Patients often desire the removal of hair for both cosmetic and medical reasons. Shaving, waxing, or chemical depilatories have traditionally achieved temporary hair removal. Electrolysis provides permanent hair removal of individual hairs. However, to reduce hair from large areas for extended periods of time, laser hair removal has become more mainstream. Below are pearls and pitfalls of laser hair removal taken from the Cosmetic Dermatology Procedure Manual.
Pearls:
1. Know the risks and remember to warn your patients of them. The most common risks are pigmentary changes, infection, and incomplete hair removal. One dreaded risk is paradoxical hair stimulation.
2. If patients complain that the treatment is too painful, or more painful than previous treatments, stop—something may be wrong. Make sure cooling systems are working properly, the settings are correct, and that the laser is working properly. Many complications could be minimized or avoided if practitioners listened to the patient warnings.
3. Patients with fillings near the front teeth may experience discomfort with treatment of the upper lip area. Placement of wet gauze under the lip during treatment will ease patient discomfort.
4. Test spots in inconspicuous areas at different fluences can be used to determine a patient’s response. Although these may be helpful, they do not ensure that no complication will occur.
5. Remember to create reasonable expectations, and treat patients with the respect you would require. Often, the average number of laser treatments required is between five and seven. Most patients then require maintenance a few years later. In order to evaluate long-term hair loss, treatments must be discontinued for six months.
Pitfalls:
1. The treatment of darker skinned patients should be performed only be experienced physicians, as it is challenging and is accompanied by an increased risk of side effects.
2. Treating suntanned patients is one of the most common reasons for LHR complications. Do not be afraid to refuse treatment in a tanned patient. Insist on waiting until the tan has faded.
3. Lasers used for hair removal may be absorbed by nevi. Examine pigmented lesions prior to treating hair overlying them. Do not treat over suspicious lesions without a biopsy.
4. Likewise, lasers used for hair removal may also be absorbed by tattoos. Do not treat over tattoos, as this may change their appearance and it may increase the risk of side effects.
5. Prophylaxis for herpes simplex should be given when treating the periorificial areas in patients with a prior history.
Whether or not you choose to offer Laser Hair Removal into your practice, be sure to do your homework. Take these pearls and pitfalls into consideration, ask your patients if there is any interest, and talk to your mentors about the best ways on integrating.
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