Making Your Choice

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As technologies continue to advance, the trend is toward more versatile devices. “No one laser wavelength works best for all patients,” says Dr. Aguilera. “The ruby laser can be better for fine hair but will burn even the lightest skin. The alexandrite is better for skin types I-III, but skin types IV and above are safest with the 1064nm wavelength. Safety is highest when the operator is experienced in choosing the right wavelength and fluence for the right skin type. I train other doctors to use lasers for hair removal and I know there is a learning curve with these devices.”
What do you need to consider when deciding which device to buy?
Safety. Most experts agree that adverse events are usually not attributable to the device but result from operator error—using the wrong fluence, overlapping too many pulses or failing to recognize tanned skin.
“There are still two major variables in laser hair removal: the Fitzpatrick skin phototype of the patient and the laser operator’s understanding of the laser-tissue interaction and his knowledge of the patient’s medical history, allowing him to identify contraindications for treatment,” says Dr. Ibrahimi.
“Laser hair removal is not in the same category as salon cosmetic procedures. Operators need thorough training and physician oversight. Laser treatments are not without risk,” adds Dr. Maas. “When an unskilled operator burns a patient, everyone offering laser hair removal is hurt. Clinics and medical spas offering laser hair removal need to establish excellent clinical care standards and careful, thorough protocols. Doctors monitoring these procedures need to insure that all adverse events are reported promptly.”
That said, when evaluating a purchase, it is important to consider ease of operation, built-in safety options and availability of training for you and any additional operators.
Range of skin types. Platforms that include both the 1064nm wavelength and either a diode or alexandrite laser can be safely used with most patients, but there may be trade-offs in efficacy with different skin types. If you can afford only one machine or the time to become expert in the use of only one device, it might be best to purchase the most efficient device for the majority of your patients and refer other skin types to colleagues.
Patient comfort. “Unfortunately, pain control remains a major issue in hair removal treatments,” says Dr. Katz. “Patients still report hesitation because of past procedures that burned or damaged their skin. There is no reason for an extremely painful hair removal experience when there are devices built for efficacy and patient comfort. I always recommend hair removal lasers that have built-in cooling.”
“Pain has been greatly reduced with newer devices,” says Dr. Aguilera. “Some use vacuum, some use cold plates or cryogen cooling, but I think the best cooling devices use air cooling that’s integrated into the handpiece. They work best because they cool at all times—before, during and after the energy pulses. There is still some discomfort, but it’s a lot less. Remember, too, that pain can aid safety. If a patient is experiencing more pain than usual, check your settings.”
Ease and cost of operation. Long-term hair removal has become a very competitive business. Before choosing a device, you need to consider not only patient outcomes but the cost of delivering each treatment, including the initial purchase price of the equipment, consumables per treatment, space requirements and operator time. “Because of competition, hair removal is a lot cheaper for patients than it was five years ago,” says Dr. Aguilera. “Prices are dependent on where the clinic is located and the patient’s hair and skin type. We offer package prices from $250 to $1500.”
Can we expect major improvements in laser hair removal devices in the near future? “We can only destroy hair in the anagen growth stage, when the hair shaft is directly attached to the area where the cells that create the hair reside,” explains Dr. Aguilera. “This means laser hair removal will always require multiple treatments and be dependent on skin type. We may be able to make additional refinements but I don’t see any major breakthroughs in the pipeline.”

Linda W. Lewis is a MedEsthetics contributing editor.

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