Laser Hair Removal

Christine Hart

MSBTh, Cristianos Laser Clinic,
Gendys Conference, 2000

 
Good afternoon, as you have heard, my name is Chris Hart, many of you know me but for the benefit of those who don't, I'm a qualified electrologist and one of the most experienced therapists in the country in the field of Laser Hair Removal. For the past three years I have operated my own clinic in Cheshire and have specialised in the treatment of TG patients.

At the Gendys 98 conference I stood on this stage with a very important message, one that I felt was worth overcoming my personal lifelong fear of public speaking for. So what was that message? What happened to the individuals who listened to what I had to say and decided to find out more. And what of the future?

The problem of unwanted hair is a shared problem in the TG community. The practicalities of living in a female role whilst having a male pattern hair growth are not only tedious but play a major part in self-acceptance and self esteem in the chosen gender role. The advent of laser hair removal brought new hope for an existence free from the tell tale blue shadow. So what happened to the dream?

Long before the commercial benefit of removing hair by laser was even considered, plastic surgeons had been restricted in the use of donor sites for re-constructive surgery solely because of the presence of hair! When medical physicist Prof Marc Clement discovered the effect of ruby light on hair growth, he and his dedicated team at The Swansea Institute strived to develop a laser for plastic surgeons and open new possibilities in reconstructive surgery, without damaging the skin.

It took many years of dedicated work and ethical clinical trials before the Chromos 694 Ruby Laser was available to plastic surgeons in the NHS.

This laser first came to the publics attention in The Tomorrows World programme in 1995 and its Swansea based manufacturers SLS Biophile Ltd were inundated with requests for more information from members of the public.

At a cost of £100,000 per laser their availability was few and far between. However, now realising the public's desperation for a better solution than electrolysis to the problem of unwanted hair, many organisations tried to emulate the patented technology at a commercially viable cost. Hence the number of machines on the market has grown over the last five years, all making claims and counter claims in a huge advertising hype. All this is aimed at convincing the potential client that their system offers something better than every other one on the market.

I believe the only way to cut through the high profile advertising jargon is to understand the principles behind the treatment, thereby giving you, the potential client, the ability to assess each laser machine on it's clinical merits.

Before we can do this we need to have a basic understanding of how hair grows on the surface of the skin. All hair looks the same but the condition of the hair follicle is vitally important to the success of laser hair removal. The growth and shedding cycle of the hair follicle is divided into three phases.

In the growing stage (anagen) the cells at the base of the hair follicle divide and form the new hair, which is pushed upward and appears on the skin surface. Once the formation of the hair is complete the cells at the base of the follicle stop dividing and the follicle then moves into the next stage (catogen). The follicle continues to nourish the hair, which is still firmly attached. The final stage (telogen) occurs where the follicle no longer nourishes the hair, which in turn is shed. After a dormant period the hair follicle will spring back to life and the process is repeated. The length of each of these stages varies in different body sites; the follicles of the scalp remain in the anagen stage much longer than any other body site, which is why our head hair grows long.

It is only in the anagen stage that enough thermal damage can be done to the hair follicle thus destroying its capacity for regrowth. This coupled with the fact that all of our hair follicles are not active at the same time, explains why laser hair removal requires more than one treatment.

So back to laser hair removal. The process relies upon a technique known as: Selective Photothermolysis.

This is the principle of using laser energy to selectively destroy a target beneath the surface of the skin whilst leaving the surrounding tissue unharmed. Ruby laser seeks to use the concentration of pigment (melanin) in the hair shaft to absorb the laser light, thereby heating the hair and causing thermal damage to the follicle whilst passing harmlessly through the other tissue components.

Factors Which Affect The Performance Of Individual Lasers.

• Wavelength - individual wavelengths have different effects on the skin tissue and on how the laser light is absorbed. The optimum wavelength for hair removal would be highly absorbed in the concentration of melanin in the hair shaft and transmitted harmlessly through the surrounding tissue.
• Pulse Duration -this is the length of time the laser light is in contact with the skin. The heat must be maintained for long enough to destroy the hair growth mechanism, but not too long as to burn the skin. The ideal pulse duration required to generate the correct amount of heat in and around the hair follicle is approx. 1 millisecond. If the pulse duration is too short not enough heat will be generated to destroy the follicle. If the pulse duration is too long heat may dissipate into the surrounding skin increasing the risk of burns.
• Energy density- This is the amount of energy required to prevent regrowth and must be between 10-25 joules per sq. cm of skin.

In conclusion the message I came with two years ago still remains true today. Laser hair removal can be the answer to the dreams of many TG patients providing:

• The skin and hair are suitable. That is, not too dark skinned and not grey/red hair. The object of the exercise is to kill the hair follicle without damage to the skin. There is no point in removing one problem and leaving the patient with another. This inevitably means even the best lasers have limitations.
• The laser type: This is a vital parameter for successful treatment. Lasers have many purposes - they don't all remove hair successfully.
• Management of the treatment: A laser is not a magic wand and there must be total commitment from both patient and clinician.

Over the past three years I have treated TG patients and on a personal level I feel privileged to have made a positive difference to each and every one. The following slides are just two patients who have had success and who have given permission to display their photographs at conference.

And what of the future? Our commitment to honest appraisal of individuals' treatment needs and potential for success remains firm. We want as many people as possible to benefit from this technology which we believe to be the best. Our second clinic opened last month in London. At this clinic we intend to run an ethically approved clinical trial to assess the benefits of treatment for female to male patients seeking hair removal prior to phalloplasty. The complication for these patients being increased androgen levels. We will also be collecting and collating data with regard to the effect the treatment has on self-esteem.

I hope to bring you the results of this research at Gendys 2002.

Cristianos laser clinic has been established for over 10 years with clinics in Manchester, London, Leeds and Lancashire specialising in all types of laser hair removal inc dark skin and light hair along with skin treatments for the trans community inc active acne, thread veins and Rosacea. Free consultations and test patches. For more information see cristianos.co.uk or contact info@cristianos.co.uk