Laser Hair Removal FAQs
What is Laser Hair Removal?
Laser hair removal is a procedure by which hair is removed from the body by utilizing a long pulse laser. Lasers were developed and designed from years of research and laser hair removal lasers in particular have been in use since 1997.
Laser hair removal is performed by a specially-trained laser specialist or a doctor, depending on the clinic, by pointing the laser device at shaved skin where the hair is present. Laser works by disabling hairs. Since various hairs will enter their growth cycle at different times, several treatments are necessary to disable most of the follicles in a given area.
2. Who is a candidate for laser hair removal?
Both men and women seek laser hair removal services to have superfluous or unwanted hair removed. Hair removal is commonly done on lip, chin, ear lobe, shoulders, back, underarm, abdomen, buttocks, pubic area, bikini lines, thighs, face, neck, chest, arms, legs, hands, and toes.
Laser is attracted to dark pigment and therefore works best on pale skin and dark coarse hair. The closer you are to this combination (i.e. the lighter the skin and the more coarse and dark the hair), the better the results will generally be after proper treatments.
Alexandrite long pulse laser types work the best on light-colored skin (types I-III - see Question #12 to determine your skin type), followed by diode (skin types I-IV) and Nd:YAG types (skin types IV and darker). Since laser targets the hair by being attracted to dark pigment, using an alexandrite type of laser at settings effective enough to kill the hair on darker skin can result in skin burning or loss of skin pigment (hypopigmentation) because laser will be attracted to the pigment in the skin, not just the hair. Long pulse Nd:YAG lasers were created to cater to dark-skinned patients, so they are safer at effective settings than alexandrite lasers, and are the only hair removal lasers that should be used on those patients given that their hair is coarse enough. Diodes are ok on skin types I-IV.
A set of at least 6-8 treatments at 8-12 week intervals are generally necessary to achieve substantial hair removal with laser. Factors that determine the length of treatment include:
* Area to be treated
* Texture of hair
* Number of treatments
3. Is laser hair removal permanent? Are there other permanent hair removal methods?
Hair removal lasers have been in use since 1997 and the Food and Drug Administration approved it for “permanent reduction.” They permanently disable hair follicles, however you have to remember that laser hair removal doesn’t work in the same way on everyone and doesn’t remove 100% of the hair in an area. Generally, this means that you shouldn’t expect to remove every single hair from an area, although you can remove the majority of it. Most people need to follow up with electrolysis treatments for any remaining hairs to achieve complete clearance, if desired, as the remaining hairs become too sparse and fine for laser to target. Some will also need touch-up treatments about once a year, especially on large areas, after the initial set of 6-8 treatments for any new growth your body may develop with age on certain areas. It has also been observed that some people seem to be non-responders – this is not confirmed and reasons are not known, and may in fact be due to lack of skill on the part of many laser operators and/or the type of machine and settings they are using. Keep in mind that it's hard to judge whether someone’s lack of results is due to a potential underlying medical condition that causes continuous growth and makes it seem like laser isn’t working, if the treatment wasn't performed properly, or whether for some people it just doesn't work for currently unknown reasons. In essence, you can’t determine what your personal results with be like unless you try it. Results depend on many variables involved, including the tech's experience, type of laser used, how settings are set, etc. It is recommended to start with one smaller area and see you’re your hair reacts before committing to an expensive set of treatments on many areas at once.
Electrolysis is an alternative permanent hair removal method that has been used for over 125 years. It involves treating one hair at a time and is a good option for smaller areas (like eyebrows or upper lip) where precision is necessary. It does take considerably more treatments compared to laser to complete a large area, but is an option as well. At this time, it is as the only permanent option for very fine and light-colored hair.
4. What should I expect to pay for laser hair removal?
Prices vary widely from clinic to clinic. Some also offer discounts for paying up front for multiple treatments. Although the upside is possibly paying less money overall, this also sometimes involves signing a contract preventing you from receiving a refund if something goes wrong or you are just not happy with the services before, during, and/or after your treatments. Remember that operator skill is very important, so it is recommended that you start with one area that bothers you most before you add on other areas and buy packages. Also, make sure to go in for at least 3-5 consultations before deciding on a clinic so you can compare types of lasers used, treatment prices, technicians’ experiences, etc.
Here is very general average pricing information in the U.S for commonly treated areas. You can estimate other areas based on the size. Keep in mind that these are just estimates based on consumers reporting what they have paid for treatments on various forums:
Price is per one (1) treatment:
Full face - $150-300
Upper lip - $50-150
Chin - $50-150
Underarms (both) - $50-150
Regular bikini - $100-200 (definition at each clinic is different – ask!)
Brazilian bikini - $200-300
Half legs (both) - $200-400
Half arms (both) - $200-400
Butt - $150-300
Back - $200-500
Chest - $100-300 (ask for definition)
Abdomen - $100-300 (ask for definition)
5. How do hair removal lasers work?
Lasers are optical devices which produce intense coherent, collimated and mono-chromatic beams of light. A laser consists of an active medium such as a crystal, gas or liquid that amplifies light when excited by an external energy source (a flash amp or electric discharge, for example). When the appropriate medium is employed, the laser can be fine-tuned to generate a very narrow band of light wavelengths (such as the individual colors of the visible spectrum).
Lasers designed for permanent hair reduction emit wavelengths of light designed to be absorbed by the pigment in the hair (melanin). If the surrounding skin is relatively light compared to the color of the hair, then the entire energy of the laser will be concentrated in the hair shaft, effectively destroying it without affecting the skin or follicle. Hair removal lasers target the dark pigment in the hair. That’s why laser hair removal works best on light skin and dark coarse (most pigment) hair.
The ability of the laser to produce a very narrow bandwidth on a consistent basis is the key to a safe efficient treatment. The types of lasers used for permanent hair reduction include ruby (old machines, not recommended), alexandrite (for very light skin type I-III), diode (for types I-IV), Nd:YAG (type IV and darker).
While the laser emits a beam that only heats the hair shaft, heat is transmitted from the hair shaft to the surrounding tissue for several milliseconds after the laser pulse. Several lasers possess cooling attachments which cool the surrounding skin to fully absorb any heat transmitted from the destroyed hair shafts.
Be cautious of hair removal systems that use traditional light for treatment (Intense Pulse Light machines or IPLs). Most light-based applications are not true lasers. These machines use a highly concentrated beam of traditional incoherent light, often in conjunction with a cream or gel, to burn the hair shaft. A serious flaw with these systems is that they lack the laser's ability to produce a selective bandwidth of light that will only affect the hair shaft (selective photothermolysis). These devices produce a wide bandwidth of light that can heat up all of the surrounding tissue, making it less effective in killing hair and putting the patient at a higher risk for burns, especially on darker skin. IPLs are generally cheaper than true laser devices and are used for various skin procedures first and foremost, with hair removal as an add-on feature. As a rule, true hair removal lasers (i.e. alexandrite, diode, and ND:Yag types) usually achieve better and faster hair removal results.
6. Is laser hair removal painful?
In one pulse, the laser can remove all the hair on a patch of skin the size of a nickel (depending on the specific laser spot size, i.e. the “laser head,” ranging from 9-18mm on average). Everyone’s pain threshold is different and generally laser hair removal is not much more painful than waxing, but the sensation is different. It resembles a rubber band snapping against the skin for a quick second with each pulse. Most people do not require an anesthetic cream (like EMLA), but one may be used for very sensitive patients/areas (can be provided or prescribed at the clinic). However, if you do not feel any pain at all, it might be an indication that the settings are set too low to actually kill the hair. Please advise your clinic if this is the case.
Be aware that using anesthetic creams is only safe on small areas (like upper lip, bikini, or underarms) and in small quantities. Using it on large areas in high lidocaine doses, for example on an entire back, can cause adverse effects or even death. Consult with your clinic and doctor if unsure.
7. Are there any possible risks, side effects, and complications from laser hair removal?
The possibility exists that some side effects or complications can occur given various variables, including:
Normal
* Itching
* Redness for up to 3 days
* Swelling (around mouth of follicle) for up to 3 days
* Pain, tingling, or feeling of numbness (cold spray)
Rare
* Crusting/scab formation (on ingrown hairs)
* Bruising
* Purpura (purple coloring of the skin) on tanned areas
* Infection
* Temporary pigment change (hypopigmentation or hyperpigmentation)
Side effects occur infrequently and are generally temporary. If any of the above last for more than 3 days, make sure to contact your technician and/or doctor. There is a possibility that settings were set too high and the technician needs to know in order to make adjustments on your next treatment.
8. How many laser hair removal treatments do I need and spaced how far apart?
Most people need at least 6-8 initial treatments spaced 8-12 weeks apart to achieve a good clearance. This is because hair grows in three (3) phases. Several treatments are needed to target all hair in every growth phase. Approximately 8-12 weeks after every treatment, the next treatment is needed to eliminate the hairs that now came out of the dormant phase and are now active. After 6-8 treatments or so, patients should experience a considerable hair reduction.
Depending on hair type, skin type, area treated, and genetic factors, some clients may require additional treatments beyond these initial treatments. If you do experience shedding every time and it still seems like the treatments are not working after 6-8 treatments, you should look into possible underlying medical factors (see Question #15) that might be causing production of new hair.
Usually, treatments are spaced 8-12 weeks apart to start, and can gradually move to 10-16 weeks apart after the initial 2-3 treatments. Instead of following an arbitrary schedule, wait until you have experienced shedding of the treated hairs (should complete within 2-3.5 weeks) and see enough hair come in after the hair-free period to justify having another treatment. Spacing also depends on area treated as hair cycles vary on various body parts. For example, women’s faces usually require more frequent treatments, whereas backs and legs require less frequent treatments.
9. Can I just reduce the density of hair on an area instead of removing it completely?
Yes, this can be achieved by having only a few treatments instead of full course of 6-8 treatments. It is important to find an experienced laser operator who is careful not to miss spots during treatments for an even reduction. Also, it’s recommended to wait at least 12 weeks between treatments to be able to correctly assess the amount of reduction achieved at any point.
10. What should I look for when selecting a laser hair removal clinic? Which type of laser is best for me?
The laser: Make sure that the laser being used is best for your skin and hair type. Do not fall for “marketing hype”. Every laser can technically be used on any skin type, but you should be looking for one that will produce the most efficient results for your specific hair and skin type. See “Laser Types” section below.
The clinic: When choosing a clinic, select an environment whose main priorities are your safety and results. It’s recommended to sample 3-5 clinics before making a commitment. After you locate clinics with the best laser for your skin type, make sure to go in for in-person consultations to see if you are happy with the way the clinic looks and feels and avoid any pressure to sign up on the spot. You will probably find that prices can vary by as much as 100-300%, and some will have options of paying up front for a package of treatments, while others won’t. Look for clinics that show more interest in your results rather than how much you will be paying. Do your research from unbiased resources to find out what works best for your skin and hair type before you come in. If you are an informed consumer, you will be able to better judge whether the clinic has your best interests in mind.
The laser operator: Make sure that the person treating you has extensive experience specifically in laser hair removal. Ask questions about who will be performing your treatment (At national chain clinics you might get a different tech every time you come for treatment. Chain clinics vary by location, so make sure you are comfortable with everyone there and that they don’t have a high employee turnover). It is not necessary for the tech to be a doctor. The best techs are those who have extensive experience specifically in performing hair removal.
Laser Types*:
*Be advised that laser works best on dark coarse hair. The more fine in texture and lighter in color the hair and the darker is your skin, the less effective the treatments will be no matter which laser you use. Fine and light-colored hair has very little pigment, so hair removal lasers cannot target it. Lasers with large spot sizes and short pulse widths are most effective.
Alexandrite long pulse lasers have a wavelength of 755nm are the most effective lasers. Their limitation is that they can only be used safely on very light skin types (Fitzpatrick skin types I-III; see question #13 to determine your skin type). Just because it is an alexandrite, does not make it the best on the market. Precision cooling of the skin prior to laser application, spot size (the larger, the better), exact delivery of an effective energy beam deep into the tissue, and proper training can make all the difference. Some of the most popular alexandrite lasers include GentleLASE by Candela Corporation (maximum 18mm spot size) and Apogee by Cynosure (maximum 15mm spot size).
Diode long pulse lasers with a wavelength of 810nm work ok on skin types I-IV, and could be a good option for patients with skin type IV when they are too dark for an alexandrite laser, but want a more effective treatment than with an Nd:YAG on finer hair. The most popular on the market is the LightSheer laser by Lumenus. Proper operation of diodes is absolutely necessary for good results, so operator skill is especially important when using this type of laser.
Nd:YAG long pulse lasers have a wavelength of 1064nm and are the only option for darker skin types (IV-VI), including patients of color such as African-American, Asian, Hispanic, Mediterranean, and Middle Eastern. The limitation of these machines is that they are made to protect darker skin from burning, and are thus not as effective on finer hair. However, for patients with darker skin, Nd:YAG is the only safe option. If you have darker skin and fine or light-colored hair, laser hair removal is probably not a good option for you, regardless of the type of laser used. In such cases, electrolysis is the only permanent option.
11. Why do I need multiple treatments to obtain results?
Under normal circumstances, hair growth in each hair follicle occurs in a cycle. There are three main phases of the hair growth cycle: anagen, catagen and telogen.
Anagen (active) is the growing phase or when the hair fiber is produced.
Catagen (club hair) is the period of controlled regression of the hair follicle. This phase is when the lower part of the hair stops growing, but does not shed, and the follicle is reabsorbed
Telogen (tired) is the last of the hair growth cycle. In this resting phase, the old hair falls out in preparation for the development of a new anagen hair.
Remember, anagen is followed by catagen, a period of controlled regression of the hair follicle. Ultimately the hair follicle enters telogen, when the follicle is in a so-called resting state. Normally this cycle of hair production will continue for the duration of the individual's life. However, other factors can influence, promote and inhibit hair production.
Patients need multiple treatments to get desired results in order to kill hair in every growth cycle. Spacing treatments 8-12 weeks apart will allow enough time for the dormant hair to surface for treatment.
12. How do I determine my skin type?
In 1975, Thomas B Fitzpatrick, MD, PhD, of Harvard Medical School, developed a classification system for skin typing. This system was based on a person's response to sun exposure in terms of the degree of burning and tanning the individual experienced. For successful removal of hair, wrinkles, veins, sun spots, and scars using laser technology, it is necessary determine your correct skin type. Please be advised that this system was not created for the purpose of hair removal, so it is an approximate tool.
TYPE I: Highly sensitive, always burns, never tans.
Example: Red hair with freckles or Albino
TYPE II: Very sun sensitive, burns easily, tans minimally.
Example: Fair-skinned, fair-haired Caucasians
TYPE III: Sun sensitive skin, sometimes burns, slowly tans to light brown.
Example: Darker Caucasians, European mix
TYPE IV: Minimally sun sensitive, burns minimally, always tans to moderate brown.
Example: Mediterranian, European, Asian, Hispanic, American Indian
TYPE V: Sun-insensitive skin, rarely burns, tans well.
Example: Hispanics, Afro-American, Middle Eastern
TYPE VI: Sun-insensitive, never burns, deeply pigmented.
Example: Afro-American, African, Middle Eastern
13. What are some brand names of lasers available?
Some of the most popular devices on the market include:
1. Alexandrite: GentleLASE, Apogee including Apogee Elite, EpiTouch Plus
2. Diode: LightSheer, F1 Diode, MeDioStar, Comet (w/RF technology), Palomar SLP 1000
3. Nd:Yag: CoolGlide, GentleYAG, Lyra-i, Sciton, Apogee Elite (this machine has both alexandrite and Nd:YAG settings)
4. IPL: Aurora (w/RF technology), Harmony, EpiLight, Aculight, Vasculight, Palomar Starlux and EsteLux
5. Ruby (outdated and not used anymore because it is only safe on skin types I-II): RubyStar, E2000
14. How should I prepare for treatment and what should I expect afterwards?
You should not be waxing or removing hair with the root with any other method for at least 6 weeks before your first treatment and throughout the course of treatment because the hair needs to be in place to be targeted by laser. The area should be shaved as closely as possible so that laser can target the most energy towards the hair follicle and not waste energy on the part of the hair that is above the skin’s surface. If you treat an unshaved area, you risk potential skin burns caused by singed hairs. You should shave the area to be treated 1-3 days prior to your treatment (some clinics will offer to do this for you, but be aware of irritation that can be caused by disposable razors). This will leave very slight stubble visible and make it a bit easier on your tech not to miss the spots you want treated if you have hair that cannot be seen at all after it’s shaved.
After treatment is completed (both underarms take under 10 minutes, a back treatment can take about an hour), you can ice the area and apply pure aloe vera gel to soothe the skin for a few days. Within 2-3.5 weeks, you should experience shedding of all treated hair. At first, hair will look like it’s growing, but it is just coming out to shed. Shedding starts at about 1.5 weeks and can last until 3.5 weeks post-treatment or so. Exfoliating and/or scrubbing gently in the shower with a loofa can help speed up the process. After shedding completes, you might still see little black dots “stuck” in the hair follicles. These are commonly referred to as “pepperspots” and will shed eventually on their own, though it might take a bit longer, or they will be singed off at your next treatment. You can exfoliate to help those out as well.
After the treated hair sheds, you should experience a hair-free period for a few weeks, until the hair in the next growth phase (which was dormant before) starts to come in. Once you see enough grow in to justify another treatment, go in for your next appointment. This usually happens within 8-12 weeks post-treatment. To complete treatments, you should continue treatments spaced at least 8-12 weeks apart until you have reached diminishing returns and the remaining hairs are too fine for laser to target, or until you have reached you desired reduction. This usually involves 2-10 treatments depending on your desired reduction.
Important Note: if you don’t experience shedding or a hair-free period, you should inform your technician. This is an indication that the treatment wasn’t effective and adjustments need to be made (for example, the settings could to be raised). If you feel that a majority of the hair didn’t shed 3-4 weeks post-treatment, the technician might have missed many spots and you may consider asking for a touch-up. Touch-ups should be done 4 weeks after the treatment as whatever remains at this point wasn’t affected. Certain clinics might offer these touch-ups free of charge when you sign up for treatments.
15. What are the possible causes of excessive hair growth and how can it affect my treatments?
The causes of excessive hair growth pattern are many and varied, including:
* Heredity
* Pregnancy
* Glandular and/or hormonal imbalances (possible PCOS condition for women), including diseases causing these effects
* Insulin resistance issues
* Thyroid problems
* Reactions to certain medications
* Normal aging processes
* Excessive temporary removal methods like waxing, tweezing, creams and depilatories, etc
Laser candidates with excessive coarse hair on uncommon areas should explore a possible underlying medical reason for the growth before starting laser treatments. If there is something in the body consistently triggering new hair growth, laser treatments might seem ineffective as they only kill the hair that’s currently present. Laser treatments do not prevent potential new growth.
Women with PCOS hair growth patterns (upper lip, chin, cheeks, etc) are advised to see an endocrinologist. Men can get tested for insulin resistance. Talk to your doctor if you suspect you might have an underlying medical condition causing excessive hair growth before starting laser hair removal. Once the condition is under control through treatment/medication, laser hair removal can then be performed to kill the currently present hair.
16. Is it true that laser hair removal can cause induced hair growth on some areas?
This occurrence has been reported by consumers on various forums, although it has not yet been medically proven. It is a rare occurrence and appears to happen only when treating woman’s face or men’s back/shoulders/upper arms when certain conditions are present. Usually, this happens more often on darker skin types (type IV and darker) when treating fine or vellus hairs, and at somewhat low settings.
The best way to stay on the safe side is to only treat the above areas with laser if they have coarse dark hair and to make sure the laser operator doesn’t treat any sparse, fine or vellus hairs. Those hairs should be removed with electrolysis.
17. How can I find a recommended laser center in my area?
There are several things you can try. You can run a search for your city name on any laser hair removal forums using the search function and read about experiences of previous consumers in your area. You can also try running a provider search on the laser manufacturer websites (Cutera and Candela Corporation offer this option on their websites). Finally, you can check your local Yellow Pages or
http://www.citysearch.com for listings in your area.
Dreaming of Laser 
my laser experience-updated 11/26/07 
