Laser and IPL systems help to quickly, safely and efficiently remove unwanted hair. However, laser hair removal, which seems at first glance to be such a simple procedure, if not carried out correctly, can lead to side effects and serious complications. At the same time, there is not only the risk of choosing high radiation parameters, but also the risk of reinsurance – the choice of settings that are insufficient to solve the problem in a particular patient and therefore ineffective, which can lead to increased hair growth. To avoid such errors, the doctor should be well aware of the “pitfalls” of laser hair removal.
The presence of unwanted hair is a problem for many people who are not satisfied with the long-term methods of their removal (shaving, waxing and chemical depilation, electrolysis) due to either a short-term result, or severe soreness, or frequent complications (for example, scarring after electro-depilation). The invention of selective photothermolysis and the creation of various laser systems with different wavelength ranges made possible the effective and long-term hair removal. Currently, several types of laser and photoepilation systems are used for hair removal: ruby laser (694 nm), alexandrite laser (755 nm), diode laser (800 nm), IPL systems (590-1200 nm), Nd: YAG laser 1064 nm).
Epilation occurs due to the destruction of the hair follicle, where the primary pigment is melanin, acting as a chromophore – a substance that absorbs radiation with a specific wavelength. With an optimal selection of wavelength, energy flux density and pulse duration, the melanin of the hair follicle is heated, and the hair follicle is destroyed. At the same time, the surrounding tissues are not damaged.
Compared with the already existing types of hair removal and depilation, laser hair removal destroys the hair follicle quickly, accurately and accurately, which explains its high aesthetic result. Also, epilation with the use of lasers and photosystems allows you to quickly, practically painlessly and with a minimum risk of complications to treat broad surfaces of the skin. It is no coincidence that it has become one of the most popular among all the aesthetic procedures carried out with the help of quantum technologies. Laser and IPL systems, according to manufacturers, help quickly, safely and efficiently remove unwanted hair. But numerous studies show that these methods of hair removal are still not devoid of side effects and complications.
In connection with the growing popularity of laser hair removal, laser therapists, dermatologists, cosmetologists, general practitioners should know the possible complications and side effects of these procedures to diagnose and treat them correctly and on time.
Causes of complications
We list the leading causes of the development of complications, typical for all types of procedures using lasers and IPL-systems.
- professional mistakes of the doctor, which include poor-quality training;
- errors in diagnosis, especially the definition of the phototype and skin condition;
- incorrect selection of the type of laser and its settings;
- failure to conduct a test impact;
- imperfection of the technique of working with a laser; incomplete awareness of the patient about the procedure, its results and post-procedural care;
- otutstvie means of protection of eyes at the patient or the doctor;
- lack of adequate cooling of the skin during the procedure;
- non-compliance by patients with the doctor’s recommendations for post-procedure care;
- the state of health of the patient during the treatment. This factor affects the effectiveness of the procedure and the development of complications in the postprocedural period.
Even with a qualitative collection of anamnesis, we can not fully take into account the patient’s presence of all aggravating factors and diseases, since he does not always know about them.
When collecting anamnesis, it is important to take into account the patient’s propensity to allergic reactions, the presence of hormonal disorders, immunodeficient conditions, connective tissue diseases and tumoral diseases, and the patient’s acceptance of medications that affect the functional activity of melanocytes.
Side Effects of Laser Hair Removal
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Now we turn to the side effects of the procedure for laser and IPL-epilation and its complications. Side effects of laser hair removal include pain, perifollicular edema and erythema skin of the treated area. Perifollicular edema and erythema occur within a few minutes after exposure, pass for several hours and do not require treatment.
The severity of these reactions depends on the color, thickness and thickness of the hair, as well as on the energy flux density. Dark, thick hair during the procedure absorbs a lot of energy and heats up strongly, as a result perifollicular edema and erythema can develop. When exposed to thin hair, perifollicular edema is usually less pronounced. Severe edema also occurs in patients with sensitive reactive skin. To reduce these side effects, it is important to use efficient skin cooling systems before, during and, if required, after the procedure.
It is necessary to select the energy flux density correctly and, if necessary, gradually increase it to achieve a clinical effect. If the edema and hyperemia are pronounced, then after the procedure, you can appoint cream with glucocorticoids or dexpanthenol. With moderately and slightly pronounced phenomena of perifollicular edema, it is sufficient to use soothing gels and creams at home, for example, those used after sunburn to remove edema and erythema.
As a means of promoting regeneration, it is possible to recommend a restoring ALOE GEL with a multivitamin complex and extracts of chamomile, and a hydro-regulating gel for sensitive and irritated skin with dexpanthenol and hyaluronic acid HYDRACTIVE. To quickly remove signs of inflammation, the super-regenerating CYTOBI nutrient cream from GERnetic International (France) is ideal. The exclusive formulation consists of five biological complexes containing amino acids, peptides, proteins and vitamins. These components are necessary for triggering the most essential biochemical reactions of regeneration, moisturizing and nourishing the skin.
Immediately after the procedure of laser hair removal, it is not recommended to conduct thermal and physiotherapy procedures, massage the treated areas, do not also sunbathe.
Laser hair removal is not a painless procedure; most patients experience during the (or immediately after) pain. Important to use an adequate method of skin cooling and, if necessary, a local external or infiltration anesthetic to reduce pain.
Complications after laser hair removal
About the complications of laser and photoepilation, they are early, developing immediately after the procedure or within the first days after it, and late, which occur over several weeks.
Avoid complications and minimize side effects – one of the main tasks of a doctor in aesthetic medicine. When performing laser hair removal, there is not only the risk of choosing high radiation parameters leading to skin overheating and related complications. The risk of reinsurance – the choice of parameters that are insufficient to solve the problem in this patient and therefore ineffective, which can lead not just to the lack of the desired effect, but to the appearance of the opposite. Laser hair removal, which seems to be such a simple procedure, can lead to serious complications if performed incorrectly.
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To early complications include skin burns of varying severity, folliculitis, exacerbation of acneiform eruptions, exacerbation of herpetic infection, allergic reactions, development of photophobia, conjunctivitis and uveitis.
When carrying out the laser hair removal procedure, it is vital to avoid applying impulses, gently treat the areas of the bony projections, where partial contact of the maniple with the skin is possible, and individual selection of radiation parameters for each patient. Do not forget about the test exposure to the laser in an inconspicuous area: it helps determine the skin’s response to radiation and choose its optimal parameters. The density of energy flow should be increased cautiously, to the apparent clinical effect and to the appearance of signs of acute damage to the skin – blisters and bright hyperemia.
1. Burns occur for several reasons:
- Use of high energy flux density during the procedure.
- Tanned skin or IV-VI skin phototypes by Fitzpatrick.
- Carrying out epilation in areas with thin and sensitive skin, for example in the perianal zone or the labia region, using improper radiation parameters.
- The incorrect technique of the procedure (impulse application, incomplete contact with the skin).
- An inadequate system of skin cooling during the procedure or its absence.
- Measures to prevent this complication primarily include an adequate selection of patients. Do not perform the laser hair removal procedure immediately after the active insolation; you need to wait 2-4 weeks to tan a little off. This is especially important when working with ruby, alexandrite, diode lasers and IPL systems. As an alternative to these lasers, it is possible to use the Nd: YAG laser with a wavelength of 1064 nm in tanned patients and patients with IV-VI skin phototypes. The point of application of this laser radiation is not the melanin of the hair follicle and the epidermis, but oxyhemoglobin, which is located in the vessel feeding the hair follicle so that skin damage will be less likely.
During the procedure, it is important not to forget about the cooling of the epidermis. Melanin, contained in the epidermis, is a competing chromophore, which can also heat up and damage the integrity of the skin. Surface cooling of the skin, performed before, during and after the procedure, reduces the temperature of the epidermis and reduces the likelihood of thermal injury to the skin. At present, different types of cooling are used in practice. This is applied to the skin of the ice, and contact cooling with a sapphire window with circulating cold water (2-6 ° C), and using a cryogenic spray or systems with a forced flow of cold air. Therapy of skin burns depends on the degree of their severity and is carried out according to accepted standards.
2. Folliculitis (inflammation of the hair follicle) can develop after laser hair removal in patients suffering from hyperhidrosis. The appearance of folliculitis is also possible when in the intervals between treatment procedures the patient visits the pool. Chemical denervation can solve the problem of hyperhidrosis with the use of botulinum toxins. You should limit your visit to the pool, especially in the first days after the treatment.
3. Acneform reactions, according to one multicenter study, account for an average of 6% of all complications of laser hair removal. These reactions are more likely to occur in young patients of both sexes, mainly in individuals with II-V skin phototypes, and when using an Nd: YAG laser. The degree of their expression is negligible. Rashes are quickly resolved and do not require treatment.
4. Exacerbation of herpetic infection occurs in patients with herpes in a history of laser epilation in the upper and lower lip and the zone of the deep bikini. To avoid this complication, a prophylactic intake of antiviral drugs (Valtrex, Famvir, acyclovir) is recommended the day before the procedure, or the day it is performed.
5. Allergic reactions after laser and photoepilation can be clinically manifested in the form of hives, contact allergic dermatitis, intense itching. The reasons for their development may be associated with the use of local anesthetics, applied before the procedure for anesthesia. There are also data on the development of allergic reactions to the cooling gas. Also, allergic reactions are possible when using various topical skin care products after epilation. Treatment includes the appointment of antihistamines, topical forms of glucocorticoids. If the cause of the allergic reaction is not established, the course of laser hair removal procedures should be discontinued.
6. Catarrhal conjunctivitis, photophobia, uveitis, decreased visual acuity – serious complications from the optical apparatus, arising during laser hair removal in the eyebrow area. They develop in patients who did not use eye protection during the procedure (glasses, metal contact lenses). When epilation of eyebrows, it is difficult to achieve a proper treatment of the entire area, if the eyes of the patient are wearing glasses, so many doctors ask him just to cover the upper eyelids with his fingers. As practice shows, this method of eye protection is ineffective and leads to severe complications. Proceeding from the above, one should refuse laser hair removal of this zone or use metal contact lenses, since the thin eyelid skin is not able to protect the eyeball from laser damage.
If we consider the group of late complications of laser and photoepilation, then it is possible to distinguish hypo- and hyperpigmentation, scars, paradoxical hypertrichosis, bromhidrosis, hyperhidrosis, malignancy or dysplasia of nevi in the area of the procedure.
1. Hypo-and hyperpigmentation is mainly a consequence of skin burn, which occurs during laser hair removal. They are most often found in tanned patients and persons with III-VI skin phototypes. It is noted that hypopigmentation often happens with the first degree of thermal damage to the skin when the crust formed after the burn has come off. Hyperpigmentation occurs in patients who do not follow the rules of post-procedure care and begin to sunbathe in the first two weeks after hair removal or do not use sunscreens in exposed areas of skin that has undergone laser treatment. Hyperpigmentation and hyperpigmentation often occur in the field of post-burn scars.
As a prevention of these complications, it is recommended to perform laser hair removal in patients with III-VI skin phototypes with long-pulse Nd: YAG-lasers. Also, these patients can use bleaching creams two weeks before the procedure.
During the procedure, it is essential to choose the right radiation parameters, use reliable and efficient methods of cooling the epidermis to prevent thermal trauma.
In most cases, hypo- and hyperpigmentation are reversible phenomena, but if they stay for long, they use medications. For correction of hyperpigmentation, bleaching agents containing hydroquinone, azelaic acid, hydroxy acids, glucocorticoids are prescribed. For the correction of hypopigmentation apply drugs based on copper, but if they do not have the proper effect, you can resort to cosmetic tattoo.
2. Scars are the result of thermal damage to the skin at a level below the basal membrane. If the burn wound is infected in the process of rehabilitation, then in almost 100% of cases there are gross hypertrophic scar changes. It is noticed that post-burn scars are most often formed on the neck and in the mandibular region. Depending on the anatomical location and genetic predisposition, atrophic, hypertrophic and keloid scars can occur.
Thus, Kluger et al. reported a case of development of a keloid scar in the tattoo zone in a 41-year-old patient with a skin phototype IIIB after laser hair removal in the thorax region. In the anamnesis, he already had keloid scars, which were successfully treated with injections of triamcinolone. In the analysis of this case, it was found that the tattoo pigments acted as a chromophore, competing with the melanin of the hair follicle. As a result of the absorption of laser energy, the tattoo pigment heated up, which led to a skin burn and then to the formation of a keloid scar.
To date, atrophic and normotrophic scars are treated with conservative methods, but with slightly a low efficiency; possibly their surgical treatment. A laser ablative and non-ablative fractional photothermolysis are used sufficiently effectively and with a high degree of efficiency to smooth the surface of the skin in the scar area.
Pathological scars, which include hypertrophic and keloid, are treated with intradermal injections in the area of the scar of prolonged forms of glucocorticoids.
Scientists recently proposed a new and entirely effective method for treating pathological scars – the use of a copper vapor laser.
3. Paradoxical hypertrichosis – enhancing hair growth after laser and photoepilation procedures. According to data from various sources, hair growth stimulation occurs in women with III-VI skin phototypes, mainly on the face and neck, on the border between the treated and untreated zones. Several mechanisms may participate in the development of this complication:
Treatment using low (subthreshold) energy flux density, which does not destroy the hair follicle, but has a stimulating effect on hair growth.
Thermal-inflammatory effect – activation of the? Sleeping? Follicles and stimulation of hair growth of the telogen phase in zones bordering on epilation.
Prevention of this complication is the use of an energy flux density sufficient to remove hair. To correct the paradoxical hypertrichosis, long-pulse Nd: YAG lasers are used.
4. Leukotrichia, bromhidrosis, hyperhidrosis. In 2009, an exciting retrospective study was conducted. According to the data obtained, laser epilation in the axillary region may lead to complications such as hyperhidrosis and bromhidrosis. Hyperhidrosis was observed in 11% of patients, mainly with II and V skin phototypes, when using a combination of two lasers – diode and alexandrite – during the procedure. In the development of bromhidrosis (4% of cases) and leukotrichia (2%), there was no significant correlation with age, skin phototype and type of laser radiation.
5. Dysplasia and malignancy of nevuses in the field of laser hair removal. Do not forget about the possibility of degeneration of melanocytic nevi in the epilation zone. Melanin nevi is a competing chromophore and absorbs laser radiation along with the melanin of the hair follicle. As a result of repeated exposure to laser radiation or pulsed light (IPL system), thermal damage to melanocyte formations occurs, their growth activates, atypical cells appear, which eventually leads to the development of melanoma.
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Prevention of this complication is not to subject the skin to laser hair removal with any neoplasms. If nevi are present in the area of exposure and hair removal is still performed, nevi should be covered with individual protective devices.
So, avoid complications and minimize side effects – one of the main tasks of a doctor in aesthetic medicine. When performing laser hair removal, there is not only the risk of choosing high radiation parameters leading to skin overheating and related complications. Laser hair removal, which seems to be such a simple procedure, can lead to severe complications if performed incorrectly. To avoid this, one should be thoughtful about the appointment of procedures and carefully collect anamnesis. When choosing the type and parameters of exposure, one should take into account the individual characteristics of the patient, especially the presence of sunburn, the skin phototype and its condition in the area of exposure. And of course, it is very important to professionally own the equipment that you apply in your work, to know the specifics of each laser and each photosystem.