Theory – How does it work
Laser light has the property of transfering energy to its target by a thin beam of light. When the beam strikes the target, energy is transferred to it and heating takes place. In sufficient quanity, Laser is capable of burning nearly anything, and where the target is skin, the control of this property is paramount. Laser can literally vaporize the tissue to any depth necessary. This has many many uses, and I was astounded while researching for this latest site upgrade that laser is now being used to treat burn victims for the prevention of scarring following third degree burns. The Idea of using a laser to target a hair resides in the tendency of a dark object (the hair root) to absorb energy more efficiently than the surrounding tissue. It still seems to require about 280 degrees Farenheit to render a follicle damaged.
Very little is known about the long-term impact of laser use and information is difficult at best to obtain about the true results of laser electrolysis. One reason for this may well be that individuals and companies are trying to withold sufficient information to prevent the improper copying of their product. With the rest of the world looking on, this is somewhat understandable. However it is entirely possible, as well, that this makes analysis of the work difficult to nail down. Such has been the thrust of a couple of television documentaries on the dangers of laser electrolysis. Also there is a problem with the lay-public learning to read the reports. In one attempt to understand a report I started out with the word “fibrosis”, and ultimately found that the report which mentioned moderate fibrosis was talking about “moderate scarring.” This is not good. So coupled with the lack of long-term view, infrequent feedback and misleading or obtuse reporting methods, the results are going to be hazy. I hear routinely that one manufacturer fields about 3-5 complaints a week from clients who have been burned by lasers. This is not exactly headline news, but it should not be ignored.
As the use of laser electrolysis continues to spread, largely through extensive advertisement, repercussions are beginning to surface. I have been encountering more and more clients who have had laser work done before seeing me. Laser work continuously results in follicles that are literally welded into the skin and difficult to remove.
PLEASE NOTE THIS: Doing laser first can result in even more hours required to complete a project. Far too often, I am simply the bearer of bad news. Doing genital work with laser has dismal results with significant regrowth. For transgender surgeries, DO NOT DO LASER. Lots of grief in the TG community over this.
Laser electrolysis on one black woman’s face in New York resulted in her disfigurement and a 10 million dollar lawsuit.
wait, wait, there is more……..
High tendency for re-growth
Then there is the issue of regrowth. It is commonly known (or is it?) that laser electrolysis works on a long term basis in about 1 out of 50 cases. For every wonderful tale of one visit and it is gone, there are a bunch of people out there who have been sapped of a great deal of money and no way to even get so much as a cent back. They have been duped into believing that a miracle is going to occur with a process that cannot even be allowed to claim “permanent”.
IN ADDITION, there is a little known cause-effect, of which I have had suspicions for a long time (like say, 15 years) and which is only now surfacing. This cause-effect lies in the tendency of skin irritation to lead to higher rates of blood/nutrient flow and also the mechanism for hair roots to begin growing. Somewhere, a while back, I described a hair follicle as a bunch of carrots lying just under the skin. Each “carrot” or hair site, has the potential to grow into a full rooted hair. Laser Stimulation can kill the main hair root, but also starts other “sites” growing. The result is an endless round-robin of stimulation and growth surrounding any attempt to remove the main hair. Again, bear in mind that the bundle of stem cells sitting just outside the main root sheath also plays a significant role in new growth.
Date: October 1, 2007
Author: Jesitus, John
Cooling method may halt hair stimulation after laser treatment.
(note the word “may”)
Grapevine, Texas – A recent review illuminates potential causes for paradoxical stimulation of hair growth following laser or intense pulsed light (IPL) -epilation. Its authors also suggest using two-pass treatments with cooling techniques to minimize this problem.
The review of 543 patients with Fitzpatrick skin types II, III and IV, treated between December 1998 and December 2003 at a clinic in Spain, contradicts much conventional wisdom regarding hair stimulation following
-epilation, says Andrea Willey, M.D., clinical instructor, dermatology, Oregon Health & Science University and a study co-author.
“It’s actually thought to be quite rare ” with low reported incidence rates focusing mainly on patients of Mediterranean descent, Dr. Willey tells Dermatology Times.
“But we see a lot of it in practice.”
I have been witnessing this phenomenon for the last 10 years.
To better understand the problem’s incidence and potential causes, owners of the Dermitek Clinic in Bilbao, Spain, enlisted Dr. Willey’s help in performing a retrospective chart review on all patients who received laser and IPL
-epilation at this facility over a five-year period. Investigators reviewed digital and other patient images before and after treatment, as well as medical histories.
Treating physicians used a long-pulsed 755 nm alexandrite laser (Gentlelase, Candela) in 85 percent of cases, an IPL source (Epilight, Lumenis) in 10 percent and a 1,064 nm Nd:YAG laser (Lyra, Laserscope) in 5 percent. Treated areas included the beard, neck and chin, excluding the upper lip. Patients received between three and 23 treatments, with treatments usually performed every two to three months.
While nearly 80 percent of patients saw some hair reduction with ongoing treatment, around 8 percent showed no improvement, and 10.5 percent experienced increased hair growth versus baseline (Willey A et al. Lasers Surg Med. 2007 Apr,39(4):297-301).
“Hair growth stimulation occurs both within the treated area and, interestingly, it can also happen in the surrounding untreated area” Dr. Willey says.
Please note the above.
Regarding causes of hair growth stimulation, she says, “Somehow when the follicle is stimulated by subtherapeutic thermal injury, it causes the hairs to become thicker and longer. And we believe this occurs in people who have prominent vellus hairs to begin with.”
It has been long-known that ANY sub-dermal injury, resulting in swelling will also lead to increased hair growth, even if it is temporary. Such injuries can include. compression injuries, abrasive injuries, and thermal injuries.
Other factors associated with failure to epilate and risk of hair stimulation include hair color, Dr. Willey says. Because
-epilation absorbs melanin within melanocytes of treated follicles, dark hair heats up more efficiently than lighter hair and is probably easier to thermally injure, she explains.
Depth of treated hair might also play a role, Dr. Willey says. In this regard, she says light sources may not penetrate sufficiently to adequately injure deeply growing anagen hairs in some areas. However, the study data didn’t prove or disprove this hypothesis, she notes.
Dr. Willey adds that in the review, terminal hair growth occurred most frequently in the low maxillary or “beard” area, as well as the neck, lateral cheeks and chin areas.
Whatever its causes, treating hair growth stimulation presents challenges, Dr. Willey says.
Though the hairs that grow posttreatment are thicker and darker than the vellus hairs originally treated, she explains, “They’re still not thick and dark enough to easily get rid of. That’s the problem.”
This is usually the point where clients come to see me after learning that they have become involved in a merry-go-round of stimulation, growth, more treatment, more stimulation, more growth, etc.
Once patients start experiencing hair growth stimulation, Dr. Willey says, “then it becomes very difficult to treat.”
Therefore, researchers offer a
-epilation protocol aimed at preventing hair growth stimulation.
For starters, Dr. Willey says, “If one uses high enough energies during hair laser treatment, one might be able to prevent hair growth stimulation within the treated area.”
This is the same fallacy that has lead to the over-use of thermolysis and the resulting scarring and disfigurement that I often see.
To prevent peripheral hair growth, Dr. Willey says, “We then cool that area with ice packs to prevent it from getting subtherapeutic thermal injury from the laser treatment.” Air cooling technologies might serve the same purpose, she adds.
Dr. Willey and her colleagues write that they have observed in side-to-side studies that two passes with a long-pulsed 755 nm alexandrite laser using an 18 mm spot size works better than a single pass (unpublished research by co-author Nerea Landa, M.D.). With this technology, their current technique requires using 12 to 14 J/cm^sup 2^ followed one minute later by a second pass using eight to 10 J/cm^sup 2^.
“If one reviews all the studies that have been published on this topic,” Dr. Willey adds, “hair growth stimulation doesn’t seem to be specific to any particular device – it can happen with any of the hair lasers” or IPL devices.
Please re-read the above. ANY OF THE HAIR LASERS. I am constantly bombarded with clients claiming that the laser used by their provider-of-choice is DIFFERENT. NOPE, and they’re still here to get “laser cleanup”.
Overall, Dr. Willey says hair growth stimulation is probably less rare than previously thought
Furthermore, she says even though the paper included only patients treated on the face and neck, “This occurs on the abdomen” and virtually anywhere on the body, to patients of both genders.
For example, Dr. Willey says the problem also can afflict males who undergo epilation on the back and arms.
Furthermore, Dr. Willey says, “It’s commonly thought that this only occurs in darker skin types.” However, she says, “Plenty of women in our sample had fair skin” and still experienced hair growth stimulation.
These patients did have prominent vellus hair growth, Dr. Willey says.
Researchers remain uncertain of any role female patients’ hormones might play, Dr. Willey says.
Although the data didn’t address this issue, Dr. Willey says, “We suspect that women who have polycystic ovary syndrome or other hormonal abnormalities are at higher risk for this, because these women often have prominent vellus facial hair.”
Generally what happens (as with most flash thermolysis, too) is that the hair is simply bombed back to the stone age, but it will one day rebuild and return. Lately, judging by the work that is turning up for me, it seems that it takes about 2 years for the hairs to re-appear. The funny thing…well, not so funny after all…is that it seems that laser resets nearly ALL the hair to “zero” where it remains dormant. Judging by three noticeable cases that I have worked on, it then makes its re-appearance all at once.
Perhaps one of the reasons that laser electrolysis is so popular is that you can hardly open a paper without reading an advertisement for it. And the nature of these advertisements are very misleading. There are claims that border on the illegal as to permanence, and I have already met clients who were fleeced of a significant amount of money before finding out that these machines are ineffective against light colored or gray hair. They do not print a surgeon general’s warning, although I think they should. Bear in mind, that I mentioned that these machines have serious capabilities. Many doctors have found that the ownership of a few of these machines can reap very large rewards – one equipment seller claims a six figure increase in office income by offering laser electrolysis.
Over the last couple of years, there has been a growing incidence of customers utilizing laser electrolysis “for a quick color removal” then asking me to remove the remaining gray and white hairs. Essentially, they are asking me to clean up after the use of laser electrolysis. I have been doing this for the last 8+ years and I found several problem areas.
Hairs that have been affected by laser electrolysis tend to exhibit characteristics similar to the use of excess heat as in flash thermolysis. Follicles are often “spot-welded” into the skin and nearly impossible to remove following galvanic treatment. Tissue moisture in the follicle has been significantly reduced and galvanic struggles to break down follicle walls so necessary for effective hair kill. In spite all of this, hair is still growing (sometimes VERY well) in the follicle. While this is happening, regrowth hairs are re-emerging somewhere during the 2 year recovery period and I have been criticized for failing to kill re-growth.
Black debris is observed scattered throughout the dermal layers of the skin. There is an explanation for this characteristic. When a follicle is instantly heated to the required 284 degrees (or higher in some cases) steam is produced at 212 degrees by the sudden rise beyond the boiling point. Because of the instant rise of temperature in any given follicle, the dark bulb at the end of the hair root, explodes in the lower follicle.
The material in the dermal papilla is liquid and dark in color. Not unlike black ink, actually. This material is subsequently spread throughout the lower follicle and surrounding skin. The theory is that the skin can eliminate this waste matter, but it has been observed that a number of clients presenting to me have permanent shadow below the skin surface that has failed to dissipate. This problem along with the difficulty in removing embedded solid debris, leads to the assumption that I am responsible for scarring and coloration problems that can expose me to charges of malpractice.
Hair that has been treated by laser electrolysis tends to grow back brittle and with no appreciable tensile strength left to it. If I attempt to remove this hair, it snaps off and I must try again to remove it. Once again, I grasp the hair with the tweezers and again, it snaps off. This occurs 5-7 times until, finally, the root and what little hair is still embedded are now broken off below the skin surface. In working on clients who have done laser electrolysis, I have found that this is nothing to me but a case of Repetitive Stress Injury waiting to happen. Be advised, a quick removal of the initial shadow may only be the beginning of a long, expensive, and arduous horror tale. I am still hearing continuously that laser will clear the area, and then a switch to “another operator” for *regular electrolysis* is still being advised as the best way to permanently clear an area. WRONG, WRONG, WRONG, The “experts” advising this are anything but knowledgeable about hair and anyone who listens to them, will pay the price for their stupidity.
Laser has the dubious distinction of being able to scar large portions of skin rather than just a few follicles. One blink mis-applied and the result is as significant and as permanent as any tatoo.
It is worth noting here, that one client had several long scar lines across the back that looked as though they had been drawn with a ruler. They were quite observable. When I queried the client as to the origin of the scars, I learned that he was unaware of them. BUT he had done laser unsuccessfully before coming to me. I tend to believe that these lines were the result of an accidental trigger pull before applying the laser scanner against the skin.
However, this is the obvious stuff. I would like to again take up arms against sub-dermal scarring. This is the insidious type of scarring in which collagen is boiled away deeper in the skin during the high temperatures involved in killing follicles only to be replaced by more dense and less flexible scar tissue. While this is done below the surface of the skin, I believe that improper laser use can lead to premature aging of the skin and it may not be evident for several years, but by then any warranties expressed, or implied, have probably run out. Caveat Emptor.
Here is where I get down and boogie. For over two years, I searched for a decent school where I might train on the use of laser. The purpose of this hunt was to learn about working with laser machines. I am always into new stuff and the creative potential for utilizing laser was intriguing. What I learned was pretty scary, though. I located several schools claiming reputations and offering certification in laser electrolysis. One of them stated that they could do this in 1-2 days! What I found, though, left me a little cold. While a bit of a “techy” myself, I feel that to adequately understand the theory of operation and application of this type of equipment, I would need some decent training. The longest school I located was 5 days of training and cost nearly as much as 4 months of training in conventional electrolysis. This worries me. I am pretty dense myself, and it might take me a little longer or a little more hands-on time to become proficient in the use of laser. So I called one prestigious school and I was told that the hands-on portion of the work consisted of “a day or so”. When I inquired about a way to obtain more “hands-on” practice time, I was told that this would come after I went back to work “for your doctor”. I guess I was to infer that my clients would be my training aids. Since that day about 8 years ago, I have been confronted by people who must have unwittingly been someone else’s training aids.
Forget using laser on gray hairs, they reflect too well, and the energy has no effect on the root structure. This same phenomenon is also present where the hair is sebaceous. This is where the hair itself is rooted within the sebaceous gland. All hair starts out this way and these glands tend to be white in color. Therefore there is no energy absorption and hence, no hair kill. Also, it would be wise to note here that often the outer sheath of a follicle can often be totally white in color while producing a black hair. Once again, laser can only work on dark colored roots by absorbing light energy and converting it to heat. No absorption, no heat, no kill.
Here it is, again……
So it was with some astonishment that I listened to a client tell me about her intentions to go to an operator who claimed that a “new system” (ALWAYS a “new system”) had been devised that used laser in conjunction with thermolysis for killing gray hair. Some days, I just want to throw things when I hear this bullshit. Where is Penn & Teller when you need them?
Guess what happened? The follicles weren’t even damaged, and now I am using my very old and reliable process on someone who was out telling EVERYONE about the “new process”…….Just another “expert” in the making.
HEY EXPERTS: PLEASE NOTE:
The FDA will not allow the use of the term “permanent” in describing the effect of laser electrolysis on hair.
At this time the rule still stands that Laser Clinics and Operators may claim that their process is capable of “permanent reduction” and nothing more than that. The definition is also in consideration of the reduction as measured in a time period of three months. Remember what I said about re-growth re-appearing in 2 years? With THAT time frame, even permanent reduction is in doubt. Caveat Emptor.
The popularity of laser hair removal has increasingly grown, prompting many laser manufacturers to conduct research and seek FDA clearance for their lasers for this indication. The market is growing so quickly that FDA cannot maintain an up-to-date list of all laser manufacturers whose devices have been cleared for hair removal, as this list continues to change. To learn if a specific manufacturer has received FDA clearance, you can check FDA’s Website at http://www.fda.gov/cdrh/databases.html under the 510(k) database. You will need to know the manufacturer or device name of the laser. You can also call FDA’s Center for Devices and Radiological Health, Consumer Staff, at 240-276-3103, fax your request to 240-276-3151 or send an e-mail to: DSMICA@cdrh.fda.gov.
Manufacturers should be aware that receiving an FDA clearance for general permission to market their devices does not permit them to advertise the lasers for either hair removal or wrinkle treatment, even though hair removal or wrinkle treatment may be a by-product of any cleared laser procedure. Further, manufacturers may not claim that laser hair removal is either painless or permanent unless the FDA determines that there are sufficient data to demonstrate such results. Several manufacturers received FDA permission to claim, “permanent reduction,” NOT “permanent removal” for their lasers. This means that although laser treatments with these devices will permanently reduce the total number of body hairs, they will not result in a permanent removal of all hair. The specific claim granted is “intended to effect stable, long-term, or permanent reduction” through selective targeting of melanin in hair follicles. Permanent hair reduction is defined as the long-term, stable reduction in the number of hairs re-growing after a treatment regime, which may include several sessions. The number of hairs regrowing must be stable over time greater than the duration of the complete growth cycle of hair follicles, which varies from four to twelve months according to body location. Permanent hair reduction does not necessarily imply the elimination of all hairs in the treatment area.
FDA does not make comparisons between systems or how well or safely they work compared to another company’s system. FDA does not recommend one laser system over another.
Lasers cleared for body hair removal are also cleared for facial hair removal.
Earliest modalities of this device have been discontinued
I was surprised to note in an investment newsletter that followed the activities of laser-based practices, that the manufacturer of one of the first laser-based electrolysis systems had closed its doors. Bear in mind, that this leaves no recourse for someone seeking damages for bad work out there. Significant, also, is the still unknown long-term repercussions of this work. By the time it becomes obvious that something out there may have been responsible for an upsurge in the incidence of skin cancer, the perpetrator(s) may be long gone.