eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Laser Hair Removal: Treatment

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Coauthor(s): Andrea James, MA, Director of HairFacts.com, Deep Stealth Productions, Inc
Contributor Information and Disclosures

Updated: Jul 2, 2009

Treatment

Medical Therapy

Alternative treatments for hair removal or concealment are available and include waxing or sugaring, electrolysis, bleaching, depilation, shaving, tweezing, and application of eflornithine hydrochloride cream (Vaniqa).

Vaniqa is a recently introduced topical cream that works for some women. The active ingredient is eflornithine hydrochloride, which inhibits an enzyme (ornithine decarboxylase) that affects hair growth. Unpublished efficacy data submitted to the FDA showed that about 58% of women using the cream on facial hair had an improvement. This observation suggests the cream may be particularly effective in postmenopausal women. Vaniqa is currently approved for use on only the face and chin in female adolescents and women older than 12 years. In theory, the agent can be used as an adjuvant to laser hair removal.

Surgical Therapy

Patients are ready for treatment after their skin type is categorized and after they have had a patch test. The treatment can be performed with or without topical anesthesia, depending on the patient's comfort level; however, see Cautions about topical anesthetics below. The pain response varies with the individual, with the area being treated (see Image 1), and with the energy level of the treatment. Accordingly, anesthesia must be tailored to each patient.


Pain-sensitivity diagram.

Pain-sensitivity diagram.

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Pain-sensitivity diagram.

Pain-sensitivity diagram.



In the opinion of the present authors, the most effective and simplest anesthesia currently available is eutectic mixture of local anesthetics (EMLA) or ELA-Max topical anesthetic cream. Table 1 lists the most common anesthetics, their active ingredients, and their advantages and disadvantages.

Table 1. Advantages and Disadvantages of Anesthetics

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Table
AnestheticActive IngredientAdvantagesDisadvantages
Ametop gelTetracaine 4%
  • Performed well in clinical trials
  • Requires no plastic covering
  • Has rapid onset
  • Must be applied generously
  • Not available in the United States
  • May become runny or sticky after application
Betacaine creamLidocaine, prilocaine
  • Requires no plastic covering
  • Has a rapid onset
  • Requires no prescription
  • Must be applied generously
  • May become runny or sticky after application
  • Can cause redness that lasts a few hours
  • Available only from manufacturer
ELA-Max or ELA-Max 5 creamLidocaine 4% or 5%, respectively
  • Performed well in clinical trials
  • Requires no plastic covering
  • Has a rapid onset
  • Requires no prescription
  • Widely available
  • Must be applied generously
  • May become runny or sticky after application
  • Can cause redness that lasts a few hours
EMLA creamLidocaine 2.5%,
prilocaine 2.5%
  • Performed well in clinical trials
  • Might be covered by insurance
  • Widely available
  • Must be applied generously
  • Must be covered with plastic
  • Has slow onset
  • Requires a prescription
  • May lose effectiveness once uncovered
  • Can cause skin whitening for a few hours
Mento-kaine liquidBenzocaine 20%, phenol, camphor, menthol
  • Good before waxing
  • Inexpensive
  • Has a rapid onset
  • Does not penetrate as deeply or as well as creams or gels
  • Irritates sensitive skin
Stud sprayLidocaine 9.6%
  • Good before waxing
  • Inexpensive
  • Has a rapid onset
 
  • Does not penetrate as deeply or as well as creams or gels
  • Small bottle
AnestheticActive IngredientAdvantagesDisadvantages
Ametop gelTetracaine 4%
  • Performed well in clinical trials
  • Requires no plastic covering
  • Has rapid onset
  • Must be applied generously
  • Not available in the United States
  • May become runny or sticky after application
Betacaine creamLidocaine, prilocaine
  • Requires no plastic covering
  • Has a rapid onset
  • Requires no prescription
  • Must be applied generously
  • May become runny or sticky after application
  • Can cause redness that lasts a few hours
  • Available only from manufacturer
ELA-Max or ELA-Max 5 creamLidocaine 4% or 5%, respectively
  • Performed well in clinical trials
  • Requires no plastic covering
  • Has a rapid onset
  • Requires no prescription
  • Widely available
  • Must be applied generously
  • May become runny or sticky after application
  • Can cause redness that lasts a few hours
EMLA creamLidocaine 2.5%,
prilocaine 2.5%
  • Performed well in clinical trials
  • Might be covered by insurance
  • Widely available
  • Must be applied generously
  • Must be covered with plastic
  • Has slow onset
  • Requires a prescription
  • May lose effectiveness once uncovered
  • Can cause skin whitening for a few hours
Mento-kaine liquidBenzocaine 20%, phenol, camphor, menthol
  • Good before waxing
  • Inexpensive
  • Has a rapid onset
  • Does not penetrate as deeply or as well as creams or gels
  • Irritates sensitive skin
Stud sprayLidocaine 9.6%
  • Good before waxing
  • Inexpensive
  • Has a rapid onset
 
  • Does not penetrate as deeply or as well as creams or gels
  • Small bottle

Preoperative Details

Patients are instructed not to pluck hairs for several weeks before treatment and not to sunbathe for several weeks or even months before treatment. Some lasers (eg, the CoolGlide laser) are reported to work even when patients sunbathe, but the procedure is less effective in people who sunbathe than in those who do not.

The area to be treated is shaved before anesthetic cream is applied. The cream is later removed, and the area is marked (an eye-makeup marker works best) and photographed. If a cooling gel is used, it is applied at this stage. If the handpiece offers dynamic cooling, it is firmly applied to the skin.

Cautions about topical anesthetics

At least 3 deaths have been linked to use of topical anesthetics in preparation for laser hair removal. Practitioners must educate patients about interactions between topical anesthetics and other pain medications, and both the practitioner and the patient must be aware of early symptoms of adverse reactions.

Intraoperative Details

The laser is applied to the target area at the fluence level predetermined by patch testing.

Postoperative Details

After treatment, most patients have a mild sunburn-type sensation that fades in 2-3 hours. Moisturizers and/or cool compresses can help during this time. Small blister areas can be treated with Bacitracin applied 3 times daily until they resolve.

Sunblock should be used for as long as 6 weeks after treatment if sun exposure is anticipated. No waxing, shaving, or dying should be performed for 2 weeks after treatment. Pretreatment restrictions also apply to the posttreatment period.

Ejection of hair shafts (ie, clearing out) occurs in the first 10-14 days. Some erythema and minor edema can persist for 2-3 days after facial treatment and longer in other areas (eg, 1 wk on the trunk). Treated sites should be washed with gentle soap (eg, Dove) and water twice a day.

Follow-up

Three treatments (range, 2-6 sessions) are usually needed to achieve the desired effects. The timing of treatments is important because hair should be treated during the anagen phase. This phase is short (6-12 wk) for hair on the head, and treatments are spaced a month apart. On the trunk, the telogen phase lasts 12-24 wk, and 2-month spacing is best.

Table 2. Distribution of Hairs in the Telogen and Anagen Phases and Growth Times

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Table
LocationResting Hairs,
%		Growth Time
TelogenAnagenTelogenAnagen
Head
Scalp13853-4 mo2-6 y
Eyebrows90103 mo4-8 wk
Ear85153 mo4-8 wk
Cheeks30-5050-70NANA
Beard or chin307010wk1 y
Mustache or upper lip35656 wk16 wk
Body
Axillae70303 mo4 mo
TrunkNANANANA
Pubic area70303 mo4 mo
Arms802018 wk13 wk
Thighs802024 wk16 wk
Breasts7030NANA
LocationResting Hairs,
%		Growth Time
TelogenAnagenTelogenAnagen
Head
Scalp13853-4 mo2-6 y
Eyebrows90103 mo4-8 wk
Ear85153 mo4-8 wk
Cheeks30-5050-70NANA
Beard or chin307010wk1 y
Mustache or upper lip35656 wk16 wk
Body
Axillae70303 mo4 mo
TrunkNANANANA
Pubic area70303 mo4 mo
Arms802018 wk13 wk
Thighs802024 wk16 wk
Breasts7030NANA

NA = not applicable.

*Adapted from Cutis. Mar 1990;45(3):199-2028

Complications

Hyperpigmentation is the most common effect and usually resolves within 6 months without treatment. The following complications are possible: itching during treatment; pain, tingling, or a feeling of numbness (with a cold spray); crusting or scab formation on ingrown hairs; bruising (rare); purpura on tanned areas; redness; swelling; infection (uncommon); and temporary hypopigmentation or hyperpigmentation; and scarring (which does not occur at proper fluences and with appropriate skin cooling).

Table 3. Reported Incidence of Adverse Events in Different Laser, Light, and Light/Heat Energy Systems on Skin Types IV-VI

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Table
Adverse eventLong-Pulsed
694 nm Ruby		Long-Pulsed
755 nm Alexandrite		Long-Pulsed
800 nm Diode		Long-Pulsed
810 nm Diode		Long-Pulsed
1064 Nd:YAG		IPLIPL/
Heat Energy
Erythema...90%69%52%23%92%54%
Burning...61%30%44%14%...4%
Blistering/crusting8%......5%...4%-12%...
Hypopigmentation4%8%5%11%-25%...12%8%
Hyperpigmentation16%40%31%9%-38%2%12%8%
Other scarring...15%6%...2%......
Adverse eventLong-Pulsed
694 nm Ruby		Long-Pulsed
755 nm Alexandrite		Long-Pulsed
800 nm Diode		Long-Pulsed
810 nm Diode		Long-Pulsed
1064 Nd:YAG		IPLIPL/
Heat Energy
Erythema...90%69%52%23%92%54%
Burning...61%30%44%14%...4%
Blistering/crusting8%......5%...4%-12%...
Hypopigmentation4%8%5%11%-25%...12%8%
Hyperpigmentation16%40%31%9%-38%2%12%8%
Other scarring...15%6%...2%......


* Adapted from J Drugs Dermatol. Jan 2007;6(1):40-69

Laser hair removal has not been available long enough to permit a full assessment of its long-term health effects. At this time, short-term data indicate that laser hair removal is generally safe. Because studies have shown that laser hair removal can alter skin structures such as sweat and oil glands, they may cause lasting changes to the skin as adverse effects in some patients.

More on Laser Hair Removal

Overview: Laser Hair Removal
Workup: Laser Hair Removal
Treatment: Laser Hair Removal
Follow-up: Laser Hair Removal
Multimedia: Laser Hair Removal
References
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References

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Further Reading

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Keywords

laser hair removal, photothermolysis, hair removal, ruby laser, neodymium:yttrium-aluminum-garnet laser, Nd:YAG laser, hair-removing lasers, hirsutism, facial hair, unwanted hair, excessive hair growth, polycystic ovary disease, congenital adrenal hyperplasia, hypertrichosis, congenital hairy nevi

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Contributor Information and Disclosures

Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD
Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Andrea James, MA, Director of HairFacts.com, Deep Stealth Productions, Inc
Disclosure: Nothing to disclose.

Medical Editor

Paul S Nassif, MD, FACS, Consulting Surgeon, Facial Plastic and Reconstructive Surgery, Spalding Drive Cosmetic Surgery and Dermatology
Paul S Nassif, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Dominique Dorion, MD, MSc, FRCSC, Program Director and Division Chair, Professor of Surgery, Division of Otolaryngology, University of Sherbrooke, Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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