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Laser hair removal Target structure for hair removal Hair

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Laser hair removal Target structure for hair removal Hair shaft Stem cell in bulge Hair matrix in hair bulb Level of hair destruction Destroy hair shaft without ... – PowerPoint PPT presentation

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Title: Laser hair removal Target structure for hair removal Hair


1
Laser hair removal
2
Target structure for hair removal
  • Hair shaft
  • Stem cell in bulge
  • Hair matrix in hair bulb

3
(No Transcript)
4
Level of hair destruction
  • Destroy hair shaft without germinative area
    injury
  • hair shaft fall out
  • hair regrow to normal anagen cycle

5
Level of hair destruction (cont.)
  • Partial germinative area injury
  • hair cycle dysfunction
  • thinner and finer hair
  • Total germinative area injury
  • long term hair loss

6
Permanent hair reduction
  • Significant long term, stable reduction in number
    of terminal hair
  • Maintain hair reduction for 6-12 month
  • E.g. laser, IPL

7
Permanent hair removal
  • Reduction of regrowing hair
  • E.g. electrolysis

8
Electrolysis hair removal
  • Galvanic
  • Thermolysis
  • Combine

9
Galvanic electrolysis
  • Direct electric current to hair follicle through
    inserted needle
  • Current produce sodium hydroxide that destroy
    hair bulb and dermal papilla
  • Most effective but slowest

10
Thermolysis
  • High frequency alternating current produce heat
    to follicular tissue
  • Destruction of hair bulb
  • Quick but not effective in thick or highly curved
    hair

11
Laser hair reduction
  • Selective photothermolysis
  • Target chromophore
  • Melanin lie in hair shaft and bulge of follicle
  • Reproducing cell in bulge, bulb Ideal candidate
    dark, coarse hair
  • Ideal candidate dark, coarse hair

12
Laser hair reduction (cont.)
  • End point
  • vaporization of hair shaft
  • follicular erythema and edema
  • 3-6 session, 1-2 month apart
  • 20-30 reduction per session
  • 70-80 long term reduction

13
Mechanism of laser hair reduction
  • Photothermal destruction
  • Photomechanical destruction
  • Photochemical destruction

14
Photothermal destruction
  • Deep, selective heating of hair shaft, hair
    follicle epithelium, heavily pigmented matrix
  • Thermal conduction from melanin rich shaft and
    matrix will heat surrounding follicular structure

15
Photomechanical destruction
  • Small local explosion
  • Extremely rapid heating chromophore
  • Damage individual pigment cell in hair follicle

16
Photomechanical destruction (cont.)
  • Very short pulse generate photoacoustic shock
    wave that cause focal photomechanical disruption
    of melanocyte in bulb but no complete follicular
    disruption leading to leukotrichia but not to
    hair loss

17
Photochemical destruction
  • Use light and photosensitizer to produce target
    photochemical reaction and therapeutic effect
  • Singlet oxygen is a potent oxidizer that damage
    cell membrane and protein
  • Effective in treating non-pigment hair

18
Photochemical destruction (cont.)
  • Photosensitizer ALA, other porphyrin, chlorin,
    phthalocyanine, purpurin

19
Type of laser hair reduction
  • Photothermal destruction
  • normal mode ruby laser
  • normal mode alexandrite laser
  • pulsed diode laser
  • long pulsed NdYAG laser
  • IPL

20
Type of laser hair reduction (cont.)
  • Photomechanical destruction
  • carbon suspension Q-switch NdYAG laser
  • Q-switch NdYAG laser
  • Photochemical destruction
  • photodynamic therapy

21
Factor to consider laser hair reduction
  • Hair color, density and texture
  • white, fine, very blonde hair not remove by
    laser
  • Skin type
  • Anatomical location

22
Patient preparation
  • No plucking, waxing 6 wk. prior to treatment
  • Shaving, bleaching, chemical depilatories not
    interfere laser treatment
  • Avoid sun tan

23
Clinical improvement
  • Absolute hair number reduction
  • Finer, lighter regrowing hair
  • Slower regrowth

24
Ruby laser (694 nm)
  • Indicate for light skin (type 1-3) with dark hair
  • Penetrate less deeply (2 mm)
  • Laser not effectively reach to hair bulb
  • Miniaturization of follicular bulb and papillae

25
Ruby laser (cont.)
  • Reduce number of terminal hair
  • Increase small vellus like hair
  • No evidence of fibrosis or destruction of hair
    follicle
  • No longer used

26
Alexandrite laser (755 nm)
  • For skin type 1-3
  • Penetrate deeply enough to affect the growth
    center of hair
  • Best of choice for light or very fine hair
  • Side effect hypo or hyperpigmentation

27
Alexandrite laser (cont.)
  • Report of paradoxical hypertrichosis after
    alexandrite that common in young female, skin
    type 3-6 with fine dark hair on lateral face

28
Diode laser (800 nm)
  • For all skin type
  • More safely than ruby and alexandrite laser in
    darker skin type
  • Deeper penetration but slightly less melanin
    absorption
  • Optimal for coarse, dark terminal hair

29
Long pulse NdYAG laser
  • Minimal absorb by melanin, so high fluence to
    adequate hair damage
  • For dark skin type with dark, coarse hair
  • Can treat pseudofolliculitis barbae

30
Q-switch NdYAG
  • Useful in dark skin type
  • Induce delay hair growth
  • Ineffective for permanent hair removal

31
Carbon suspension Q-switch NdYAG
  • Use exogenous melanin
  • For blonde, gray or white hair
  • Induce delay hair growth
  • Non permanent hair removal

32
IPL
  • Non laser induced selective photothermolysis
  • Wide choice of wavelength, pulse duration and
    delay interval
  • Effective for all skin type
  • Required more treatment session

33
IPL (cont.)
  • High risk of dyspigmentation in darker skin

34
PDT
  • Photosensitizer localized in follicular
    epithelium
  • 40 hair reduction after 6 month of single
    treatment
  • Side effect temporary hyperpigmentation
  • No significant hair loss but prevent regrowing
    hair

35
Electro-optical synergy (ELOS)
  • 590-1200 nm
  • Synergy between RF (electrical) and laser or
    light (optical)
  • RF
  • electrical heat (non selective heat)
  • heat focus on hair follicle and bulge area

36
ELOS (cont.)
  • Optical
  • heat from light absorbing chromophore
  • heat focus on hair shaft
  • For all skin type

37
Complication
  • Pigmentary change
  • hypopigmentation
  • hyperpigmentation
  • Folliculitis
  • Blistering or crusting
  • Scarring

38
Complication (cont.)
  • Koebner phenomenon in psoriasis vulgaris,
    vitiligo, lichen planus, Darier disease
  • Intense pruritus
  • Urticaria
  • Temporary or permanent leukotrichia

39
Complication (cont.)
  • Found conversion of fine vellus hair to dark,
    coarse terminal hair or induction of growth of
    long fine hair from repetitive low fluence

40
New treatment
  • Photopneumatic therapy broad band light with
    pneumatic energy
  • Elevation of hair follicle closer to skin surface
    by air pressure
  • More light absorbed by melanin in hair follicle

41
New treatment (cont.)
  • Minimize thermal damage to surrounding epidermal
    and dermal structure
  • Reduce necessity of higher fluence
  • No pain
  • 5x more efficiency to delivery energy to unwanted
    hair
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