PracticalDermatology

Is Laser Hair Removal a Viable Option?

Thoughts from H.L. Greenberg, MD

Is laser hair removal viable in a medical-aesthetic practice? Absolutely, yes! Does having a laser hair removal machine mean that it is going to be instantly successful and pay for itself? Absolutely not! You need a strategy to feed your machine and generate revenue.

What is a reasonable strategy for your laser hair removal business? First and foremost, you need excellent technology. At Las Vegas Dermatology, we have two lasers for hair removal—a 755nm Alexandrite Laser for light skinned patients and a 1064nm Nd:YAG laser for darker skinned patients—both by Cynosure. Some people like an 810nm diode machine and others like IPL devices for hair removal, but I don’t find them as effective as our machines.

Now that you have chosen your technology, you need to focus on how you will get patients through the door and make them aware of your services. Internal marketing is essential to growing your laser hair removal business. Each new patient and patients who haven’t been seen in the past year fills out a cosmetic interest questionnaire, which includes a question on laser hair removal interest. If you’re not prepared to follow up on the question, don’t ask it. My staff is getting better at following up on our questionnaire, leaving a laser hair removal brochure and price sheet with the patient while they are waiting for their regular medical appointment when the laser hair removal interest box is checked.

Next, choose your laser hair removal candidates wisely. It is easiest to deal with already educated patients who have seen a video on or read about laser hair removal. Once the pump is primed, and the patient is more aware of how lasers work, I briefly discuss the technology of laser hair removal with the patient including the proper length of hair for the procedure and emphasize that it is permanent hair reduction, with most patients requiring six treatments for most areas, but others requiring more depending on their response to the laser.

Additionally, I make people aware that even when treatments are complete, they may need touch ups for that occasional, “Wolf-woman” or “Wolf-man” hair that pops up.

Targeting Tattoos

Thoughts from Will Kirby, DO, FAOCD

The use of selective, pulsed lasers is considered the gold standard means to remove unwanted tattoo ink because of the ability to selectively target the ink chromophore and minimize damage to the surrounding healthy tissue. The unfortunate fact, however, is that these lasers treatments are uncomfortable and require multiple treatments. That said, selective laser treatment is still the best option available and it is predicated by two overlying concepts: selective photothermolysis and wavelength of light extruded by the device.

Tattoo removal was revolutionized by Anderson and Parrish’s principle of selective photothermolysis. They postulated that if a wavelength was well absorbed by the target (tattoo pigment) and the pulse width was equal to or shorter than the target’s thermal relaxation time, the heat generated would be confined to the target. With the advent of Q-switched (QS) lasers operating in the billionth of a second range and picosecond (Pico) lasers operating in a trillionth of a second range, efficient tattoo removal has become a reality for many.

Different tattoo ink colors preferentially absorb different wavelengths of light. A wavelength is chosen to achieve selective absorption for that ink color while minimizing the nonspecific thermal effects from the surrounding hemoglobin and melanin. The wavelengths available for the QS lasers include the Ruby (694nm), the Alexandrite (755nm), and the Nd:YAG (1064/532nm). The wavelengths available for the Pico second lasers include Alexandrite and the Nd:YAG.

Since many laser treatments are needed to remove a tattoo, regardless of the device manufacturer chosen, it remains to be seen if the promised theoretical advantages of a new technology will offer a true improvement. Healthcare providers have an ethical obligation to educate themselves on nuances of treatment options and offer patients complete and accurate information.

As with any procedure, a patient must have realistic expectations if a successful outcome is to be obtained. Patients must be informed that they will need to undergo multiple treatment sessions to remove a tattoo, that treatments may be painful, and that they must adhere to post-treatment care instructions to avoid unwanted side effects.

While QS and Pico lasers provide a dramatic improvement over previous tattoo removal modalities, it is possible that we will see even more efficient removal techniques in the future with the use of femtosecond (one quadrillionth of a second) lasers. We may also see “tunable” lasers that offer a wider array of wavelengths to choose from. n

 Want more? Look for Dr. Greenberg’s full discussion of the viability of laser hair removal and Dr. Kirby’s full discussion of tattoo removal in the September/October edition of Modern Aesthetics®.