... I & II with blond hair; better to use Ruby laser 694 nm. â¢Diode laser (800 or 810 nm): suitable for all skin types. â¢Overlapping 10% except moustache area (no.
Laser hair reduction BY Rania Abdulghani Madi, MD Lecturer of dermatology & venereology Al Azhar University
Principals • Laser hair reduction is based on selective photothermolysis • The target chromophore is melanin in the hair follicle; mainly the matrix and the bulb • No complete hair removal; the best response is about 80-85 %
• Pre operative considerations: History of HSV 1 or 2 History of systemic retinoids History of minoxidil therapy History of hair plucking (sweet, threading, or waxing) a weak before Tanning Pregnancy History of previous hair reduction by laser Ttt: systemic acyclovir, sunscreen, bleaching agents
• On clinical assessment: Age of the patient ( take care if > 35 ys!!!!) Presence of white hair (count !!!) White scalp hair Hirsutism (ask about hormonal profile) Skin phototype, colour and thickness of hair Presence of : • Post inflammatory hyperpigmentation • Acne • Psoriasis • vitiligo
• Operative considerations: Skin phototype III and more with black thick hair (Egyptians); better to use long pulsed Nd:YAG 1064 nm Skin phototype II & III with thin and brown hair; better to use long pulsed Alex. 755 nm Skin phototype I & II with blond hair; better to use Ruby laser 694 nm Diode laser (800 or 810 nm): suitable for all skin types Overlapping 10% except moustache area (no overlap)
Common Problems • Start with high fluence if the patient has white hair in the ttt site, scalp hair, or age >35 ys with good cooling and post op. bleaching agent • Thin and brown hair after 3rd or 4 th session: Not common with Alex. To avoid this problem when using Nd:YAG 1064 nm; make 2 passes on the 3rd seesion, use other type of laser in the same session( IPL or Alex.), shit the pt. to Alex.
Common Problems • Paradoxical hypertrichosis: use optimal fluence with good cooling to the surrounding areas • Don`t touch the eye brow; ensure complete protection • Don`t touch lips specially if the patient has tattoo • The last areas to respond are labia majora, overlips, and centre of axilla
Common Problems • If the patient has acne; laser hair reduction is allowed if the pt. doesn`t use systemic retinoids • If the pt. has bleaching or dying her hair; laser hair reduction is allowed if there is no erythema bec. These agents don`t reach to our laser target • If the pt. has psoriasis; laser hair reduction is allowed in stable psoriasis, no systemic retinoids
Common Problems • If the pt. has vitiligo; laser hair reduction is allowed in stable lesions • Active infection, active HSV, erythema, tanning, or recent plucking- postpone the session • White hair: photodynamic therapy or Radiofrequency; results are not satisfying • IPL is not suitable for hirsutism
Post operative considerations
• Sun screen • Systemic antiviral • topical steroids; once at night for 3 days only • Healing and moisturizing agents • Bleaching agents after one weak
Pseudosycosis barbae • Better to use long pulsed Nd:YAG 1064 nm lesional (3 stacks with cooling) and perilesional (single pulse) • Diode laser could be also used • Combined with systemic antibiotics
Acne keloidalis • Better to use long pulsed Nd:YAG 1064 nm lesional (3 stacks with cooling) and perilesional (single pulse) • Diode laser could be also used • Combined with intralesional injection of steroid
Hidradenitis suppurativa • Better to use long pulsed Nd:YAG 1064 nm lesional (3 stacks with cooling) and perilesional (single pulse) • Stage I & II • Combined with systemic antibiotics
Pilonidal sinus • Better to use long pulsed Nd:YAG 1064 nm lesional (3 stacks with cooling) and perilesional (single pulse) • Diode laser could be also used • Combined with systemic antibiotics
Follicular hyperkeratosis • Better to use long pulsed Alex. • Long pulsed Nd:YAG 1064 nm could be used but with high fluence and multiple passess • Combined with topical keratolytic agents and chemical peeling
