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Laser Treatment of Unwanted Hair David J Goldberg 1-618.01.2005 16:41 Uhr Seite 61 Laser Treatment of Unwanted Hair David J. Goldberg, Mussarrat Hussain 4 ▲ ondary to genetics or medical conditions. These Core Messages individuals may be classified as having hir- A wide variety of lasers can now sutism or hypertrichosis. More commonly, induce permanent changes in un- those seeking hair removal have hair that would wanted hair. be considered normal in distribution and den- Hair removal lasers are distinguished sity. However, these individuals, for emotional, not only by their emitted wave- social, cultural, cosmetic, or other reasons, lengths, but also by their delivered want the hair to be removed. pulse durations, peak fluences, spot There has always been the need for an ideal size delivery systems, and associated method of hair removal that is both practical cooling. and effective. Traditional hair removal tech- Nd:YAG lasers with effective cooling niques have included shaving, waxing, tweez- represent the safest approach for the ing, chemical depilation, and electrolysis. treatment of darker skin. In the early twentieth century, radiograph Complications from laser hair re- machines were widely used for removal of facial moval are more common in darker hair in women. Unfortunately, these treatments skin types. were associated with a high risk of complica- Pain during laser hair removal is gen- tions and the potential for subsequent treat- erally a heat-related phenomenon ment-induced carcinogenesis. and is multifactorial. Maiman, using a ruby crystal in 1960, devel- Laser treatment of nonpigmented oped stimulated laser emission of a 694-nm red hairs remains a challenge. light. This was the first working laser, and it is from this prototype that today’s lasers are derived. Since 1960, research and technical advances have led to modern day lasers. Leon Goldman, the father of laser surgery, published History preliminary results on the effects of a ruby laser for the treatment of skin diseases. Ohshiro et al. Human hair, its amount and distribution, plays noted hair loss from nevi after treatment with a an important role in defining appearance in ruby laser (Ohshiro et al. 1983). contemporary society. Hair also functions in Early reports described the use of a CO2 many mammals as a sensory organ, reduces laser to eliminate unwanted hair on flaps used friction in certain anatomic sites, protects for pharyngoesophageal procedures. A continu- against the environment by providing thermal ous-wave Nd:YAG laser has also been shown to insulation and thermoregulation, aids in remove hair in urethral grafts All of this early pheromone dissemination, and plays both work described lasers using ablative techniques social and sexual roles (Wheeland 1997). with the effect of nonspecific vaporization of Individuals, seeking consultation for the skin cells. These methods are not commonly removal of unwanted body hair, generally have used for hair removal today because of their increased hair in undesirable locations sec- limited effectiveness as well as their commonly Goldberg 1-618.01.2005 16:41 Uhr Seite 62 62 Chapter 4 Laser Treatment of Unwanted Hair induced permanent pigmentary changes and to be damaged by heat diffusion from the highly scarring. pigmented/strongly absorbing portion of the chromophore (the heater or absorber). Such nonspecific thermal damage evokes the concept Selective Photothermolysis of thermal damage time (TDT). The TDT of a target is the time required for irreversible target A detailed understanding of laser-tissue inter- damage with sparing of the surrounding tissue. action emerged in 1983 as the theory of selective For a nonuniformly absorbing target structure, 4 photothermolysis was conceived for the laser the TDT is the time it takes for the outermost treatment of pediatric port wine stains (Ander- part of the target to reach a target damage tem- son et al. 1983) perature through heat diffusion from the heated The theory of selective photothermolysis led chromophore. to the concept of a laser-induced injury con- According to the concept of extended selec- fined to microscopic sites of selective light tive photothermolysis, target damage can still absorption in the skin, such as blood vessels, be selective even though the TDT is many times pigmented cells, and unwanted hair with mini- as long as the thermal relaxation time (TRT) of mal damage to the adjacent tissues. To achieve the actual target. this selective effect, lasers would need to fulfill This new extended theory of selective ther- three requirements: mal damage of nonuniformly pigmented struc- 1. They should emit a wavelength that is highly tures in biological tissue postulates that the tar- absorbed by the targeted structure. get is destroyed by heat diffusion from the 2. They should produce sufficiently high ener- absorbing chromophore to the target but not by gies to inflict thermal damage to the target. direct heating from laser irradiation, as is seen 3. The time of tissue exposure to the laser with selective photothermolysis. This theory should be short enough to limit the damage has now been applied to the treatment of to the target without heat diffusion to the unwanted hair. Ultimately, the use of hair surrounding tissues. This is known as the removal lasers expanded rapidly with the sub- thermal relaxation time (TRT). sequent development of appropriate cooling devices that minimized epidermal injury. These concepts revolutionized cutaneous laser treatment and led to the development of success- ful laser and light-based hair removal devices. Physical Basis of Laser Hair Removal Successful treatment of unwanted hair is depen- dent on an understanding of the optical proper- Extended Theory ties of the skin. It is these properties that deter- of Selective Photothermolysis mine the behavior of light within the hair shaft and bulb, including the relative amount of The concept of selective photothermolysis (An- absorption of incoming photons. derson et al. 1983) emphasizes both the selective Different physical factors including deliv- damage and minimum light energy require- ered fluence, wavelength, pulse duration, and ments seen with current laser technology. How- spot size diameter play an important role in ever, the use of such a short pulse width laser maximizing the efficacy and safety of laser- system may become inapplicable when the tar- assisted hair removal. get absorption is nonuniform over a treatment For optimal laser hair removal, one needs to area. This may be seen when the actual target use an optimal set of laser parameters based on exhibits weak or no absorption, yet other sur- anatomic and physical principles. This is deter- rounding portions of the target exhibit signifi- mined by a time–temperature combination cant absorption. If this is the case, the weakly with the ultimate effect being transfollicular absorbing part of the target chromophore has denaturation. Goldberg 1-618.01.2005 16:41 Uhr Seite 63 Factors Affecting Efficacy/Results 63 Pulse Duration Fluence Laser pulse width seems to play an important In general, higher-delivered laser fluences lead role in laser-assisted hair removal. Thermal to better laser hair removal results. However, conduction during the laser pulse heats a region the higher the utilized fluence, the greater the around each microscopic site of optical energy discomfort and risk of complications. The effec- absorption. The spatial scale of thermal con- tive fluence for any one area of hair is deter- finement and resultant thermal or thermome- mined mainly by hair color, whereas the toler- chanical damage is therefore strongly related ated fluence is determined mainly by skin color. to the laser pulse width. Q-switched laser The tolerance fluence can be increased sub- nanosecond pulses effectively damage individ- stantially by various means, such as cooling the ual pigment cells within a hair follicle by con- skin surface before, during, and/or after the finement of heat at the spatial level of melano- optical pulse. somes (Zenzie et al. 2000). They can induce leukotrichia and cause a temporary hair growth delay, but do not inactivate the follicle itself. Factors Affecting Efficacy/Results On the other hand, lasers with longer pulse durations not only allow gentle heating of the Hair Color melanosomes, but also target the entire follicu- lar epithelium by allowing thermal conduction Hair color is genetically determined, and is a from the pigmented hair shaft and pigmented result of both the type and amount of melanin epithelial cells to the entire follicular structure. within the hair shaft. Melanin production occurs Therefore, lasers emitting longer pulse only during the anagen phase, by melanocytes in durations can achieve two goals: (1) Epidermal the bulb that transfer melanin granules to hair melanosomes are preserved. This then helps to keratinocytes. Distinct types of melanosomes preserve the epidermis. (2) Adequate heat diffu- exist in hair of different colors. Dark hair con- sion occurs to the surrounding follicle from the tains large numbers of eumelanin granules, light-absorbing melanized bulb and shaft. whereas light hair contains mostly pheomelanin. The use of a longer laser-emitted pulse Red hair contains erythromelanin granules that width may necessitate the use of higher fluences are rich in pheomelanin. In gray hair, melano- because the longer pulse now heats a larger vol- cytes show degenerative changes such as vacu- ume of tissue. This may be of some benefit in oles and poorly melanized melanosomes, allowing higher fluences to be used on dark whereas in white hair melanocytes are greatly skin types with both less risk of epidermal reduced in number or are absent. injury and increased chances of transfollicular Most individuals demonstrate greater damage. melanin density in their hair as compared to their skin epidermis such that the absorption coefficient of the hair shaft and bulb is roughly Spot Size 2–6 times that of the epidermis. Thus, hair will generally absorb more of the melanin-absorb- Large diameter laser exposure spots (e.g., ing wavelengths emitted from today’s laser and >10 mm) are associated with substantially less light source hair removal systems.
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