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Laser Hair
Removal: Comparing Single Wavelength and IPL
Technologies
Philip L. Bailin, M.D.,
F.A.C.P. CHairman, Department of Dermatology
Cleveland Clinic Foundationn
Clinical Paper
No. 1
Introduction
Light-based Hair Removal
systems continue to grow in popularity. With the promise
of never having to shave again, a plethora of companies and
devices, including Lasers and broad-spectrum light
devices, are attempting to satisfy this growing demand for
Permanent Hair reduction.
Laser or light-based Hair Removal is based upon the principles of
selective photothermolysis—which states that the light
energy must be well absorbed by the targeted chromophore for
efficacy and less well absorbed by competing chromophor(s)
to prevent collateral thermal damage. In the case of Hair
reduction, the targeted chromophore is perifollicular
melanin and the competing chromophore is epidermal melanin.
Lasers are single wavelength devices with absorption coefficients relatively
specific to the chromophores they are intended to target.
Intense Pulsed-light (IPL) devices expose the patient to a
broader spectrum of light energy defined by cut-off filters,
typically in the range of 600-1200 nm. The fact that
Lasers and IPL devices may target multiple chromophores
allow these products to be marketed as being capable of
treating a variety of conditions in addition to Hair
Removal, including treatment of vascular and pigmented
lesions, warts, wrinkles, and even acne. Customer demand is
also fueling this marketing approach, as every Laser
purchaser wants one device that “does it all.”
Since no two Lasers
or IPL devices have identical operating parameters (i.e.,
wavelength, fluence, pulse duration, spot size, or epidermal
cooling methodologies), the performance levels of these
products differ substantially.
In particular, the
comparative results of Lasers and IPL devices vary
greatly in Hair Removal. The purpose of this paper is
to compare and contrast the efficacy, ease-of-use, and
patient satisfaction using two different technologies to
provide Permanent Hair reduction—a single
wavelength alexandrite (755 nm) Laser and an IPL
broad-spectrum light device with cut-off filters.
Method
Patient #1 - The patient (J.H.) was a 24-year old
Arabic female. She complained of excess dark terminal
Hair on both cheeks, as well as on the nape of
her neck. Previous treatments had included waxing and
bleaching. Her skin type was Fitzpatrick IV. She routinely
used broad-spectrum sun blocks. Her skin pigmentation in the
areas of excess Hair growth was uniform and even
without any blotchiness. She had no history of abnormal
scarring or excessive response to mild trauma.
She began on (IPL) therapy.
A test session was performed using chilled ultrasound gel on
the skin intraoperatively and icing postoperatively and the
following settings:
Fluence: 30 J/cm2
Pulses: 3
Duration: 3.2
Delay: 5
Filter: 645 nm
These settings resulted in
mild follicular erythema without blistering.
Follow-up at two weeks
revealed no complications. The patient then underwent three
sequential IPL treatment sessions at monthly intervals.
Settings were as above. No problems were noted, but response
was only fair in terms of Hair Removal.
Two treatments were then
performed with GentleLASE at an interval of one
month. Settings were as follows:
Fluence: 10 J/cm2
Spot size: 15 mm
*DCD™: 70 spray/80 delay.
*Dynamic Cooling Device™
No complications were
encountered.
Three months later, an
additional IPL treatment was performed. Settings were as
follows:
Fluence: 28.5 J/cm2
Pulses: 3
Duration: 3.0
Delay: 50
Filter: 645 nm
The patient called at 24
hours after that treatment with severe pain and blistering
throughout the treated area. She was seen and treated for
first and second degree burns. The areas healed without
appreciable scarring, but demonstrated irregular hyper- and
hypopigmentation.
She was treated with mild
bleaching agents to the hyperpigmented areas. These
eventually responded, and after six months pigmentation was
almost normal. She then continued with GentleLASE
treatments without further complication. After a total of
four GentleLASE sessions, Hair Removal was
estimated at 80-90%.
Patient #2 - The patient (M.R.)
was a 46-year old white female with a long history of
excessive Hair growth in many anatomic areas. She had
previously undergone electrolysis to her Face,
abdomen, and upper thighs/Bikini areas. She was
judged to be skin type Fitzpatrick III, with blue Eyes
and light brown Hair. She presented for Hair
Removal with excess black terminal Hair on both
Legs.
A test session was
performed utilizing both an IPL device and the GentleLASE
(one on each lower extremity). IPL settings were:
Fluence: 35 J/cm2
Pulses: 3
Duration: 3.2
Delay: 30
Filter: 645 nm
Cooling: chilled gel and
ice packs.
GentleLASE settings were:
Fluence: 16 J/cm2
Spot size: 15 mm
DCD: 70 spray/80 delay.
Both test areas responded
well immediately with mild erythema. No complications were
noted within the two-week follow-up period.
Treatment was then
undertaken using one of the devices on each Leg.
Settings remained as above. No untoward events were noted
during the session. However, later that evening, the patient
developed significant pain in the Leg treated with
the IPL device. This was followed by diffusely scattered
blisters and some areas of “sloughing.” She was seen the
next day and began on a regimen for superficial burns.
The patient declined
further IPL therapy but wished to continue with
GentleLASE to the opposite extremity. She had four
additional treatment sessions with these settings:
Fluence: 20 J/cm2
Spot size: 18 mm
DCD: 70 spray/80 delay.
No complications were
encountered. The IPL-treated Leg showed irregular
hyperpigmentation and focal textural changes. These were
treated with bleaching agents and topical steroids. They
resolved in approximately six months.
Hair
Removal on the GentleLASE-treated side was judged to
be approximately 90%. There was no measurable reduction in
Hair growth on the IPL treated side (one session
only).
Results
Two patients of different
skin types have been presented. Both had test sessions with
IPL devices that showed no problems during or after the test
sessions. However, both of them subsequently experienced
significant problems during their course of therapy. Without
any significant treatment parameter alterations, both
experienced painful burns. It is of great importance that in
neither case did the patient nor the operator note any
unusual tissue response during the treatment which would
have indicated a problem. Both patients developed resultant
pigmentary alterations which required months of therapy for
resolution. Additionally, one of them experienced textural
changes in the skin. No problems were encountered in these
same patients with the GentleLASE treatments. Discomfort was
minimal during and after all sessions. Pigmentation of the
skin in the treated areas was unaffected, and neither
patient required any type of additional therapy for
complications. Both patients indicated a preference for
GentleLASE even before experiencing their IPLinduced burns,
mainly due to intraoperative comfort provided by the Dynamic
Cooling Device. Most important, both patients noted
significant clearing of excessive Hair in the
GentleLASE-treated areas. This had not been the case with
one of them in regard to IPL-treatment.
Discussion
Lasers and intense pulse-light devices are gaining in popularity not only
because of patient demand for Permanent Hair
reduction, but also because of physician demand for
increased utility. Unfortunately, these devices vary widely
in their ability to deliver on their promoted indications,
including Hair Removal.
Because Lasers use
single wavelengths of energy, the side-effect profile and
dependability of response are superior to IPL devices. This
differing performance level is a function of IPL design—IPL
subjects the skin to a wider range of light energies of
varying absorption coefficients for the chromophores
targeted for Cosmetic Laser procedures.
While IPL devices are
marketed for a variety of treatment applications, their
performance levels are inferior to Lasers,
particularly in Hair Removal. Further, IPL
needlessly exposes patients to some unnecessary and/or
ineffective wavelengths of radiation and are lacking, by
definition, the purity of treatment available with a
single-wavelength Laser. Specifically, IPL Hair
Removal treatments resulted in an increased frequency
of complications and offered overall inferior results when
compared to Laser Hair reduction. Based on our
experience at the Cleveland Clinic, we have ceased using IPL
devices in our department due to the inconsistency of
response between patients and even between sessions on the
same patient. Another reason for the cessation of IPL use
was the unacceptably high complication rates. At the
Cleveland Clinic, we had far more adverse skin reactions
(usually minor and transient, but occasionally serious) from
IPLs than from any Laser system.
By contrast, the
GentleLASE alexandrite (755 nm) Laser from
Candela is marketed as a Hair Removal Laser,
and its performance is exemplary. The large spot,
deliverable
Candela Corporation
530 Boston Post Road
Wayland, MA 01778, USA
Phone: 508-358-7637
Fax: 508-358-5569
Toll Free: 800-821-2013
www.candelaLaser.com
GentleLASE
is a registered trademark of Candela Corporation. Dynamic
Cooling Device and DCD are trademarks. To find out more
about Candela and its products, contact your authorized
Candela representative, or call toll free worldwide (800)
821-2013. Dial USA country code if calling internationally.
www.gentlelase.com
Printed in the USA. 04/03
0920-23-0194 Rev. 01 fluence, and skin protection afforded
by the patented, cryogen-based DCD system available on all
Candela Lasers make the GentleLASE an
especially easy-to-use, safe, and comfortable Laser.
Based upon physician feedBack and patient
satisfaction, the GentleLASE, in our opinion, is the
“gold standard” in Laser Hair Removal. While
GentleLASE is also cleared for vascular treatments, and
several other clearances are pending with the FDA, this
paper does not take a position on alexandrite Laser
efficacy for any other indication other than Hair
Removal. The GentleLASE Laser is the
superior treatment modality when compared to any IPL
technology we are aware of for Permanent Hair
reduction.
Reference
Anderson RR, Parrish JA:
Selective Photothermolysis:
Precise microsurgery by selective absorption of pulse
irradiation. Science 220:524-527, 1983.
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