Laser hair removal can provide an effective entrée into plastic surgery

Laser hair removal (LHR) is one of the fastest-growing aesthetic trends in the United States. In fact, among all types of aesthetic procedures, surgical and nonsurgical, LHR ranked second only to botulinum toxin Type A injections last year, according to the American Society for Aesthetic Plastic Surgery.1 Nearly 1.6 million LHR procedures were performed in the United States in 2005, up 11% from the previous year, and we continue to see a tremendous growth of interest and clientele in our laser centers.

Locating laser centers in the offices of physicians—dermatologists, obstetrician–gynecologists, ophthalmologists, and, to a very large extent, plastic surgeons—is beneficial, because LHR can be an easy first step toward more extensive aesthetic surgery. Because LHR is noninvasive, the procedure enables patients who are not yet ready for surgery to step into the plastic surgeon’s waiting room without becoming anxious about the procedure or its potential side effects.

There, they can gain exposure to brochures, videos, and other information that may ease their concerns about somewhat more invasive procedures, and open their minds to advancing another step in resolving aesthetic imperfections. LHR can push clientele forward, and a wide range of physicians have adopted it because of its potential to enhance income and patient relationships.

The LHR procedure targets hair follicles. When a follicle is struck by laser radiation of the appropriate wavelength and sufficient energy, it is destroyed permanently. The procedure is generally not painful; rather, it feels like a quick pinch to most patients.

Individualized Treatment
Just as with any other aesthetic procedure, physicians must plan an individualized course of treatment for each patient if they expect to obtain consistently positive results from LHR. We have found that instrument settings must be adjusted for each patient’s skin type, individual characteristics, and even skin condition on the day of treatment. A variety of laser types is available as well, including those that use a combination of light and other radiofrequency energy. A one-size-fits-all approach that considers only a minimal number of factors may lead to ineffective treatment or even injury.

Determining skin type is of primary importance. The standard evaluation technique is the Fitzpatrick scale, which determines type—from very fair (type I) to very dark (type VI)—based primarily on the skin’s reaction to sunlight. We have advanced this methodology to incorporate genetic factors, such as eye, skin, and hair color, and also the patient’s ethnic background in the calculations. We compile a score for each patient and then determine the treatment setting for that day for that individual.

Skin condition will vary with the time of year and degree of sun exposure. Skin tone is important, because in most devices, the laser beam is attracted to pigmentation. If an individual is deeply tanned, the light energy is diverted in part to the skin instead of the hair follicle, and the results can be less than desirable.

Therefore, we advise our patients to avoid tanning for at least 4 weeks before treatment. For lower-body treatments, such as the legs, sessions are scheduled farther apart, so patients may be able to get a tan between treatments—but as a rule, we recommend they stop tanning altogether. Tanning accelerates the skin’s aging process and can sensitize individuals to additional damage, if not the danger of melanoma.

Dark Skin, Light Skin
This does not mean, however, that dark-skinned individuals cannot be treated. We have developed special protocols that correlate to our candidates’ evaluations. In expert hands, settings can be adjusted to a depth that minimizes risk and tailors the treatment to the individual with darker skin. Typically, this is done by increasing the radiofrequency and reducing the laser energy in treatments.

Safety is further enhanced when treating dark-skinned individuals by using a monitoring system that tracks the change in heat to the section of skin treated with each pulse. Thus, we can set an allowable level of heat to be delivered and verify that the limit was not exceeded.

At the other end of the spectrum, some physicians and patients believe that LHR is not effective for people with blonde and light brown hair because of its sparse pigmentation. The fact is that modern techniques will permanently remove lighter hair, although they will not achieve the same degree of hair reduction as seen with darker hair colors.

Once the initial evaluation is completed, the actual LHR treatment should be administered by a certified clinician who is supervised by a physician and who has been trained in very safe protocols. The length of treatment and the time be-tween treatments depend primarily on the body part for which LHR is being carried out. A laser treatment on the upper lip may take 10 minutes, but both lower legs may require 45 minutes.

The chest and back are generally covered in 90 minutes to 2 hours. The procedure is time-intensive because we map out the areas to be treated and then administer the laser beam one spot at a time. Spot size varies by laser type, but on average, each pulse may impact an area of 1.5 cm x 1.0 cm. Centimeter by centimeter, we expose the mapped area to the LHR treatment.

Timing Is Everything
We recommend a package of six treatments, because LHR is effective only during one stage of hair growth. Each hair continually cycles through a rapid phase, a slowing phase, and a dormant phase, and then repeats the cycle. It is susceptible to LHR only during the period of rapid growth.

At any one time, only 10% to 15% of an individual’s hair is in the rapid-growth phase. Those hairs will be destroyed by the laser, which essentially burns away the hair follicle to prevent the hair from returning. Patients must come back over a period of many weeks for LHR to be effective on all the hairs in a given area.

The hair-growth cycle is faster in the upper body, such as the lip and chin, so those treatments may be scheduled more closely together. Hair remains in its dormant phase much longer in the lower part of the body, so those treatments are spread out.

Some patients may experience excellent results in just three visits and can stop the treatments at that point. Others may need eight or 10 treatments. To reassure patients, our centers offer a 2-year guarantee. After the sixth treatment, if additional treatments are required in the targeted area within the next 2 years, we administer them at no additional charge.

Cost is sometimes an initial barrier to gaining patient acceptance of LHR. Costs vary with the area to be treated but average several hundred dollars per session. In discussing this factor with our patients, we have had exceptional success in educating them to the potential cost of shaving supplies (razors, blades, and cream) and depilatories over the next 50 or 60 years that will be averted by an investment in LHR. The LHR treatments cost far less over a lifetime than the alternative hair-removal methods, and patients also save the time that would have been involved in daily or periodic shaving.

Some patients also may be worried about the effect of the laser light pulses on their skin, expressing concern that they may have harmful long-term consequences. They should be reassured by the physician’s explanation that the laser uses a portion of the light spectrum far removed from UV, the type of rays that can alter cells and cause skin cancer. In fact, laser systems specifically filter out UV light from the light energy used on the patient’s skin.

Those who undergo LHR treatments should be encouraged to use specially developed moisturizers to support those procedures. Formulations that contain antioxidants and vitamins will help the skin heal from the redness and dryness that often accompany LHR. In addition, we recommend a sunblock with a high SPF value. Whereas SPF 30 will block up to 95% of UV radiation, sunblocks with higher SPF values provide incrementally greater protection and should be applied to maximize coverage for LHR patients.

Educate for Success
In the end, education is the key to developing a successful LHR practice. First, educate patients on the value of LHR—the long-term savings of time and money that it offers the patient. Explain the reasons for requiring half a dozen or more treatments over extended time periods to alleviate doubts over the necessity of paying for multiple sessions. Then, deal with any misperceptions that may exist regarding the safety or efficacy of the procedure. Finally, educate patients about the inadvisability of tanning—whether or not they are undergoing LHR .

With an orientation toward patient education, an expertise in evaluating skin types, an understanding of the particular characteristics of the lasers being used, and an entrepreneurial attitude toward introducing patients to aesthetic procedures, plastic surgeons will find laser hair removal to be an ideal service to heighten patient satisfaction, starting with their very first procedure, and to augment both revenues and reputation for the physician. PSP

Kathleen Gilmore, MD, is the medical director of American Laser Centers. She can be reached via her Web site,

1. American Society for Aesthetic Plastic Surgery. 2005 Cosmetic Surgery National Data Bank Statistics. Available at: . Accessed July 6, 2006.