Rebecca Treston shares her technique and advice for best practice in removing hair with laser
While it seems that laser hair removal (LHR), one of the most popular and therefore profit-yielding aesthetic treatments, is readily available at an abundance of clinics, it is the expert touch and technique of individual practitioners that determines how great a reputation an institution has for the treatment, and which in turn will influence the volume of LHR patients coming through the door. In general, it is those practitioners that hold an in-depth understanding of the science behind the procedure that are most proficient at carrying out the treatment, and boast the highest patient satisfaction rate. The primary principle behind laser hair removal is selective photothermolysis (SPTL), or heating up a target chromophore. In the case of LHR, the chromophore is melanin: the chemical that gives skin and hair its colour. Because of the selective absorption of photons of laser light, only black or brown hair can be removed. By matching a specific wavelength of light and pulse duration it is possible to safely and thermally destroy the melanin in the area that causes hair growth – the follicle – whilst not heating the surrounding tissue (skin) and therefore causing no damage to the skin. Since its widespread introduction in the 1990s, constant research has led to safer, more effective LHR treatments with dramatically less downtime, pain and exponentially improved results. For instance, although white skin with coarse dark hair was the ideal subject for the treatment, the latest generation of LHR treatments offer a variety of right wavelengths and varying parameters to ensure treatments for all skin types. That said, on darker skin types it is very important that the practitioner understands the treatment’s limitations and that these skin types are much more susceptible to burning and post inflammatory pigmentation. When treating dark skin, it is vital to change the wavelengths and parameters to allow for this sensitivity. For skins that are tanned or measure four to six on the Fitzpatrick Scale, I use ND-YAG 1064nm laser; while for skins that measure one to four on the scale, a 755 nm Alexandrite laser can be used. I also have a Q switch NDYAG which is perfect for dark, fine, velous hair which would not be affected by LHR, and this technique is particularly brilliant for bleaching or for post-LHR maintenance. I have worked in the Middle East for the past 15 years, so when treating darker skin patients in this hot humid environment, it is possible to suffer post inflammatory pigmentation. By educating my patients in what they should do before and after the treatment, however, I am able to minimise this occurrence. I often advise patients that would be prone to these side effects to use topical solutions to minimise the melanocytes in the skin, stop all peeling creams two weeks prior to treatment and very importantly, to have no sun exposure before the treatment and to always wear a broad spectrum UV SPF. One major advance in LHR treatments as they have grown in popularity is their now relatively pain-free nature, which is due to cooling systems. I use the Zimmer cooling system which is effective in counteracting the heat that is felt during the treatment. To ensure the patient feels no pain, I also apply a thick layer of topical anaesthesia one hour before a treatment, which acts to reduce the discomfort considerably. I find that this combination is more than adequate to ensure that the patient will be relaxed throughout the treatment. Prior to offering any individual a treatment at my clinic I will carry out a full and thorough consultation, and in the case of LHR this first step is no different. During this, we can learn about the patient’s medical history, and we might even carry out further blood tests if we suspect the patient has hormone-related problems such as polycystic ovaries. It is important to understand the effects of any medications that the client might be taking. For example, a supplement such as St John’s Wort can make the skin photosensitive to laser and result in burning or post-inflammatory pigmentation. A consultation also allows us to assess the patient on an individual basis – to discover the reasons why they have chosen the treatment, to ensure their suitability, to outline any possible side effects they may experience and to explain to them the realistic results that they can expect. Once the patient fully understands the different stages of hair cycles and protocols of the treatment, a consent formed is signed, and this is followed by a patch test to ensure the patient does not have an adverse reaction. In my experience, there are certain areas of the body that yield the best results due to the hair being thicker, denser and darker. These include the bikini line, the underarm, the lower leg – and for male patients the neck. The number of treatments needed varies between areas but in general, the face will require between four and eight sessions, while the body will need four to six. Maintenance treatments may also be required but these will be one or twice per year.
Tips for best practice
Undertake regular conferences and courses to update your knowledge and ensure you are a qualified, experienced practitioner.
Become a licensed laser specialist.
Check the credibility of your laser and manufacturer.
Always do a thorough consulation with extensive medical history and offer pre and post-care advice.
Always carry out a patch test, and when increasing fluence perform further patch tests.
Educate patients on the importance of SPF and avoidance of sun for the duration of treatment.
Update medical notes after each treatment.
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