Shining a Light on the Pros and Cons of Laser Hair Removal

In a culture where hair on the head is the only kind that's prized, laser hair removal has joined a bevy of other cosmetic procedures in popularity. Despite its growing use, however, the treatment is not a one-size-fits-all solution for getting rid of unwanted hair.

Available since the 1970s and generally considered safe, laser hair removal aims intense, pulsating light beams at hair follicles, damaging them and deterring future hair growth.

"Our culture is beauty-centric, and this is a non-surgical, relatively inexpensive thing to do," said Dr. David Goldberg, a dermatologist practicing in New York, Florida and Massachusetts who has written a textbook on laser hair removal. In the last five years, laser hair removal has become "extraordinarily popular," Goldberg said.

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How it works

Hair follicles can be destroyed when pigment molecules within them absorb the energy in the laser beam.

However, this means the treatment works best on those with light skin (which contains little pigment) and dark hair (which contains much pigment).

Until recently, laser hair removal didn't work on people with darker skin because the pigment in their skin would absorb the laser's energy and heat up along with the hair follicles, causing the skin to burn. Newer equipment now makes treating darker-skinned people possible, but burning remains a considerable challenge, according to physicians.

Similarly, because blonde, gray and white hairs have little pigment, laser removal is not as effective on them. In these cases, a better alternative is electrolysis, which kills hair follicles by zapping them with a needle that delivers mild electric current, said Dr. Russell Kridel, a Houston plastic surgeon and laser expert.

Laser treatments and electrolysis each have their pros and cons. Lasers can damage large areas of follicles at once, such as on the legs and back and in the bikini area, while electrolysis destroys follicles one at a time. Electrolysis eradicates hair permanently, while laser hair removal may need regular maintenance treatments to keep hair away, and in stubborn cases may not achieve this.

Normal hair growth and dormancy cycles make it necessary to receive six to eight laser treatments, spaced six to 10 weeks apart, because only hair in a growth phase is susceptible to the treatment, Kridel said.

"Some people only have a few facial hairs they want to get rid of," Kridel said, "so for them, it makes more sense to use electrolysis."

According to the Cleveland Clinic, several types of lasers are used for hair reduction, including:

• Ruby laser: Best for use on fine and light hair, the Ruby laser is the oldest type. Darker-skinned or tanned patients are not candidates for this treatment due to a high risk of burns.
• Alexandrite laser: Safe for light and olive complexions, the Alexandrite laser can quickly treat large body areas and is one of the most widely used.
• Diode laser: This is most effective for darker skin, but does not work as well for finer, lighter hair. It also can rapidly treat large areas.
• Nd: YAG laser: Safe for all skin types, this laser may cause more discomfort than other lasers.
• Intense Pulsed Light (IPL) Devices: IPLs are not lasers per se, but work on the same principle. They are typically found in spas offering hair removal, Kridel said, and may not be as safe or effective because poorly trained and less-experienced technicians often administer the treatments.

Does it work?

Not everyone who undergoes laser hair removal is satisfied with the long-term results. Ken Howard, 45, underwent laser hair removal and said those who treated him implied that the hair treated on his back and shoulders would be gone forever, which is far from the case.

"I have more hair there than ever before," said the West Hollywood, Calif., resident, who had about 10 sessions between 2002 and 2006, and paid about $200 per session. "I was told there was permanent destruction of the hair follicles. I feel kind of ripped off by it."

Goldberg and Kridel, however, say their patients are always told their hair may grow back, depending on factors such as type and texture of their hair and their hormone levels.

"We're very careful to educate patients on the front end," Kridel said, "and while there's almost always a reduction in hair, there's not a permanent loss in all cases."

If hair grows back, it sometimes is thinner and wispier, he added.

Both doctors also advised that patients be aware of the stinging involved in laser hair removal — a pain akin to having a rubber band snapped against the skin. Howard described it as "endurable but painful."

The doctors also cautioned that the procedure is not risk-free.

"In the worst cases, it has been darker-skinned people being burned in spas that used the wrong machines," said Goldberg, who, like Kridel, strongly recommends consumers seek only physicians and their staff to receive laser treatment, which is currently  unregulated.

"That's not the fault of the machine," Goldberg said. "That's the fault of the person doing it."

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