A Complete Guide to Laser Hair Removal

The laser hair removal procedure involves the use of a pulse laser to remove hair from any part of the body.  Years of research have helped develop and design the existing laser techniques.  Through the study of the hair follicle anatomy, the parameters of laser have been carefully defined by matching both the laser light and the pulse duration to the size of the hair follicle, its depth and also location to prevent hair from growing back.

Either a doctor or a trained laser specialist could perform laser hair removal by distributing the light of the long pulse laser on the skin, depending on where you choose to have this procedure.  During the time of treatment, the laser can disable the hairs while they are still in the active growth cycle.  Several treatments may be necessary before the laser could disable all the hair follicles in a particular area since the other hairs grow at different times.

Candidates for Laser Hair Removal

All men and women who have unwanted hair could get laser hair removal procedures.  The usual places for hair removal are face, eyebrow, hairline, top of the nose, ear lobe, lip, chin, neck, breast, shoulders, underarms, arms, hands, back, abdomen, pubic area, buttocks, bikini lines, legs and toes.

The laser procedure is more effective on those who have dark coarse hair and pale skin.  Generally, you would have better results if you were close to this combination (the paler the skin and also much coarser and darker hair).  The lasers that work well on those who have light-colored skin are the alexandrite long pulse and the diode lasers.  While the Nd:YAG pulse laser works well and safer on those who have darker skin.  Using either a diode or alexandrite laser could possibly result in skin pigment loss (hypo-pigmentation) or skin burning since the laser works by targeting the skin's dark pigment.  Also,  the Nd:YAG pulse laser was especially created for dark-skinned people so this is much safer and effective on the skin in settings that could actually affect the hair compared to diode and alexandrite lasers.

When you go over your hair removal options, choose a place where the main concerns are your health, safety and results.

Is the procedure permanent?

According to the US Food and Drug Administration, laser hair removal can be considered a permanent reduction.  Although it is widely believed that the procedure is permanent, it does not exactly work on everyone.  Just do not expect the laser to get rid of every single hair on a specific area.  Usually, a lot of people will need follow up electrolysis treatments for the complete clearance of the remaining hairs since they can become much too fine for the laser to target and lessen returns.  Many people would also have to get touch-up treatments about one to two times a year from their initial set of laser hair treatments since their might be new hair growth as your body develops.

There are also instances that some people do not respond well to laser hair treatments but this is not really confirmed and the reasons behind this are not known since there is no sufficient research on this.  Also take note that it is also hard to judge whether someone's non-responsiveness is a result of a person's medical condition, which can cause continuous hair growth and make it appear that the laser is ineffective, whether the treatment was properly performed or is just not effective on some people.  You can actually know for yourself when you try the treatment.  The results are also dependent on other variables like the type of laser, its settings and the technician's experience.

To achieve substantial laser hair removal, you would need at least a set of six to eight treatments.  The different factors that determine the time-span in between treatments are the hair texture, frequency of treatments, area of treatment, history of hair removal procedures taken (shaving, tweezing, waxing and depilatories), among others.

Another permanent hair removal treatment which has been popular in last 125 years is electrolysis.  This may take a relatively longer time since it involves treating only one hair follicle at a time.  This treatment is recommended for small areas, such as the eyebrows, upper lip and chin, as well as for light-colored and fine hair.  To be more cost-efficient, you could begin with laser treatments to remove majority of the hair and then finish with electrolysis treatments to get rid of the remaining finer hair.

How laser hair removal works

Lasers are actually optical devices that create intense coherent, collimated and also monochromatic light beams.  Lasers have an active medium like a gas, crystal or liquid, which intensified light when it is excited by an outside energy source like an electric discharge or a flash amp.  As long as a suitable medium is employed, then the laser could be fine-tuned in order to produce very thin band of light wavelength.

The lasers created for permanent hair removal generate wavelengths of light that is absorbed by the pigment (melanin) found in the hair.  If ever the surrounding skin is somewhat light in contrast with the hair color, then all the laser's energy will be focused on the hair shaft, which effectively destroys it without affecting either the follicle or skin.  This is the reason why laser hair removal treatments work more effectively on those with light skin and coarse dark hair.

The key to an efficient and safe treatment is to make the laser constantly generate an extremely narrow bandwidth.  The various kinds of lasers that are utilized for hair removal include alexandrite, diode, Nd:YAG and ruby (an old machine that is safe only for really fair skin but is not usually recommended).     

When the laser releases a light beam that heats only the hair shaft, the heat from the hair shaft is then passed on to the surrounding tissue just for a few milliseconds subsequent to the laser pulse.  There are many lasers that have cooling attachments which can completely absorb the heat from the damaged or ruined  hair shafts and in effect, cool the surrounding skin.

Those that use traditional light or Intense Pulse Light (IPL) machines are not genuine lasers for hair removal.  These machines utilize a high intense beam of incoherent traditional light, usually in conjunction with a gel or cream, to destroy the hair shaft.  A major flaw in this method is that it does not have the laser's capability to generate a selective light bandwidth that affects only the hair shaft  or otherwise known as selective photothermolysis.    Creating a wide light bandwidth, these machines could heat up the surrounding tissue.  Generally, IPLs are cheaper and these machines are used for different skin procedures and hair removal is more like an afterthought.  According to consumer feedback, the real lasers produce better and quicker results with regards to hair removal.

Things to do before and after laser hair removal treatment

One to three days prior to treatment, it is recommended that the hair in the specific area to be treated be shaved; although there are clinics that could do this, you might experience some irritation due to disposable razors.  You should not wax or remove the hairs with its roots for at least four to six weeks prior to and during the whole course of treatment since the hairs need to be in place in order to be targeted by the laser.  You should really shave the area as closely as you can so the laser would be able to target a lot of energy towards the follicle and not waste the energy on the hair part that is on top of the skin's surface.  If you have the kind of hair that you cannot really see after shaving, then you should consider shaving one or three days before the treatment so the technician would not miss a spot since the outline of the hair growth is still slightly visible.

After the treatment (10 minutes for underarms and about an hour for back treatments), soothe your skin by applying aloe vera on it.  You will experience shedding of treated hair within two to three and a half weeks.  Initially, the hair will appear like it is growing back but it actually is coming through your skin to shed.  The shedding will start is about one and a half weeks and could last for about three and a half weeks after the treatment.  You can exfoliate or gently scrub the treated area with a loofa to help accelerate the process.  After shedding, you might feel some black dots stuck in your skin.  These are usually called "pepper spots" and these will eventually shed but might take a while.  Try to exfoliate those also.

After shedding, you would be hair-free for about a few weeks, until the next batch of dormant hair starts to grow.  When there is enough growth, go for your next treatment.  This normally occurs within six to ten weeks after your previous treatment.  You should continue this proves until you have reached diminishing returns and when your remaining hairs become too fine for the laser, or just until you achieve your desired reduction.

If there is no shedding, it is possible that the settings applied might have been very low and you should tell your technician about your condition.  And if you sense that plenty of hair did not shed, it is also possible that the technician missed some area; you might want to ask for a free treatment touch-up.  You should do this about four weeks after treatment since there would be complete shedding and you would determine the remaining unaffected areas.  There are some clinics that may offer free touch-ups if you avail of their laser treatment services.

How many treatments are necessary?  How far apart should they be spaced?     

Majority of the people would need at least six to eight initial treatments that are spaced about six to ten weeks apart.  The reason for this is that there are three phases of hair growth and the first active growing phase (anagen) is when the hair is destroyed.  You would need a lot of treatments to target all the hair in the anagen phase.  You would need additional treatment about six to ten weeks after prior treatment to get rid of the hairs that came from the dormant stage and became active.  After at least six or eight treatments, you would see a considerable amount of hair reduction.  But some people might need more treatments aside from the initial ones, depending on the hair type and also genetic factors.  If there are no positive results after the initial treatments, then you should check on other possible underlying causes.

The treatments are normally spaced about six to eight weeks in the beginning, and then gradually increased to eight to ten weeks apart after the second or third treatment.  You can choose to follow this schedule or you can wait until there is adequate shedding (within two to three and a half weeks) and you could see enough hair growth to justify another treatment.

Is the treatment painful?

The laser can actually get rid of all the hair on an area that is as small as a nickel with just one pulse; this is dependent on the specific spot size that could range from an average of about 9-18mm (the eye of the laser where the power is being emitted with every pulse).   Each person's threshold for pain is different from another but laser hair removal is generally more painful compared to waxing and there is a different sensation to it.  The feeling of the laser pulse is similar to that of a rubber band that is snapping back against the skin.  A lot of people do not need to use anesthetic cream, such as EMLA, although you can opt to use one for sensitive areas (the clinic provides or prescribes this).  Be cautious though that anesthetic creams are safe for use in small quantities and only on small areas such as the upper lip, underarms or bikini area.  If you use these creams on larger areas such as your back, there is the risk of having adverse effects or worse, even death.  Be sure first by consulting with your doctor and technician.

Are there complications, side effects and risks in laser hair removal?

There is the possibility that you may encounter some complications or side effects, depending on some variables.  Normal side effects include itching, tingling, pain, numbness, redness and swelling up to three days. 

Rare complications are bruising, infection, crusting, pupura  on areas that are tanned, and also temporary pigmentation (hyper-pigmentation or hypo-pigmentation).

The side effects do not frequently occur and if they do, they are only temporary.  When some of  the side effects listed above lasts more than three days, then you better call your doctor or technician about it.  It is possible that the laser settings were too high. They need to know about this to adjust it on your next treatment.

How can hair growth affect laser hair removal treatments?  What are its possible causes?

There are various causes of hair growth.  These include heredity, pregnancy, normal aging process, insulin resistance issues, excessive temporary hair removal methods (tweezing, waxing, cream and depilatories), reactions to some medications and hormonal and/or glandular imbalances (PCOS condition) and diseases causing these effects.

Potential laser candidates should look into the possible reasons for excessive hair growth before getting laser treatments because if something were constantly triggering your hair growth, then the treatments would be ineffective.  It would appear like there is no hair reduction but in reality, that might be new hair growing and not the treated hair growing back.  Those women who have PCOS condition and hair growth patterns in the upper lip, cheeks, chin, should get a hormonal test and consult with an endocrinologist.  While men can get an insulin resistance test or something.  If you think that you may have an undiagnosed medical condition regarding extreme hair growth, then you should consult with a doctor before getting laser hair removal treatments.  Once your condition has been treated and controlled, then you can go on with your laser treatments.  Keep in mind though that laser only affects the existing hair but cannot stop new hair from growing.

Things to consider when looking for a laser hair removal clinic:

1.The laser hair removal clinic
When you go in the clinic for a free consultation, observe the place and see if you like how it looks and feels (clean, updated and informative), also do not feel pressured when sales representatives make you sign up right there and then, which often happens in chain clinics.  It is best if you sample about three to four clinics before you commit to one.  You will discover that the varying prices can differ from 100% to 200%, some clinics have options for you to pay up front for a set of treatments while the others do not have any.  Find out if they show more interest in the effectiveness of the treatment for you instead of just how much you would be paying for it.

2.The laser hair removal technician
The person performing the treatment should have an extensive experience in laser hair removal and has ample knowledge on how to effectively get rid of the hair.  Inquire with different technicians in various chain clinics cause.  Chain clinics have different locations so you have to be sure that you are very comfortable at the place you selected and make sure that they do not have a very high employee turnover.  When you ask your questions, take note if they were able to provide the right answers based on the research you made.  It is good to be an informed customer so you can tell whether they have your best interests or otherwise.  And also take note that whether or not the one doing the treatment has an M.D. is not really a reflection of the skills in laser hair removal.  Medical schools do not teach hair removal so just look for someone who has particular knowledge of this and ample experience as well.

3.The type of laser
You have to be certain that the laser is the best one for your hair type and skin.  Do not let all the marketing hype fool you.  All lasers can actually be used on all skin types but you have to find the one that will provide you with efficient results.

Alexandrite lasers.  These are the long pulse and the diode lasers that are most effective for those with light skin types and dark hair so it can attract the laser and target the follicle.  But just because this is an alexandrite laser does not mean that it is the best one in the market.  A lot of factors can come into play between maintenance only or permanence.  Factors include proper training, correct delivery of the effective energy beam to the tissue and also meticulous cleaning of the skin before laser treatment.  A few of the most well-known alexandrite lasers are Apogee by Cynosure and GentleLASE by Candela Corporation.

Diode lasers.  These lasers are more effective on those with skin types I-IV and the most popular brand is the LightSheer by Lumenus.

Nd:YAG.  These are long pulse lasers that work best on those who have dark skin (types IV-VI; more specifically,  people of color, such as Asian, African-American, Mediterranean, European, Hispanic and Middle Eastern.

Generally, the alexandrite and diode lasers work really well for those with finer hair that have been placed on high settings compared to YAG lasers.  Alexandrite and diode are recommended for those who have fine hair and skin types III-IV.  But if you have darker skin (more than type V) and you have fine hair, then you should get a test spot first before the actual treatment so you would know if you have enough pigment for laser treatment.

What is the usual hair growth cycle? 

Normally, the hair in each of your follicle grows in a cycle.  The cycle has three phases: anagen or active,  catagen and the telogen.

Anagen is the active growing phase when the fiber of the hair is produced.  In this stage, your hair has a lot of melanin, which is the pigment that gives color to your hair.  This phase is the one in which laser treatment is very effective.

Catagen is the phase when you have club hair and there is controlled regression of the follicle.  In this stage, the lower part of your hair ceases to grow but it also does not shed, the follicle is just reabsorbed.  Permanent hair removal is hard to achieve when your hair is in this phase.

Telogen is the stage when you have tired hair and is actually the last phase of the growth cycle.  In this stage, the old hair sheds in preparation for the growth of new anagen hair.  Permanent laser hair removal has been found to be ineffective in the telogen hair growth phase.

Take note that the anagen phase is followed by the catagen phase, in which the hair follicle is in a state of controlled regression.  Eventually, the hair follicle goes into the telogen phase, in which it is now in a resting state.

This hair growth cycle goes on for the duration of a person's life.  But there may be some factors that could influence the increase or reduction of hair production.  The effectiveness of the laser to remove hairs is dependent on the person's hair type and color, skin type and color, as well as the initial cause of hair growth.

What is a Fitzpatrick skin type and how is it determined?

Thomas B. Fitzpatrick, an M.D. and Ph.D. in Harvard Medical School, was the one who created a skin type classification system in 1975.  The system he developed was based on the response of a person to sun exposure with regards to the degree of tanning and burning.  It is important to correctly determine your skin type for effective laser removal of hair, veins, spots, scars and wrinkles.

Skin Type I - This is the highly sensitive type that always burns but never tans.  Examples of people in this category are those who have red hair and freckles or Albino ones.

Skin Type II - This type is very sensitive to the sun and it burns easily but tans minimally.  Examples of people who are in this category are the fair-haired and fair-skinned Caucasians.

Skin Type III - This type is also sensitive to the sun and the skin burns sometimes and also tans gradually from light to brown.  Examples of people who have this skin type are the darker Caucasians and European mix.

Skin Type IV - This type is only a little sun sensitive and just burns minimally but always tans to a moderate brown color.  Examples of people who have this skin type are Asians, Hispanics, Europeans, Mediterranean and American Indian.

Skin Type V - This type is not really sensitive to the sun and it rarely burns but tans really well.  Examples of people who have this skin type are the African-Americans, Hispanics and Middle Eastern.

Skin Type VI - This type is also not sensitive to the sun and the skin is deeply pigmented and also never burns.  Examples of people who have this skin type are the Middle Eastern, African and African-American.

What are the some of the lasers popular brand names?

  • For the alexandrite laser, the well-known names are Apogee, GentleLASE and EpiTouch Plus.

  • For the diode laser, the popular brands are SLP 1000, LightSheer, LaserLite, F1 Diode, Epistar, MeDioStar, Apex 800, Palomar SLP 1000 and Comet (with RF technology).

  • For the Nd:Yag laser, the popular ones are GentleYAG, CoolGlide, Lyra-I, Apogee Elite, Sciton, Medlite IV, Athos and Varia.

  • For the IPL, the famous brands are EpiLight, Harmony, PhotoDerm, Aculight, Quantum, Vasculight, Estelux, Palomar Starlux and Aurora (with RF technology).

  • For the Ruby laser, a couple of popular brands are the RubyStar and E2000.

Can laser hair removal cause more hair growth compared to the original hair growth?

There is actually no medical proof or confirmation even though some consumers have reported this incident.  It is just a rare occurrence that most likely happens in laser treatments on women's faces or men's shoulders, upper arms or backs; usually during treatments for fine vellus hairs or sparse single hairs at low settings.  The best thing to do is to just get laser treatments on areas that have dark coarse hairs and also remind the laser technician not to touch any vellus or sparse hairs.  Such hairs can only be removed with electrolysis.

Is it possible to lessen the density of hair in a specific area rather than completely removing it?

Yes this is possible and it can be accomplished by getting just a few treatments rather than the whole package of about six to eight treatments and also make sure that the technician is very careful not to miss any spot during treatments.    

How much does laser hair removal cost?

The prices differ from each clinic.  There are some clinics that give discounts when customers pay in cash for a treatment package.  The major advantage is that you get more value for your money but then you might have to sign a contract that would not allow you to get refunds in case anything goes wrong or if you are not content with the services.  Before you make any decision, remember that it is possible that laser treatments will not work on everyone.  It is best if you attend about three to four consultations before you decide what clinic to choose and then also compare their prices and the technician's experience.

The following is a list of the general average price of various laser treatments in the U.K.  Just estimate the prices of the other areas based on their sizes.  These are only guidelines and you should ask your clinic for a writen quote for your treatment plan.

Price per laser treatment:

Upper lip 50-150
Underarms 50-150
Chest 100-300
Abdomen 100-300
Regular bikini 100-200
Half arms 200-400
Half legs 200-400
Full face 150-300
Brazilian bikini 200-300
Back 200-500
Chin    50-150