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1. LASER HAIR REDUCTION
Dr. Sowmyacs
Department of Dermatology
KIMS
Bangalore

2. Introduction
The removal of unwanted hairs by
lasers and light devices is one of the
most commonly performed cosmetic
procedures in the world and the
demand continues to grow.

3. Definitions
Temporary hair reduction-is defined as
a delay in hair re-growth, lasting 1-3
months, consistent with the induction
of telogen. Temporary methods of hair
reduction include plucking, shaving,
waxing and chemical depilatories

4. Definitions
Permanent hair reduction-significant
reduction in the number of terminal
hairs after a given treatment, which is
stable for a period of time longer than
the complete growth cycle of the hair
follicles at the given body site.

5. Principle of laser kinetics and
dynamics for hair reduction:
Photothermaldestruction
Photomechanical destruction
Photochemical destruction

6. Principle of laser kinetics and
dynamics for hair reduction:
LHR based on principle of selective photothermolysis
introduced by Anderson and Parrish .
Selective destruction of the hair follicle achieved by
choosing the correct wavelength of laser light (which is
absorbed by melanin in the hair shaft)
At a pulse duration that is equal to or shorter than the
thermal relaxation time TRTof the target
along with the right amount of energy delivered to the
chromophore(target absorbing the laser light)

7. HPE

8. Hair cycle
Hair growth cycle involves the
following stages;
anagen(period of active synthesis)
catagen(regression)
telogen(rest) and
exogen(shedding)

9. LASERS FOR HAIR REMOVAL
1. RUBY LASERS:694nm
2.ALEXANDRITE LASER:755nm
3.DIODE LASER:800nm
4.NEODYMIUM-YTRRIUM-ALUMINIUM-
GARNET(Nd:YAG) LASER:1064nm
5.INTENSE PULSED LIGHT(IPL) WITHOUT
HEAT:550-1200nm
6.LIGHT AND HEAT ENERGY LHE: 400-
1200nm.

10. Next Generation Technology
IN DERMATOLOGY
ELOS
(electro optical synergy)
Technology

11. Elōs =Electro-Optical Synergy
Cooling
Optical energy
light / Laser
Electrical energy
Conducted RF

12. elos Technology
Gold standard technology:
Very effective, safe with Impressive
results on all skin types and all hair
colors

13. INDICATIONS
Elos Technology for Complete Aesthetic
solutions
Hair Removal.
Wrinkle reduction fine and deep wrinkle,
textures, laxity.
Acne treatment.
Skin Rejuvenation, Photo facial,
Pigmentation.
Cellulites and body shaping.

14. CONTRAINDICATIONS:
ABSOLUTE
Prepubertalpatient
Less than 15 years of age.
Uncooperative non compliant or unrealistic
patient
Associated Photo-Aggravated skin diseases and
medical illness e.g. SLE.
Treatment area with active cutaneousinfections
e.g. Herpes labialis, staphylococci infections etc
As recommended by taskforce on laser hair
removal no age limit is imposed for laser hair
removal. One can consider LHR in younger
patients for appropriate indications after
adequate counseling of parents and patient

15. CONTRAINDICATIONS:
RELATIVE
Patient having keloidsover area to be lased
are best avoided, for those who have keloidal
tendencies-utmost caution & to conduct a
patch test first.
Patient on long term photosensitizing drugs
e.g.doxycycline, Minocyclines, Isotretinoin
etc.. Sun protection is mandatory.
Unrealistic patients.

16. CONTRAINDICATIONS:
RELATIVE
Patients with underlying chronic dermatoseslike
Psoriasis and Vitiligoshould be treated cautiously
as there is increased risk of koebnerizationof the
treated area.
Previous history of herpes simplex is a relative
contraindication for Laser Hair removal because
of risk of precipitation of active lesions.
The risk and benefit should be explained to the
patient, and the procedure should be performed,
after proper informed consent and only after a
course of oral acyclovir.

17. RF (radio-Frequency) Current
Properties
Used in medicine for nearly 100 years
High frequency electrical current (NOT electro-
magnetic radiation)
Creates pure thermal effect
Penetration depth is about half of the distance
between electrodes
Heat distribution depends upon tissue conductivity
No scattering or reflection
No effect on melanin
Can be on-line measured and controlled
Time
RF Current

18. ELOS Technology
Efficacy, Safety, Predictability
The combination of bipolar electrical and
optical energy providing a synergistic,
therapeutic treatment
Active epidermal cooling
Automatic safety and monitoring to protect
your clients

19. Properties of ELOS
Light pulse pre-heats the tissue and the target
( hair shaft)
A Higher Temperature in the target area will
lower the impedance of the target area.
–Lower impedance provides an easier path for
electrical energy to flow
Light energy

20. Properties of ELOS
Well known in medicine
Is not absorbed by melanin
All Electrical parameters (Voltage,
Current, Impedance) are measured and
controlled during the treatment.
Electrical Energy

21. Two Selectivity Mechanism
Optical energy: absorbed in the target
chromophore by the right choice of
wavelength and pulse duration
Electrical RF energy: Current flows
where there is least resistance
(impedance) independent of skin or
target color!

22. RF Current Behavior
RF current distribution in
uniform tissue
Pre-cooling the skin surface
pushes RF current into the deep
dermis
RF current is concentrated in a
pre-heated layer or in layer
having higher
conductivity=lower impedance

23. ELOS –Electro-Optical
Synergy
Synergy between conducted RF and Light is
based upon preheating of the target part of the
tissue with light and making it more selective
for the RF energy.
Light Heat Conductivity RF 

24. Advantages of the elos Technology
Efficacy
–Optical and electrical RF synergizing energies used
simultaneously
–Enhanced selectivity and targeting
–Enhanced penetration depth
Safety
–Lower optical energy compensated by RF
for epidermalsafety
-Long pulse type to protect dark skin
–Epidermalcooling –system can be disabled if
epidermal temperature rises
–Active dermalmonitoring of impedance (heat)
energy delivery stops above a safety limit

25. Treatment Parameters
Optical energy:
–Lowervalues for darkskin / Higherfor lightskin
–Lowervalues for dark, coarse or dense hair/
Higherfor light, fineor sparsehair
RF energy:
–As high as tolerable

26. Technique
Incomplete contact cooling
All RF current is concentrated in
one point, potential for increased
tissue temperature at contact
points
Complete contact cooling
RF current is distributed over
entire electrode surface

27. Treatment Parameters
Preliminary
Optical energy levels
–Short pulse mode for skin I-IV
–Long pulse mode for skin V-VI
–Higher energy for lighter and finer hair
–Lower energy for dense hair areas
Start from long12-16 (VI), 12-30 (V),
short30-40 (IV), 30-40 (III), 40-50 J/cm
2
(I-II)
RF levels
–30-50 J/cm
3
, as high as tolerated
–Lower for dense hair areas
–Lower on bony areas, such as shin
–Lower on curved areas, such as ear

28. How does ELOS™work?
Pre-Pulse test
First 10 ms
+
+
Contact Test
Cooling Test

29. How does ELOS work?
Light Pulse
+
+
Target is Pre-heated
Impedance of
target is
decreased

30. How does ELOSwork?
Electrical Pulse
Continues while
monitoring impedance
+
+
Higher Electrical Current
in Zone with Low
Impedance
Target is heated more
efficiently than
dermis or skin

31. Review: How do they work
together?
Light Energy
+
Electrical
Energy
+
Active Cooling
+
Dermal
Monitoring
VORTEX HEATING

32. Heat Created by Optical Energy
Light heats
selectively hair shaft
Bulge and follicle are
damaged due to
heat transferfrom
hair shaft
Shaft
Follicle

33. RF Selectivity for Hair Follicle
Current density is 2-3
times higher in the
follicle than in
surrounding tissue
Heat is 4-10 times higher
in follicle than in
surrounding tissue
Electrodes
normal
treated

34. Heat Created by RF Energy
RF createsDIRECTheat
in the 30 µfollicular
layer around the hair
shaft
Heated layer includes
hair follicle and bulge =
TARGET
Shaft
Follicle

35. Heat Created by Combination
of Optical and RF Energies
Combination of two
types of energy
create uniform
selective heating of
the hair shaft and
follicle

36. What about White Hair ?
Electrodes
How do you treat a follicle
with no chromophore?
Electrical Energy heats and
degrades follicles
It takes longer –Anywhere
from 6 –12 treatments are
necessary
No other system can Treat!

37. White Hair Destruction
After ELOS
Before ELOS

38. History and examination
A detailed history to rule out any associated illnesses is
essential before taking up a patient for laser hair reduction.
These include
history of use of photosensitizing drugs,

recent sun exposure and tanning
keloidaland hypertrophic scarring,
history of herpes simplex,
prior hair removal methods used and their outcomes

39. History and examination
menstrual history in females,
history of thyroid disordes,
diabetes, hypertension, obesity etc.
Female patients must be thoroughly evaluated for
underlying causes of hirsutism. A gynecology and/or
endocrinology opinion should be sought if deemed
necessary.
Specific tests that may be carried out are listed in table`

40. List of investigations in a
patient for laser hair
removal
complete blood counts
fasting blood sugars
urine analysis
serum LH, FSH
serum prolactin
serum DHEAS
free and total testosterone
T3 T4 TSH
RBS, sr. insulin
usg-abdomen & pelvis

41. PRE-PROCEDURE
WORKUP
Patients are instructed to avoid
bleaching, threading, plucking,
thermolysisor electrolysis, waxing of
the treatment area 2 weeks prior to
starting LHR.
Sun avoidance and sun protection to
avoid tanning of the treatment area.

42. PRE-PROCEDURE
WORKUP
It is preferable to avoid any herbal products,
OTC products, homeopathic treatments prior
to LHR procedure.
Counseling & written informed consent
Pre treatment photographs
Use of topical skin lightening creams prior to
LHR if the patient is excessively tanned.

43. Test patch:
Test patches may be performed to
define the precise treatment
parameters and to determine the pain
threshold of the patient

44. LASER HAIR REMOVAL
PROCEDURE
Hair is trimmed with an electric trimmer or the patient can
shave the treatment area a day prior to the procedure.
Any make up should be removed and the area is cleaned
thoroughly before the treatment is commenced.
Local anesthesia is generally not required but topical EMLA
(eutectic mixture of lidocaineand prilocaine) can be used 45
min to 1 hour before the procedure in apprehensive patients
and those with poor pain tolerance .
It is important to ensure adequate illumination of the
treatment area.

45. LASER HAIR REMOVAL
PROCEDURE
Pre, parallel and post cooling of the treated area during
the laser procedure is preferable as it minimizes
discomfort and protects the epidermis from thermal
injury.
Most lasers today have built in cooling devices either in
the form of contact cooling, air cooling or cryogen spray.
Cooling is essential especially while treating darker skin
types as it minimizes the chances of epidermal injury
and burns.
Ice packs may also be used before and after treatment.

46. LASER HAIR REMOVAL
PROCEDURE
Standard laser protocol should be followed such as
eye protection for the patient with eye shields &
the treating physician with eye goggles
Treatment area should not have any metallic
objects such as jewelry, chains etc.
Emergency hazard switch may be used in case of
an emergency or sudden unauthorized entry.

47. LASER HAIR REMOVAL
PROCEDURE
Treatment parameters should be
individualized and a record of each session is
maintained for future references.
Cooled gel is applied to the prepared area
prior to LHR
The hand piece is placed perpendicular to the
treatment area and laser is delivered in a
single pass with minimum overlap (approx
10%) to prevent any skipped areas.

48. LASER HAIR REMOVAL
PROCEDURE
In the low fluencetechnique laser light is delivered in
motion and with repeated passes in a circular or to and
fro motion until the desired cumulative energy is
delivered to the specified, marked out area.
The end point is usually erythemaand perifolicular
edema.

49. LASER HAIR REMOVAL
PROCEDURE
After the completion of the treatment:
the area is cleaned and ice packs applied to cool the
area.
Mild topical steroid with antibiotic may be used for a
short time post procedure to minimize redness, swelling
and any erosions/scabs that may arise after treatment.
The patient is encouraged to use sun block post
procedure.

50. LASER HAIR REMOVAL
PROCEDURE
The laser treatment is repeated at 4-8 weekly intervals
(depending on the site and re-growth of the hairs).
Multiple sessions are generally necessary to achieve
sufficient reduction of the unwanted hairs.
Written instructions on post treatment care and follow
up is suggested.
Patient is encouraged to report any adverse effects such
as blistering, crusting, scabbing, herpetic lesions on the
treatment area.

51. How Many Treatments?...
No way to predict exactly how many treatments each
patient requires to achieve good clearance –individual!
Averagenumber is 4-8treatments for dark hair under
normal circumstances
Averagenumber is 8-12for light/fine hair
Facial hair and men’s chest/back usually require more
treatments than average because of follicle density and
hormone involvement
Medical conditions, drugs, hirsutism, hormone changes are
factors that influence hair growth= may require more
treatments than average
Maintenancetreatments depends on how much and when
re-growth occurs

52. Treatment Intervals
Subsequent RxsFirst 3 RxsArea
When re-growth
appears
(about 2 months)
Every 4-6 weeksFacial
When re-growth
appears
(about 3 months)
Every 6-8 weeksBody
These are guidelines based on typical cycle time of follicles

53. Hair Removal End Point
Immediate response:
-Perifollicular erythema and/or edema
-No visible change
Long term effect:
-Synchronization of hair growth
-Long-term or permanent hair reduction, resulting from
destruction of follicles followed by their degeneration
and replacement by fibrotic tissue
-Hair growth delayexpressed as miniaturization of
coarse hair follicles to vellus-likefollicles

56. Before After

57. Before
6Months after
3 treatments
Immediate
response

58. Hair Removal Treatment
Number of
Sessions: 2
Pre-treatment Post-treatment
Follow-up:
10 months

59. Before 6months following
3 treatments

60. Three
Months
After 1
treatment

61. Thank You