Presentation Transcript

1. Laser hair removal

2. Target structure for hair removal Hair shaft Stem cell in bulge Hair matrix in
hair bulb

4. Level of hair destruction Destroy hair shaft without germinative area injury :
hair shaft fall out : hair regrow to normal anagen cycle

5. Level of hair destruction (cont.) Partial germinative area injury : hair cycle
dysfunction : thinner and finer hair Total germinative area injury : long term hair
loss

6. Permanent hair reduction Significant long term, stable reduction in number of

terminal hair Maintain hair reduction for 6-12 month E.g. laser, IPL

7. Permanent hair removal Reduction of regrowing hair E.g. electrolysis

8. Electrolysis hair removal Galvanic Thermolysis Combine

9. Galvanic electrolysis Direct electric current to hair follicle through inserted

needle Current produce sodium hydroxide that destroy hair bulb and dermal
papilla Most effective but slowest

10. Thermolysis High frequency alternating current produce heat to follicular

tissue Destruction of hair bulb Quick but not effective in thick or highly curved
hair

11. Laser hair reduction Selective photothermolysis Target chromophore :Melanin

lie in hair shaft and bulge of follicle :Reproducing cell in bulge, bulb Ideal
candidate : dark, coarse hair Ideal candidate : dark, coarse hair

12. Laser hair reduction (cont.) End point : vaporization of hair shaft : follicular
erythema and edema 3-6 session, 1-2 month apart 20-30% reduction per session
70-80% long term reduction

13. Mechanism of laser hair reduction Photothermal destruction Photomechanical

destruction Photochemical destruction
14. Photothermal destruction Deep, selective heating of hair shaft, hair follicle
epithelium, heavily pigmented matrix Thermal conduction from melanin rich shaft
and matrix will heat surrounding follicular structure

15. Photomechanical destruction Small local explosion Extremely rapid heating

chromophore Damage individual pigment cell in hair follicle

16. Photomechanical destruction (cont.) Very short pulse generate photoacoustic

shock wave that cause focal photomechanical disruption of melanocyte in bulb
but no complete follicular disruption leading to leukotrichia but not to hair loss

17. Photochemical destruction Use light and photosensitizer to produce target

photochemical reaction and therapeutic effect Singlet oxygen is a potent oxidizer
that damage cell membrane and protein Effective in treating non-pigment hair

18. Photochemical destruction (cont.) Photosensitizer : ALA, other porphyrin,

chlorin, phthalocyanine, purpurin

19. Type of laser hair reduction Photothermal destruction : normal mode ruby
laser : normal mode alexandrite laser : pulsed diode laser : long pulsed Nd:YAG
laser : IPL

20. Type of laser hair reduction (cont.) Photomechanical destruction : carbon

suspension Q-switch Nd:YAG laser : Q-switch Nd:YAG laser Photochemical
destruction : photodynamic therapy

21. Factor to consider laser hair reduction Hair color, density and texture : white,
fine, very blonde hair not remove by laser Skin type Anatomical location

22. Patient preparation No plucking, waxing 6 wk. prior to treatment Shaving,

bleaching, chemical depilatories not interfere laser treatment Avoid sun tan

23. Clinical improvement Absolute hair number reduction Finer, lighter regrowing
hair Slower regrowth

24. Ruby laser (694 nm) Indicate for light skin (type 1-3) with dark hair Penetrate
less deeply (2 mm) Laser not effectively reach to hair bulb Miniaturization of
follicular bulb and papillae

25. Ruby laser (cont.) Reduce number of terminal hair Increase small vellus like
hair No evidence of fibrosis or destruction of hair follicle No longer used
26. Alexandrite laser (755 nm) For skin type 1-3 Penetrate deeply enough to affect
the growth center of hair Best of choice for light or very fine hair Side effect : hypo
or hyperpigmentation

27. Alexandrite laser (cont.) Report of paradoxical hypertrichosis after alexandrite

that common in young female, skin type 3-6 with fine dark hair on lateral face

28. Diode laser (800 nm) For all skin type More safely than ruby and alexandrite
laser in darker skin type Deeper penetration but slightly less melanin absorption
Optimal for coarse, dark terminal hair

29. Long pulse Nd:YAG laser Minimal absorb by melanin, so high fluence to
adequate hair damage For dark skin type with dark, coarse hair Can treat
pseudofolliculitis barbae

30. Q-switch Nd:YAG Useful in dark skin type Induce delay hair growth Ineffective
for permanent hair removal

31. Carbon suspension Q-switch Nd:YAG Use exogenous melanin For blonde, gray
or white hair Induce delay hair growth Non permanent hair removal

32. IPL Non laser induced selective photothermolysis Wide choice of wavelength,
pulse duration and delay interval Effective for all skin type Required more
treatment session

33. IPL (cont.) High risk of dyspigmentation in darker skin

34. PDT Photosensitizer localized in follicular epithelium 40% hair reduction after
6 month of single treatment Side effect : temporary hyperpigmentation No
significant hair loss but prevent regrowing hair

35. Electro-optical synergy (ELOS) 590-1200 nm Synergy between RF (electrical)

and laser or light (optical) RF : electrical heat (non selective heat) : heat focus on
hair follicle and bulge area

36. ELOS (cont.) Optical : heat from light absorbing chromophore : heat focus on
hair shaft For all skin type

37. Complication Pigmentary change : hypopigmentation : hyperpigmentation

Folliculitis Blistering or crusting Scarring
38. Complication (cont.) Koebner phenomenon in psoriasis vulgaris, vitiligo, lichen
planus, Darier disease Intense pruritus Urticaria Temporary or permanent
leukotrichia

39. Complication (cont.) Found conversion of fine vellus hair to dark, coarse
terminal hair or induction of growth of long fine hair from repetitive low fluence

40. New treatment Photopneumatic therapy = broad band light with pneumatic
energy Elevation of hair follicle closer to skin surface by air pressure More light
absorbed by melanin in hair follicle

41. New treatment (cont.) Minimize thermal damage to surrounding epidermal

and dermal structure Reduce necessity of higher fluence No pain 5x more
efficiency to delivery energy to unwanted hair