Within a lively ongoing dialogue such as the one that exists among our laser hair removal message board, it's natural for a lot of similar questions to pop up. We thought it would be handy to have a solid, but ever-evolving resource that answers such common questions, so we asked one of our certified hair removal consultants to compile a list of FAQs. Consumer Rep "Blink888" provides rich, insightful commentary and feedback as a guest moderator on our message board and can answer any of your questions about laser hair removal and other hair removal techniques. Note: The Q&A below has been completely updated for 2011!
Currently, there are three popular types of hair removal lasers made by various manufacturers: Alexandrite, Diode, and Nd:YAG. Intense Pulse Light systems (IPLs) are also used for hair removal.
Some of the more popular brands of devices currently on the market are:
1. Alexandrite: GentleLASE, Apogee
2. Diode: LightSheer, F1 Diode, MeDioStar, Palomar SLP 1000, Comet (w/RF technology)
3. Nd:YAG: CoolGlide, GentleYAG, Lyra-i, Sciton
4. Alexandrite/ND:Yag Combination Devices: GentleMAX, Apogee Elite, Apogee MPX
5. IPL: Palomar Starlux and EsteLux, Harmony, EpiLight, Aculight, Vasculigh, Aurora (w/RF technology)
In order to determine the best device to use, patients need to figure out their skin type using the Fitzpatrick Skin Chart*. 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.
*This tool is approximate
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: Mediterranean, 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
*ND:YAG lasers were specifically created to cater to dark-skinned patients. This is the only type of laser that should be used on skin types V and darker. Using any other types of lasers on this type of skin can result in burns if they are used at settings that disable the hair permanently.
Lasers designed for permanent hair reduction emit wavelengths of light that are absorbed by the pigment in the hair (melanin). If the surrounding skin is lighter than the color of the hair, the energy of the laser is concentrated in the hair shaft, effectively destroying it without affecting the skin or the follicle.
Since lasers target pigment, treatments are most effective on coarse hair because it has a lot of pigment and can absorb a lot of heat. Fine hair cannot absorb much heat.
The ability of the laser device to produce a very narrow bandwidth on a consistent basis is the key to a safe efficient treatment. 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.
Intense Pulse Light (IPL) machines are not 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). IPLs produce a wide bandwidth of light that can heat up all of the surrounding tissue, making it less effective in disabling hair and putting the patient at a higher risk for burns, especially on darker skin.
IPL devices are generally cheaper than laser devices, which is why many clinics choose to use them. Generally, true hair removal lasers (i.e. alexandrite, diode, and ND:Yag types) tend to achieve better and faster results than IPLs.
Most patients need at least 6-8 effective treatments spaced 8-12 weeks apart. Because hair grows in cycles, several sessions are necessary in order to affect all hair on any given area. Due to length of hair growth cycles, treatments are usually needed once every 8-12 weeks. Hair cycle length varies depending on body part. Face usually requires more frequent treatments (about 8 weeks apart) whereas legs and back need less frequent treatments (closer to 12 weeks apart).
Shedding of all treated hair should be expected within 3 weeks of each treatment. The hair that doesn’t shed and is growing as usual after 3 weeks has likely been either missed or not affected due to inappropriate settings. If this is the case, a touchup treatment is necessary at that time. All 6-8 treatments should be good effective treatments in order to achieve good results.
Once the hair sheds, patients should experience a hair-free period for several weeks. Once new hair comes in again, patients should come in for their next session.
Laser hair removal lasers have been in use since 1997 and the Food and Drug Administration approved them for “permanent reduction.” They disable hair permanently as long as the right type of hair is treated with an appropriate type of laser at effective settings.
However, it is called a “reduction” because, no matter what some clinics may claim, hair removal lasers cannot and do not remove 100% of the hair in an area. With proper treatments, laser can remove the majority of the coarse hair on a body area, but they cannot remove finer hair. Be cautious of clinics making claims that seem too good to be true.
In order to achieve 100% clearance of hair in any one area, most people need to follow up laser treatments with electrolysis treatments to remove any remaining finer hairs. Laser can only remove coarse hair.
Generally, a patient can tell how much reduction was achieved from a course of treatments after waiting 6-12 months from their last treatment. Any hair that grows in after the 12-month period is new hair that the body can develop due to numerous factors such as age, diet, hormonal changes, and medical conditions such as PCOS. Patients who experience new growth later in life can get touchup treatments.
Some experts believe a small percentage of people are non-responders to laser hair removal treatments. This has not been confirmed or proven, and reasons are not known. At the same time, it's difficult to judge whether a patient’s lack of results is, in fact, due to being a non-responder. Lack of results could be due to an undetected underlying medical condition or improperly performed treatments.
In essence, it’s difficult to predict results. Results depend on many variables, including type of laser used, how settings are set, underlying causes of the hair growth, the technician’s experience, etc. That is why it’s a good idea to start treatments on one small area before committing to an expensive course of treatments on many areas at once.
Electrolysis is the only other proven permanent hair removal method, which has been in use for over 125 years. It involves treating one hair at a time and is a good option for smaller areas where precision is necessary (like eyebrows or upper lip). At this time, it is as the only permanent option for any fine and light-colored hair.
Prices vary widely from clinic to clinic. It’s a good idea to get quotes from several clinics in the area to compare prices and other factors.
Some clinics offer discounts if paying for a package of multiple treatments upfront. However, buying a package also prevents an unhappy patient from switching providers. Since laser operator skill is very important in achieving results, it is recommended to start with one small area and investing in treatment packages only once satisfied. It’s a good idea to compare types of lasers used, treatment prices, technicians’ experiences, and other factors among at least 3-5 clinics in the area.
Below is very general average pricing information for most commonly treated areas at clinics across the US:
Price per session:
Underarms (both) - $50-150
Regular bikini - $100-200 (definition varies by clinic)
Brazilian bikini - $200-300 (definition varies by clinic)
Half legs (both) - $200-400
Half arms (both) - $200-400
Butt - $150-300
Back - $200-500
Chest - $100-300 (definition varies by clinic)
Abdomen - $100-300 (definition varies by clinic)
Full face - $150-300
Upper lip - $50-150
Chin - $50 – 150
In one pulse, laser removes all the hair on a patch of skin the size of a nickel or a quarter. Generally, laser hair removal is not much more painful than waxing, though the sensation is different. With each pulse, the feeling resembles a rubber band snapping against the skin for a quick second. Pain is only felt while laser is hitting the skin and doesn’t last. Most people do not require an anesthetic cream, though one can be prescribed to more sensitive patients. EMLA is one popular option.
Using anesthetic creams is safest on small areas. It’s also important to obtain a cream that is properly compounded. Using an inappropriately compounded numbing cream on large areas can result in adverse side effects or even death. Patients should consult with their doctor.
*It should be noted not feeling any pain during treatments may be an indication that the laser is set too low to produce permanent results.
Some people may experience the following potential temporary side effects:
The following rare side effects are indicative of inappropriate laser type and/or settings:
Yes. This can be achieved with 3-4 treatments instead of the full course of 6-8 treatments. To achieve an even reduction without patchiness, it is imperative to find an experienced laser operator who overlaps properly while covering the area and doesn’t miss spots. It’s also a good idea to wait at least 12 weeks between sessions in order to correctly assess the amount of reduction achieved at any point during the course of treatments.
THE LASER: Choose a clinic with the best laser for your skin type*. Do not fall for marketing hype. Every laser can technically be applied to any skin type without adverse side effects by manipulating the settings, but only the right laser at appropriate settings will result in permanent hair reduction.
*Patients who are in between skin types on the Fitzpatrick skin chart should get test spots done with various laser types to determine whether their skin can handle aggressive settings on the more powerful devices.
THE CLINIC: Choose a clinic whose main priority is your results. Schedule consultations with at least 3-5 clinics with the best laser type for your skin type before making a commitment. Be an informed consumer and ask questions to assess the clinic’s knowledge of laser hair removal. Avoid clinics with high-pressure tactics. Prices can vary by as much as 100-300%, and are often negotiable.
THE LASER OPERATOR: The person operating the laser device should have extensive experience specifically in laser hair removal. The best technicians are those who have the most hands-on experience, not those with the most education on paper. It’s a good idea to find out whether the same person will be performing each session.
Patients should not wax, epilate, or remove hair with the root using any other hair removal method for at least 6 weeks prior to their first session and throughout their course of treatments. The hair needs to be in place in order to be targeted by laser as laser devices targets the pigment in the hair.
The area to be treated should be shaved 1-2 days prior to treatments so that the energy is targeted towards the hair follicle and not wasted it on the hair above the skin’s surface. Treating unshaved skin can result in burning of the skin by singed hairs.
Treatments are relatively quick. Both underarms take about 5 minutes. Full legs can take 1-1.5 hours. After the treatment, applying ice packs and cooled pure aloe vera gel help soothe the skin.
All hair should shed within 3 weeks* following the treatment. Sometimes, shedding doesn’t start until about 10 days after the session. During the shedding phase, hair may look like it’s growing, but it is actually coming out to shed. Exfoliating and/or scrubbing gently in the shower with a loofa can help speed up the shedding process.
After 3 weeks, some patients may see small black dots remain in the hair follicles on some areas. These are commonly referred to as “pepperspots”, which eventually shed on their own. Exfoliating may help speed up the process. Regardless, they will be singed off in the following session.
Once the hair sheds, patients should experience a hair-free period for several weeks. Once new hair grows in, patients should come in for their next session. For most people and on most body areas, this happens about 8-12 weeks after the previous treatment.
Patients should continue treatments until remaining hairs are too fine for laser to target, or until they’ve reached their desired reduction.
*Shedding of all treated hair should be expected within 3 weeks of each treatment. The hair which doesn’t shed and is growing as usual after 3 weeks has been either missed or not affected due to inappropriate settings. If this is the case, a touchup treatment is necessary at that time. All 6-8 treatments should be good effective treatments at aggressive settings in order to achieve permanent results.
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.
Normally this cycle of hair production will continue for the duration of the individual's life. However, various factors can influence, promote and inhibit hair production.
Laser affects hairs when it’s in its anagen phase of growth. Thus, patients need multiple treatments in order to disable each batch of hair as it enters the anagen phase of growth. Hair cycle length varies depending on body part. Face usually requires more frequent treatments (about 8 weeks apart) whereas legs and back need less frequent treatments (closer to 12 weeks apart). Spacing treatments 8-12 weeks apart allows adequate time to target hair on most body areas.
The causes of excessive hair growth are many and varied, including:
Before starting laser treatments, patients with excessive hair growth on uncommon areas should explore possible underlying medical reasons for it. Hair removal methods can only impact hair that’s currently growing. They cannot prevent the body from developing new hair after treatments are completed.
Women with facial male-pattern growth are advised to see an endocrinologist to explore the possibility of PCOS or elevated testosterone levels. Men experiencing excessive growth can get tested for insulin resistance.
Some patients report that finer hairs treated with laser become more prominent and more numerous. Related discussions have begun at industry conferences. It is a rare occurrence which happens only when treating fine hair, especially on women’s faces and men’s upper arms, shoulders and upper backs. It is also a concern when treating sparse hairs of any kind on any body area. Darker skin types (type IV and darker) are more susceptible to experiencing laser-induced growth.
It is advised to only choose laser hair removal for body areas with dark coarse dense growth. Laser devices are only effective on coarse growth. Fine and vellus hair should be removed with electrolysis.
The easiest thing is to use Hair Removal Forum's convenient "Doctor Finder" to locate rated laser clinics across the United States. You can discuss clinic options with other customers at online forums like the Cosmetic Enhancements Forum.