LASER Hair Removal by using Medio shoer High Power Diode Laser

The laser hair removal system a work using the principal of selective photothermolysis, in which a carefully timed pulse of laser energy passes through the skin and is absorbed and converted to heat energy at the hair follicle. Because of 800nm wavelength laser light penetrates deeper.

Laser Hair Removal works best in lighter skinned, darker haired patients. Because the target chromophore in hair follicles is melanin pigment, less laser energy is absorbed by the skin and more by the hair follicle. Tanned skin also "robs" laser energy as it passes through the skin to the hair follicle. The Diode lasers are less dependent on skin color than the ruby and alexandrite lasers. Because the pigment in the hair is the target for the laser energy, gray or white hair (which lacks pigment) cannot be effectively treated with any laser or light-based device.

Multiple laser treatments are necessary for best results: Laser energy has its greatest effect on growing, or anagen hair follicles; as the dormant, or telogen hairs become active, usually within 3 weeks to 3 months, some new hair growth will be observed. Usually at least 3 treatments over the course of a year will be necessary for satisfactory, long-lasting results. The female face, armpits, and bikini lines are areas which respond fastest to laser treatments- backs, arms and legs usually need more treatments over time. The scalp is very resistant to treatment.

Repeated laser treatments appear to induce a permanent reduction in the amount of visible hair: Although current studies have shown a "permanent" reduction in hair growth, some hair regrowth may occur over time, although this is usually much slower and much finer than before treatment. Imagine a garden overgrown with weeds-after the first few weeding sessions, only occasional "touch-ups" are needed. True "permanent" "total" hair removal may be possible with repeated treatments over time.

• The area to be treated may be clipped or shaved, and a cooling gel is applied. For small, curved areas, such as the chin, a grid is marked out directly on the skin, and on larger, flatter areas, such as the bikini line, chest, or back, a transparent plastic guide grid is placed over the gel to assure even treatment.
• Laser pulses are then applied over the marked area. Discomfort ranges from absent, in light-skinned individuals with coarse hair, to mild stinging in patients with darker skin or more hair follicles. An anesthetic cream can be used before treatments in extremely sensitive patients.
• In the weeks following treatment, hair shafts may extrude from the damaged follicles, and may mimic the appearance of regrowth. These may be left to fall out, or they may simply be plucked. The area can be treated again when dormant follicles become active, usually about a month on the face, and longer for other body areas.
  
  

	Before		After

Hair does not have to be grown out, and should not be plucked or few weaks before this removes the hair shaft and decreases the effect of the laser. Please inform us if you are taking any medications, using any prescription creams or ointments such as Renova or Retin-A, or if you are pregnant.

Forearms ("arms")	Chest	Abdomen	Thighs	Legs

	Laser Hair Removal Chart
Back		Buttocks

The New Look Laser Clinic is using Medio Star High Power Diode Laser Which is USFDA-approved safe and effective for Laser Hair Reduction. Clinical trials have shown good reduction in hair count after a single treatment, with complete destruction of most actively growing hair follicles. Indications are that this laser system may yield the most "permanent" hair removal, in the sense that individual hairs are gone forever. As with other laser hair removal systems, multiple treatments are necessary, and gray or white hairs are resistant to treatment. In our experience, we've seen no skin discoloration or blistering, even in patients with very dark skin. Discomfort during treatment depends on the thickness of hair in the areas to be treated. Discomfort can be managed by decreasing the fluence (which may make more treatments necessary), cooling the skin with ice packs just before treatment, or applying anesthetic cream when necessary. For extremely sensitive areas, such as dense, coarse facial hair, local anaesthetic can be used.

Male pattern facial hair in a female, pre-treatment (left), 2 months after 3 Medio after Medio Star High Power Diode Laser Treatments

About Hair:

Hair is a dermal appendage found almost everywhere on the human body except the palms, soles, and lips. Vellus hairs are fine, colorless hairs ("peachfuzz") covering most of the body, except those areas covered with Terminal hairs, which are coarse pigmented hairs found on the scalp and eyebrows. Vellus hairs can transform into terminal hairs when stimulated by androgens (male sex hormones), especially those on the face, back, chest, abdomen, axillae (armpits) and genitalia at puberty. Vellus hairs can tranform into terminal hairs with aging. The number of hair follicles present in the skin is fixed at birth.

The hair shaft is composed of the protein keratin and is produced in the lower part of the follicle, or bulb. The middle part of the follicle contains the opening for a sebaceous gland, the attachment of the arrector pilii muscle, and a thickened area in the root sheath called the "bulge", which is believed to contain stem cells important for regeneration of the hair follicle. Melanin is produced in the bulb and possibly in the bulge, and concentrated in the hair shaft and upper part of the bulb. Depending on the thickness of the skin, the bulb may be as deep as 7mm, below the skin in the subcutaneous tissue. Actively growing, or anagen hair follicles are longest and deepest, while follicles just coming out of dormancy, the bulb is much more superficial (see hair cycle, below)

Melanin is the pigment which gives both hair and skin its color. Much more melanin is present in hair than in skin, and this property allows relatively more absorption of laser light energy in hair than in skin (see below). Hair color is determined not only by the absolute amount of melanin, but by the relative amounts of black-brown eumelanin and reddish brown pheomelanin, and refraction of light within the layers of the hair shaft itself.

Hair growth cycle: Hair growth occurs in cycles throughout an individual's lifetime. Active hair growth is called Anagen, and the length of the anagen phase determines the length of the hair. Scalp hairs may remain in the anagen for up to 3 years. Hair follicles then enter Catagen, a phase of regression which lasts a few weeks. The Telogen, or resting phase, can last for months, depending inversely on the number of actively growing hairs in the area, ie. the scalp has a shorter telogen phase than the chest. As anagen resumes, the hair follicle lengthens, the bulb descends deeper into the skin, and the old hair shaft is gradually shed. In humans, individual hair follicles are more or less independent, with most hairs in anagen at any given time. In animals which shed their hair, the follicles cycle more or less simultaneously.

Physical Basis for Laser Hair Removal: Laser Hair Removal is based on the principle of selective photothermolysis, in which energy is delivered to the treatment area in such a manner as to maximize tissue damage to the hair follicle while sparing the skin and surrounding tissue. Melanin pigment makes a logical target chromophore, because it's most abundant in the hair bulb, which is believed to be the most important target for hair removal, much less abundant in epidermis, even in dark-skinned patients, and it absorbs well in the skin's "optical window" between 600-900nm.

Wavelengths under 600nm are strongly absorbed by hemoglobin and protein (scatter), and wavelengths above 900nm are strongly absorbed by water in tissue. Skin is relatively "transparent" in the 600-900nm range, with melanin-bearing structures as the most attractive target for laser energy.
Melanin absorption decreases with increasing wavelength. Ruby laser light at 694nm is strongly absorbed by melanin, not only in hair but in epidermis, so epidermal melanin content limits the depth of penetration and energy fluence that can be used without unacceptable thermal injury to the skin. Nd:YAG laser light at 1064nm is much less strongly absorbed by melanin as well as other chromophores present in skin, and therefore penetrates much more deeply and with minimal epidermal reaction and collateral heating. These properties can be exploited clinically, as outlined below.

Diode Laser: Solid state 800nm diode lasers feature a longer wavelength and pulsewidth, theoretically offering an advantage in treating darker skinned patients. The Aesculap-Meditec MeDioStar has obtained the USFDA approved for Permananent hair reduction.

Q-Switched Nd:YAG: With a wavelength of 1064nm, relatively low melanin absorption, and skin penetration up to 5mm, the Nd:YAG laser is an excellent choice for laser hair removal, at least in theory. However, the nanosecond-range pulse width of the Q-Switched YAG is thousands of times too short to cause complete disruption of the hair follicle, resulting in prompt hair regrowth. In order to enhance absorption of energy, a suspension of carbon particles can applied before treatment, usually after hair removal by waxing, allowing the carbon suspension to penetrate into the follicle and conduct absorbed laser energy to the follicular structures, as in theThermolase SoftLight system. Although safe for darker-skinned patients and effective for short term hair reduction, the Q-Switched Nd:YAG is generally considered the least effective laser for long-term hair reduction.

Photodynamic Therapy: In photodynamic therapy a photosensitizing compound is applied topically to hair-bearing skin after waxing, to allow the compound to enter the now-empty hair follicle. The area is then irradiated with laser light to activate the photosensitizer, which releases toxic oxygen radicals that damage the hair follicles. Currently in the investigational stage, preliminary studies have demonstrated up to 40% hair loss at 6 months after a single treatment. Photodynamic therapy has been used with limited success for certain malignant tumors, but the lack of safe, effective, selective photosensitizers have limited its use.

Practical Aspects of Laser Hair Removal:

Preoperative evaluation: The most important consideration with Laser Hair Removal is the patient's skin type and hair color. The differential absorption of melanin in the hair follicle and melanin in the epidermis determines the amount of energy that can be safely used. The Ideal Patient has light (type I) skin with black hair, and a patient with very dark (type VI) skin with white or grey hair would have little if any response. Presumably because of the absence of melanin, no currently available device works well in patients with canites, or grey hair.

An underlying cause for the excess hair, if present, should be corrected. These causes may include endocrine abnormalities and medication effect, including minoxidil, steroids, oral contraceptives, and some immunosuppressive agents.

Contraindications to Laser Hair Removal include patients who have healed poorly after other types of laser treatments, patients prone to skin discoloration, patients with grey or white hair, and patients who are pregnant. There's no scientific evidence to suggest that laser light used in hair removal can injure a fetus, but the question of injury will not arise should any fetal problems occur. Patients who are tanned should wait for the tan to fade for best results, and patients using photosensitizing medication such as Accutane, tetracycline, or Retin-A should discontinue the medication weeks, and for Accutane, months before treatment. Herpes Simplex Labialis (fever blisters) can be activated by Laser Hair Removal, especially on the upper lip, and patients with a tendency for fever blistering can be started on antiviral medication before treatment.

Preoperative preparation: Hair should not be plucked or waxed before treatment. This removes the hair shaft from the follicle, thus removing most of the melanin chromophore. Hair may be shaved, which preserves the chromophore in the follicle, and prevent dispersion of energy by external hair. Lotions, cosmetics, and other skin preparations should be avoided on the day of treatment.

Postoperative care: In most cases, little specific postoperative care is necessary. Mild burning sensations and redness can be treated with ice packs and oral pain medication. In cases where blistering occurs, topical antibiotic cream and a non-adherent dressing can be applied. Sun exposure should be avoided, and an SPF 15 or greater sunblock should be used. Moisturizing lotions and makeup may be applied the next day. During the weeks after treatment, damaged hair follicles and hair shafts are extruded or shed, and may be misinterpreted as early regrowth of hair. This is especially noticeable in areas with thick, coarse hair.

Efficacy of Laser Hair Removal: The "permanence" of Laser Hair Removal is often called into question. In practice, no laser destroys all of the hair follicles. Some follicles are destroyed, others are miniaturized into vellus hairs, and some are shocked into prolonged dormancy. Multiple treatments are needed for best results, and the best interval for treatment is when new hair regrowth is observed, usually 6 to 12 weeks after the first treatment, and 3 to 6 months after the second treatment. In most cases there will be visible improvement within a week after the first treatment. Repeat treatments can be performed at suitable intervals.

It's possible that with a sufficient number of treatments, true "permanent hair removal" can be ultimately achieved, but not for every single hair present in a given area. As an example, only 30% of hair follicles on the back are in anagen (active growth) at a given time-70% of the hair follicles are in telogen (dormant), even though they may contain visible hairs. Assuming a single laser treatment permanently eliminates every actively growing follicle (the actual figure may be closer to half), 70% of the hair follicles originally present may eventually sprout visible hair. After 3 months (the average length of dormancy on the back), 30% of the remaing follicles will enter anagen, and if a second laser treatment eliminates every actively growing follicle (30% of the 70% remaining after the first treatment), then only an additional 21% of the original hair follicles will be destroyed, leaving 49% of the original hair follicles able to regrow visible hair. A third treatment will leave 34% of the orginal follicles, a fourth 24%, and so on. In actual practice, some of the follicles are shocked into prolonged dormancy, or converted to vellus hairs, so the visible effect is greater than suggested by the percentages. Experience to date with laser hair reduction suggests that the hair reduction achieved is "permanent".