Laser Hair Removal: Myths and Realities

With the advent of LASER the treatment of this vexing problem has really been revolutionized.

Sheeba ( name changed) is a 25 year old female who has just finished her college. Her parents are now into finding a suitable life partner for her. However, Sheeba is facing a disturbing psychological problem these days. She is suffering from excessive hair growth on her face as well as body which has become so evident that she cannot hide it any more. Measures like waxing and plucking the hair do give her a temporary relief but the hairs come back within days. She has heard about laser hair removal but she is not sure about its efficacy. She has been hearing different versions from different people about this procedure and with the result she is not sure about whether she should go for it or not.

She visits a dermatologist one day for this issue and here is what transpires between her and the doctor.

‘Doctor, I have this problem of excessive hair growth on my face and body. Is there a treatment for this?’

‘Yes, there certainly is! Your condition is absolutely treatable in today’s world. Basically, treatment of abnormal hair growth anywhere on the body has to be treated scientifically and if you treat it on scientific lines your problem is certainly going to be tackles satisfactorily.’

‘So, what is the scientific treatment of my problem, doctor?’

‘Treatment of abnormal hair growth is done on two fronts and both of these fronts are equally important. The first front is to destroy all the abnormal hair that has already developed on the body. Many techniques have been traditionally used for this purpose in the past but the technology that has now replaced everything else is the LASER. With the advent of LASER the treatment of this vexing problem has really been revolutionized. The second and equally important front is to find the underlying cause for the abnormal hair growth and then treat that specific cause with proper drugs.’

‘Doctor, I have heard so many versions about the laser hair removal procedure. Some people say that it is not effective at all and the hair comes back after the treatment is stopped. Is it really true?’

‘See, for the treatment of abnormal or even normal hair on the body, there is only one technology that has stood the test of time and this is LASER. Lasers have been used for this indication for the last 3 decades and all scientific studies have unequivocally shown the efficacy of lasers in causing a permanent hair reduction. In fact, laser is the only device used now all over the world for permanent hair reduction. So, scientifically speaking this is the only technology that is effective in today’s world.’

‘So, why do people say that the hair comes back after laser treatment?’

‘There are many reasons for this. The first and most important is ‘IMPROPER MACHINE’. There are many lasers and laser like devices that have virtually flooded the market today. Many of these machines are cheap devices which are not manufactured as per FDA norms. As these machines are really cheap as compared with the standard lasers, they are more commonly procured by cosmetology centres etc. These machines can never match the results that are achieved with standard lasers for hair removal. So, if you are undergoing a laser hair removal or if you are contemplating to do so, you should know which laser machine is being used on your body.

The second aspect is the PERSON WHO IS DOING THE PROCEDURE. Nowadays, unfortunately there are beauticians and technicians who are into what they call a laser hair removal. These people are not entitled to use lasers or laser like devices as they are not expected to know what a laser is and how it works. These people don’t use the right parameters for the procedure and this leads to less efficacy or even failure of hair removal.

The third and the last issue is ‘NOT TACKLING THE UNDERLYING CAUSE’. If you do a laser hair removal and you don’t take care of the underlying cause, you are bound to have a recurrence of hair growth. We almost always try to rule out any underlying cause by lab tests and as I have mentioned earlier treating the cause is an equally important front for getting satisfactory results’

‘Doctor, how does a Laser work?’

‘Laser is basically a light source which gives a light of a particular wavelength. The light is coherent and penetrates deep into the human skin. The light is absorbed preferentially by different cells and tissues depending upon their absorption spectrum. For example, the skin and hair pigment, MELANIN absorbs light in the range of 600-1000nm wavelength, the red blood cells [haemoglobin] absorbs light in the range of 540-560nm etc.. Laser basically takes advantage of this selective absorption spectrum of tissues due to which only specific cells and cellular constituents are destroyed without harming the tissues nearby. Laser that is used for hair removal employs a light that is selectively absorbed by the hair pigment. As the concentration of this pigment is the highest at the hair bulge or root, the root absorbs this laser energy to the maximum extent. As a result of this energy absorption the root gets heated up and is destroyed. This is the mechanism for the permanent hair reduction that is seen with lasers’      

‘Does that mean that the whole hair gets destroyed by just one treatment with the laser?’

‘No, that is not the case! Laser hair removal needs at least five to ten sessions at varying intervals depending upon the site to be treated. The reason for this is that hair passes through different phases in its life cycle and it is only the hair in growing phase [anagen phase] that is targeted by the laser light. At a point in time only about 20% of hair on the face is in growing phase, so only about 20% of hair can be destroyed in a single sitting.’

‘Doctor, can I treat my body hair as well with lasers?’  

‘Laser can destroy hair anywhere on the body provided it is pigmented and not really very fine. In fact, laser hair removal is much more effective on the body hair as compared with the facial hair. Body hair needs less number of sessions and at longer time intervals than facial hair. Some people can get a satisfactory hair reduction on the body after just 3-5 sessions. In fact laser hair removal of body hair is very popular in India and abroad. Here in the valley people are probably not aware or not sure about this option and that is why we have less patients coming for laser treatment of body hair. The situation is gradually changing and we do treat cases for hair removal on the under-arms, chest, back, arms and legs etc. So, both normal as well as abnormal hair on the body can be treated satisfactorily with lasers’

‘Doctor, can you tell us the name of the laser that is used for hair removal?’

‘Well, there are many laser systems that are used for permanent hair reduction throughout the world. These include Diode laser, Alaxendrite laser, Nd_YAG laser and Intense Pulse Light [IPL]. While all of these devices are efficacious in hair removal but the laser that is considered to be the STANDARD HAIR REMOVAL laser is the DIODE LASER. This laser system is considered to be the BEST for hair removal in the whole world.’

‘Doctor, is the same laser used for facial as well as body hair’

‘Technically, yes. The same laser can be used for face as well as body hair. However, as the surface area on the body is much more than that on the face, laser hair removal becomes a tedious process on the body if a small probe is used. There are now even DIODE LASERS WITH LARGE PROBE SIZE available which can tackle the body hair in much less time. As an example we now have Diode lasers which can treat the whole arm in about 10 minutes only.’  

‘Doctor, are there any side effects of laser treatment? I have heard that the skin darkens after laser treatment, is it true?’

‘Laser treatment is a relatively safe procedure when used on the right candidate by a qualified doctor. There have been no reports of any long term adverse effects of laser treatment from anywhere in the world till date. However at times some crusting and burning sensation can occur for a day or two after laser procedure. What you need to remember is that the procedure should be done by a trained, qualified doctor who knows your skin type and the right parameters that need to be used on your skin.’

‘Doctor, are there any special precautions needed during and after laser treatment?’

‘Well, you need to avoid sun exposure after laser treatment especially for the first two days after the procedure. Regular use of a broad spectrum sunscreen lotion is advocated strongly after any laser treatment.

‘Doctor, what are the main causes of abnormal hair growth on face?’

‘See, hair growth on the face and in fact anywhere on the body including our scalp is controlled by certain hormones. Hormones, known as androgens [‘andro’ for ‘male’; male hormones] start their secretion at a certain age in both males as well as females. These androgens lead to an increase in the size of hair roots (follicles) on the face or elsewhere in some females. These enlarged roots then produce thicker, darker hairs which are considered abnormal on a female face. The effect that is seen on the facial follicles also occurs on the chest, part of abdomen and back and even on the upper and lower limbs [androgen dependent areas].

Remember also that there is a delicate balance in the secretion of different hormones in both males and females and if there is even a slight change in this balance anywhere things start getting abnormal.

‘Where does this imbalance occur usually?

‘The imbalance can be seen at any site like the ovaries, the adrenal glands, pituitary gland and even in the thyroid gland. However the commonest site remains the ovaries which can be affected by different diseases like the Polycystic ovarian disease [PCOD], hormone secreting cysts and tumours etc.

‘Doctor I have heard a lot about PCOD, what is it?

‘PCOD is incidentally the commonest cause of abnormal hair growth in females. In clinical studies conducted in different parts of the world PCOD accounts for about 60% of all cases of hirsutism. In our valley also PCOD is very common and as per the experience we have had at our clinic PCOD accounts for not less than 60-70% cases especially the ones with severe hair growth. In patients with PCOD the ovaries have multiple small cysts especially at the periphery and these cysts produce abnormal amounts of androgens [male hormones] leading to multiple adverse effects on the female body.

In addition to the hair growth these patients can suffer from delayed menstrual cycle [delayed periods], scanty menstrual bleeding [oligomenorrhoea], infertility secondary to anovulation, obesity [abnormal weight gain] and even a male type of voice. One needs to remember that all these constellation of signs and symptoms have a single basic cause—the multiple cysts in ovaries’

‘What are the other reasons, other than the hormones?’

‘There are many other causes but I would like to tell you about a specific cause that is probably peculiar to our valley. We call it ‘steroid face’ or ‘betnovate face/ steroid damaged face’.

We have a problem of steroid abuse here in our valley. You will commonly see females applying different steroid creams on their face over months and years. These creams and ointments are used as regular-use cosmetics here and you will even see these creams at general stores and cosmetic shops now. What these females don’t understand is that these steroids have devastating side effects on the facial skin including abnormal and thick hair growth [steroid hirsutism]. In addition to the hair growth the skin gets progressively thinned with time and then it reacts adversely to even minor sun exposure and even to soaps and other creams. What makes matters really worse is that after the steroid has been used for some time, the skin becomes dependent on it. So when the steroid cream is discontinued the skin reacts by way of excessive redness [erythema], dryness and itching.’

‘Doctor, can we treat males also with laser for hair reduction’

‘Yes, certainly. We do have male patients who come for treatment of threading area on the face or even on the neck. We have started getting male patients for treatment of hair on the chest and back as well. These patients respond really well to laser hair reduction.’