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Procedure: Laser Hair Removal

Author: Joely Kaufman, MD FAAD

Laser Hair Removal - learn DiscoverBeauty - an online resource for information related to cosmetic surgery procedures that allows patients to directly communicate with doctors using the BeautyCanvas, an intuitive morphing tool.

Laser Hair Removal

Laser Hair Removal

According to the American Society for Aesthetic Plastic Surgery (ASAPS), laser hair removal popularity has nearly doubled in the last decade, ranking as the second most popular non-surgical cosmetic procedure performed in 2009. This trend continues, with more and more men and women opting for this permanent hair reduction technique. Understanding how these systems work for hair removal is important, as there are several methods of removing hair with various lasers and light-based energy devices.

In the past, methods of hair removal resulted in a temporary elimination of hair, only to have regrowth days to weeks later. These methods, including waxing, shaving, plucking, electrolysis and threading, are still popular, but do not result in permanent hair removal. Laser hair removal can also be a good alternative in helping those who suffer from ingrown hairs and irritation from shaving. Much has changed since the first introduction of lasers for hair removal. In fact, the first laser used for this purpose, the Ruby laser, is no longer used for hair reduction by most physicians. There are now several good options to choose from, and figuring out which device is the right one for you is a very important step in the decision making process.


How Does It Work?

Hair removal with laser and light energy systems occurs due to the reaction between the light and the melanin, or pigment, in the hair. This is a necessary and key step in order for the treatment to be considered a success. The light is absorbed by the dark pigment in the hair resulting in heat and breakage of the hair. This heat then travels into the area of the follicle responsible for hair growth and destroys those cells. All of these steps must be done while protecting the skin from damage. This is why all of these systems come equipped with cooling systems, which keep the top of the skin cold, while allowing enough heat to travel to the follicle and destroy it. If the hair is very light, or even white or gray, the laser light does not get absorbed well and the treatment is often ineffective. Therefore, if you have very light, thin hair, you may not be a good candidate for laser hair removal. Darker hairs absorb a lot of the light energy and are therefore easier to remove. Very dark, thick hair responds well, but care must be taken to use lower, more appropriate settings to prevent too much of a reaction. For those of you who have already experienced laser hair removal, you will know that in the areas where there is a higher concentration of dark hair, the treatment is more painful than the areas of lesser hair, which are almost painless.



Another important factor to consider when deciding on laser hair removal is what color your skin is. Darker skin types can absorb some of the laser light, requiring a more experienced clinician to select the appropriate treatment settings. Tanned skin is also a cause for concern in laser hair removal treatments as the skin has already been reacting to the sun’s rays (light energy). Therefore, patients should take care to be out of the sun both before and after treatments.

Complications from using lasers improperly on tanned or dark skin may include abnormal pigment changes in the skin’s color, burning and even scarring. So again, one must be sure to go to a respected clinician who is experienced in treating this type of skin for laser hair removal treatments. Fortunately, now there are lasers available that are capable of being used on even the darkest skin types. However, these procedures are much more complex, and specific techniques and the right laser devices must be used to avoid complications. For those who have lighter skin, these treatments are not as complicated and clinicians have devices available for you as well.


Treatment Options

The current selection of lasers that are available for hair removal are listed in table 1.  The Alexandrite laser is a short wavelength laser that is able to see pigment very well. It can be used on lighter skin types, but is risky to use on darker or tanned skin. One of its strengths is that it is one of the only lasers able to get fine light hair. The diode laser can be used on all skin types as can the Nd:Yag laser. The Nd:Yag is usually considered the safest for dark skin, but is only able to remove dark, thick hair. There are also several IPL (intense pulsed light) devices available for hair removal. These are not laser devices, even though they may look and feel like lasers. These all differ in their wavelengths and cooling attachments. They are effective at hair removal, but most experienced physicians believe they are not as effective as the lasers.

Depending on the combination of variables described above (hair color, skin color, laser type), laser hair removal will require a series of treatment sessions. For the more difficult to treat (darker skin, lighter hair), you can count on anywhere from 5 to 15 sessions for the best results. With the easier to treat individuals, 4-6 sessions may suffice. The type of laser being used and the area being treated may also influence how many treatments are required. Hair removal of the legs typically takes more sessions than the axillae (underarm).

There is typically some discomfort during the treatment and some physicians may prescribe a topical anesthetic cream to be applied prior to the procedure. If this is the case, your physician will prescribe a specific amount of cream to use, so be careful to follow these instructions, as using too much in too large of an area can result in complications including death in the most extreme cases. If you have questions about how much to apply and where, be sure to ask your physician before you proceed.  With some of the laser systems, such as the Alexandrite, I rarely use topical creams, as the pain is very manageable.



Prior to the procedure you should not wax for at least 2 weeks. Shaving up to the day before is generally acceptable. In fact, if the hair is too long, the treatment is more painful and the hair may burn against the skin.



Post procedure, it is normal for the area to be red for a couple of days. Any pain in the area should be resolved within one hour. The area immediately surrounding the hair follicle will be swollen for a couple of hours. This is normal. Crusting, blistering, or severe pain is not an expected side effect, and your physician should be contacted immediately should this occur.

Most devices are approved by the FDA for ‘permanent reduction of hair’. This means that even after a full series of hair removal treatments, you may still have a few stray thin hairs. Touch ups once a year are a real possibility, so plan accordingly.



With an experienced operator, laser hair removal is a quick and very effective method of permanently removing hair. The savings in time and money not spent on waxing or shaving are real. Not everyone is a good candidate, so make sure you ask your physician whether they would recommend it for you. For those of you with darker skin types, I would encourage you to pick a very experienced and reliable office for your procedures. If complications occur, most of the time they can be completely resolved when recognized and treated immediately by an experienced physician. 


Table 1













Light skin








Light or dark










Thick dark






Light to medium