Page 185 - Chapter 3 - Laser/IPL Hair Removal

Chapter 3 – Fundamentals of Laser/IPL Hair Removal 2nd Edition
So, thin hairs growing back after treatment is a sure sign of insufficient fluence!! You may have killed some of the more superficial follicles in that region, but the deeper ones were not fully cooked. This explains why we see bald patches with some finer hairs in them.
The answer is to target those thin hairs with more fluence than last time, to ensure sufficient energy reaches deep enough to kill all the remaining stem cells.
Some people think that using shorter pulses will also help – it doesn’t make any difference, as described above. The pulsewidth merely determines the temperatures in the hair shafts, but not in the stem cells. As long as the correct fluence is applied, the follicles should be irreversibly denatured.
Skin Pressure
This only applies to devices which make physical contact with the skin surface, including all IPLs and most diode lasers. Our clinical tests have indicated that applying a firm pressure when treating hair may be beneficial. Not only does it aid the surface contact cooling process, it also ‘squeezes’ blood from the capillaries. This may have a ‘marginal’ benefit in the treatment process, or it may not!
Some diode laser manufacturers employ a vacuum system to help relieve the pain sensation. This is based on some research from a few years ago which indicated that using a vacuum appeared to reduce the sensation. In our opinion, applying a heat-removing cold tip is much more efficient in reducing the pain.
Test Patches
Test patches are important! They will help you find any potential problems which may arise in your patient’s/client’s skin. Many insurance companies demand that test patches are carried out prior to any treatment programs beginning.
A very good, and highly recommended, practice is to spend the first visit with the client/patient imparting information and carrying out tests on 2 - 4 test areas (if more than one area is to be treated). These test areas should be as close to the treatment areas as possible and with typically 1 pulse each, at a fluences starting at the thresholds for the particular areas, initially. We recommend using pulsewidths in the range 5 to 50ms – as pointed out previously, the pulsewidth becomes less important as the fluence increases.
Always start at the threshold fluences and increase gradually, in steps of 0.5 J/cm2. These should also only be used with truly ice-cold gel of a minimum 2 mm in thickness. (In such cases the gel should feel slightly solid due to ice particles).
The client should be asked to return after 1 to 2 days for evaluation and the first full treatment. The purpose of the test patching is two-fold. Firstly, it allows you to assess whether the client’s skin is amenable to this type of therapy. Clients suffering from photo-sensitivity will
________________________________________________________________________ 185 Chapter 3, Ed. 2.0 Laser/IPL Hair Removal
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