Hair removal with Intensive Pulse Light System (IPLS): a 6-month follow-up Hadi Abed Hadi Al-Wakeel (MBChB DDV MSc PhD) Department of Physiology, College of Medicine, University of Kufa. إ ازلة الشعر بواسطة الا شعة الضوي ة المركزة د ارسة النتاي ج المستقبل ة بعد ستة أشهر من انتهاء المعالجة الا هداف: تق م الكفاءة الا ع ارض الجانب ة والنتاي ج المستقبل ة لا زالة الشعر بطرقة الا شعة الضوي ة المركزة. الطر قة: أجرت الد ارسة على خمس ن من النساء المصابة بزادة نمو الشعر في منطقة الوجنت ن الحنك والشارب من ذوات الجلد الا سمر والشعر الا سود الخشن. لقد تم إعادة الجلسات ما ب ن أربع إلى ست جلسات لكل مرض. النتاي ج: لوحظ عن طرق الم ارقبة والتصو ر الفوتوغ ارفي أن هناك انخفاض ملحوظ في نسبة الشعر مع زادة في 384 درجة نعومته وتا خر في ظهور. كما لوحظ عدم ظهور أع ارض جانب ة داي م ة في منطقة العلاج. الخاتمة: إن طرقة الا شعة الضوي ة المركزة هي من الطرق الحد ثة لا ازلة الشعر بشكل داي مي وبدون أع ارض جانب ة. Abstract: Background: A variety of lasers and light sources have been used for hair removal. A novel flashlamp-based device, with a mechanism of action of flash light therapy has recently become available. Objective: To assess the efficacy, side effects and long-term results of the Intensive Pulse Light therapy for photo-epilation. Methods: A total of 50 female patients, skin types IV and V, with dark, coarse hair mainly on the chin, cheeks and mustache, were reviewed after having been treated during the previous 18 months with this system. Each patient had at least four sessions with a maximum of nine. No depilatory treatment except shaving was allowed during the time of follow-up. The percentage of hair reduction was measured clinically or by comparing (before and after) photographs. Results: After four to nine sessions, depending on the anatomic location, all patients showed hair reduction as well as hair thinning. The percentage of reduction varied depending on the anatomic location and number of sessions, the covered areas responding better than the exposed areas. Transient side effects were limited to a stinging sensation during the session and to redness, which lasted for up to 2 days. No chronic side effects were observed. Conclusion: The present study demonstrates that this device is safe and effective for hair removal with a long-term effect.
Introduction: Unwanted hair is a common cosmetic problem. Traditional methods of hair removal such as shaving, plucking and waxing are temporary, 1 while electrolysis has shown its limitations in terms of side effects by way of pain or potential scarring. 2 Since 1995, lasers have been available for the medical and cosmetic market, beginning with red lasers and then infrared lasers and intense pulsed light sources (IPLS). (3-5) IPL therapy, also called photo rejuvenation, uses intense pulses of broadband light to smooth and tighten the facial skin and remove age spots, freckles, and visible blood vessels. Unlike the narrow band light of lasers, the light used in IPL is delivered to the deeper parts of the skin (the dermis) and does not damage the surface (the epidermis) of the skin. Therefore, no recovery time is needed and a larger area of skin can be treated at one time. The thermal effect of IPL also causes production of new collagen, leading to improvement in wrinkles. Their efficacy has been well demonstrated by thermally damaging the hair follicle. (6) However, these systems are usually quite large in size because they require highenergy densities as well as a cooling means to be effective. In order to evaluate the intensive pulse long-term efficacy, a clinical study was conducted and the results of longterm hair removal obtained with it were reported. Materials and methods Patients: This study included 50 female patients with Fitzpatrick skin types IV and V. The mean age, weight, onset of hirsutism and the time of recurrence after using the familial methods of hair removal were shown in table 1. Hair was coarse and black or dark brown in colour. Treatment sites included: the cheeks, chin and mustache areas table-2. The frequency of methods used for ordinary hair removal is demonstrated in table-3. Most of the patients are slightly tanned. The system: The Intensive Pulse Light System is a flashlamp device, emitting light energy. The light energy targets melanin as its final chromophore. The selective absorption of light is based on the principles of selective photothermolysis. The heat energy originating from hand piece, is deposited and conducted via the epidermis and mainly by the hair shaft down to the hair papilla. The system operates an optical energy fluence range between 20-35 J/cm2, wavelengths between 400 and 1200 nm and a 10 cm size. This large spot size allows deep penetration by enhancing the scattering phenomenon. In addition, the system induces a temperature gradient that forces the heat generated by the flashlamp to flow in the direction of the skin, which thus induces heat convection from the lamp to the hair shaft. Treatment protocol: Prior to the treatment, all patients were instructed to avoid sun light exposure of the areas and mechanical epilation of the hair required for photoepilation. Avoid using any local treatment. The areas were freshly shaved 3-4 days prior to treatment to allow new hair to appear. The skin areas were photographed prior to treatment with a standard digital camera (Mercury Digital Camera VQ4810Z, 4 mega pixels). No local anesthesia of any kind was required, and cooled gel was not used during the session. No post-treatment regimen was used, except the recommendation for sun avoidance for at least 2 weeks after each session. The hand piece of the system was 385
applied gently on the skin, without any pressure at all, and the system was then activated. No overlapping was done. Fluences vary from 20 J/cm2 to 35 J/cm2. The observable endpoint of treatment was darkening or burning of the hair and follicular erythema. Photographs were taken prior to the treatment, at the end of the treatment and 3 6 months after the last session to observe the long-term global hair reduction. Between four and nine sessions were performed at 4-week intervals table 4,5. Owing to hair growth delay seen usually around the third or fourth session, intervals between treatments had a tendency to be longer between the last sessions (up to 3 months). The percentages of hair reduction were determined by clinical assessment using only the before-treatment photographs as baseline and the follow-up photographs. Results: All patients had a significant percentage of hair reduction on all treated areas table-4,5. At the conclusion of the treatment period the group average hair reduction was 77% (range from 50% to 90%). On average, 5.5 sessions (range 4 7) were conducted for the patients. Significant hair reduction (71%) was observed 3 6 months after the last session, with a group average of 69% (range 30 90%). No major immediate or chronic side effects have been observed. Patients felt a slight stinging sensation at the time of the treatment. Erythema was seen on the treated areas in all cases, which lasted from a couple of hours up to 2 days after the session. No scarring was observed. Table (1): The mean age, weight, onset of hirsutism and speed of recurrence after ordinary method of removal. Factor Min. Max. Mean SD Age (years) 16.00 51.00 27.0200 6.53246 Weight (Kg) 54.00 110.00 68.8600 13.61573 Onset of hirsutism (years) 1.00 12.00 5.0800 3.13532 Speed of recurrence after removal by ordinary methods (days) 1.00 20.00 6.6400 4.54349 Table (2): The anatomical location of hirsutism. Anatomic Location Frequency Percentage Chin 49 57.6 Cheek 28 33 Mustache 8 9.4 386
Table (3): Ordinary methods of hair removal. Hair removal method Number Percentage Thread 29 58% Electrical 7 14% Thread-wax 5 10% Mechanical 3 6% Mechanical-Electrical 1 2% Mechanical-Thread 1 2% Shaving-Thread-Wax 1 2% Thread-Electrical-Wax 1 2% Thread-Electrical 1 2% Thread-Mechanical 1 2% T0tal 50 100% Number of Shoots / first session number of shoots/ last session Table (4): Result of hair reduction. Number of sessions 387 Hair reduction at the end of sessions Hair reduction at 3-6 months after the last treatment 8 4 80% 70% Table (5): Total number of sessions. Number of session frequency percentage 2 17 34 3 13 26 4 8 16 5 7 14 6 5 10 Total 50 100 Discussion: This study carried out with the Intensive Light Therapy System shows results with 30 90% clearance at 3 6 months after four to nine treatments. Other systems, which are based on a high energy delivery (e.g. lasers), show results with 50 70% clearance at 6
months after two to three treatments. (7-10) The hair reduction results given in Tables 4 are based on global clinical assessment. It is known that heat is mandatory to obtain long-term hair removal results, although it is not really known precisely which portion of the follicle has to be damaged. (9) To avoid heating the epidermis a long pulse duration is ideal, which enables the epidermis to cool simultaneously as it is being heated. However, this approach will lead to conductive heat loss from the targeted structures and hence reduces the peak temperature of these structures. A second option is to deliver light energy solely via the hair shaft and follicle an impractical task. Alternatively, since heat, and not light, is responsible for the hair s damage, heat energy, rather than excessive light energy, should be brought into play from a different source. The pulse duration of the system is 35 ms. This duration leaves time for the epidermis, which has a short thermal relaxation time (up to 7 ms), to cool down while the hair follicle, which has a much longer thermal relaxation time (40 100ms), will continue to increase in temperature, allowing the thermal damage required for hair reduction. The need for cooling the skin before, during or after treatment is eliminated. The bulk heat energy that is naturally emitted from the handpiece light source enables the use of much lower energy fluence while maintaining effective thermal confinement for the hair follicle and epidermis. This enables the use of a much smaller electrical energy source without the need for a cooling system, resulting in a device that is significantly smaller in dimension than existing systems. The interval between treatments ranged from 4 to 8 weeks according to previous studies, demonstrating that a shorter interval between treatments will negatively affect the cosmetic outcome. (11) Female hair removal on the covered area was superior to that of the exposed one. This is not surprising, knowing that the skin on the exposed area is much thicker than on the covered area. Therefore, the hair structure on the covered areas, being closer to the surface, is easier to damage with this method as well as with laser systems. In general, as with other systems, it is still very difficult to predict the outcome for a particular patient. Side effects were all minor and transient. This is probably due to the low-energy density used, as high-energy density is one of the factors producing complications. In conclusion, the current study demonstrates that the Intensive Light Therapy System is a safe and effective long-term photo-epilation system. References: 1. Olsen EA. Methods of hair removal. J Am Acad Dermatol 1999; 40: 143 55. 2. Richards RN, Mehrag GE. Electrolysis: observation from 13 years and 140 000 hours of experience. J Am Acad Dermatol 1995; 33: 662 6. 3. Grossman MC, Dierickx C, Farinelli W, et al. Damage to hair follicles by normalmode ruby laser pulses. J Am Acad Dermatol 1996; 35: 889 94. 4. Gold MH, Bell MW, Foster TD, Street S. Long-term epilation using the Epilight broad band, intense pulsed light hair removal system. Dermatol Surg 1997; 23:909 13. 5. Lask G, Elman M, Slatkine M, et al. Laser-assisted hair removal by selective photothermolysis. Dermatol Surg 1997; 23: 737 9. 6. Lask G, Eckhouse S, Slatkine M, et al. The role of laser and intense light sources in photo-epilation: a comparative evaluation. J Cutan Laser Ther 1999; 1: 3 13. 388
7. Troilius A, Troilius C. Hair removal with a second generation broad spectrum intense pulsed light source a long-term follow-up. J Cutan Laser Ther 1999; 1: 173 8. 8. Gold MH, Bell MW, Foster TD, Street S. One-year follow-up using an intense pulsed light source for long term hair removal. J Cutan Laser Ther 1999; 1: 167 71. 9. Alster TS, Bryan H, Williams CM. Long-pulsed Nd:YAG laser-assisted hair removal in pigmented skin. Arch Dermatol 2001; 137: 885 9. 10. Handrick C, Alster TS. Comparison of long-pulsed diode and long-pulsed alexandrite lasers for hair removal: a long-term clinical and histologic study. Dermatol Surg 2001; 27: 622 6. Lloyd JR, MacGillis DR. Laser hair removal: results of 2-week versus 6-week treatment intervals. Lasernews.net / LaserExpress July 2002.Hair removal with a combined light/heat-based photo-epilation system 167. 389