LASER HAIR REMOVAL

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Most consumers think "permanent" means lasting forever. Unfortunately, that's not always the case as it's used in advertising. For instance, a permanent wave in your hair is not really permanent, and a permanent marker is not necessarily permanent.

It's difficult to assess a new hair removal method that claims to be permanent. Most people figure that after a certain amount of time, it's unlikely that a hair will ever return. That's why several people, myself included, have suggested a specific definition of "permanent." Some of these definitions seem inadequate to me. One manufacturer claims their device is permanent based on results after 9 weeks. That's ridiculous. Waxing can last that long, and it's been clinically proven temporary.

Permanent hair removal

For the purposes of hair removal, the hairfacts definition of "permanent" is being able to go a year after your final hair removal treatment without having to use another method of hair removal. Keep in mind that a year might not be long enough to determine true permanence, but most consumers would be happy to have one treatment a year.

The only method of clinically proven permanent hair removal is electrolysis. Some lasers and flash lamps have been able to achieve permanent hair reduction, as discussed below.

Long-term hair removal

Another undefined term is "long-term" hair removal. Again, it depends on what your definition of "long" is. The hairfacts definition of "long-term" is being able to go 6 months after your final treatment without having to use another method of hair removal. Your definition may vary, but I don't consider 9 weeks to be long-term. I arbitrarily decided on 6 months as a working definition, because most hair growth cycles will have completed in 6 months.

Semi-permanent hair removal

A newer term used by some hair removal marketers is "semi-permanent hair removal." This is a marketing term used in the salon industry that some salons have started using to describe laser results. In the salon industry, it means "lasting a few weeks."

Hair reduction vs. hair removal

Permanent hair removal has been established as the complete destruction of a hair follicle's ability to regenerate and grow hair.

Several lasers have demonstrated permanent hair reduction in clinical studies and are allowed to make this claim by FDA. The word "reduction" adds another term that is vaguely defined. FDA has accepted the definition of reduction as a stable reduction in the number of coarse dark hairs. Some lasers have demonstrated in clinical testing that they can reduce the size of hairs and lighten the color. In some patients, this reduction appears to be permanent

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Basic facts

Permanent hair removal for most consumers if performed correctly (which requires considerable training and skill).

Description

A hair-thin metal probe is slid into a hair follicle.

Proper insertion does not puncture the skin.

Electricity is delivered to the follicle through the probe, which causes localized damage to the areas that generate hairs.

Advantages

By far the best and longest track record of results.

Over 125 years of clinically proven safety and effectiveness. [1]

Disadvantages

Can be expensive.

Can be painful.

Can be tedious.

Can be difficult for large amounts of hair.

If done improperly, it can result in:

partial to full regrowth

lasting skin damage

spread of infection

Regulation varies by state, so inadequate controls exist to ensure competent practitioners.

Regrowth rates have not been accurately established and cannot be predicted due to numerous variables.

Some consumers do not respond to treatment.

Quack claims

"Painless" or "virtually painless"

While many clients tolerate electrolysis without requiring pain relief, it's overpromise to state that treatment will be painless for all consumers.

"100% permanent"

The vast majority of patients experience permanent removal of treated hair over the course of treatment, but published studies have observed that between 7% and 10% of consumers did not have satisfactory results.

"Guaranteed 0% regrowth"

There is no published clinical data to substantiate this sort of overpromise.

"Easy to use" personal units

Small battery-powered probe units like the One Touch may claim to be easy to use, but performing electrolysis on yourself is very difficult and not recommended

With over 125 years of clinically proven safety and effectiveness, [1] electrolysis can be a permanent hair removal option when properly performed. Performing electrolysis on yourself is very difficult and not recommended. [2, 3]

Background

Three kinds of energy are used:

Galvanic electrolysis works by causing salt and water in the skin around the probe to be chemically altered to produce a small amount of sodium hydroxide, or lye. Lye is the active ingredient in some crystal drain openers. If enough is produced, it can damage the cells that cause hair growth. The chemical reaction is expressed like this:

NaCl (salt) + H2O (water) + direct current = NaOH (sodium hydroxide) + Cl (chlorine) + H (hydrogen)

Thermolysis works by causing water molecules in the skin around the probe to vibrate, which creates heat. If enough heat is produced, it can damage the cells that cause hair growth.

Blend is based on the theory that lye is more caustic when heated. Theoretically, blend is more effective than other methods if performed correctly. Blend is recommended by several experts, [4, 5, 6] but electrologist skill is by far the most important factor in safe and effective treatment.

History

Although several researchers were apparently experimenting with electrical epilation after the Civil War, it's generally accepted that St. Louis ophthalmologist Charles Michel was the first to discover and publish permanent hair removal results with an electrified needle. [7]

In 1875, Dr. Michel reported he had been successfully using a battery-powered needle epilator to treat ingrown eyelashes (trichiasis) since 1869. [8] This DC powered method was called electrolysis because a chemical reaction in the hair follicle causes sodium hydroxide to form, which damages the follicle. It's also sometimes called galvanic electrolysis.

Use of electrolysis for hair removal continued through the early part of the 20th century. Its commercial popularity as a cosmetic treatment was briefly eclipsed by x-ray hair removal, which was advertised as both "painless" and "harmless" (only one of which was true, of course).

Subsequent innovations in the field included the use of multiple needles, developed by Paul Kree in 1916, and the use of AC electricity, which causes thermal damage within the follicle. [9] This was first reported in medical literature in 1924 by Dr. Henri Bordier, following over a decade of experimentation by numerous researchers. [10] This method was called diathermy by Bordier and is also called thermolysis, short-wave, high-frequency (HF), radio-frequency (RF), etc.

Incremental improvements in the equipment and technique continued through World War II. At that time, Arthur Hinkel and Henri St. Pierre applied for a patent for a blend method they'd been developing. They received their patent in 1948, and 20 years later published the groundbreaking book Electrolysis, Thermolysis and the Blend, discussing their use of scientific techniques to improve the method. [11] In the wake of Hinkel's book, several other useful practical overviews have been written. [4, 5, 6]

The second half of the 20th century saw more incremental equipment improvements incorporating transistors and computerized controls, as well as insulated probes and sterile disposable probes.

Despite improvements in equipment, electrolysis remains highly dependent on the skill of the practitioner. Electrolysis trade groups have set standards for member certification, but many U.S. states do not regulate the practice of electrolysis. [12] For this reason, it's very important for consumers to go to a practitioner recommended by someone who is done and happy with the results.

Clinical data

Following a long absence from medical literature, electrolysis was once again taken up as an issue worthy of research in the latter part of the 20th century. [13, 14]. Good review articles by physicians [15, 16] complement the practice manuals by professional electrologists. [4, 6, 11]. The best electrolysis book written and edited by a physician is Richards. [5]

Electrolysis improperly performed or performed on non-normal skin can cause scarring, [17] spread infection, [18] and potentially cause isomorphic outbreaks or spread of lesions. [19]

One well-designed study found that about 2% of women under 50 who seek electrolysis have an undiagnosed glucose intolerance. [20]

Two studies, one small and one large, respectively demonstrated that 90% to 93% of consumers have satisfactory results [21, 22]

Two well-designed Japanese studies demonstrate permanence in treating underamrs. The thermolysis study showed "little to no regrowth" at 6 to 36 months after 3 to 8 treatments to the underarm. [23] The blend study observed no regrowth at 6 months after 7 to 14 treatments, while comparative plucking resulted in no significant hair removal at 6 months. [24]

References

Please see my selected list of published electrolysis medical literature.
Caldwell IW. The electronic pencil. British Medical Journal, 1972, 03 Jun(813):591-592.
Please see hairfacts.com for a discussion of home-use personal electrolysis units: cons and pros.
Gior F. Modern Electrology: Excess Hair, Its Causes and Treatments, 3d ed. 2000 and Published by Hair Publishing, Inc., Roslyn, New York 11576. (previous edition from Tarrytown NY: Milady Publishing, 1987) ISBN: 0-87350-413-5
Richards RN, Meharg GE. Cosmetic and Medical Electrolysis and Temporary Hair Removal: A practice manual and reference guide. Toronto: Medric Ltd. 1991. ISBN: 0-9694746-0-1. Pages 37-40.
Bono M. Real world electrology: the blend method. Santa Barbara, CA: Tortoise Press, 1994. ISBN: 0-9642682-0-5
But see Wagner RF Jr, Brysk H, Tyring SK. Revisiting the Michel/Green controversy of 1879: was Carron du Villards the first to use probe/needle electrolysis for permanent hair destruction? International Journal of Dermatology 1997 Dec;36(12):947-51.
Michel CE. Trichiasis and distichiasis; with an improved method for radical treatment. St. Louis Clinical Record, 1875 Oct; 2:145-148
Richards (1991) page 39. Available online via American Electrology Association.
Bordier H. [New treatment for hypertrichosis with diathermy]. Vie Medicale, 1924, 5:561 [article in French]
Hinkel AR, Lind RW. Electrolysis, Thermolysis and the Blend: the principles and practice of permanent hair removal. Los Angeles, CA: Arroway Publishers, 1968. ISBN 0-9600284-1-2
Please see hairfacts.com for a list of states that regulate electrolysis.
Chernosky ME. Permanent removal of superfluous hair. Texas Medicine, 1971, 67:72-78.
Johnson E. Epilation of growing hair follicles. Journal of Expermimental Zoology 1975 May;192(2):259-63.
Wagner RF Jr, Tomich JM, Grande DJ. Electrolysis and thermolysis for permanent hair removal. Journal of the American Academy of Dermatology 1985 Mar;12(3):441-9.
Hobbs ER, Ratz JL, James B. Electrosurgical epilation. Dermatologic Clinics 1987 Apr;5(2):437-44.
Vogt HJ [Formation of keloids after electroepilation]. [Article in German] Hautarzt 1973 May;24(5):203-4.
Ditmars DM Jr, Maguina P. Neck skin sporotrichosis after electrolysis. Plastic and Reconstructive Surgery 1998 Feb;101(2):504-6.
Petrozzi JW. Verrucae planae spread by electrolysis. Cutis, 1980, 26:85.
Dumesic DA, Herrmann RR, O'Brien AM. Estimated prevalence of undiagnosed glucose intolerance from hyperandrogenic anovulation among women requesting electrolysis. International Journal of Fertility and Womens Medicine 1997 Jul-Aug;42(4):255-60.
Verdich J [Treatment of hypertrichosis in women by means of electroepilation] Ugeskrift for Laeger, 141:2056-2057.
Richards RN, Meharg GE. Electrolysis: observations from 13 years and 140,000 hours of experience. Journal of the American Academy of Dermatology. 1995 Oct;33(4):662-6.
Kobayashi T, Kamiyama G. Electroepilation using insulated needles. Aesthetic Plastic

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Some consumers have experienced permanent hair reduction, but there is limited data on how long hair reduction usually lasts, how much hair reduction is typical, and how often permanent hair reduction occurs.

Description

Light at a specified wavelength is delivered from a handpiece into the skin, where it targets dark material (usually the pigment in hair).

This is intended to cause thermal and/or mechanical damage to a hair follicle while sparing surrounding tissues.

Advantages

Some consumers have experienced long-lasting hair removal or permanent hair reduction.

Considered safe if performed properly.

Useful for large areas such as backs or legs.

Regrowth can come back lighter in color or finer in texture.

Light-skinned consumers with dark hair have the best results.

Disadvantages

Long-term data on safety and effectiveness have not been accurately established.

Response rates have not been established.

Regrowth rates have not been accurately established and cannot be predicted due to numerous variables.

Generally not as effective on unpigmented (gray) hairs and red or blonde hair.

Must be used very cautiously (if at all) on darker skin tones or on consumers who tan themselves.

Improper treatment can cause burns, lesions, skin discoloration lasting several months, or patchy/patterned regrowth.

Recent data suggest other skin structures are often affected by laser irradiation, and long term effects of this constitute an unknown risk.

Requires eye protection.

Can be expensive.

Some find treatment painful.

Regulation varies by state, so inadequate controls exist to ensure competent practitioners.

Some consumers, even ideal candidates, do not respond to treatment.

Quack claims

"Painless" or "virtually painless"

While many clients tolerate laser without requiring pain relief, it's overpromise to state that treatment will be painless for all consumers.

"Permanent hair removal" or "100% permanent" or "permanent"

Some consumers experience permanent reduction of treated hair over the course of treatment, but published studies have observed that many consumers are not good candidates, and even ideal candidates with light skin and dark hair do not always respond to treatment. See the page on permanent hair reduction below.

"Guaranteed 0% regrowth"

There is no published clinical data to substantiate this sort of overpromise.

"Laser electrolysis" or "lasertrolysis"

These quack marketing terms are used to blur important distinctions between laser and electrolysis effectiveness. Laser has several advantages over electrolysis, and vice versa. Terms like these only confuse consumers.

"Light years ahead of electrolysis"

This quack marketing term suggests that laser is better than electrolysis for consumers, but this is not always the case.

Other laser pages in this section

Due to the complicated issues surrounding this hair removal method, I have divided this into several sections. If you're researching a specific laser type or issue, you can go right to that topic. For a more thorough review, I recommend reading the pages in order.

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Basic facts

Some consumers have experienced permanent hair reduction, but there is limited data on how much hair reduction is typical, and how often hair reduction occurs.

Description

Full spectrum (non-coherent) light and low-range infrared radiation are filtered to allow a specified range of wavelengths.

This filtered light is delivered from a handpiece into the skin, where it targets dark material such as the pigment in hair.

This is intended to cause thermal and/or mechanical damage to a hair follicle while sparing surrounding tissues.

Advantages

Some consumers have experienced long-lasting hair removal or permanent hair reduction.

Considered safe if performed properly.

Useful for large areas such as backs or legs.

Regrowth can come back lighter in color or finer in texture.

Light-skinned consumers with dark hair have the best results.

Disadvantages

Long-term data on safety and effectiveness have not been established.

Response rates have not been established.

Not as effective on unpigmented hairs and red or blonde hair.

Must be used very cautiously on darker skin tones or on consumers who tan themselves.

Improper treatment can cause burns, skin discoloration lasting several months, or patchy/grid-like regrowth.

Requires eye protection.

Can be expensive.

Some find treatment painful.

Regulation varies by state, so inadequate controls exist to ensure competent practitioners.

Some consumers do not respond to treatment.

Quack claims

"Painless" or "virtually painless"

While many clients tolerate flashlamp without requiring pain relief, it's overpromise to state that treatment will be painless for all consumers.

"Permanent hair removal" or "100% permanent" or "permanent"

Some consumers experience permanent reduction of treated hair over the course of treatment, but published studies have observed that many consumers are not good candidates, and even ideal candidates with light skin and dark hair do not always respond to treatment.

"Guaranteed 0% regrowth"

There is no published clinical data to substantiate this sort of overpromise.

"Beyond laser"

This marketing term suggests that flashlamp is better than laser for consumers, but this is not always the case.

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Basic facts
For some, the best treatment involves fighting unwanted hair with several methods in combination.

Description:

Popular options include a temporary clearance followed by permanent method for maintenance, an antiandrogen in combination with a permanent method, or the prescription topical Vaniqa in combination with a permanent method.

Advantages:

Quick clearance at onset gives immedaite cosmetic improvement.

Topical or oral medications can reduce hair growth, making permanent methods more effective and less costly.

Disadvantages:

Expensive

Clinical data:

Most combinations have not been carefully studied in controlled consitions at this time.

Costs:

Vary widely

Background facts
Some consumers have had good results from fighting unwanted hair on several fronts. If you seek permanent hair removal, it is a good idea to discuss your options with a dermatologist. You may benefit from supplementing electrolysis or laser with an antiandrogen or topical drug like Vaniqa.

For some consumers, especially males treating large areas, starting with a temporary method like shaving and waxing can offer immediate cosmetic improvement, and then hairs can be treated as they come back in.

Some consumers with light colored skin and dark hair have benefitted from a few laser treatments, followed by electrolysis on hairs the laser couldn't treat.

Because of the number of possible combinations and the number of possible skin and hair types, space does not permit discussing every option. Please ask on the hair removal forum if you have a specific question.

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