Laser Hair Removal

Electrolysis has been the gold standard for the removal of unwanted hair for decades, but it was gradually replaced by laser technologies. Electrolysis involves the insertion of a fine wire into the hair follicle. An electric current then travels down the wire and destroys the root of that hair follicle. This process is painful and must be done on each hair individually. Hence, each session of electrolysis takes a considerable amount of time and multiple sessions are required.

Laser hair reduction is currently the state-of-the-art hair removal technique. Electrolysis still has its place in treatment of unwanted hair: it is useful for those who have only several stray hairs or patients with gray or light hair. For most other patients, laser treatment is a much better method. The laser treats large areas in one session because it does not target individual hair follicles, but rather hundreds of follicles per laser pulse. In that way, even treatment of a large area of the body (back, chest, abdomen) takes only about an hour.

Lasers for hair reduction have been available since the 1960’s. The early lasers had low efficacy and many side effects. Only since the 1990’s has laser technology matured enough so that safe and effective treatment is now available. Laser hair removal works by passing an intense light beam through the skin. The laser focuses on dark pigment, called melanin, in hair. When the light beam hits the target ( the hair follicle) the intense heat destroys it. Because the laser needs to focus on dark pigment, it is not effective for the removal of light, light red, or gray hair.

Alexandrite, Diode, and Nd:YAG are the most commonly used lasers. The “ideal” patient for hair removal is the one with light skin and dark hair. For such a patient Alexandrite laser is probably the best choice in efficacy. Diode laser is able to treat patients with light to semi-dark skin. If you have dark skin, Nd:YAG laser is the safest and most effective choice. The laser your doctor will be using might not be referred to by the technical names stated above. It will likely have a brand name like Gentelase, LightSheer, Gentle YAG, etc. Multiple companies produce laser devices but the important factor is not the brand name of a laser, but the underlying technology.

The effectiveness of laser hair removal depends on the characteristics of the individual. Some patients achieve up to 90 % permanent hair reduction, while others have a small reduction in hair growth (30-40%) and require periodic maintenance treatments. The claims of “100 percent permanent hair removal”, or “guaranteed 0% re-growth” are absolutely not substantiated. While most of patients are very satisfied with their results, there are some who do not do as well as others.

Complications from laser hair removal include skin pigment change (darkening or lightening), scarring or blistering. These complications are very rare if the procedure is done by a Board Certified dermatologist or plastic surgeon. The majority of these complications arise when hair removal is done by non-medical personnel in spas, salons, and clinics. Non-dermatology physicians whose training was no more than a weekend seminar in laser technology very often lack adequate training in skin physiology are also occasionally the culprits. Your doctor should evaluate your skin prior to laser hair removal and determine the appropriate treatment plan. If a nurse or physician’s assistant performs laser hair removal, your doctor should be available in the office to supervise the procedure.

Alexander Doctoroff, D.O., F.A.O.C.D.
Assistant Chief of Dermatology,
Veterans Administration Medical Center
East Orange, New Jersey

Assistant Clinical Professor of Medicine,
University of Medicine and Dentistry of New Jersey