almost too good to be true. You may wonder, Is it really that easy? Is it safe? Does it matter where I go? And, Does it work?

Let’s review this technology and bring you up to date on your choices.

Doctors first observed lasers inhibit hair growth nearly 40 years ago, when lasers used on skin surface pathologies also changed the way the hair grew in the treated area. But, with the technology of the day, the injuries occurring to the skin removed any thoughts of using those lasers for cosmetic hair removal.

Modern laser hair removal has only existed since 1996 and the changes since then have been amazing. I bought my first hair removal laser in 1998 when only three or four systems were available. Today, the number of choices has increased 10 times and it’s difficult for me, let alone my clients, to know what’s best for them.

“Hair is susceptible to lasers only during the active growth phase.”

Many things are common to hair growth in all of us. Genetics and sex hormones principally determine the location, color and quality of hair growth but all hairs go through a cycle of active growth, transition and resting phases. The length of hair on various body parts is determined primarily by the length of the growth phase. During this phase, the hair follicle rapidly produces the hair shaft with different degrees of melanin. The concentration and type of melanin determines the hair color. On every hair-bearing site of the body there are hairs in different phases at all times. Hair is susceptible to lasers only during the active growth phase.

Hair removal lasers deliver intense light energy into the skin. This light can either reflect off the surface, scatter into tissue or be absorbed by targets called chromophores. The skin’s most common chromophores are melanin and hemoglobin and each absorbs different light wavelengths preferentially. When light is absorbed, the energy is usually converted to heat-causing injury to the chromophore and whatever is near it. The success or failure of laser hair removal is determined by this heat injury to the hair shaft-producing portion of the follicle. The difficult part is that all your skin, not just the hairy bits, has these same chromophores in various amounts.

By carefully manipulating the light intensity, wavelength and pulse duration and controlling skin temperature, modern laser hair removal systems can selectively injure and thereby disable active hair follicles with minimal risk to the surrounding skin. The wrong decisions can lead to ineffective hair removal or worse: injury in the form of burns, scarring, and temporary or permanent skin color changes. All lasers have the potential to cause these injuries, so think carefully about the practitioner you choose to perform your treatments. Plastic surgeons and dermatologists are formally trained in the use of skin lasers and are knowledgeable about the skin and soft tissues. Other physicians may have extensive personal experience with lasers. I strongly recommend you investigate the training of the physician performing or supervising this treatment.

While no single technology is capable of optimal hair removal for all patients, current technology combined with skilled assessment and treatment can be safe and effective. Most laser systems target the melanin in the region of the hair follicle known as the bulb and the bulge. These two areas are responsible for producing another hair shaft. By injuring these areas sufficiently, the follicle can be permanently disabled.

“...to most of us 'permanent' means no more hair growth, ever, period.”

For the best results, patients must have a series of treatments (usually five to eight) each separated by one to two months. This allows hairs in the resting phase to come into their active phase and be disabled by the laser light. For unclear reasons, some patients respond better than others. Nearly all patients experience some degree of hair reduction, meaning fewer hairs as well as the hair becoming less coarse and lighter in color. Approximately 50 per cent of clients have little or no hair growth over the long term after a series of five treatments.

So, what can you make of all the claims about permanent hair removal? This is a personal pet peeve of mine because to most of us permanent means no more hair growth, ever, period. However, the clever folks who market these machines use the FDA definition of permanent hair removal, which is “significant and stable loss of hair for a period longer than the complete natural hair growth cycle (usually a year).” In reality, those who respond best still need occasional hair removal if they want to be completely hair free. Most choose maintenance laser treatments or simply rely on the old standbys of shaving, tweezing, waxing or depilatories.

My final advice is to be an informed consumer. Nothing in life is without some risk and it’s up to you and your doctor to weigh the risks against possible benefits. You decide if slogans such as: 50% Off Sale, Extra Areas Treated For Free, Guaranteed or Your Money Back, We Will Match Any Offer or Special Introductory Price convey the sort of environment you want for your laser treatment.

I expect the technology will continue to improve. Lasers will become smaller, more affordable and more available. We really have come to a point in hair removal where you can almost say goodbye to the razor.

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