Note: The writer of this article received no goods or services from Anara Med Spa for this article’s publication. This is not a paid promotion. Dr. Ram Chandra MD is a board-certified medical professional.
Laser hair removal has become one of the most effective hair removal methods available today. When initially introduced, its cost deterred a lot of interested people. As time went on, more people strutted their laser hair removal results. As more establishments offering the service became prevalent, the results began speaking for themselves.
Again, as more places began popping up and offering the service, a spectrum of result-quality also began to emerge.
It’s recommended to see a qualified medical professional for the best laser hair removal results.
Unfortunately, lower-quality lasers at cheaper rates have become available at salons, and for people to use at home. People have begun learning the hard way of getting what you pay for with these cheaper alternatives.
Fortunately, Dr. Ram Chandra MD, Medical Director and Cosmetic and Laser Physician at Anara Med Spa has yet again come to the rescue to clarify these misconceptions on laser hair removal. Read on so you don’t make the irreversible mistake of improperly practiced laser hair removal!
After a few years of laser hair removal gaining popularity, what is the recommended number of sessions to achieve goal results?
“Since I have personally performed (not delegated) more than 60,000 laser procedures, that experience has helped me understand all skin types, and how they respond. The recommended or optimal number of sessions to get the best results depends on the body area, skin type, hormonal imbalance (like polycystic ovary syndrome, or hirsutism from other causes,) in a person who is deemed a suitable candidate after history and examination by a physician. Typically, 6-8 sessions as a series for most areas, to begin with, is recommended. Subsequently, maintenance sessions as needed. From my experience legs, bikini and underarms respond the best, and the face is the most resistant area. I have seen exceptionally impressive results with bikini and legs in all skin types, except the very dark skin where there is minimal to no contrast between skin and hair. Men's chest, back, and legs respond very well. Since the laser is attracted to darker colored hair, it will not work on white (gray) hair, extremely blonde hair, red hair, and baby hair/peach fuzz. The hair must be at least light brown in color.”
Are certain hair/skin types better candidates for laser hair removal than others?
“The ideal candidate is someone with the lightest skin and the thickest darkest hair. The more contrast there is between the skin and the hair colors, the better the results. This is not the case for most people, however! The laser hair removal machine is not going after hair follicles! It is going after melanin, which is in the highest concentration in hair follicles. Now it is easier to understand why it is important to avoid sun exposure, tanning beds, spray tanning throughout the laser procedure series, and apply sunblock in the areas that need treatment. It also does not mean that if the skin is darker, there is no hope! Since laser works by targeting the darker melanin, those with darker skin will experience more discomfort as the excessive melanin of darker skin is also going to compete for laser and pick up heat, which we do not want, but that is just science! If the hair is extremely thin, especially on darker skin, the results will not be that great, even though there is still some benefit. If the skin is lighter, then we can safely use certain wavelength lasers that are very efficiently attracted to melanin, but for the same reason, these lasers can burn the skin in a darker person. Hence treating skin of color needs a lot of experience and knowledge of laser physics, and laser-tissue interactions. We use different lasers for different skin types, sometimes 2-3 technologies at the same time and different settings each time based on the previous response. There is not an exact cookie-cutter way if we need to get the best and safer results. I have also noticed certain ethnicities achieve remarkable results, notably those with Chinese, Korean, and Japanese ancestries. This might reflect some genetic advantage.”
What areas of the body are suitable for laser hair removal?
“If the hair is not too thin, any area of the body is suitable for laser treatment. If the skin is too dark, as in Fitzpatrick 6, the results may not be so great. But if they have thicker hair, we may be able to get a 50-60% reduction to an aesthetically pleasing level but it may be unrealistic to expect 100% hair gone. As I said before, a bikini, legs, underarms, men’s chest, and men’s back are some of the very satisfying areas to get bang-for-the-bucks-results from the treatment. In addition to these areas, other popular areas we treat are face, buttocks, areola, neck, stomach area, and arms.”
Once you complete the recommended number of sessions, can you kiss your hair goodbye? Or is there maintenance?
“No! Each time you have laser treatment, provided you are suitable as examined by your Aesthetic Physician, all the hair follicles in the growing “anagen” phase will be destroyed. What comes back weeks later are new hair follicles which are influenced by “male” androgenic hormones in most parts and also genetics. Both men and women have male and female hormones, but the ratio varies. Hence in general you cannot kiss hair goodbye after a series. You will require maintenance treatments. The face will require more frequent maintenance typically 3-4 times a year and the body – specifically legs, bikini, chest, and underarms will require less frequent maintenance, like 1-2 times a year. If you keep regular maintenance as dictated by your body, you are unlikely to go back to the original stage. I have seen some women, who after an initial series of sessions, need to come 3-4 times a year for their face, while for their legs or bikini just once a year! This is because different areas of the body are influenced differently by hormones.”
Who is an ideal candidate for laser hair removal? What is the difference in potential results and safety when considering the laser in a doctor’s office for laser hair removal vs the at-home machines designed for hair removal?
“This is the generalization for an ideal candidate: someone with the thickest and darkest hair but someone who also has the lightest skin. In New Jersey, this is less than 20% of the population! Interestingly, most people are therefore not ideal! “Ideal” is one thing, “will benefit from” is another! In other words, most people are not ideal candidates, but they all will benefit from this life-changing treatment!
Let us talk about at-home machines. At-home machines are too weak. They have either IPL (Intense Pulsed Light, which is NOT a laser) or a weak diode. Just because these at-home machines are approved by an agency entrusted with protecting the public, does not mean they are satisfyingly effective! All they need is reasonable safety and evidence that some hair follicles are reduced. This does not translate into efficacy. As I said before, thinner hair has less melanin and is more difficult to treat. These at-home devices, by virtue of their lower power, can often cause thinning of the hair rather than permanently destroying them. Worse, they can stimulate more hair growth, especially on the face, (so-called paradoxical hair stimulation.) Now, future treatments even with the high-powered professional class 3-4 lasers become more difficult. I do see every week so many clients who tried at home-devices, and now they are coming to us with complications and regretting their use of these devices. Diode and IPL at-home devices, can also cause hyperpigmentation and worsening of melasma in some women. We also do not know how many of these people have subtle and varying damage to their vision from improper use that may manifest years later. Lasers at all strengths are dangerous to the eyes, and the only guaranteed 100% protection is by using metal eye shields. Also, one must think about how a $300 machine can do what a $100,000+ medical laser hair removal machine will do. Only IPL and diode lasers with very low power can be made for at-home use, but not Alexandrite or Nd YAG lasers.”
Who can legally own and perform laser procedures and supervise them? What is the law for lasers and medspas?
“The law keeps changing and for up-to-date information, one should look up individual State requirements. In New Jersey and most other states, a class 3 or 4 lasers or IPL device used for hair removal, is considered a medical procedure and falls in the category of medical practice. In New Jersey, only a Licensed Physician or a Podiatrist can independently perform medical laser procedures, including laser or IPL hair removal. A trained nurse (RN), a nurse practitioner (NP), or a physician assistant (PA) can also do laser hair removal under the onsite supervision of a physician. A physician or a PA must examine the patient (client) before initiating treatments and must be available to treat any complications or emergencies. PA or NP must collaborate with a Physician who specializes in lasers. As of now in New Jersey, laser hair removal or IPL hair removal CAN NOT be performed by an Aesthetician, Beautician, Cosmetologist (hair stylist/barber), Medical Assistant, Laser Technician, Pharmacist, LPN (Licensed Practice Nurse), Chiropractor or a Dentist. In New Jersey, Chiropractors, Nurse Practitioners, non-physicians, and Dentists cannot be Medical Directors for a Medspa or Medical Aesthetics Practice. It is also not legal for anyone to just sign off the charts once a week or once a month without seeing the patient or client. Medspa and Medical Aesthetics practices are considered as Medical Offices and hence in New Jersey, more than 50% ownership should be by a physician.”
Why is there a requirement for physicians to perform and supervise onsite laser hair removal or any other laser procedures? How is this protecting the consumers and patients like us?
“That is a wonderful question. New Jersey protects its residents by these laws. First, class 3 and 4 lasers and IPL machines emit visible and invisible lasers and lights that can damage the eyes and cause slow deterioration in vision and even rapid onset of blindness. Lasers and IPL can also cause burns, disfiguring scars, worsening of melasma and hyperpigmentation, especially in darker-colored skin, and flare-ups of Herpes or cold sores. This requires early recognition and treatment. Treatments might involve prescription medicines to address hyperpigmentation, swelling, itching, and viral or bacterial infection. Some people might need pre-treatments with topicals and antiviral medications by mouth before some treatments. There are reports that in New York, which has extremely poor laser and medical aesthetics regulations, beauticians (generally estheticians, cosmetologists & hairstylists) come from Europe, stay for a few months working illegally, and do all medical aesthetics procedures- lasers, injections, etc. They make their money and go back to their country, and it is reported that they do this several times a year. Remember beauticians, cosmetologists and hairstylists are not medical professionals. Yes, it is shocking! Recently New York senator Diane Savino has introduced legislation to regulate Laser Hair Removal! Currently, this Bill is referred to the Senate Committee on Consumer Protection.
In our practice, I see and assess every client who comes for laser or IPL treatments, and often it takes me 45 minutes or more for consultation. Nothing is left for chance. That is one of the reasons people sometimes get upset if they could not get an appointment early! Clients are willing to drive 1-2 hours to come to us, and we do not take that lightly.”
What should the consumers and patients know before they consider a laser hair removal procedure?
- “1. Do your research for any facility that you are considering going to for laser hair removal. With all that we already discussed you know what questions to ask. Do they have a licensed physician or a cosmetic dermatologist who will be assessing and doing the treatments? If they are delegating it to a non-physician, is that non-physician trained and certified, and is the physician on-site? Specifically, make sure you are not being treated by someone whose credentials you do not know, who is an aesthetician, cosmetologist, beautician, hair stylist, laser technician, medical assistant, or LPN.
- 2. Ask how many clients have they treated? Can they prescribe?
- 3. How often do they service their lasers? Do they have diverse types of lasers for different skin types? Have they treated enough colored skin?
- 4. Does a physician do the assessment first or do you just walk in for a laser treatment from a discounted price you paid on a deep-discount third-party website?
- 5. Nowadays it has become easier to illegally buy low-quality IPL and even Laser machines from some eastern countries. Never get these treatments in someone’s home, even if it is a friend or a relative’s house, who could be illegally practicing medicine without a license. If you have a complication, there will not be anyone to help you!
- 6. It is okay to go cheap for buying shoes, bags, jewelry, clothes, used cars, and other commodities, but as far as your body, skin, and health is considered it’s important to give the best.
- 7. If you come across any of the following, run away from there:
- a) If someone tells you that you need X number of sessions and you are done for life and never have to shave again.
- b) If someone tells you that you will never have any complications with them, they do not need a doctor. That is being untruthful.
- c) If you see unreal pricing that seems too good to be true (for example, 8 session laser package for, say $160 advertised online on a deal site!). Something is wrong: unlicensed individual or facility, inferior quality machine, IPL being deceptively portrayed as laser, no physician-oversight, or surprise price hike or the number of sessions needed when you start going for the sessions.”