Laser Hair Removal Workup

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS; Chief Editor: Arlen D Meyers, MD, MBA more...

Updated: Apr 13, 2012

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Other Tests

Do not forego skin patch testing, the most important step in laser hair removal. The results of skin patch testing determine the settings for the laser and the safety profile.
Perform testing in a low-visibility area with the same skin type as the area intended for treatment. If possible, allow at least 3 days before reexamining the site to assess for efficacy and for a reaction.
If sufficient energy is delivered and absorbed, a generalized hyperemia reaction with mild focal swelling is visible after 3-5 minutes.
- Increase the fluence for the particular skin type, and note the patient's pain reaction until the hyperemia reaction is observed.
- For light or thin hair, the reaction may be minimal even at high settings.
Note the laser setting for each type of treated area.

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dominique Dorion, MD, MSc, FRCSC, FACS Vice Dean and Associate Dean of Resources, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Sherbrooke Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD Private Practice in Otolaryngology and Facial Plastic Surgery, 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 of Otolaryngology, Dentistry, and Engineering, 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 Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

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Pain-sensitivity diagram.

Anatomy of the hair follicle.

Absorption spectrum of melanin and oxyhemoglobin.

Table 1. Advantages and Disadvantages of Anesthetics

Anesthetic	Active Ingredient	Advantages	Disadvantages
Ametop gel	Tetracaine 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 cream	Lidocaine, 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 cream	Lidocaine 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 cream	Lidocaine 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 liquid	Benzocaine 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 spray	Lidocaine 9.6%	Good before waxing Inexpensive Has a rapid onset	Does not penetrate as deeply or as well as creams or gels Small bottle

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

Location	Resting Hairs, %		Growth Time
Location	Telogen	Anagen	Telogen	Anagen
Head
Scalp	13	85	3-4 mo	2-6 y
Eyebrows	90	10	3 mo	4-8 wk
Ear	85	15	3 mo	4-8 wk
Cheeks	30-50	50-70	NA	NA
Beard or chin	30	70	10wk	1 y
Mustache or upper lip	35	65	6 wk	16 wk
Body
Axillae	70	30	3 mo	4 mo
Trunk	NA	NA	NA	NA
Pubic area	70	30	3 mo	4 mo
Arms	80	20	18 wk	13 wk
Thighs	80	20	24 wk	16 wk
Breasts	70	30	NA	NA
NA = not applicable. Adapted from Cutis.* Mar 1990;45(3):199-202^[12]

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

Adverse event	Long-Pulsed 694 nm Ruby	Long-Pulsed 755 nm Alexandrite	Long-Pulsed 800 nm Diode	Long-Pulsed 810 nm Diode	Long-Pulsed 1064 Nd:YAG	IPL	IPL/ Heat Energy
Erythema	...	90%	69%	52%	23%	92%	54%
Burning	...	61%	30%	44%	14%	...	4%
Blistering/crusting	8%	...	...	5%	...	4%-12%	...
Hypopigmentation	4%	8%	5%	11%-25%	...	12%	8%
Hyperpigmentation	16%	40%	31%	9%-38%	2%	12%	8%
Other scarring	...	15%	6%	...	2%	...	...
* Adapted from J Drugs Dermatol. Jan 2007;6(1):40-6^[13] 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.

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