Laser general medical data General observations
 There are very few well-designed long-term
laser hair removal studies.
Results vary widely and are not accurately
predictable at this time.
Some laser hair removal consumers have
permanent reduction in the size and color of hairs.
In some consumers, this is a dramatic improvement.
This result is most likely in light-skinned,
dark-haired "ideal" candidates.
Even "ideal" candidates do not
always respond to treatment.
Despite promotional claims, there is not
enough published comparative data to determine if one type of
laser targeting melanin is more effective than other types.
Cooling the skin can reduce pain and side
effects.
Skin discoloration which can last several
months can occur in 1% to 10% of patients, with a higher likelihood
in darker skin.
Consumers must avoid sun before and after
treatment to reduce the risk of discoloration.
Consumers who have realistic expectations
about laser hair removal are often satisfied.
Why clinical data should be given the most weight
Promotional material from manufacturers
and practitioners is often unreliable
As noted by pioneering laser researcher Christian Raulin,
M.D.: "Laser companies, tattoo and cosmetic studios as
well as self-proclaimed "laser institutes" promote
their work with full-page advertisements in newspapers and
lifestyle magazines... It is not uncommon for the industry
to advertise newly developed lasers for which the efficacy
has not been determined by means of objective, randomized
trials. When a laser is first marketed, there are thus no
dependable data available from studies; instead, physicians
must rely upon the often unfounded claims from the advertising
literature." [1]
Personal experiences of consumers are unreliable
While consumer experiences are very important in determining
what treatment is like and general satisfaction, it's very
difficult to assess quantitative effectiveness based on one
or a few consumers. As I discuss in my section on Vaniqa,
one-third of patients using a placebo were judged by physicians
to have improvement or even marked improvement, and that was
under controlled clinical conditions. There are simply too
many variables between individuals to determine if one person's
result will predict your own results.
Consumers are better served when they follow the advice of Whitney
Tope, M.D. and Maria Hordinsky, M.D.: "Look for studies incorporating
rigorous design to produce believable data and conclusions."
[2]
Echoing Tope and Hordinsky, laser researcher Sharyn Laughlin
recently stated:
"It appears that the laser industry and the clinical arena
of epilation are being driven by market forces and economic
factors, with a minimum of consideration given to evidence-based
medicine. The majority of clinical trials and peer-reviewed
reports do not address the issues of permanence or specific
dose-response relationships..."
"There are few comparative data to allow physicians and
their patients to make rational choices... Patients deserve
to know the precise benefits and limitations of the particular
system to be used in relation to whether their expectation is
for temporary or permanent epilation." [3]
Dr. Raulin adds: "Well-founded scientific studies are no
longer the basis for the wide-spread use of lasers. Careful clinical
assessment cannot occur under such conditions, and the absolute
opposite of the Hippocratic Oath to do no damage can easily be
achieved." [1]
Rox Anderson, M.D., one of the pioneers in the field of laser
dermatology agrees "there is a big problem brewing":
"Unfortunately, there is relatively little good, hypothesis-driven
research on lasers in dermatology. These studies are expensive
and slow to perform, analyze, present, and publish. The laser
companies are quick to promote their new devices and procedures,
even before efficacy and safety are well established, and before
a specific FDA clearance is given..."
"When poorly researched before use on patients, cosmetic
lasers or anything else are no different than the infamous patent
medicines of the 19th century... But the problem lies mainly
with us, the professionals. We should simply refuse to believe
infomercials over peer-reviewed studies... Those industry salesmen
who can't support their claims well, should be tolerated only
as village idiots. In short, the patients are ours, and we should
make better patient care the only real bottom line." [4]
This has been my point since 1995. Luckily, a few researchers
have continued to publish rigorous long-term studies.
Published clinical data by type
If you are researching a specific model of laser and don't know
what type it is, ask the practitioner or check this list
Nd:YAG clinical
data
Ruby clinical data
Alexandrite clinical
data
Diode clinical
data
(see also Flash lamp
Photoepilator
Argon laser)
References
- Raulin C, Greve B, Raulin S. Ethical considerations concerning laser
medicine. Lasers in Surgery and Medicine 28:100-101 (2001).
- Tope WD, Hordinsky MK. A hair's breadth closer? Archives
of Dermatology. 1998 Jul;134(7):867-9.
- Laughlin SA, Dudley DK Long-term Hair removal using a 3-millesecond
alexandrite laser. Journal of Cutaneous Medicine and Surgery.
2000 Apr;4(2):83-88.
- Anderson RR. Response to "Letter to the Editor.''
Lasers in Surgery and Medicine 28:102 (2001).
- Please see hairfacts.com for a current list of available lasers.
 = recommended only for in-depth researchers
= may be worth ordering
= strongly recommended
General articles/overviews
Anderson (1981): A good overview on theories in the optics
of human skin and laser interactions.
Anderson (1983): One of the earliest articles about the
concept of selective thermolysis, the theory behind laser hair
removal.
Wagner (1998): Survey found only 6% of dermatologists thought
independent non-physician laser practitioners should be allowed
to practice.
Chernoff (1997): A pretty good synopsis of hair physiology,
with a very brief discussion on Nd:YAG and ruby lasers.
Bargman (1999): A point-counterpoint article discussing advantages
of laser hair removal, with a companion piece on electrolysis
(Richards 1999)
Comparative data (hair removal)
Nanni (1998): A practical review for Q-switched Nd:YAG,
ruby and alexandrite lasers.
Nanni (1999): A comparison of side effects for Q-switched
Nd:YAG, ruby and alexandrite lasers.
Comparative data (other applications)
Rosenbach (1997): A comparison of Q-switched alexandrite
and Nd:YAG lasers for nevi removals.
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