A discussion of Laser Hair Removal by John Keller M.D. Ph.D., Board Certified Laser Physician of Toronto Ontario.

Many patients ask about the need for test spots prior to treatment. Many non-medical spas advertise that they do these for free, and suggest they are vital for better results. In fact, there are several published articles in peer-reviewed journals that demonstrate test-spotting really is of little use. This is because patients often will develop mild side effects like hyperpigmentation or crusting, which always resolve, even after several treatments at the same laser settings. They are unpredicatable. At our clinic we only test spot type 6 skin. In other cases, using moderate settings, and carefully monitoring the first treatment is the best route to safe, effective treatment.

Patients often ask why we recommend that they are not tanned when they undergo laser hair removal. Many spas claim to have "lasers" that allow patients to be treated when tanned. The simple truth is that it is always best if you have been sun free for at least 8 - 12 weeks prior to laser hair removal. This is because all laser and light systems target the pigment in the hair, melanin, to destroy it. When you tan you increase the melanin in your skin as well, and the laser can target the skin as well. No matter what laser is used, the energy must be turned down, compared to tan free skin, and the risk of complications greatly increase. Tan free equal better, safer results, period.

Patients often wonder if laser hair removal is a painful process. Generally it is not. Some lasers, like the Yag or Diode, penetrate a little deeper, and can cause some discomfort. The vast majortiy of patients tolerate laser hair removal without any form of anesthetic. At our clinic, we use an alexandrite laser, and we find perhaps 5% of patients require some topical freezing gel. Certain areas require freezing more than others, just as male backs or faces, and occasionaly bikini lines in females. But overall it is very unusual for a patient not to continue treatment becasue of discomfort.

Patients often ask whether laser hair removal is permanent. It is important to understand the distinction between "permanent" hair removal and "total" hair removal. "Permanent" removal is usually defined as the destruction of a hair follicle, and its not regrowing for a period of one year. This means that the hair will not re-grow and is gone forever, because it is passed the time when a new cycle would occur. Powerful laser systems, like the Gentlease or diode lasers, achieve this - they permanently destroy the hair. "Total" removal means 100% of all the patients hairs are destroyed. Unfortunately this is not always achievable, because some hair bulbs do lie below the penetration of the laser. But a properly done treatment, with the right laser can come close to achieving this "total" removal in many cases, though some areas are more difficult than others.

Can laser hair removal work on blond or white hairs? The answer is that, while certain companies claim that their intense pulsed light or radio frequency devices can do this, it is simply to early to tell. There is no real hard evidence, or at least not enough of it, in my opinion, to be sure that these claims are accurate. True lasers operate by being absorbed by the dark pigment in the hair shaft and bulb, and then burning and destroying it. There is not enough pigment in blond hair or white hair to allow the laser to do its work, and so, only patients with moderate brown and darker hair are generally good candidates for laser hair removal.