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J Cosmet Laser Ther 2004; 6: 27–31# J Cosmet Laser Ther. All rights reserved ISSN 1476-4172DOI: 10.1080/14764170410029022 Effective epilation of white andblond hair using combinedradiofrequency and optical energy fluences varied from 24 to 30 J/cm2.
of Dermatology, University ofOttawa, Ottawa, Ontario, Canada the low intensity of target melanin chromophore in hairfollicles exhibiting the aforementioned phenotypes. In this There has been a continued evolution of photoepilatory regard, the present study examined the long-term photo- technology, which has improved the long-term efficacy of epilatory effect on blond and white hair of a new technology laser and intense pulsed light (IPL) source hair removal.
which combines an IPL source (680–980 nm), producing These technologies vary from short wavelength ruby optical energies as high as 30 J/cm2 with pulse durations up to (694 nm) and alexandrite (755 nm) sources, which target 120 ms, with a bipolar radiofrequency device, which can lighter hair/light skin phenotypes, to longer wavelength generate radiofrequency (RF) energy as high as 20 J/cm3 with diodes (800–900 nm), IPL sources (500–1200 nm) and a pulse duration as long as 120 ms designed to deliver RF 1064 nm Nd:YAG technologies for darker hair/dark skin electrical current at a depth of 4 mm, which can target deep- lying follicles capable of producing long-term photoepilation.
However, the major refractory hair phenotype targeted by The theory behind this technology is to deliver a relatively low these technologies has been red, blond and white hair due to level of optical energy that is safe for all skin types whilecompensation for the lack of high laser light intensity isachieved by utilizing an additive energy that is not optical and Correspondence: Neil S Sadick, MD, 772 Park Avenue, New York, does not require melanin as a target chromophore, but is NY 10021, USA.
Tel: (z1) 212 772 7242; Email: nssderm@sadickdermatology.com selectively absorbed by the hair structure.
erythema that lasted more than a few minutes after eachpass was completed.
Thirty-six adult women with white and blond facial hair A baseline hair count was obtained manually by two (aged 38–83 years; mean age 58 years) and skin phenotypes independent observers marking terminal hairs under 66 I–V were included in the study (Table 1). Forty-one study magnification with an apochromatic optical loupe (Nikon) sites were selected; 36 sites were on the chin and five sites within a well-defined 3 cm2 region. The following reference were on the upper lip or moustache area. Twenty-one sites landmarks were utilized: lip (mid-philtrum), chin (mid- had blond hair while 20 exhibited white hair.7 Patients mandibular notch/mid-lower lip vermillion border) in were screened for endocrine disorders, recent Accutane1 order to achieve uniformity of sequential hair counts.
ingestion, recent sun exposure and scarring tendencies.
Percentage hair reduction was defined as the average Discontinuance of any epilatory or bleaching agents for 1 number of terminal hairs present at each defined time month was mandated prior to treatment. Patients with a interval compared with the average number of terminal history of previous laser, IPL or electrolysis treatment were hairs at baseline. Hair counts were taken after each treatment session, at months 12 (following the last treat- Informed consent from all participants was obtained and ment) and 18 (6 months following the last treatment).
the body site to be treated was identified and photo- Subjective patient reports and adverse effects were also graphed. No topical anesthetic agent was applied to treated recorded at each follow-up visit. A patient satisfaction scale was instituted at the last follow-up visit. The following scale The study group of patients received four treatment was utilized: grade I –no improvement; grade II – mild sessions over a period of 9–12 months and results were improvement; grade III – good improvement; grade IV – monitored 18 months after the first treatment or 6 months The target area was shaved prior to treatment. Sequential digital photography using identical lighting, patient posi-tioning and camera equipment (Fujifilm FinePix S2 Pro Digital SLR Camera, Tokyo, Japan) were obtained of alltreatment sites at baseline and 1, 3 and 6 months after the During the first week after the treatment, no significant last treatment. A thin layer of transparent gel was used for hair reduction was observed. Maximum reduction in hair cooling and skin hydration. Light pressure was applied via counts was observed at 6–8 weeks after each treatment.
the applicator to the treatment site in order to ensure good Hair density was decreased from treatment to treatment coupling of electrodes onto the skin surface. Contact as noted by both patients and investigators. An average cooling (x4‡C) was provided via incorporation of a clearance of 48% was observed at month 18 (6 months cooling chamber head in the treatment tip.
following the final treatment session) (Figure 1). A slightly The level of RF energy was set at 20 J/cm3 in all study higher photoepilatory efficiency was noted for blond hair patients in a short pulse profile mode. The range of (52%) versus white hair (44%) treatment sites (Table 2).
fluences used in the study protocol was 24–30 J/cm2, Upper lip and chin sites had comparable hair removal depending upon skin phenotype. Test pulses were carried efficiency. Two patients had minimal response (less than out on an area adjacent to the study site to determine thelevel of optical energy suitable for each patient. Pulses wereplaced in an adjacent minimally overlapping pattern overthe entire study site. Multiple passes were carried out to amaximum of four passes unless there was persistent (A) Before combined intense pulsed light (IPL)/radiofrequency (RF)white hair removal; (B) after combined IPL/RF white hair removal (four treatments; month 18 (6 months following last treatment); Demographic profile of the IPL/RF study population (36 patients).
optical energy~26 J/cm2; RF energy~20 J/cm3).
diminution of melanocytes is associated with a lower The results of this study indicate that combined RF and optical energy is an effective method of photoepilation for white and blond hair (Figure 2). It is generally acceptedthat white hair is unresponsive to light systems operating in Mean hair removal efficiency in the IPL/RF study population (four The thermal damage time (TDT) varies with the diameter of the hair shaft and follicle, and the temperatureof the hair shaft or matrix.1 For medium to coarse hairs 10% mean hair reduction). These two patients were older (50–125 microns) the TDT is 170–1000 ms.1,2 The use of super-elongated pulses should theoretically be a more A total of 67% of patients graded their improvement as efficient way to produce pan-trichodestruction.25 This good or excellent, with the majority noting good or no mechanism of injury may be advantageous for treating Side effect profiles noted in this study were minimal.
blond or red hair where optical coupling to lower levels ofblack-brown granules is diminished. Few such technologies Transient hyperpigmentation requiring no therapy was with super-long pulses are presently available for clinical noted in 8% of patients; 14% of patients had mildpersistent erythema, which resolved within 24 hours.
usage. For white hair without pigment for optical coupling, Results showed no significant dependence on skin color, even a super-long pulse is likely to be effective.
as lighter and darker skin types responded similarly to With any pulse width, optical energy targets melanin and heating of the hair follicle occurs from the inside and proceeds outwards. In contrast, RF energy heats the hairfollicle from the outside in and requires no chromophore.
For gray or white hair where there is little or no melanin, the optical component of the electromagnetic pulse plays aminor role. It is hypothesized that there is non-specific Hair color is genetically determined by the presence of the preheating of the follicle acting as a macroscopic structure black-brown pigment melanin and the yellow-red pigment absorbing light. The preheating reduces the impedance and pheomelanin. There is no simple arithmetic relationship facilitates the concentration of RF current within the outer between eumelanin/pheomelanin ratio and hair color, but layers of the follicle. This progression of outward to inward the highest levels of eumelanin occurs in black hair and the heat transfer is likely responsible for the injury ensuing to the highest levels of pheomelanin are appreciated with red hair.
germinative area of the hair follicle which results in the hair Eumelanin absorbs red or infrared light more than removal efficiency that is clinically noted in this setting. This pheomelanin and it is the black-brown pigment granules mechanism of injury should also theoretically provide in the matrix cells and hair shaft that provide the primary effective epilation when the target chromophore is reduced, target chromophores. Thus, it is not surprising that as with blond or red hair as shown in the present study.
previously reported studies confirm that photoepilation Other lasers being studied based on this concept include is less effective for red, blond and white hair, where the super-long pulsed 810 nm diode laser.36,37 Figure 2(A) After intense pulsed light (IPL) white hair removal (optical energy~20 J/cm2; no radiofrequency (RF) energy); (B) after combined IPL/RF whitehair removal (optical energy~20 J/cm2; RF energy~20 J/cm3).
Other techniques used to target white hair include response noted in two elderly patients with coarse white photodynamic therapy utilizing a photosensitizer such as 5 hair may be expected in view of the larger surface area of amino-levulinic acid, which also leads to non-chromophore heating required for this phenotypic population.
targeting of pilosebaceous structures.38 Melanin encapsu-lated liposomes (Meladyne) have also been studied as anexogenously introduced target for non-pigmented white,grey and light blond hair. Six-month follow-up studies utilizing the diode laser showed 75–100% hair reductionafter three treatment sessions in 90% of treated patients.
Further comparative studies looking at the effect on hair However, these results have never been substantiated by RF alone versus light and RF are needed.
other investigators (Personal communication).
Integrated RF and optical energy technology represent a The 48% hair removal efficiency observed 6 months new effective photoepilatory technology for the long-term following a third monthly treatment session reported in the removal of blond and white hair phenotypes. It is present study population suggests that combined RF and hypothesized that this technology in this patient population optical energy offers a favorable alternative to this is based primarily on thermal damage induced by the RF previously difficult to treat patient management subgroup.
component. Although results may not be quite as efficient However, it should be noted that the epilatory efficiency of as with chromophore-targeting primarily light-based tech- this technology, as demonstrated in the present study, is nologies, it does offer a new approach to this previously not as advantageous as pure laser sources utilized for the refractory group of photoepilatory individuals.
removal of darker hair skin phenotypes. The slightly higherphotoepilatory efficiency of 52% noted for blond hairversus 44% noted for white hair might be expected based upon the potential synergistic effect of combined chromo-phore targeting and non-selective RF heating. The poorer Dr Sadick is a research consultant for Syneron.
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