Expanding Access to Laser Hair Removal

With Omar Ibrahimi, MD, PhD

Despite oft-cited concerns that laser hair removal would become commoditized, many dermatologists see demand for this treatment within their practices. And technology continues to evolve to increase treatment efficiency and comfort. Nonetheless, there is ongoing confusion in the public and even among some dermatologists about the ability to provide laser hair removal for patients with skin of color. Omar A. Ibrahimi, MD, PhD, founding and medical director of the Connecticut Skin Institute in Stamford, CT, addresses the safe and effective use of lasers for hair removal.

How can laser hair removal be performed safely in dark skin?

Omar A. Ibrahimi, MD, PhD: We are definitely able to safely and effectively remove hair in all skin types in 2021. The ideal candidate is fair skinned with dark, thick hair, but we can also successfully treat even the darkest skin types with laser hair removal today. The challenge lies in the fact that our target in laser hair removal is the melanin in the hair shaft and that people of color have a larger amount of melanin in the epidermis compared to fair skinned individuals. This epidermal melanin competes with the hair shaft melanin for the laser photons. When too much energy is absorbed by the epidermal melanin, it will give us unwanted side effects like blistering and hyper- and hypopigmentation. The 1060nm and 1064 nm wavelengths are ideal to treat skin of color patients because they have a much lower absorbance by melanin, thus making it less likely for the epidermal melanin to heat up to unsafe levels when using these wavelengths, compared to other popular hair removal wavelengths like the 755nm alexandrite or 800nm diode laser.

The other trick is to make sure there is sufficient cooling of the epidermis to counteract any heating of the epidermis. This can be done with either a contact cooled handpiece or using a cryogen spray to hit the skin just before the laser pulse.

Can patients with skin of color anticipate any differences in terms of number of treatments or even long-term outcomes?

Dr. Ibrahimi: Similar outcomes can be achieved in skin of color patients. There is an excellent review article that reviews much of the published data (Dermatol Ther. 24(1):94-107).

Basically, the main difference is that treatment with the 1060nm and 1064nm laser tends to be a little more painful, and that is the trade-off for safety.

What is unique about the 1060nm wavelength?

Dr. Ibrahimi: This is a wonderful wavelength. It’s a diode laser, so it’s very stable. Aside from laser hair removal, this wavelengthcan also be used to do skin rejuvenation and treatment of some vascular lesions in skin of color patients.

I consider the 1060nm Lightsheer device (Lumenis) to be among the best laser hair removal devices. It comes with two different wavelengthsthat give you the ability to treat all skin types. It also comes with a variety of handpieces that allow you to treat large areas, like the legs or back very quickly and with little discomfort.

Adopting Lasers with Broad Application

With Bruce Katz, MD

Among energy-based devices, radiofrequency (RF) and microneedling devices are often considered safe for use on most skin tones. But in many cases, Bruce Katz, MD, Director of JUVA Skin and Laser Center in New York City finds that he gets better results for skin tightening—and a range of other indications—using a specific Nd:YAG device. Ahead, he shares his experience.

When thinking about lasers that offer application across a broad range of indications and skin types, what do you use in your practice?

Bruce Katz, MD: The Aerolase Neo Elite (1064nm) is a workhorse laser in our practice, and we use it pretty commonly for telangiectasias on the face, red areas, particularly in people who have rosacea or persistent pigmentation after having acne. We use it for brown spots, pigmentation issues, solar lentigos. And it’s used for laser hair removal. We also use it for skin tightening in areas such as the neck, the décolleté area, upper arms, and abdomen—particularly in women who’ve had multiple pregnancies. Finally, we use it for active acne.

The Aerolase Neo Elite has 40 different applications. It is a unique laser and has a very short, high-powered pulse, which is not seen in other Nd:YAG lasers. With its 650ms pulse, this laser can be used safely on dark skin tones. That’s a big positive, and a reason why we use the Neo for a lot of different indications.

How does the device compare to alternative energy-based devices?

Dr. Katz: I think Neo probably works better than the monopolar RF devices that are available. It’s probably neck-in-neck with the bipolar RF devices. I think it’s more effective than microneedling RF. I don’t think we see that much benefit, in terms of skin tightening, with the microneedling devices. I think they’re more effective for improvement in texture and some acne scarring.

What has been the uptake for acne treatment?

Dr. Katz: We use the Neo Elite to treat acne commonly in our practice with good results, and we use it for persistent erythema after acne. We can use it to treat acne scarring, as well. However, the fractional CO₂ device generally offers better results for acne scarring.

Acne is a workhorse application for us, but that may reflect our practice, which has always had a high volume of non-medical patients. Patients who are prepared to pay for laser treatment for their acne will be satisfied with the outcomes.