Updates in Laser Hair Removal

A variety of laser and light devices are available on the market for hair removal, including the Alexandrite laser (755 nm), diode laser (800 nm), intense pulsed light (IPL, 590 nm - 1200 nm), and neodymium-doped:yttrium aluminum garnet laser (Nd:YAG, 1064 nm).¹

However, not all lasers are considered equal when discussing optimal results for hair removal.

For board-certified dermatologist Will Kirby, DO, FAOCD, Chief Medical Officer of LaserAway, Nd:YAG is the best choice for their clinics.

“It’s well established in the aesthetic dermatology community that the gold standard for laser hair removal treatment is [Nd:YAG] and that technology has pretty much uniformly replaced the older [IPL] and diode lasers,” says Dr. Kirby.

Specifically, his clinics use the Cynosure Elite+, which is his workhorse. “I pride myself on being meticulous and, as it stands today, there is simply no better company or device in the laser hair manufacturing industry,” he tells Aesthetic Authority.

The Elite+ Nd:YAG laser has dual 755 nm and 1064 nm wavelengths that the operator can switch between for different treatments in the same session and has a longer pulse duration of up to 300 ms, according to the manufacturer.

The most recent platform innovation, Elite iQ, includes the industry’s only FDA-cleared melanin reader, which enables physicians to identify test spot settings and customize treatments based on individual patient skin type, ethnicity, and lifestyle.

“It takes out any skin typing guesswork for novice clinicians and adds another element of safety,” says Dr. Kirby.

Skin Tone and Safety

Today, both the Nd:YAG and diode laser have become the go-to choices for hair removal in patients with darker skin.

Until more recent technology advancements, laser hair removal was a gamble for patients with darker skin tones. Devices weren’t sophisticated enough to distinguish between the melanin in the skin and the melanin in the hair follicle, which could result in hyperpigmentation, blisters, and scarring around the follicle.

The Nd:YAG’s wavelength penetrates deeper into the skin than the diode, meaning it more successfully bypasses skin pigment, explains a recent study in Dermatologic Therapy.²

“Hair removal is [an] application of long pulse Nd:YAG lasers, and decreased light absorption by melanin at 1,064 nm reduces the risk of pigmentary side effects, which makes long pulse Nd:YAG laser the safest laser in darker skin types,” according to study authors.

Effectiveness and Tolerability

While the Nd:YAG has many positive attributes, studies in the Balkan Medical Journal and Dermatologic Surgery have suggested that it may be less effective than diode lasers and Alexandrite lasers but more effective than IPL and ruby for long-lasting hair removal results.^3,4 Still, it is many physicians’ first choice in laser technology, given its safety profile for use on darker skin.

Although more complicated for Fitzpatrick types V and higher, a study in the Journal of Cutaneous and Aesthetic Sugery suggests the diode laser may be more tolerable than the long pulse Nd:YAG.⁵ According to study authors, skin types I to IV treated with the longer pulse 810 nm diode laser have a significant reduction in hair density and thickness due to its efficacy and safety. For treatments on darker skin, the diode laser’s energy needs to be delivered more slowly per pulse and its instant cooling device employed to protect the pigment from overheating and causing subsequent skin damage.

Device Selection

“If the underlying technology is the same quality and caliber, then you are really comparing apples to apples,” says Dr. Kirby. “But as anyone who has ever been to a grocery store will tell you, there are lots of types of apples out there. So efficient handpiece ergonomics or an intuitive interface are just two examples of device differentiators that make a huge difference in clinician satisfaction.”

Other than treating the area like a sunburn, avoiding sunlight to avoid post-inflammatory pigmentation, and not waxing or tweezing, patients’ only worry is about getting their next appointment on the books.

Dr. Kirby advises that physicians looking to add or grow laser hair removal to their practice commit and embrace the treatment option.

“Laser hair removal, I will tell you firsthand, can be rewarding from both an emotional and financial perspective… if you want to be truly successful, you have to really be an unconditional expert in each and every single treatment you offer at your practice—you can’t just dabble in a laser treatments and expect to be prosperous,” says Dr. Kirby. “Laser hair removal is unquestionably a wonderful elective treatment choice for the right practice and clinician, but you must have a true appetite for it. So do your homework when choosing a device and get comprehensive education and experience before you embark on your aesthetic journey.”

References:

1. Bonan, P., Troiano, M. and Bruscino, N., 2017. Laser and light based hair removal. PMFA Journal, [online] 4(4). Available at: https://www.thepmfajournal.com/features/post/laser-and-light-based-hair-removal​
2. Kaya TI, Guvenc U. Long pulse 1,064-nm neodymium-doped yttrium aluminum garnet laser in aesthetic dermatology. Dermatol Ther. 2019;32(3):e12907.
3. Karaca S, Kaçar SD, Ozuğuz P. Comparison of SHR Mode IPL System with Alexandrite and Nd: YAG Lasers For Leg Hair Reduction. Balkan Med J. 2012;29(4):401-5.
4. Bouzari N, Tabatabai H, Abbasi Z, Firooz A, Dowlati Y. Laser hair removal: comparison of long-pulsed Nd:YAG, long-pulsed alexandrite, and long-pulsed diode lasers. Dermatol Surg. 2004;30(4 Pt 1):498-502.
5. Puri N. Comparative Study of Diode Laser Versus Neodymium-Yttrium Aluminum: Garnet Laser Versus Intense Pulsed Light for the Treatment of Hirsutism. J Cutan Aesthet Surg. 2015;8(2):97-101.