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PST 012: Laser Hair Removal — Read the Transcript

May 15, 2018

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Hello and welcome. Dr. Stephen Mulholland here from SpaMedica in Toronto, Canada on Plastic Surgery Talk. And we are here for another podcast. And this podcast is the most common laser treatment in the world and that is laser hair removal. What is laser hair removal? Laser hair removal is the highly-evolved science of taking a laser energy and permanently killing unwanted hair. It has been now about 12 years that we’ve had high-speed hair removal systems and 20 years since the very first FDA-approved laser to kill hair.

So, the use of laser, which is a device that emits a photon, a little bundle of energy, like little bullets fired at targets. Some of our targets are blood vessels, skin pigment. What we are targeting in hair removal is that follicle. And we get at it through heating and photocoagulating the shaft. So, we hit the hair, and we kill the factory workers that make new hairs. And how do we do that? With a laser, a device that emits bundles of light. So, the secret is to buy the right bundles of light, the right laser, for the kind of hair removal patients you have in your practice.

So, we know how laser hair removal works. A laser emits a bundle of light, and we fire it in a controlled way through a handpiece at the hair we don’t want. So, what hair on the body is available and successfully removed permanently with lasers that are targeting it? Well, first of all, the most common area done is the face. Facial hair in women, the lip, the chin, sideburn. And in men, the shave zone where you get that follicular sort of rash pattern following shaving. Then armpit hair, particularly in women. Chest and back hair in men. And then for women, bikini and leg hair. Those are the most common areas that we do hair removal.

There are some subtle areas were we do hair removal, like on a guy, the unibrow, the heavy between-the-eyebrow hair, the nape of the neck hair, the back of neck hair. These are our commonly performed. Less commonly, back of the hand on some women. Knuckles and back of the hand on some men. And so, the only hairy areas on the body we almost never, ever treat are the scalp. And that hair, those follicles, are too deep to be assaulted by a laser even if you wanted to. So, face, armpit, bikini, arm, forearm, leg, thigh, chest, and back, all easily accessible and very successful at removing.

So, who’s a good candidate for laser hair removal? Well, a patient with realistic expectations means we can get a very good permanent reduction but maybe not 100% permanency. A patient who is medically well, with no health conditions that get in the way of a laser treatment. A patient who has appropriate physiologic conditions, meaning, a patient must have dark hair. Gray hair, blonde hair, red hair are not candidates for laser hair removal. There has to be some dark melanin to act as the target for the laser, to act as the lightning rod to heat the shaft that has pigment in it so it can explode with thermal energy and kill the factory workers way down in the bulb. If your shaft has blonde hair, gray hair, or red hair, there’s no target, no explosion, no heat, no permanent death. So, you must have dark skin and dark hair, be a realistic patient with reasonable expectations, and medically well, and then you’re a good candidate for some of the great laser hair removal devices we now have.

What do we need to be successful in hair removal? Well, after patient selection and making sure that there’s dark hair, and the patient can be light-skinned or dark-skinned, but must have dark hair, we have other criteria. There has to be hair growing in the area. So, we want to see a little bit of stubble in all the areas that we are going to treat. The axilla in the woman, the armpit, the bikini, the leg, the arm, the chest, the back.

So, a patient cannot wax the area just prior to laser hair removal because you actually pull out the shaft, which is the target, and you pull out the bulb. And we have nothing to treat. So, you must have hair growing. It doesn’t have to be too long. A woman doesn’t have to come in with her chin braided in a Fu Manchu. But there’s got to be a visible hair that’s a few millimeters long. And then we shave down to a stubble. We shave to a stubble of about a millimeter, which gives us our target. Then we prep the skin, and we apply the laser.

If the goal of laser hair removal is the maximum amount of permanent reduction we can achieve somewhere upwards of 50, 70, 80% of all hairs killed permanently, we have to ask then, how many sessions does it take? What kind of success can we achieve? And what do we do with the hair that we didn’t kill? So, you’re a good candidate realistically, you’re not medically unwell, and you’ve got light skin or dark skin, but you’ve got dark hair. You’re a good candidate.

What can you expect in terms of number of sessions? I tell most patients no matter what hair removal device we use, and I’ve got 10 different hair removal systems, we need five to seven treatments, every single growth phase, which is different for different hairs of the body, in order to get maximum, permanent hair reduction. Why do we need multiple treatments? Because if you think about it, some of your hair is sleeping, in the telogen phase. Some is growing in the anagen phase. And every day, a different hair, couple of days, a different hair comes out.

And so, we need to capture all the hairs in a mitotic division, or an actively dividing living phase in order to kill the nucleus, which is the engine of the hair follicle. If the hair follicle is sleeping, there’s no follicular cells dividing to kill. So, we must have a growth cycle. So, how often do we treat? On the face area, it’s once every growth cycle, which is every six weeks. For the axilla, or the armpit, and the groin, and the chest, and the back in a man, every 8 to 10 weeks. For the lower extremity, thigh, leg in a woman, it’s every 12 to 16 weeks.

So, as you go down the body, the growth cycles, anagen, telogen, or growth and sleeping phase get longer and you need still five to seven treatments, just less frequently. And so, multiple treatments, five to seven treatments, are done every growth cycle. At the end of that five to seven treatments, most patients will get 50- to 70% hair permanently gone. So, 50% of patients after five to seven treatments get 50- to 70% primary reduction. If you’ve got a good laser with a good spot size and a good fluence, that’s the consistent outcomes I’ve had for many, many years.

Now, the next question is, if we kill 70% of the hair, what happens to the other 30% that’s not dead? Well, if we’ve hit it five to seven times, four things happen that are very good that are permanency. Number one, we can miniaturize the follicle. So, we do carpet bombing every five to seven treatments every growth cycle. And if we haven’t killed the follicle, we’ve heated and shrunk it and miniaturized it so the hair shaft it makes is much less density, much less coarseness, much finer, much more wispy, and therefore, usually more aesthetically appealing. So, smaller hair.

Number two, we change the melanin concentration. We can go from dark, coarse hair to very fine, light hair. So we change its visibility, its melanin content. If we don’t kill it, we can lighten it. If we don’t kill it, we can thin it. Number three, we can prolong telogen. What does that mean? Well, let’s say the sleeping cycle on the face is six weeks. After five to seven treatments, we synchronize all the hairs into the same growth, and we prolong that sleeping phase till 10 to 12 weeks, so we can double the telogen anagen cycle, meaning that your maintenance treatments for your residual hair are less frequent, because the last feature is harmonization of anagen telogen. What does that mean?

We have all these different hairs in different growth phases. After we treat five to seven times, we shock them all into the same growth phase, and they all grow at once. We laser them all down, and you don’t have to come back until they all grow again. And now, with the growth phase being prolonged by up to double the length, it means infrequent maintenance treatments.

So, this is how it works. You come into SpaMedica or your local clinic. You’ve Googled laser hair removal, your town or your city. You look for the best possible center with the most experience and the best technology. Let’s say you come into SpaMedica. We do a consultation, you’re a good candidate. You’re gonna do five to seven treatments every growth cycle. So, let’s say you’re a woman, it’s your lower legs. It’s after Labor Day. You do a treatment in September, and by the time you get to the May 24 Weekend, or Memorial Day in the US, you have killed 70% of your hair.

But the hair you didn’t kill is now synchronized, harmonized, miniaturized, and lighter. And it may not grow till after Labor Day. And then it all comes up, you do two or three maintenances during the winter. And you’re ready for a summer free of shaving. No waxing, no folliculitis, bikini-free, shave-free zone for the summer. And that’s generally how we work things. We have a Laser Hair Removal Club with customer value pricing that you can access after your fifth or seventh treatment. And we optimize your permanent reduction.

Are all laser hair removal devices created equal? And the answer is absolutely not. There is no one removal device you can buy that treats all skin types and all hair types optimally well. And so, in general, the best laser hair removal centers are gonna have one, two, or three, preferably three different wavelengths. They’re gonna have what’s called a Neodynium YAG, or a 1064 nanometer photon wet laser for dark skin and dark hair. They are going to have an 810 diode, an 810 nanometer diode, for medium skin darkness and dark hair. And then a 755 nanometer Alexandrite for light skin, dark hair.

Those three wavelengths, the Alex, the diode, and the 1064, should usually be in any high-quality busy hair removal center to give you the best possible result. Because if one hair removal device stalls in its efficacy, you can deploy another. We can also tailor and customize the treatment. And some lasers, the highest tech ones, have two wavelengths in the same pulse. So for dark skin, we can treat with an 810 and a 1064 to get the best result. And for light skin, a 755 and an 810. So, do your research, do your homework. Not all lasers are created equal. And the best laser hair removal centers have more than one laser.

Does the hair start to grow back at any point? Well, the hair that’s dead is dead, gone forever. We do have about, some patients, it’s really a bell curve. 90% of patients are going to get some result. If you look at those 90% of patients, about five or 10% get 100% reduction. They do their five, six, seven treatments and there’s no hair left. That’s uncommon, but it happens. And those are the happiest patients. There’s another 5% at the other end of the curve, that you hit them with every laser ever made, every wavelength, and they just have super-duper follicles and you can’t get a significant permanent reduction in them. They are rare, but they do exist. And then they have to drop back to standard depilation techniques such as waxing, threading, or electrolysis.

The vast majority of patients are right in the middle. 50- to 60% of patients after five to seven treatments, will get up to 70% permanent reduction. And then they have a 20- to 30% that still’s growing. But it’s synchronized, harmonized, lighter and finer. It grows infrequently. And then they generally join a laser hair removal club when it does have regrowth. And three times a year, they get very, very affordable, “Join-the Hair-Removal-Club” maintenance with a laser.

Laser hair removal is now 20 years old. It’s had its 20th anniversary this past year, in 2017. It’s here to stay. It is the number one way hair is removed permanently, in the world. It’s become a very refined and elegant process. So if any of you are out there with light skin or dark skin or dark hair, it’s the best way to get permanent hair control and hair reduction, and even permanency. So, best of luck. Again, Dr. Stephen Mulholland here in Toronto, Canada. Thank you for joining us on Plastic Surgery Talk. This is another one of our many podcasts. This one was on the huge and popular topic of laser hair removal.

If you found this informative, entertaining, or both, please share it on all your social channels. And we look forward to seeing you again on Plastic Surgery Talk for our next exciting podcast.

Posted by Anne

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