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Join Dr. Zain, Heather, and Courtney in this informative episode of Skinside Out as they delve into the world of laser hair reduction. They explain the science behind laser treatments, including the theory of selective photothermal lysis, and discuss different types of lasers such as Alexandrite, Diodes, ND YAG, Ruby, and IPL. The team also covers what makes a good candidate for laser hair removal, the consultation, and treatment process, and important aftercare tips. Additionally, they discuss common concerns, potential complications, and the importance of choosing a qualified provider for safe and effective treatment. If you're curious about laser hair reduction, this episode is a must-watch!
00:00 Introduction to Skin Side Out
00:50 Understanding Laser Hair Removal
03:05 Different Types of Lasers
08:03 Good Candidates for Laser Hair Reduction
13:29 Treatment Expectations and Maintenance
17:21 Exploring At-Home Treatments
18:10 Key Questions for Consultations
19:20 The Importance of Qualified Providers
22:41 Pre-Treatment Tips and Precautions
24:02 Pain Management During Laser Hair Removal
27:17 Post-Treatment Care and Side Effects
28:05 Understanding Paradoxical Hypertrichosis
29:35 Optimizing Laser Settings for Best Results
31:08 Concluding Thoughts on Laser Hair Reduction
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
06 - Skinside Out
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[00:00:00] Welcome to Skin Side Out where Science Meets Beauty. I'm your host, Dr. Zane, joined with Heather and Courtney. So today we're talking all about laser hair reduction.
Heather Murray, PA-C: I. So we'll kind of break it down for you. We're gonna talk about how it works, different devices to use or that can be used, what makes a good candidate for laser hair removal?
And we'll walk you through the consultation and the, and the treatment process.
Dr. Zain Husain, MD: Great. So let's kind of get into the science first. So, how does laser hair removal or reduction work. So it goes back to one of the fundamental [00:01:00] principles in laser medicine, the, um, theory of selective photothermal lysis. So that's a mouthful, but what it is, it's basically a theory where we are using light energy to target, um, something in the skin called the chromophore, which absorbs that light energy.
Heats it up and destroys it. So it gives us its correct clinical endpoint. So for instance, if we're doing laser hair removal, we are targeting the pigment within the skin called melanin. And within that melanin, it accepts that heat. And due to that heat, it actually destroys or damages the stem cells in that hair follicle, which leads to that reduction that we see.
Heather Murray, PA-C: Yeah, to kind of break that down to just breaking down the word photo, thermo lysis, photo meaning light thermo, meaning heat lysis being destruction. So we're using that light to convert it to heat, to destroy a specific target.
Dr. Zain Husain, MD: Yeah, and this is kind of important because with all laser [00:02:00] medicine, we are using different wavelengths of light.
So these are properties of light, that selective, um, you know, things within the skin can absorb. So say you're treating, um, you know, treating melanin which is pigment, or if you're looking at blood vessels, it's looking for hemoglobin or what's in red blood cells and or if you're targeting water on the surface of the skin.
These are all different targets for these, um, for this light energy to create a clinical endpoint.
Courtney Carroll, LE: I feel like we could do literally a three hour episode just on lasers, because I know we say it all the time, but, um, each laser really is created differently and there's different methods of laser hair reduction.
So you do have, um, not only different lasers, but the different wavelengths and they can affect each skin type differently.
Dr. Zain Husain, MD: Absolutely. And that's also great that we have different lasers that we can use. For hair removal. So we can kind of use the right device for, um, [00:03:00] the patient's skin type and type of hair that they have.
And it really allows us to customize the treatment. So let's go into those specific lasers that are out there and where we might use some of these lasers. So let's kind of go through some of the list of technologies that they're out there.
Heather Murray, PA-C: So I think just to kind of explain the main difference between the lasers, um, we'll go into different names and stuff, but, um, the main differences between the wa lasers, like Dr.
Zane said, is the wavelength, but also you have to think about the medium. So a lot of the laser names are based off of what medium is used, and so a medium is just a particle. Usually it's like a crystal . Used to amplify that light. And I think when a lot of people hear the word laser, they think.
Everybody knows what laser means, but not everybody knows what it actually means. Mm-hmm . So laser is actually an acronym. Mm-hmm . It stands for Light Amplification by Stimulated Emission of Radiation. And so that's a [00:04:00] mouthful. . It is a mouthful. And so to kind of break it down, um, like we touched on with the different mediums and the wavelength, so one example is the Alexandrite, which is a wavelength of 7 55 nanometers.
This one does a really good job for the lighter skin types, but it's definitely not something used for the darker skin types because it's really targeting that melanin.
Dr. Zain Husain, MD: Yeah. And if you ever hear it called Alex, that's the same thing. Mm-hmm . Yeah. Mm-hmm .
Courtney Carroll, LE: Yeah. You also have your diodes, which um, are kind of controversial.
I don't. I don't love diodes for hair removal. I don't think that the results have been nearly as significant as with like the Alex and with the 10 64. Um, that's just my experience. , I, I, I think,
Dr. Zain Husain, MD: I think it depends on the device. Yeah. There are some great diodes out there. And one of the advantages I see with diodes is the speed.
Yeah.
Courtney Carroll, LE: Um, you can get a
Dr. Zain Husain, MD: lot. Mm-hmm . You'd cover a lot of ground, um, in a short period of time. Um, but yeah, I mean, it has its place. Yeah, for sure.
Heather Murray, PA-C: And I don't know if you [00:05:00] mentioned this, but the wavelength is around 800 to eight 10 nanometers, so it goes a little bit deeper than the Alex. Um, so it, it can be good for lighter skin types, but it can also be used for the darker skin types
Dr. Zain Husain, MD: too.
Yeah. And then we have the 10 64 ND ag. Um, this is a popular wavelength to use because safely treats melanin and darker skin types. Mm-hmm . So for laser hair removal, this is the one that I go to.
Courtney Carroll, LE: Yeah, I, I really like the 10 64. I feel like there's no real hesitation. I mean, um, even for, you know, patients who have tried like the diodes and stuff, I feel like mm-hmm
You know, the 10 64 is a nice alternative option.
Heather Murray, PA-C: Yeah. And to get a little nerdy, the, what does ND Egg, what does it stand for? So. It stands for neodymium, doped Atrium, aluminum Garnet. So that Bravo, someone gets an A plus today. Yeah, that atrium. Aluminum garnet is the yag. And so that's the crystal that creates the, um, [00:06:00] amplifies the light into energy and it uses those neodymium ions to help create that photon of light.
And so it's getting a little like physiological and scientifical, but um, that's kind of the. The nerdy breakdown of it. Yeah. .
Dr. Zain Husain, MD: And there are other technologies out there. So, um, there's also the Ruby laser, which is pretty old school. Um, it was also used for laser hair reduction as well as also vascular, um, purposes.
It's a little higher risk. So, and it's not really in use that much, but it is one of those relics from back in the day. Um, so it can be used. I'm sure there's some that are operating out there. Um, so that is an option. And then IPL, intense pulse light. a true laser. It's actually a broad spectrum of wavelengths that can also target melanin, but unfortunately it can also, um, lead to potential complications.
It's not as targeted, so it's not the best treatment. You can get away with it with lighter skin types or kind of really cranking down the energy, but it is higher risk [00:07:00] and not something that I routinely recommend.
Courtney Carroll, LE: Yeah. Um, and it's funny, even, you know, with all of those different wavelengths being mentioned, you can still have the same wavelengths but with different lasers.
So, for example, one laser, um, that I've used in the past is the Gen Max Pro. It does have the dual wavelength with the Alex as well as the nd yag. That one does have a cooling system where it uses, um, cryotherapy essentially as like a, a spray. So as soon as you pulse it, you'll get that cold air as well.
, the one we have in our office is a Cutera XL hr, and that one actually has a cooling tip on it. So, um, you can change the degree of temperature on there to help cool down the skin before you pulse. Mm-hmm . So all of them have their own little, benefits, I guess. Um, and, and some
Dr. Zain Husain, MD: use like, um, you know, Zimmer or a cold spray.
Yeah. To kind of keep the temperature of the skin cool enough so it limits the amount of damage that can happen. Yeah.
Courtney Carroll, LE: Like I said, just all, all lasers kind of being created differently and, and [00:08:00] kind of finding the, the right one for you is important.
Yeah. ,
Heather Murray, PA-C: let's talk about some, um, good candidates. I mean, anybody who has unwanted hair is pretty much a good candidate, but Courtney, do you wanna touch on other reasons why you wanna do laser hair reduction? Yeah.
Courtney Carroll, LE: Yeah. So, um. Specifically, the darker the hair, the easier it's going to be to treat. So your blonde hairs, your red hairs historically are not going to react as well as your darker coarser hairs.
Heather Murray, PA-C: I think that Alex does a little bit of a better job. Mm-hmm . Compared to some of the others. 'cause it can target the thinner. Mm-hmm . What about gray
Dr. Zain Husain, MD: and white hairs?
Heather Murray, PA-C: Gray and white hairs. Yeah. Yeah, unfortunately.
Courtney Carroll, LE: So I always joke with my patients, you wanna zap 'em while they're still got some color on them.
Heather Murray, PA-C: Dr. Zane's got a few on his
Courtney Carroll, LE: neck. Yeah, unfortunately. Can we get a zoom it now? . Um, so, and the reason for that is, like Dr. Zane had mentioned earlier, is that the lasers are picking up on that pigment. So when you have a white or gray hair that lacks that pigment. There won't be anything for that laser to [00:09:00] find and focus on.
So the darker the hair and the coser the hair, the better it tends to respond.
Dr. Zain Husain, MD: So what do these gray haired individuals do? suffer. Just kidding, . Um,
Courtney Carroll, LE: there is an alternative, um, electrolysis, which you may have heard of. Electrolysis, is a procedure where they actually are using this tiny little probe to go into the follicle, each individual follicle, to destroy that, um, you know, tissue essentially is.
Painful , . It's tedious. I specifically, , like the laser for the larger surface area, and I, and this is coming from someone who used to do electrolysis as well. I do like using the laser for the largest surface area possible. You're able to get the whole area in one treatment where electrolysis, depending on how much hair you have, you may need.
15 minutes, 30 minutes, 45. I mean, some people, especially like your PCOS patients who have a lot of hair mm-hmm . Will require a long time to sit through and it can be really [00:10:00] tender. So that's where I think the laser, excels. But again, the gray and white hairs electrolysis.
Dr. Zain Husain, MD: What about if like fine velas hairs,
Heather Murray, PA-C: it doesn't do a very good job, especially because they're just so thin.
Mm-hmm . It doesn't really catch up on it.
Dr. Zain Husain, MD: Yeah. The course or the better.
Heather Murray, PA-C: Yeah. Yeah.
Courtney Carroll, LE: I do find sometimes with my, . Like sometimes those sideburn areas, they do do well I think because they are a little bit coarser. But yeah, once you're getting into those really fine cheek hairs, the laser won't tackle that.
Yeah, I think Dermaplaning is great for that. Yes. Yeah. Yeah. Big dermaplaning fan . Mm-hmm.
Heather Murray, PA-C: I think as far as other candidates for laser hair reduction, um, it's definitely worth considering somebody who has like folliculitis, so inflammation around the hair follicle, if they get razor bumps from shaving.
Mm-hmm . I think HS is a big one too. So hidradenitis is super tiva. That is a condition where it's very centralized around the follicular spacious unit. So if you can destroy that hair follicle, it kind of helps relieve some of the symptoms. And
Dr. Zain Husain, MD: pilonidal cysts, they're really painful, uncomfortable. [00:11:00] And that can sometimes reduce the incidence of developing Pilonidal cyst, um, getting rid of that hair in that very.
In a gluteal area,
Courtney Carroll, LE: PCOS patients, definitely. I, I see a lot of PCOS patients and I think it's been life changing for them, to say the least. So, um, people who have PCOS are more apt to produce or overproduce hair, essentially in that beard distribution area. And so it can be extremely helpful and just managing that.
Heather Murray, PA-C: We saw a patient the other day, um, I had seen her and she was also seeing Courtney too. Um, for her one month follow up, she was doing laser hair removal on her chin and it, the photos, the before and afters are so dramatic. That's even just by, by one or two treatments. Yeah. And
Dr. Zain Husain, MD: by reducing like folliculitis too associated with those hair follicles, then we can kind of start reducing the post-inflammatory hyperpigmentation.
And that's a huge game changer. 'cause a lot of people are self-conscious about that.
Courtney Carroll, LE: That's exactly what I was gonna touch on, is especially people of color who, um, have that hyperpigmentation from the hair and [00:12:00] may have been plucking or waxing mm-hmm . Which just kind of contributes to that. I love pairing that with a lightning agent like hydroquinone and seeing the difference not only in the hair reduction, but the brightening of the area.
It's just, it's my favorite thing to see before and after . Yeah. And
Dr. Zain Husain, MD: a personal story for myself. I mean, I used to get a lot of folliculitis from shaving. I did all the best practices, you know, using, you know, warm water right after, like, you know, getting a shower, um, using my shaving cream, soothing gels, um, you know, shaving with the grain and everything.
And I would just like break out all the time. So I decided to finally do laser hair reduction. Um, and, you know, within six months I stopped having to shave from my atoms apple down. Don't get those painful cysts anymore, or that PIH. I haven't shaved in like over seven, eight years now. And That's awesome.
Courtney Carroll, LE: Yeah. So
Dr. Zain Husain, MD: it can be a game changer for guys too.
Courtney Carroll, LE: Yeah. Yeah. I've treated a lot of backs chest, um, on my male patients. Yeah. Beard line necks. Um, we've treated your neck [00:13:00] several times, ,
Heather Murray, PA-C: and we have those patients who want total body, which end today. Yeah. ,
Courtney Carroll, LE: they wanna
Dr. Zain Husain, MD: be a. Smooth as a dolphins.
Courtney Carroll, LE: Yeah. . Yeah. So I think those are, um, yeah.
All in the realm of good candidates. Mm-hmm . And, you know, if you do have that more blonde velas hair, for example, I know like my upper thighs for example, I would not be a great candidate because . More than likely you'll be spending, um, more money than you would like to for very little, if any results.
So just keeping that in mind.
Heather Murray, PA-C: Yeah. So let's also talk about treatment expectations. So most people tend to need six to eight sessions to see a significant reduction, usually four to eight weeks apart, but it depends on . How far into the treatments you are, as well as the treatment area?
Courtney Carroll, LE: Yeah, I, my guideline normally, and a lot of times you have patients who wanna treat multiple areas mm-hmm
So for example, the underarms and the legs. Or the face. And the legs. So typically I've done six to eight weeks on my legs, Brazilians. Then [00:14:00] about four to six weeks on the underarms and face. So six weeks I find to be a pretty good, yeah. Happy medium. Yeah, happy medium.
Dr. Zain Husain, MD: And also one of the expectations, so just kind of breaking it down, I colloquially we all hear it as laser hair removal.
Mm-hmm . It's really laser hair reduction as you've seen us referring to this procedure multiple times, um, during this podcast. But . , I always tell my patients there's gonna be some maintenance that is involved with these treatments. You're gonna get some little hairs coming and you know, you might have to, you know, do a little maintenance treatment here and there.
And like Courtney, I mean, with your patients, , you know, you're usually seeing them a few times a year maybe. Mm-hmm .
Courtney Carroll, LE: Yeah. I think, um, you know, the hope and the goal is to get around 80% reduction in hair. Um, at that point, you know. The maintaining, hopefully, depending on the area will be very infrequent.
I do find the face tends to be more, um, hormonally driven. Mm-hmm . So I think typically I find that we have to upkeep that a little bit more than maybe the Brazilian or maybe the legs. So I would expect, you [00:15:00] know, when I, and I, when I do my consults, I tell patients, if we're treating the face, just know Yeah.
We will require more touchups. You know, as time goes on,
Dr. Zain Husain, MD: it can make the hair, um, a lot thinner. Yeah. And less noticeable. Exactly. So you don't maybe. Not to like care about it. Like for me, like I get hear, you know, here and there, but it's not anything to write home about. Yeah, exactly.
Heather Murray, PA-C: I think you also have to consider people who are on medications or supplements that can stimulate hair growth.
So like people who are on Minoxidil. Mm-hmm . It can cause you to grow hair places you don't, may not want it. Um, biotin supplements, um, protein shakes, people who are heavy on the protein shake shakes and um, high carb diets too can definitely play a role.
Courtney Carroll, LE: I like. Um, speaking to just that point on medications, I do love pairing, especially my PCOS patients with spironolactone mm-hmm
Or, um, . Something of that nature, especially because Spironolactone is an oral medication that we use for acne, but it's a androgen blocker, so it blocks the male hormone, which can kind of contribute to that [00:16:00] beard appearance in our female patients. And I think the combination of utilizing that with the laser hair reduction just.
Promise is a much better result and they can sustain those results longer.
Dr. Zain Husain, MD: Yeah. And there's also like a topical that we use mm-hmm . In dermatology. Um, you know, it was previously known as Vica. Mm-hmm . Or a fluorine. , so currently off the market as a, as a, you know, brand name, but I think you can get it compounded and what this does, it just slows down the hair growth process.
So sometimes pairing that with laser hair reduction can also, um, impart longer lasting results.
Courtney Carroll, LE: Mm-hmm . Yeah. Um, other things you wanna keep in mind too are seasons because you do not want to be tanned for this procedure. Mm-hmm . And so, you know, kind of timing your sessions around more of that. Fall to winter is usually recommended.
It's kind
Dr. Zain Husain, MD: of tough 'cause like six to eight treat months, hard months, it's hard.
Courtney Carroll, LE: Yeah. Mm-hmm . Um,
Dr. Zain Husain, MD: so I mean, I guess if you're really invested in it, yeah. Um, just be careful about the sun or sunscreen. It's really [00:17:00] important.
Courtney Carroll, LE: Yeah. I find legs to be the biggest culprit face. Um, I think most people are pretty good about wearing sunscreen on their face.
Yeah. Especially those who are taking you know, laser sessions. They wanna make sure that they're maintaining and that they're protecting their skin. But, , underarms, Brazilians tend to do okay during the summer, but the legs, they're tricky. . Yeah.
Heather Murray, PA-C: Yeah. Um, let's talk about at-home treatments. 'cause I feel like that's very popular now.
Um. There's so many options on the market. I mean, my opinion is that they're kind of underpowered, , the light scatters in a way to where it's not gonna give you that guaranteed. Mm-hmm . You know, like 80 percent-ish reduction. These are like
Dr. Zain Husain, MD: mostly IPL devices. Yeah.
Heather Murray, PA-C: So, um, I think I. You know, I guess it's a good place to start, but it's not gonna give you that significant reduction.
Courtney Carroll, LE: And if it's a IPL device, I just, you know, I wonder about my darker skin patients. Yeah. Because IPL is not indicated for darker skin tones and I think it poses a risk. [00:18:00]
Dr. Zain Husain, MD: And what about those photo sensitive patients? Mm-hmm . You know, people with melasma like that can worsen things. Mm-hmm . So you gotta be really careful about that.
Heather Murray, PA-C: Yeah. So as far as what, if you have a consult, what are things that you should ask during a consult? I think the biggest thing, um, in my opinion is I. Checking to see what lasers they do. Mm-hmm . Do they have experience with skin of color? If you are someone who has skin of color, um, read reviews. I think that's the biggest thing.
Mm-hmm . What other things do you guys think are important during a consultation?
Courtney Carroll, LE: Yeah, I think, you know, asking the type of laser in the wavelength and I would, you know, I would even encourage people to inquire about their settings. Uh mm-hmm . I have patients who come in and they've . Done 10 or 12 sessions.
Mm-hmm . Of laser hair reduction. And the amount of hair that I'm seeing is baffling for someone who has had that many sessions. Yeah. So I think sometimes what happens is you see these Groupons or [00:19:00] you see these deals. Yeah. And maybe they're promising 10, 12 sessions, but the settings that they are using much must be substantially lower than what.
What I'm using because to still have that much hair growth by the eighth session, you should have, you know, . At least a 60% reduction. Absolutely. And
Dr. Zain Husain, MD: I honestly think it's because like a lot of these patients are going to medi spas now. Mm-hmm . Um, we don't know who's treating them, what their qualifications are, what their training is, and sometimes the protocols are built at these places so that they under power.
Mm-hmm . So they don't. Harm the patient, which is a good thing. Yeah, yeah. But they're not getting the results that they're looking for. So that's why it's really important to go to someone who is experienced, understands the science. There's a lot of science and physics we talked about today. It is not something that you just pick up, um, like a weekend course.
They're just looking at a manual and just kind of going willy-nilly. You can do some serious damage with us. Yeah. So I do think that the protocols that a lot of these places have are underpowered. Um, [00:20:00] they under deliver results, , but it's to kind of keep the patient safe. Mm-hmm . Um, but I think that it would be more worthwhile to go to someone who's qualified, who has extensive knowledge and get the results that you're paying for.
Um, and honestly, like knowing what technologies that these places are using is so important. Like, I had a patient who, um, you know, unfortunately went to this medi spa. And they had the right device. It was an Alex and nd YAG laser. However, instead of picking nd yag on this darker skin patient mm-hmm . They forgot to change it from Alex.
Yeah. And literally looked like a zebra, like mm-hmm . I've seen strip before stripes of absolutely like depigmentation. It was horrible. Yeah. So I really do think that you have to be really careful about . where you get your treatments done, who's doing them? And that's why I think the dermatology office is the best place.
Mm-hmm . Um, we treat skin [00:21:00] disease day in, day out. We also understand like what lesions to look out for. Mm-hmm . Like you just don't wanna go over any like abnormal looking. Oh yeah. You know, lesion because places, oh, let's mole, let's get rid of it with a laser. That's not the way to approach it.
Courtney Carroll, LE: Well, and even to speak to that, you shouldn't be treating really any moles, um, or treating over any moles because it can pigment that mole.
It can, um, cause a little bit of an abnormal appearance to it. Mm-hmm. I mean, I, I'm thinking back to our patient that we removed the melanoma from. I'm treating her legs with. Laser hair removal, um, reduction. And, you know, there's a few moles that whenever I'm treating I, I tell her like, all right, we're going around because you just don't wanna set yourself up for that risk or the patient for that matter.
Heather Murray, PA-C: Yeah. I unfortunately have, um, seen dermatology offices too, have medical assistants to laser hair removals, and I think you just have to be careful, you know, even though you're going to a dermatology office. Mm-hmm . Definitely ask your questions, you know, make sure you're doing . Your treatments with someone who's [00:22:00] qualified.
Courtney Carroll, LE: Yeah. The risk of burning someone is so significant with laser hair reduction, and I think that's why it's so important to, yeah, really question. And you're not being annoying when you're asking what someone's qualifications are, how long they've been doing it, what type of laser, what settings they feel comfortable with.
Those are all things that your provider should be willing and happy to answer for you.
Dr. Zain Husain, MD: Yeah. And just for your information, the highest rate of litigation in any aesthetic procedure is laser hair reduction. Mm-hmm . So it tells you like, you know, you need to do things right, otherwise you can seriously harm patients and you know, that can damage your practice and your reputation.
Courtney Carroll, LE: Yeah. So some things, um, I know I talk about with my patients during their consult is, I can say this 110 times and people will still forget this, but shave before your appointment . I, I think you
Dr. Zain Husain, MD: give a good shave to my patients .
Courtney Carroll, LE: I have had men come in with like full, bare [00:23:00] backs, you know, oh, I forgot to shape.
Mm, that's an extra a hundred dollars. No , . Um, but, but it is important to discontinue any waxing. Mm-hmm . Um, any of the nares or at home treatments? I do normally recommend that people shave either the day before or the day of treatment. And that's because you wanna get that. Follicle, when you are pulling that hair out of the follicle, the laser has nothing to tackle.
So waxing and, , the nare and things like that will essentially make your laser treatment ineffective. So the shaving, making sure that the laser still has access to that follicle and is not being blocked by that hair, without it being pulled out is super important.
Heather Murray, PA-C: Yeah, I think, um, sun exposure, trying to limit sun exposure or even like tanning bed spray tans, um,
Courtney Carroll, LE: makeup self
Heather Murray, PA-C: tanner.
Yeah, self tanner makeup. Don't come
Courtney Carroll, LE: in with self tanner. Don't come in with makeup.
Heather Murray, PA-C: Yeah. ,
Courtney Carroll, LE: it, it puts you at a higher risk for burning and your provider doesn't want that. [00:24:00] And you definitely don't want that. Yeah.
Dr. Zain Husain, MD: Yeah. So does laser hair reduction hurt?
Heather Murray, PA-C: It depends. who, yeah, I think it, it definitely depends on who you know, everybody's pain tolerance is different.
I think it definitely depends on the area. In my opinion, the underarms are really not bad at all. Mm-hmm . I think the bikini is a little bit spicier. Um, but we use different techniques to help with comfort. You know, we use the Zimmer, like you mentioned. Mm-hmm . Which is a very cold. Hose and we can change the, the amount of cold air that's flowing through that Zimmer to help kind of numb the skin almost.
Dr. Zain Husain, MD: Yeah. It almost serves dual purpose, right? Is it numbing the skin a little bit? Mm-hmm. With that cold air, but it's also cooling the temperature of the skin, giving that protection from the treatment too. Yeah.
Courtney Carroll, LE: To
Heather Murray, PA-C: minimize side effects. Mm-hmm .
Dr. Zain Husain, MD: Yeah.
Courtney Carroll, LE: There are things like prox, um, which is essentially laughing gas.
Um, nitrous oxide and people do opt for that sometimes if they're treating a larger surface area or a more tender surface area. So something like the Brazilian [00:25:00] or the full legs. , my male patients who are not used to, um, as much pain their chest and back, their, they love the Pron . Um, and that just makes.
For a more comfortable setting and a more tolerable setting. Yeah.
Dr. Zain Husain, MD: I mean, and for small areas, topical anesthesia is still fine. Mm-hmm . Um, we typically have our patients applied to the area, you know, half an hour to an hour before. Um, but you don't wanna use, um, topical anesthetic compounds, especially these high concentration ones over large areas because you can get lidocaine toxicity and that can be deadly.
Heather Murray, PA-C: Yeah. And I think during the treatment process, you know, if somebody can go without the topical numbing, that does help just have a guidance of where their pain is during the process. Mm-hmm . Because, um, that helps limit side effects too.
Courtney Carroll, LE: Yeah. I've heard, um, different practices won't. won't offer numbing because they want feedback from their patient to say, Hey, this is feeling really tender, or, oh, I don't [00:26:00] feel it at all.
Dr. Zain Husain, MD: Yeah,
Courtney Carroll, LE: and sometimes those little hints from your patient are really imperative to treat because Okay. I know that. They're not really feeling anything. Maybe I can increase a little bit. Mm-hmm . Or, oh, this is really hurting them. Okay. Maybe I just need to come down you know, a couple settings for this First go around
Dr. Zain Husain, MD: and not only are we looking at pain, but we're also clinically looking at the skin.
Yeah. Making sure there's no evidence of, you know, blistering or any signs of burns. Yeah.
Courtney Carroll, LE: Which. Is not to be confused with, um, per follicular erythema, which is what you want to see. Yeah. So, um, this can happen after your laser sessions. It's completely normal. This is where you will see kind of more red and bumpy.
Mm-hmm . Um, it's specifically around the hair follicle itself. So almost looks a little like folliculitis or you know, of that nature. Um, but it's. Essentially a response from the laser with the follicle. And that's actually a good sign. I, I like to see that in my patients. Mm-hmm . So you can always take a Zyrtec or Allegra just to help with that histamine response.
Usually it's pretty tolerable [00:27:00] as far as after. Um, I don't typically have patients complain of any lingering burning sensation or pain. I do feel like it's pretty in that moment where that pain is coming from. Yeah.
Heather Murray, PA-C: Most people will describe it just as a little rubber band snap on your skin. So yeah, for most people it's tolerable.
Yeah. , um, after treatment, are there any things that you guys tell your patients to avoid?
Courtney Carroll, LE: Sometimes exercise. I think sometimes sweat can irritate the follicle, so, you know, like intense exercise. Yeah, exactly. Especially the underarms. They get a little sensitive sometimes. I really don't have a lot of aftercare for my patients.
Mm-hmm . I
Dr. Zain Husain, MD: avoid the sunscreen, avoid the sun
Courtney Carroll, LE: wear sunscreen, especially on the face. Um, but usually my patients don't need any special kind of like aloe or moisturizer or things of that nature. Yeah. If
Dr. Zain Husain, MD: it's really looking inflamed, then, you know, I throw on a topical steroid. Yeah. That can calm things down a little bit.
Yeah.
Heather Murray, PA-C: Or like avoiding like hot showers or saunas. I mean, that's . Not as common to see a [00:28:00] severe reaction with, but it could increase your risk for some lingering side effects.
Dr. Zain Husain, MD: So have you guys ever seen paradoxical hypertrichosis from laser treatments?
Courtney Carroll, LE: I have not. Yeah. Not yet. I hope. I never did .
Dr. Zain Husain, MD: So I have.
Seen it. Um, and it was a woman who was treated, I guess being undertreated elsewhere. Do you wanna explain that? Oh yeah. That's good. . So it's basically this rare, um, side effect where you actually get increased hair growth with laser hair reduction treatments. Mm-hmm . And often it's due to being underpowered.
So like almost the hair follicle gets stimulation from that laser and that heat, but it's not the point where it damages it, it almost encourages this growth. So it gets a little bit coarser. Yeah. And more pronounced. So that's something to, you know, take into account and really helps us or helps you as a consumer to pick a good provider for this because if you, even if you do an underpowered treatment, you can cause more harm,
Courtney Carroll, LE: Yeah, very true. I um, probably. [00:29:00] That's probably why I've not seen it, because ,
Dr. Zain Husain, MD: that's right. Yeah. , you did good treatments. Yeah, yeah,
Courtney Carroll, LE: yeah. I used to work with a provider, an esthetician who, man, her settings were like, criminally low, and I know it's because she was scared and I totally get it. Mm-hmm . But I would tell her, I mean, she would have like, sometimes the JUULs at like.
I dunno, 10 JUULs on like the Alex and even less than that sometimes. And yeah, you just, you know, as you learn laser, you just realize that sometimes, like I said, it's, you almost feel like you're taking money from people. The session's just not gonna be successful. So. Yeah.
Heather Murray, PA-C: And Courtney and I have touched on this a couple times.
As far as like during the treatment process, often we will be changing the energy or the JUULs mm-hmm . Um, just to get that . Adequate result that we're looking for. So we might start a little bit lower. Mm-hmm . And then we increase it throughout.
Courtney Carroll, LE: Yeah. So there's, um, the power of the laser, which is, um, you, you'll see a J on the screen, which stands for JUULs.
Um, the [00:30:00] milliseconds or the pulse duration is essentially how long the laser is sitting in the skin for. So you can change that pulse duration based off. Skin type, skin color mm-hmm . Um, typically you'll have a lower pulse ation, like, you know, with lighter skin mm-hmm. Versus darker skin because you don't want that to sit in the, the skin, um, and put them at risk of burning.
, typically those are the two kind of settings you'll see on, on, you know, especially Alex and Yas. Um, . But that's why I think, you know, asking your provider too can be really helpful. And especially if you're going to a new provider. I have people who've moved from out of town or outta state, and so they tell me, oh, well I've done two or three sessions,
All right. Like what are your settings? Like, what are we working with here? 'cause I just, you know, wanna get a good gauge on how well you've handled it and how you're responding.
Dr. Zain Husain, MD: Yeah. Um, another thing that I think is important, um, for some of these patients who are having excessive hair growth, making sure that there's a thorough medical evaluation.
[00:31:00] Yeah. Making sure there are no hormonal imbalances like PCOS or any thyroid disorder. Things like that. So that's something also to take into account.
Courtney Carroll, LE: Yeah. Yeah. Overall, I, I love, I mean, it's one of my favorite procedures to do. Mm-hmm . I think the results are so life-changing for so many people and you know, we just don't, um, think about how.
Annoying is to have to shave every day. Yeah. For some of these people, like you mentioned earlier, they can get really painful bumps. Mm-hmm . So I think, you know, I always joke around like, I think it's such a great, um, like birthday gift for like your daughters when they hit like 18, like just get 'em some laser hair
They're all like, who wants to shave for the rest? Appreciate it. Yeah.
Dr. Zain Husain, MD: Yeah. That's a game changer.
Courtney Carroll, LE: Yeah. . Yeah.
Dr. Zain Husain, MD: Agreed. All right. So I mean, that was a great talk on laser hair reduction. Um, we talked about, um, who are the ideal candidates, um, what type of lasers are out there, what to avoid, um, and potential complications.
So, you know, if you guys have any questions about laser hair reduction, [00:32:00] um, you know, just hit us up. Um, we are happy to answer any questions you may have. . But, if you like this episode, please subscribe and you know, comment below and we'll be seeing you next time. Skin side. Skin side out