Laser Hair Removal
Dec. 1st, 2006 01:44 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
bookofmirrorsI've been meaning to make this post for a while, just because a lot of people are curious, and I'd like to have the info out there, 'cause I don't think enough people, even those who are having it done, are educated about the process. ![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-userinfo.gif)
cloudwatcher put it in my mind again, so here goes.
OK, for the purposes of this post, I'm going to focus on three types of lasers - the alexandrite, the YAG (ymtrium aluminum garnet), and the diode. Each of these works pretty much the same way. I'm NOT referring to the Aesthera laser, which is an intense pulsed light laser, and works quite differently, and different results can be expected.
Most of the time, the main question people ask is, does it hurt? The answer is yes. Don't believe the bullshit about it feeling like a rubberband snap or some shit like that. The best comparison I've heard, as both a giver and a receiver of laser hair removal, is that it feels like a tattoo. Of course, if you don't have a tattoo, this is a useless analogy, but it's honestly the best one out there. I will qualify this statement by saying that pain is highly subjective, and your mileage may vary. I've seen people fall asleep during the procedure, and I've seen people, even while wearing a topical numbing cream and being heavily drugged with pain killers, and iced down, sob throughout the procedure. Everyone is different. Different body parts also tend to have different levels of pain. For the types of lasers discussed here, I've seen a few things I have found to be pretty consistent. 1 - the darker/coarser the hair, the more pain; 2 - anything directly over a bone hurts more; 3 - the density of the hair in the area; 4 - fine delicate skin (this is to a much lesser degree than the other factors). By far, the most painful area is the skull. However, this area is rarely treated, so, for more practical purposes, I will say that the most painful areas seem to be: men - face, chest/abs; women - underarms. I think the reason for underarms, which meet fewer of the pain criteria, is the density of lymph nodes in that area. Again, your mileage may vary. Personally, I'm totally cool with my underarms being done, and you can hear me screaming down the hallway when I get my bikini done. (And yes, I mean that literally.) So, from top to bottom: scalp - hurts like hell; anterior neck - no big deal if you're a woman, hurts like hell if you're a guy; posterior neck - hurts like hell; back - hurts quite a bit for a guy, especially in the flank area, notsomuch for a woman; chest/abs - hurts like hell for a guy, notsomuch for a woman; underarms - hurts like hell, seems to be less so for men; bikini - not so bad, really, even for guys, the painful area is the pubic bone; buttocks - not bad at all, except for the anal area, which hurts like hell; arms - tend to hurt more over the bony areas, so wrists hurt more than shoulders; legs - ditto arms, so pretty painless on the thigh, pretty painful over the ankles; hands/feet - hurt like hell. Again, your mileage may vary, and I've been trying to decide if it seems like men have more pain over muscular areas, as opposed to the bony areas. This could very well be the case, but my personal jury is still out on that one. Also, darker pigmented areas tend to hurt, so freckles, varicose veins, etc. hurt more. (Note: Dark freckles will often fry and either fade or flake off altogether after LHR. Most people consider this a bonus, but if you really like your beauty mark or whatever, make sure they cover it up.) (Other note: For some reason, the second treatment tends to be the most painful. I have yet to come up with a good reason for this, it just is.)
How does it work?
The laser seeks out pigmentation. The most ideal combination for LHR is dark hair and light skin. This allows the laser to really hone in on the hair, with minimal damage to the skin. If your hair is light (blonde, gray, and, to a lesser degree, red), the laser won't work well at all. Certainly, there are settings that are more likely to get lighter/finer hair, but certainly don't count on it. If you have two types of hair in a particular area, focus on the darker and/or coarser hair. That will get you the best results. What these lasers do is see the pigmentation of the hair, and target it. The laser uses the hair as a path, and follows it down, frying it as it goes. (Clients often tell me they can smell burning hair - this is normal, if unpleasant, I'm told; I've gotten so used to it I don't notice it anymore.) The hair fries all the way down to the bulb, and, more importantly, the capillaries that feed it. The bulb is fried, and the capillaries are cauterized. This is why LHR is permanent. If the hair has no food, it can't grow back. This mechanism also explains why multiple treatments are required. At any given point, the hairs on your body can be in the growth phase, the dormant phase, or the fall-out phase (there are technical terms for this, but I can never remember which is which). It is only in the growth phase that the hairs have a bulb, and are therefore connected to the capillaries. If the hair is in any other phase, it only gets fried down as far as the hair goes, so the results aren't permenant at that time. Treatments are scheduled at intervals to predict (as accurately as possible) when the hair is in the growth phase.
As a result, what someone should expect to see after a treatment, is a period of smoothness. When the laser fries the hair, it dies, at which point your body considers it a foreign object, and tries to work it out. This will look like your hair is growing, but it is not. (Note: There is often a phase where the hair is sticking out of your skin, clearly black and charred-looking, and the razor won't touch it, no matter how hard you try to shave it. This is annoying as fuck. Use the loofah and be patient. It sucks, but it's transitory. Ditto for hairs that have fallen out, but there are little black dots under the skin. Your loofah [or whatever scrubby thing you like] is your friend.) After about 2-3 weeks, the hair will fall out and there will be nothing left behind. There is a possibility of ingrown hairs at this stage. It's a good idea to use a loofa or some other scrubby thing on the area when you shower, to keep the skin kinda broken (not bleeding or anything like that) so that the hair isn't hindered as it works its way out. LHR people will often talk about "fallout" and ask if people noticed fallout. This is a misleading term, since it implies that one will actually see the hair falling out, which is very rarely the case - what they really mean is, did you notice a smooth phase at about 2-3 weeks after your treatment?
The smooth phase is important as a diagnostic tool. I've been told that you don't have to go 100% smooth after a treatment, but I've been doing this long enough to know that if you don't, the settings probably weren't quite right. (Note: In earlier treatments, this isn't necessarily a bad thing - it's best to start out a bit more conservative, as it's better to have an ineffective treatment than a burn.) If you're left with patches of hair after treatment with the above types of lasers, your settings weren't high enough. I will qualify that statement by saying that, if you have light-colored or very fine hairs in the treatment area, you shouldn't expect those to fall out. If the dark coarse hairs don't fall out, you need your settings turned up next time. A second qualifier is if you have stripes of hair, or sections of hair that were clearly left behind as a result of a less-skilled technician. If this happens, call the facility and explain the situation - they should offer a touch-up of these areas. It's very important to call quickly, because there is a very short window in which a touch-up can be done, if they can be done at all. Where I work, the rule of thumb was that touch-ups could ONLY be done in the 3rd week after treatment - before then, you couldn't be sure the hair had worked its way out; after that, you fucked with the treatment window. Other places will vary. The smooth phase should last about a month, although this can vary, as well. It tends to last longer on arms/legs, where the growth phase is longer, and less time on the face, where the growth phase is shorter.
When the hair starts to grow back, it's a very frustrating time. This isn't in the literature, but this is the time I most hear about ingrown hairs. Remember your loofah. While you can't tweeze (more on that later), it's perfectly acceptable, and in my opinion, recommended, to remove ingrown hairs by squeezing them like a pimple. If they're still attached, this won't damage the follicle and decrease the efficacy of the laser; if they're not, they'll pop right out. The grow-back phase is very frustrating for a couple of reasons. First of all, everyone wishes that they're be part of that almost non-existent group that it (for whatever bizarre reason) takes pretty much on the first treatment. You're not that person. Trust me. You're just not. You get real used to the smoothness, real fast. The hair growing back is a major bummer.
Also, remember what I said about the hair in the growth phase, and not all of it being permanently removed the first time? Well, only about 20% (give or take) of your hair is in the growth phase at any given time, so about 80% of your hair is going to grow back. From a visual standpoint, after having been bare for about a month, 80% looks an awful lot like 100%. After your second treatment, 80% of the 80% that was left looks pretty close to that, too. Most people don't really notice results until after their third treatment. This is normal. Don't sweat it. If you don't notice results after your third treatment, speak up!
Often, even after the first treatment, the hair will become finer in texture. This is fine. It's a good thing. It means that whatever hair ends up being left over after all is said and done is likely going to be so soft you won't care if it gets shaved or not, and no one will notice it, even if they're up close and feeling you up. Take note, however, that hair that is finer in texture usually responds to different laser settings that coarse hair - make sure your technician takes note of this, and adjusts your settings accordingly. Ditto for hair that gets lighter as a result of the treatment, or was light to begin with. Never hesitate to discuss this with your technician. An experienced/good one will know exactly what you're talking about; if they don't, don't be afraid to ask to speak with someone more familiar. LHR costs a shitload of money.
You're not going to lose 100% of your hair. There will always be some left over. As I mentioned, you probably won't care, 'cause the texture/color will have become something negligible. Just accept that. It's still way worth it, trust me.
A few words about the before, during and after
BEFORE:
No sunlight, tanning bed, airbrush, or self-tanner for at least 3 weeks prior to the treatment. Remember I said the laser seeks out pigmentation? The last thing you want is the laser focusing on your skin rather than your hair. (I'll comment on naturally dark skin later.) There are two things wrong with this - one, you're more likely to burn. Burns are bad, m'kay? The other is, you'll get a less effective treatment. If the laser has trouble differentiating between your hair and your skin, it doesn't focus its power on the hair as much. And a special note on sunlight and tanning bed - not only does it make your skin darker, it excites the melanocytes in your skin, which are crucial for tanning, and for burning. The laser also excites the melanocytes, which makes it like a burn on top of a burn. If you're one of those people who can lay out in the sun with Crisco on for weeks on end and still remain lily-white, a good laser technician will still send you home, because you'll still burn. The opposite is also true - if you're one of those people who can lay out for an hour the first day of summer, and stay dark the rest of the season even if you never see sunlight again, you're better off staying out of the sun. (More on all of this later, when I discuss the YAG vs. the alexandrite laser.) Some caveat with sunblock, of course. NOT SUNSCREEN, it must be SUNBLOCK. SPF at least 15, I recommend 30. Buy a separate one for your face and use it everyday if that area's being treated.
Shave as close to your treatment as possible - ideally, the same day. If there is hair on the surface of your skin, the laser will waste its power there, and not be as strong when it hits the capillaries. Also, it fries that hair, too, so it's like laying a tiny piece of burning wood on your skin. More painful, more potential for burns.
No moisturizers, deodorant, make-up, or the like before treatment. I'll discuss numbing creams later. They fuck with the laser beam in various ways, and make your treatment less effective. (Make-up can also be a pigment issue, a la self-tanner as mentioned above.
No antibiotics for 2 weeks prior to treatments. Many can make you photosensitive and more likely to burn.
No waxing, bleaching, tweezing, or depilitory (Nair and the like). They will damage the follicles of your hair, and makes your treatment ineffective. You can't do it for a month prior to treatment, and most treatments are close to that time between, so just don't do it at all till you're done.
Most places won't treat you if you're pregnant, or suspect you might be. Some might take a note from your OB/GYN, but not all. Ask.
Certain medications are no-nos for LHR. Some you can't be on, period (blood-thinners, for instance), some they just don't want you on within a certain time frame of your treatment (retin-A on the treated area, for instance). Check.
DURING:
Most LHR places are cold. The equipment needs to be kept cold, or it overheats. Most use some sort of cooling agent, such as cooling air, and/or ultrasound gel. Take warm clothing, socks, whatever. (This isn't always possible, depending on how naked you have to get for the treatment. There should be robes and blankets, of course.) A note about the cooling air and the gel - they're completely unnecessary. They're strictly for your comfort. If you like it better without them, say so. Some places will insist on it because they say it decreases your risk of burning. While this is a sound theory, I've never really known it to be the case in real life. The ultrasound gel is cold and messy, but you might have to put up with it, because it's often more for the technician than you. Most lasers, it's hard to tell what you've treated and what you haven't. The gel provides a guideline, and prevents missed spots and stripes. Often, the technician will draw on your skin with a white make-up pencil to grid out the areas, for the same reason. Ironically, the best thing to take this off is shaving cream.
Ask to stop when you need to. Trust me, your technician has seem it all. There's no shame in whatever reaction you have. Stress balls are great. So is your iPod, or any number of other things to take your mind of the pain. Use what works for you. Don't hit your technician, try to hold still, and don't knock the hand holding the laser.
Depending on the area you're getting treated, you'll be asked to contort in some weird and potentially embarassing positions. It's the nature of the beast. The laser only works properly if it's at a right angle to the skin, and if it can't be positioned for that, your treatment will suck.
AFTER:
Rule of thumb is to treat your skin as if you had a sunburn, because that's exactly the case - you've been given a controlled deep sunburn that just happens to target the hair bulb and capillaries, but the surrounding tissue was in the way, and got affected, too.
24-48 hours, don't shave, wear make-up, deodorant, harsh chemicals of any kind. Don't work out (sweat can be irritating), swim in a chlorine pool, take very hot showers, go out in the sun/tanning bed, wear coarse/binding clothing, or anything else you can think of that will irritate your skin. The loofah I mentioned before shouldn't be used until after this time. A caveat to this that I usually tell my clients. With the exception of the sunlight/tanning bed thing, which is a safety concern because you can burn, pretty much everything else is about your skin irritation. If you have very sensitive skin, follow that to the letter, and then some. If you know you can take a bath with an SOS pad every day with no ill effects, then take those instructions with a grain of salt. If you've been holding off on the antibiotics to get your treatment taken care of, you can start taking them immediately after your treatment.
All the things you shouldn't do for a sunburn, it also applies that all the things you would do for a sunburn are good after LHR. Lotion is great (mild, unscented), aloe is better.
ADVERSE REACTIONS
Redness and some mild swelling are normal. Again, like a sunburn. You should not have crusting, bruising, or discoloration. Crusting isn't a big deal, really. It's annoying, and probably frightening, and it shouldn't have happened, but it's not gonna kill you, and it's extremely unlikely to leave a scar. Do the triple antibiotic ointment thing and you should be fine. Bruising is extremely unusual, and usually only happens if you're on a blood-thinner, or have taken aspirin recently. Again, not really a big deal if it happens. It'll go away. You could just be someone who bruises easily. Discoloration (hyper or hypo pigmentation) can happen, and that's much more of a pain in the ass. Again, not a big deal in the sense that it'll go away, but it can take up to a year to do so. If you keep your skin pale, you're less likely to get it.
Blistering is BAD. Call the clinic. They may have their own doctor, or send you to one, but you definitely want it on record that it happened. (Ditto for any reaction, of course, but the other stuff you can just mention next time you go in.)
Histamine
This is the same neurochemical that causes an allergic reaction. LHR can sometimes set it off. It doesn't mean you're allergic, it just means your skin is none too happy with you. I typically see three different manifestations of this.
Histamine response: This happens during treatment. It looks horrible (like hives), but is painless and otherwise not noticable (if you're not looking at it). It typically goes away in about an hour, and generally doesn't require treatment. (You can treat it like you would the more severe response, below, if you like.)
Histamine response (more severe): Generally takes about 3-4 days after treatment to show up. Same thing with the looking like hives, but this generally itches, and is more annoying. It'll go away on its own in a week or two, but Benadryl (diphenhydramine) or Cortisone cream helps a lot. You can also take Benadryl (diphenhydramine) orally, but it makes most people sleepy, and some hyper, so unless you already know how you react to that, you're better off with the creams.
Histamine reaction: Generally shows up 1-2 days after treatment. Red, swollen, usually skips itchy and goes straight to painful. The creams and pills don't help much. You need a prescription. Call and get one. You'll need it. You'll need to pre-treat with that same prescription prior to every subsequent treatment to minimize that reaction, 'cause you're going to get it every time. Sucks to be you. Luckily, this is very rare. You'll mostly see it on legs, and bikini.
Different Lasers, Different Skin Tones
The alexandrite laser (common brands are Cynosure and Candela) is one of the most common lasers. It's used to treat light skin and dark hair. It will fry the fuck out of anyone with a tan, or dark skin. (If it's set low enough to not fry, it won't be strong enough to work, either.)
The YAG laser (ditto on the brands) is newer (about 5-7 years old) and was designed to treat darker skin. It's more forgiving to the pigment. Cooling measures (ice, and even the cooling air I mentioned earlier) are more effective and useful for the YAG. It tends to be more painful. This laser has a longer wavelength, and is designed to go through the thicker melatonin layer of darker skin. There are some places that will offer to use the YAG laser if you've been tanning, and your skin is dark, but you've been out of the sun for the required period. I do NOT recommend this. The YAG tends to overshoot the mark on people who are naturally light-skinned when they've not been tanning, and the treatment is not as effective.
I'm not as familiar with the diode lasers (common brands LightSheer and Soprano), so I won't say much about them here. My understanding is that they are similar to the alexandrite, although I know that the LightSheer can be used on dark skin.
A quick note on the Aesthera laser, which is intense pulsed light. I wasn't gonna post about it here, but hell, I'm here, I'm up, and I might as well finish what I started. The difference with the Aesthera is that it works with a suction action, and pulls the target area into the laser piece. (It's not technically a laser, actually, but for ease of speech...) Rather than use the hair to travel down to the bulb/capillaries, it targets them directly. The before and after are the same, although it's less likely to burn you. The during is different because it doesn't use gel or cooling air, just water, and a spray to cool the tip as needed (the spray doesn't go against your skin). It pretty much doesn't hurt. If it's burning, you likely need more water, or a shot of the cryospray to the tip. The pinching is inevitable, because of the sucking action, but compared to the other lasers, this is a piece of cake as far as pain goes. The difference in results is the fall-out phase - this laser doesn't have one. Since it doesn't fry every hair on its way down, only the hairs that were in the growth phase to begin with fall out, so you lose the hair in patches, and what falls out stays gone. Still about 20% at a time, and still hard to tell a difference until after the third treatment. Rumor has it it works better on light hair, and tightens the skin as it works, but none of those things have been proven in testing, so it's not advertised as such. I have high hopes for this laser, but the nurses where I work are skeptical. I've used it and definitely like the lack of pain factor, but I also miss the smooth phase. It also seems like it takes longer for the hair to fall out, but that could be just me.
Anyway, that's my laser 101. Feel free to ask questions, comment, heckle, whatever.
cloudwatcher put it in my mind again, so here goes.OK, for the purposes of this post, I'm going to focus on three types of lasers - the alexandrite, the YAG (ymtrium aluminum garnet), and the diode. Each of these works pretty much the same way. I'm NOT referring to the Aesthera laser, which is an intense pulsed light laser, and works quite differently, and different results can be expected.
Most of the time, the main question people ask is, does it hurt? The answer is yes. Don't believe the bullshit about it feeling like a rubberband snap or some shit like that. The best comparison I've heard, as both a giver and a receiver of laser hair removal, is that it feels like a tattoo. Of course, if you don't have a tattoo, this is a useless analogy, but it's honestly the best one out there. I will qualify this statement by saying that pain is highly subjective, and your mileage may vary. I've seen people fall asleep during the procedure, and I've seen people, even while wearing a topical numbing cream and being heavily drugged with pain killers, and iced down, sob throughout the procedure. Everyone is different. Different body parts also tend to have different levels of pain. For the types of lasers discussed here, I've seen a few things I have found to be pretty consistent. 1 - the darker/coarser the hair, the more pain; 2 - anything directly over a bone hurts more; 3 - the density of the hair in the area; 4 - fine delicate skin (this is to a much lesser degree than the other factors). By far, the most painful area is the skull. However, this area is rarely treated, so, for more practical purposes, I will say that the most painful areas seem to be: men - face, chest/abs; women - underarms. I think the reason for underarms, which meet fewer of the pain criteria, is the density of lymph nodes in that area. Again, your mileage may vary. Personally, I'm totally cool with my underarms being done, and you can hear me screaming down the hallway when I get my bikini done. (And yes, I mean that literally.) So, from top to bottom: scalp - hurts like hell; anterior neck - no big deal if you're a woman, hurts like hell if you're a guy; posterior neck - hurts like hell; back - hurts quite a bit for a guy, especially in the flank area, notsomuch for a woman; chest/abs - hurts like hell for a guy, notsomuch for a woman; underarms - hurts like hell, seems to be less so for men; bikini - not so bad, really, even for guys, the painful area is the pubic bone; buttocks - not bad at all, except for the anal area, which hurts like hell; arms - tend to hurt more over the bony areas, so wrists hurt more than shoulders; legs - ditto arms, so pretty painless on the thigh, pretty painful over the ankles; hands/feet - hurt like hell. Again, your mileage may vary, and I've been trying to decide if it seems like men have more pain over muscular areas, as opposed to the bony areas. This could very well be the case, but my personal jury is still out on that one. Also, darker pigmented areas tend to hurt, so freckles, varicose veins, etc. hurt more. (Note: Dark freckles will often fry and either fade or flake off altogether after LHR. Most people consider this a bonus, but if you really like your beauty mark or whatever, make sure they cover it up.) (Other note: For some reason, the second treatment tends to be the most painful. I have yet to come up with a good reason for this, it just is.)
How does it work?
The laser seeks out pigmentation. The most ideal combination for LHR is dark hair and light skin. This allows the laser to really hone in on the hair, with minimal damage to the skin. If your hair is light (blonde, gray, and, to a lesser degree, red), the laser won't work well at all. Certainly, there are settings that are more likely to get lighter/finer hair, but certainly don't count on it. If you have two types of hair in a particular area, focus on the darker and/or coarser hair. That will get you the best results. What these lasers do is see the pigmentation of the hair, and target it. The laser uses the hair as a path, and follows it down, frying it as it goes. (Clients often tell me they can smell burning hair - this is normal, if unpleasant, I'm told; I've gotten so used to it I don't notice it anymore.) The hair fries all the way down to the bulb, and, more importantly, the capillaries that feed it. The bulb is fried, and the capillaries are cauterized. This is why LHR is permanent. If the hair has no food, it can't grow back. This mechanism also explains why multiple treatments are required. At any given point, the hairs on your body can be in the growth phase, the dormant phase, or the fall-out phase (there are technical terms for this, but I can never remember which is which). It is only in the growth phase that the hairs have a bulb, and are therefore connected to the capillaries. If the hair is in any other phase, it only gets fried down as far as the hair goes, so the results aren't permenant at that time. Treatments are scheduled at intervals to predict (as accurately as possible) when the hair is in the growth phase.
As a result, what someone should expect to see after a treatment, is a period of smoothness. When the laser fries the hair, it dies, at which point your body considers it a foreign object, and tries to work it out. This will look like your hair is growing, but it is not. (Note: There is often a phase where the hair is sticking out of your skin, clearly black and charred-looking, and the razor won't touch it, no matter how hard you try to shave it. This is annoying as fuck. Use the loofah and be patient. It sucks, but it's transitory. Ditto for hairs that have fallen out, but there are little black dots under the skin. Your loofah [or whatever scrubby thing you like] is your friend.) After about 2-3 weeks, the hair will fall out and there will be nothing left behind. There is a possibility of ingrown hairs at this stage. It's a good idea to use a loofa or some other scrubby thing on the area when you shower, to keep the skin kinda broken (not bleeding or anything like that) so that the hair isn't hindered as it works its way out. LHR people will often talk about "fallout" and ask if people noticed fallout. This is a misleading term, since it implies that one will actually see the hair falling out, which is very rarely the case - what they really mean is, did you notice a smooth phase at about 2-3 weeks after your treatment?
The smooth phase is important as a diagnostic tool. I've been told that you don't have to go 100% smooth after a treatment, but I've been doing this long enough to know that if you don't, the settings probably weren't quite right. (Note: In earlier treatments, this isn't necessarily a bad thing - it's best to start out a bit more conservative, as it's better to have an ineffective treatment than a burn.) If you're left with patches of hair after treatment with the above types of lasers, your settings weren't high enough. I will qualify that statement by saying that, if you have light-colored or very fine hairs in the treatment area, you shouldn't expect those to fall out. If the dark coarse hairs don't fall out, you need your settings turned up next time. A second qualifier is if you have stripes of hair, or sections of hair that were clearly left behind as a result of a less-skilled technician. If this happens, call the facility and explain the situation - they should offer a touch-up of these areas. It's very important to call quickly, because there is a very short window in which a touch-up can be done, if they can be done at all. Where I work, the rule of thumb was that touch-ups could ONLY be done in the 3rd week after treatment - before then, you couldn't be sure the hair had worked its way out; after that, you fucked with the treatment window. Other places will vary. The smooth phase should last about a month, although this can vary, as well. It tends to last longer on arms/legs, where the growth phase is longer, and less time on the face, where the growth phase is shorter.
When the hair starts to grow back, it's a very frustrating time. This isn't in the literature, but this is the time I most hear about ingrown hairs. Remember your loofah. While you can't tweeze (more on that later), it's perfectly acceptable, and in my opinion, recommended, to remove ingrown hairs by squeezing them like a pimple. If they're still attached, this won't damage the follicle and decrease the efficacy of the laser; if they're not, they'll pop right out. The grow-back phase is very frustrating for a couple of reasons. First of all, everyone wishes that they're be part of that almost non-existent group that it (for whatever bizarre reason) takes pretty much on the first treatment. You're not that person. Trust me. You're just not. You get real used to the smoothness, real fast. The hair growing back is a major bummer.
Also, remember what I said about the hair in the growth phase, and not all of it being permanently removed the first time? Well, only about 20% (give or take) of your hair is in the growth phase at any given time, so about 80% of your hair is going to grow back. From a visual standpoint, after having been bare for about a month, 80% looks an awful lot like 100%. After your second treatment, 80% of the 80% that was left looks pretty close to that, too. Most people don't really notice results until after their third treatment. This is normal. Don't sweat it. If you don't notice results after your third treatment, speak up!
Often, even after the first treatment, the hair will become finer in texture. This is fine. It's a good thing. It means that whatever hair ends up being left over after all is said and done is likely going to be so soft you won't care if it gets shaved or not, and no one will notice it, even if they're up close and feeling you up. Take note, however, that hair that is finer in texture usually responds to different laser settings that coarse hair - make sure your technician takes note of this, and adjusts your settings accordingly. Ditto for hair that gets lighter as a result of the treatment, or was light to begin with. Never hesitate to discuss this with your technician. An experienced/good one will know exactly what you're talking about; if they don't, don't be afraid to ask to speak with someone more familiar. LHR costs a shitload of money.
You're not going to lose 100% of your hair. There will always be some left over. As I mentioned, you probably won't care, 'cause the texture/color will have become something negligible. Just accept that. It's still way worth it, trust me.
A few words about the before, during and after
BEFORE:
No sunlight, tanning bed, airbrush, or self-tanner for at least 3 weeks prior to the treatment. Remember I said the laser seeks out pigmentation? The last thing you want is the laser focusing on your skin rather than your hair. (I'll comment on naturally dark skin later.) There are two things wrong with this - one, you're more likely to burn. Burns are bad, m'kay? The other is, you'll get a less effective treatment. If the laser has trouble differentiating between your hair and your skin, it doesn't focus its power on the hair as much. And a special note on sunlight and tanning bed - not only does it make your skin darker, it excites the melanocytes in your skin, which are crucial for tanning, and for burning. The laser also excites the melanocytes, which makes it like a burn on top of a burn. If you're one of those people who can lay out in the sun with Crisco on for weeks on end and still remain lily-white, a good laser technician will still send you home, because you'll still burn. The opposite is also true - if you're one of those people who can lay out for an hour the first day of summer, and stay dark the rest of the season even if you never see sunlight again, you're better off staying out of the sun. (More on all of this later, when I discuss the YAG vs. the alexandrite laser.) Some caveat with sunblock, of course. NOT SUNSCREEN, it must be SUNBLOCK. SPF at least 15, I recommend 30. Buy a separate one for your face and use it everyday if that area's being treated.
Shave as close to your treatment as possible - ideally, the same day. If there is hair on the surface of your skin, the laser will waste its power there, and not be as strong when it hits the capillaries. Also, it fries that hair, too, so it's like laying a tiny piece of burning wood on your skin. More painful, more potential for burns.
No moisturizers, deodorant, make-up, or the like before treatment. I'll discuss numbing creams later. They fuck with the laser beam in various ways, and make your treatment less effective. (Make-up can also be a pigment issue, a la self-tanner as mentioned above.
No antibiotics for 2 weeks prior to treatments. Many can make you photosensitive and more likely to burn.
No waxing, bleaching, tweezing, or depilitory (Nair and the like). They will damage the follicles of your hair, and makes your treatment ineffective. You can't do it for a month prior to treatment, and most treatments are close to that time between, so just don't do it at all till you're done.
Most places won't treat you if you're pregnant, or suspect you might be. Some might take a note from your OB/GYN, but not all. Ask.
Certain medications are no-nos for LHR. Some you can't be on, period (blood-thinners, for instance), some they just don't want you on within a certain time frame of your treatment (retin-A on the treated area, for instance). Check.
DURING:
Most LHR places are cold. The equipment needs to be kept cold, or it overheats. Most use some sort of cooling agent, such as cooling air, and/or ultrasound gel. Take warm clothing, socks, whatever. (This isn't always possible, depending on how naked you have to get for the treatment. There should be robes and blankets, of course.) A note about the cooling air and the gel - they're completely unnecessary. They're strictly for your comfort. If you like it better without them, say so. Some places will insist on it because they say it decreases your risk of burning. While this is a sound theory, I've never really known it to be the case in real life. The ultrasound gel is cold and messy, but you might have to put up with it, because it's often more for the technician than you. Most lasers, it's hard to tell what you've treated and what you haven't. The gel provides a guideline, and prevents missed spots and stripes. Often, the technician will draw on your skin with a white make-up pencil to grid out the areas, for the same reason. Ironically, the best thing to take this off is shaving cream.
Ask to stop when you need to. Trust me, your technician has seem it all. There's no shame in whatever reaction you have. Stress balls are great. So is your iPod, or any number of other things to take your mind of the pain. Use what works for you. Don't hit your technician, try to hold still, and don't knock the hand holding the laser.
Depending on the area you're getting treated, you'll be asked to contort in some weird and potentially embarassing positions. It's the nature of the beast. The laser only works properly if it's at a right angle to the skin, and if it can't be positioned for that, your treatment will suck.
AFTER:
Rule of thumb is to treat your skin as if you had a sunburn, because that's exactly the case - you've been given a controlled deep sunburn that just happens to target the hair bulb and capillaries, but the surrounding tissue was in the way, and got affected, too.
24-48 hours, don't shave, wear make-up, deodorant, harsh chemicals of any kind. Don't work out (sweat can be irritating), swim in a chlorine pool, take very hot showers, go out in the sun/tanning bed, wear coarse/binding clothing, or anything else you can think of that will irritate your skin. The loofah I mentioned before shouldn't be used until after this time. A caveat to this that I usually tell my clients. With the exception of the sunlight/tanning bed thing, which is a safety concern because you can burn, pretty much everything else is about your skin irritation. If you have very sensitive skin, follow that to the letter, and then some. If you know you can take a bath with an SOS pad every day with no ill effects, then take those instructions with a grain of salt. If you've been holding off on the antibiotics to get your treatment taken care of, you can start taking them immediately after your treatment.
All the things you shouldn't do for a sunburn, it also applies that all the things you would do for a sunburn are good after LHR. Lotion is great (mild, unscented), aloe is better.
ADVERSE REACTIONS
Redness and some mild swelling are normal. Again, like a sunburn. You should not have crusting, bruising, or discoloration. Crusting isn't a big deal, really. It's annoying, and probably frightening, and it shouldn't have happened, but it's not gonna kill you, and it's extremely unlikely to leave a scar. Do the triple antibiotic ointment thing and you should be fine. Bruising is extremely unusual, and usually only happens if you're on a blood-thinner, or have taken aspirin recently. Again, not really a big deal if it happens. It'll go away. You could just be someone who bruises easily. Discoloration (hyper or hypo pigmentation) can happen, and that's much more of a pain in the ass. Again, not a big deal in the sense that it'll go away, but it can take up to a year to do so. If you keep your skin pale, you're less likely to get it.
Blistering is BAD. Call the clinic. They may have their own doctor, or send you to one, but you definitely want it on record that it happened. (Ditto for any reaction, of course, but the other stuff you can just mention next time you go in.)
Histamine
This is the same neurochemical that causes an allergic reaction. LHR can sometimes set it off. It doesn't mean you're allergic, it just means your skin is none too happy with you. I typically see three different manifestations of this.
Histamine response: This happens during treatment. It looks horrible (like hives), but is painless and otherwise not noticable (if you're not looking at it). It typically goes away in about an hour, and generally doesn't require treatment. (You can treat it like you would the more severe response, below, if you like.)
Histamine response (more severe): Generally takes about 3-4 days after treatment to show up. Same thing with the looking like hives, but this generally itches, and is more annoying. It'll go away on its own in a week or two, but Benadryl (diphenhydramine) or Cortisone cream helps a lot. You can also take Benadryl (diphenhydramine) orally, but it makes most people sleepy, and some hyper, so unless you already know how you react to that, you're better off with the creams.
Histamine reaction: Generally shows up 1-2 days after treatment. Red, swollen, usually skips itchy and goes straight to painful. The creams and pills don't help much. You need a prescription. Call and get one. You'll need it. You'll need to pre-treat with that same prescription prior to every subsequent treatment to minimize that reaction, 'cause you're going to get it every time. Sucks to be you. Luckily, this is very rare. You'll mostly see it on legs, and bikini.
Different Lasers, Different Skin Tones
The alexandrite laser (common brands are Cynosure and Candela) is one of the most common lasers. It's used to treat light skin and dark hair. It will fry the fuck out of anyone with a tan, or dark skin. (If it's set low enough to not fry, it won't be strong enough to work, either.)
The YAG laser (ditto on the brands) is newer (about 5-7 years old) and was designed to treat darker skin. It's more forgiving to the pigment. Cooling measures (ice, and even the cooling air I mentioned earlier) are more effective and useful for the YAG. It tends to be more painful. This laser has a longer wavelength, and is designed to go through the thicker melatonin layer of darker skin. There are some places that will offer to use the YAG laser if you've been tanning, and your skin is dark, but you've been out of the sun for the required period. I do NOT recommend this. The YAG tends to overshoot the mark on people who are naturally light-skinned when they've not been tanning, and the treatment is not as effective.
I'm not as familiar with the diode lasers (common brands LightSheer and Soprano), so I won't say much about them here. My understanding is that they are similar to the alexandrite, although I know that the LightSheer can be used on dark skin.
A quick note on the Aesthera laser, which is intense pulsed light. I wasn't gonna post about it here, but hell, I'm here, I'm up, and I might as well finish what I started. The difference with the Aesthera is that it works with a suction action, and pulls the target area into the laser piece. (It's not technically a laser, actually, but for ease of speech...) Rather than use the hair to travel down to the bulb/capillaries, it targets them directly. The before and after are the same, although it's less likely to burn you. The during is different because it doesn't use gel or cooling air, just water, and a spray to cool the tip as needed (the spray doesn't go against your skin). It pretty much doesn't hurt. If it's burning, you likely need more water, or a shot of the cryospray to the tip. The pinching is inevitable, because of the sucking action, but compared to the other lasers, this is a piece of cake as far as pain goes. The difference in results is the fall-out phase - this laser doesn't have one. Since it doesn't fry every hair on its way down, only the hairs that were in the growth phase to begin with fall out, so you lose the hair in patches, and what falls out stays gone. Still about 20% at a time, and still hard to tell a difference until after the third treatment. Rumor has it it works better on light hair, and tightens the skin as it works, but none of those things have been proven in testing, so it's not advertised as such. I have high hopes for this laser, but the nurses where I work are skeptical. I've used it and definitely like the lack of pain factor, but I also miss the smooth phase. It also seems like it takes longer for the hair to fall out, but that could be just me.
Anyway, that's my laser 101. Feel free to ask questions, comment, heckle, whatever.
