Razor to Laser

Hair Removal

Woman's LegsFor many years the beauty industry has been offering a variety of hair removal or depilation treatments, ranging from waxing and sugaring to electrolysis. However, the biggest revolution in the field of depilation came with the introduction of light-based devices, such as laser and Intense Pulsed Light (IPL); designed to effectively and safely target the hair and literally ‘zap’ it away.

Now, according to the American Society for Aesthetic Plastic Surgery (ASAPS), almost 1.5 million laser hair removal procedures were performed in clinics and salons in the USA in 2006, making it the 3rd most popular non-surgical cosmetic treatment behind Botox® and dermal filler injections.

According to sk:n, the UK’s largest chain of specialist laser clinics, nearly 70,000 people were treated with laser hair removal in their clinics in 2004-2005, rising to over 110,000 in the period 2006-2007. Jane Lewis, Development Director for sk:n, notes; “Of the 20,000 clients treated every month at sk:n’s 25 clinics nationwide over 50% have laser hair removal. The male:female split is 60:40 and women aged between 18-50 tend to make up most of the client base.”

“Women tend to be motivated primarily by facial hair and once they’ve seen the results move on to other areas, particularly the underarm and bikini line areas. Men tend to be aged between mid-twenties to mid forties and the most popular treatment areas are backs and chests”; concludes Jane Lewis.

In this month’s feature article we look at the evolution of light and its use for hair removal, some of the new and advanced machines now available and discuss the impact of home use devices now being launched in the UK.

Background on the Use of Light for Hair Removal

The general rule for light based treatments for hair removal is that the hair colour should be darker than the skin colour, due to the absorption of light by the melanin or pigmentation (present in both skin and hair), which acts as the chromophore or target of the light. Treatment is most effective where there is a good contrast between the skin and hair colour, making dark hair on pale skin an ideal candidate and making the treatment of lighter hair colours and darker skin tones somewhat trickier if not contraindicated in some cases due to non-responsiveness and an increased risk or scarring or burns.

The effect of light based hair removal is most obvious during what is known as the ‘anagen’ phase of hair growth. That is when new hairs start to grow. During this period of growth, the hair follicle has increased pigmentation or melanin and growth of new cells that makes it more open to damage from light treatment. Hence, due to this natural growth cycle, treatments with any light based device will be scheduled into several repeat sessions, at frequent time intervals, to catch each individual hair at its optimum growth phase.

The absorption of light by melanin (without absorption of the light by other surrounding tissues such as haemoglobin or blood) is best created with wavelengths or colours of light between 650 – 1200nm, i.e. from red light to infra-red light.

The first light based devices to be used for hair removal were lasers (Light Amplified by the Stimulated Emission of Radiation), and specifically the type of laser known as a Ruby laser (a 694nm wavelength with a deep red light). However, later research proved them to only be safe for use on light skin tones, making them much less popular for hair removal treatments nowadays due to the variety of skin types in this country.

Then came the Alexandrite laser (a 755nm wavelength with near infra red light) which was safer for use on darker skin types than the Ruby laser, and which proved to be very effective, despite the unreliability of early models.

Further developments came along with the Nd:YAG (a 1064nm wavelength with near infra red light) and Pulsed Diode (an 810nm wavelength with near infra red light) lasers which although slower, and often with a smaller treatment zone, had the advantage of being able to safely treat darker skin as well as light to medium tones. These two lasers were subsequently heavily marketed for hair removal treatments in clinics and beauty salons.

In the late 1990s, the LightSheer™ from Lumenis, a pulsed diode laser with an 800nm wavelength became the first laser to receive FDA approval in America for ‘permanent hair reduction’. Since then, many more devices have been approved for this treatment and this ‘qualification’ has proved to be the gold standard in light-based hair removal, as to date no light-based device has been proved to produce ‘permanent hair removal‘, hence device claims are strictly vetted, both in the US and UK.

Following on from lasers came the development of IPL or Intense Pulsed Light technology. Unlike lasers which deliver one single wavelength or colour of light, an IPL device which is based on a flash lamp can produce a wide spectrum of wavelengths which can then be filtered to produce the same wavelengths as the different laser types. This allows the operator to treat a variety of skin types by switching the filters to create the best wavelength type for the skin type that they are treating, although caution is still needed with IPL and very dark skin types due to the risk of hyper- or hypo–pigmentation. IPL devices are also marketed using terms such as broadband light or Light Heat Energy (LHE) which uses a longer pulse of light to create a thermal effect but is still pulsed light.

Most large medical aesthetic clinics offering laser hair removal tend to favour having a multi-device offering including an Alexandrite and Diode laser and an IPL system. This way they are able to target many of the skin and hair types of those who request treatment with the most effective modality.

Many smaller clinics and beauty salons however tend to opt for an Intense Pulsed Light system, primarily due to cost constraints, as a single IPL device still enables them to treat a variety of different patient types safely and relatively effectively.

The increase in the availability of laser/IPL hair removal treatments, primarily due to the increased uptake of IPL devices within the beauty salon trade, has lead to the cost of treatment falling for the consumer due to this increased competition. In fact, according to results from the Guild News magazine’s Beauty Industry Survey, (carried out annually based on a poll of its subscribers), the average price of a laser/IPL hair removal treatment has fallen from £128.88 in 2002 to just £39.10 in 2005; although this has seen a rise again in 2006 to an average of £59.22, demonstrating a drop in the cost of laser/IPL treatments of 46% over 4 years. Good news for the consumer!

“Hair removal has come of age; it is no longer seen as a ‘space-age’ treatment sold as a novelty and based on the perception of the ‘laser’ as a Tomorrow’s World miracle available only to the jet-set. 21st century hair removal is now seen as a scientifically based, clinically demonstrated and publicly accepted solution for the age-old problem of unwanted hair”; comments Paul Stapleton, Managing Director of The Mapperley Park Clinic in Nottingham.

Combining Modalities for Improved Treatment

More recently manufacturers have been combining different light and electrical modalities in an attempt to produce better and longer lasting results for hair removal treatments, along with the ability to treat a wider variety of hair and skin colours, including red, blonde, grey and white hair, which as they do not contain any pigment for the light to target have historically been unresponsive. Additionally the holy grail of pain-free treatment is sought by many device manufacturers.

Syneron mode of actionSuch examples come from Syneron, who have combined both a pulsed diode laser (810nm) and an IPL system (680-980nm) with bi-polar radiofrequency (RF) to produce their eLaser™ and eLight™ systems based on proprietary elos™ (electro-optical synergy) technology. By combining the light source with RF the devices are able to preheat the hair follicle using the light or optical energy, which creates a thermal path for the bi-polar RF to travel along, thus meaning that the RF travels directly to the hair follicle which then cannot further conduct the energy to the surrounding skin etc. This build up of energy in the hair follicle causes it be become terminally disabled and damaged. Unlike with laser where the hair is effectively ‘singed’ away at the root, the RF energy simply disengages the follicle at the root, leaving the hair shaft itself intact which will then shed over time or can indeed be pulled out without resistance.
Although these devices claim to treat white, blonde, grey and red hair they do require multiple passes of the device set at maximum RF energy settings to achieve results, compared to darker hairs. Coarse white, red and grey hairs seem to respond better than fine blonde hair with this device, as the company notes that approximately 3 in 10 patients may not have a reduction on blonde hair, which is normally confirmed after 3 treatment sessions.

At this time there is little in the way of robust theory or clinical evidence to suggest that RF mediated devices are any better than the same device without the RF component.


PPX Photopneumatic Therapy - mechanism of action

PPX Itellitip
PPx™ Photopneumatic Therapy from Aesthera combines IPL (400-800nm) broadband light (“photo”) with pressure (“pneumatic”) modalities in a device which draws the area of skin (and hair) being treated up into the treatment tip to bring the hair follicles closer to the surface of the skin and reduce the blood concentration in the area, before the light energy is applied. This means that the energy applied is concentrated in the target area only thus eliminating the heat spread to surrounding normal tissues. The manufacturers state that by using this combination they are able to use a reduced amount of light energy leading to a gentler and pain-free treatment compared to existing laser/IPL devices.

The downside for clinicians and consumers alike, who will share the cost, is the per-patient disposable treatment tips or Intellitip™, available in various sizes for treating different areas of the face and body.

What’s New in Lasers & IPL?

Despite the relative usefulness of an IPL based device in being able to treat a broad range of skin and hair types, it is still considered to be somewhat of a compromise over a more targeted laser device producing one particular light wavelength; hence manufacturers are now investing more and more in the development of yet more powerful and less painful lasers, along with improving the existing IPL technology to compete with the laser platforms. The Holy Grail as such has yet to be found it seems but here are some of the newest laser and IPL technologies now available to treat unwanted hair.

The Soprano™ XL continuous wave long pulse diode (810nm) laser from Alma Lasers markets itself with the line “virtually painless laser hair removal”, due it says to its revolutionary new delivery method which dramatically changes the way laser hair removal has been performed for the last 15 years. Soprano

The device offers a dual mode application of pulse diode laser energy for hair removal, known as Hair Removal (HR) and Super Hair Removal (SHR) modes. The HR mode offers treatment with the standard technique employed for this type of laser, whereby a single pulse of high fluence (energy) laser light is delivered to target the hair follicles. The SHR mode meanwhile uses a lower fluence, high repetition pulse rate, (10 pulses per second – the fastest on the market) which is applied to the treatment area with the hand piece in motion. It is this new technique, whereby the hand piece is constantly being moved by the operator whilst the laser energy is fired, which results in a more gradual heat build up and a less painful treatment. The in-motion delivery use the chromophores in the surrounding tissue as reservoirs to effectively heat up the hair follicle, along with the heat energy which is actually absorbed in the normal way directly by the hair follicle itself. This combined gradual heating damages the follicle and prevents re-growth, without damaging the epidermis (skin’s surface). Alma Lasers state that the Soprano is safe and effective for all skin and hair types, including tanned skin, which is often noted as a contra-indication for laser hair removal treatment, due to the absorption of heat by the epidermis.

In 1998, Deka was the first company to launch a long pulse (LP) Nd: YAG (1064nm) laser device for hair removal. Now in 2007, they have launched a new multi-laser/IPL platform called the Synchro HP which offers the same LP Nd:YAG but uniquely with a spot (or treatment area) size of up to 20mm – the largest on the market today – which allows for much quicker treatment times. The manufacturers state that this laser is ideal for treating all skin types, especially darker tones, and also claims to treat all hair colours, except white.

iPulse i300 unitClaiming to be a major breakthrough in Intense Pulsed Light technology is the iPulse™ (530 – 1200nm) from Cyden Ltd. This is due it says to a unique and patented way of delivering the micro-pulses of light, known as the ‘square pulse’, which produces an effective clinical performance but with a lower energy requirement, leading to a lower running cost for clinics and less painful treatments for consumers.

In conventional IPL devices, the electric current surges through the flash lamp in a wave and the wavelengths of light vary during this pulse. At its peak, the energy is too high and produces more blue light that must be filtered out. Much of the energy is therefore lost so to be effective treatments are carried out at wastefully high energy levels that can be uncomfortable, as well as costly. iPulse technology solves this problem with unique circuitry that creates a constant input current of energy to the lamp generating a constant wavelength of light, in a ‘square pulse’, meaning that effective treatment can be carried out at lower energy levels (which also means that it requires less contact cooling than other IPL devices) and without the need for additional filters for the device for treating different skin types. Additionally, the iPulse device used multiple lamps which allow it to have a large spot or treatment size leading to much quicker treatment times, especially for large areas. For clinicians this technology also means that the device is much smaller thus taking up less room within a clinic.

Home Use Lasers

In December 2006, Palomar Medical Technologies announced that it had become the first company to receive US Food & Drug Administration (FDA) approval for an over-the-counter, home use, light-based hair removal device, allowing the device to be sold directly to consumers in the United States upon launch. The device, registered with the FDA as the ‘ABC Hair Removal System’ is composed of a base unit, umbilical cord, hand piece, chiller system with chiller coolant, cleaning wipes, ABC lubricant, power supply and safety components. It is rumoured to be a diode laser which will cost in the region of $1,200 (approx. £600) and is being developed by Palomar and commercialised in conjunction with The Gillette Company, already famous as the leading manufacturer of razors. So far, no device has actually been launched but is anticipated sometime in 2008.

Tria - at home laser hair removalIn 2003, a team of American dermatologists, engineers, and executives, who were previously behind the development of the Lumenis diode laser LightSheer™ back in the early 1990s, went on to found SpectraGenics. They then began the development of its flagship diode laser device for home use, TRIA™, which was subsequently launched in the UK in early 2007.

The device which is compact, hand-held and rechargeable offers 3 settings (high, medium and low) for the level of energy delivered, which can be chosen by the user based on their own comfort levels, although the higher setting is likely to produce the better results. There is no requirement for gels or chilling components.

So far TRIA™ is only available in the European countries of Italy, Spain and the UK, plus in Japan where it has sold over 12,000 units in the last year under the brand name i-epi™. The company report that product acceptance in both Asia and Europe has been positive to date and they plan to commercialise the product in the USA soon.

A recent clinical trial showed that the device was not only safe and effective for home use, but that users experienced both excellent short-term, single-treatment hair removal and excellent sustained hair removal with periodic treatments. The only observed side effect was mild-to-moderate redness, which typically resolved in less than 30 minutes, and slight pain during treatment.

The TRIA™ currently retails in the UK for £695.00. Although, when The Consulting Room™ recently conducted a small online poll of 75 people and asked them how much they would be prepared to spend on an at-home laser hair removal device, we noted that the majority, 40%, were only prepared to invest less than £100, with 29% prepared to go up to £250, and 23% up to £550, with few willing to pay above that price. It seems that the public will still need some convincing as to the long-term cost savings available with this device. However, Spectragenics claims that based on national averages, a woman can expect to spend between £1,500 and £4,500 for hair-free underarms, bikini line, upper lip and chin over the next ten years, making the TRIA™ a cost effective solution to unwanted hair. TRIA™ can also be effectively sold by clinics to patients as a method of managing unwanted strands of re-growth following a hair removal treatment course.