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Chapter 71-D | LASER Hair Removal | Dermatology | OneMedicine — Transcript

by OneMedicine · 2,693 words · 421 segments · language en · Watch on YouTube

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0:00foreign
0:01[Music]
0:21[Music]
0:35dollar industry today and remove
0:38unwanted hair first started with the use
0:40of sharp Stone earlier they used to
0:41Sharp Stone remove unwanted hair now it
0:44has come a long way with the use of
0:45lasers these days depilation
0:47manipulation both of that are done for
0:48hair removal
0:49or lasers have actually been started
0:52using for hair removal since the 1960s
0:54it's a news and the first therapeutic
0:56use was for a condition called a
0:57stitches in 1995 FDA approved India
1:01Glazer for treatment of um hair removal
1:04mechanism of action principle uh the
1:06principle of laser removal is the light
1:08amplification by stimulated emission of
1:10radiation another principle is selective
1:13photothermalysis and then we have
1:14extended theory of selective photo
1:15thermolysis on which the laser hair
1:18removal basically Works uh so this laser
1:20has the device has a power source it has
1:23a power source which goes inside this
1:27lazing medium this is inside everything
1:29will be inside the laser system itself
1:31so this is the lazing medium through
1:34which this light is actually sent and
1:36out comes the laser output so this is
1:38the laser output which comes outside of
1:40the laser device that we see the light
1:42that we see so inside the laser medium
1:44normally or any atom has proton in the
1:48center and this is positively the
1:50neutral Neutron will be there and
1:52surrounding this will have electrons
1:54which are negatively charged so the
1:56force between the protons and the
1:58electron keeps the new atom in a stable
2:00state
2:01so what happens when exposure uh to
2:03light or any energy source this electron
2:05from this Lower State moves into a
2:07higher orbit an outer orbit and this is
2:10uh when the atom is unstable now and to
2:13become stable it will again move back to
2:14its original orbit and when it moves
2:17back towards urgent orbital it releases
2:19photons or energies and this photons or
2:21energy is seen as the light that we see
2:24in laser so this method is used for
2:27producing laser light numerous electrons
2:29like that will be present inside the
2:30lazing medium producing these photons
2:32which causes a beam of light coming out
2:34of it and that is the light
2:36amplification by stimulated emission of
2:38radiation we give this power source to
2:40excite these electrons and then when
2:42they return back they release the
2:43photons and that laser light itself is
2:45used for our treatment purposes here
2:49there's also this selective
2:51photothermalysis which basically says
2:52that only the target has to be destroyed
2:54in laser systems so the Targets in the
2:57skin for laser would be we have water as
2:59a Target hemoglobin as a Target and
3:01melanin as a Target these targets are
3:03nothing but the chromophores which on
3:05which the laser light acts an artificial
3:08chromopho for example would be the stat
3:09to pigment laser light is also is for
3:11removing tattoos so the statue pigment
3:13itself acts as a chromophore or the
3:15target for the laser light in the normal
3:17skin we have water hemoglobin melanin
3:19which acts uh here as the chromophobe in
3:22the laser hair removal when it comes to
3:23hair removal we target melanin this
3:25melanin is present in the hair so we
3:27target this melanin in the hair for uh
3:30destroying the hair follicle and only
3:32the pigmented hair that's why can be
3:34treated with laser hair removal
3:35effectively as melanin is present in
3:37only the pigmented hair so selectively
3:39only we have to Target this and not the
3:41surrounding tissue is what the selective
3:43food thermolysis is
3:45and the electromagnetic width that we
3:47choose in the wavelength and the fluency
3:48that we choose has to be uh so that only
3:51the hair follicle is affected not the
3:52surrounding tissue as the wavelength
3:54increases uh that's to be noted as a
3:56wavelength increases the depth of
3:57penetration of the laser light also
3:59increases so this even the epidermis has
4:01got melanin and the hair follicle also
4:03has got melanin so we have to Target
4:05only the hair follicle melanin or the
4:08epidermal melanin to prevent this we
4:10need a deeper penetration for deeper
4:11penetration we need a higher wavelength
4:13so the suitable wavelength also has to
4:15be used and the energy that we use per
4:17centimeters which is the fluency also
4:18needs to be important to damage the
4:21target tissue here
4:22extended Theory sometimes uh what
4:24happens this is wherein a weekly
4:27absorbing path has to be destroyed by
4:28the heat diffusion from a highly
4:31absorbing part called the heater or the
4:32absorber here to be the target here is
4:35the hair follicle whereas the high
4:36absorber is the melanin bearing
4:37structures like the hair shaft and hair
4:39Matrix so when these structures which
4:41absorb the laser light to a higher
4:42extent they will diffuse their energy
4:44through heat to the to the hair follicle
4:46and then the hair follicle will be
4:48destroyed this is the extended theory of
4:50um uh photothermalysis okay and also
4:52it's to be noted that anagen has got
4:55maximum number of melanos also the hair
4:57removal basically Works uh effectively
4:59in anagen has when the stage of the hair
5:01cycle is an energy not in the cateogen
5:03or in the teluguent phase
5:05certain parameters to be considered are
5:07the wavelengths of the laser light the
5:09fluence the spot size the pulse duration
5:11of pulse width the cooling and number of
5:13settings or sessions that is required
5:14for hair removal wavelength of laser
5:17light of VC are several wavelengths have
5:19been used for hair removal we have rupee
5:20694 Alexandra itself these are all the
5:23crystals which are used inside the
5:25lazing medium they may have Alexander at
5:27755 nanometer pulse diode is a commonly
5:29used 890 810 nanometer then India India
5:32which is one zero six four ideal
5:34wavelength for the laser hair removal
5:37would be between 690 2000 nanometer as
5:40the absorbing chromophores the
5:43competitors for melanin like the water
5:45and the oxymorgulamin is eliminated or
5:47it's very less at this wavelength so
5:50melanin wavelength would be uh between
5:52690 2000 nanometer any laser under this
5:55in this particular wavelength can be
5:58used
5:59higher wavelength is used to Target the
6:01chromopho melanin because it has to
6:03reach the hair follicle
6:04so this Bridges the hair follicle and
6:07destroys it effectively
6:08when your fluence also fluence is the
6:10amount of energy per unit area of the
6:12target tissue which is expressed as
6:13joules per centimeter square of the area
6:16higher height has to be high enough to
6:18pass Maximum Destruction of the hair
6:20follicle it has to be low enough also to
6:22decrease any epidermal side effects also
6:24so that um Range that has to be kept in
6:27mind fluence can be increased by
6:29effective cooling before during and
6:30after the pulse is given the pulse is
6:32nothing but the shot that we give the
6:33laser shot so do uh maintain that
6:36particular fluency you can use cooling
6:38as a method to increase the fluency as
6:40well also have spot size of the laser
6:43which is important larger resistance
6:45greater will be the penetration so if
6:47greater is the penetration then it will
6:49effectively reach the hair follicle and
6:50destroy the hair follicle okay so here
6:52you can see the larger spot cell has
6:54reached uh to Greater extent whereas the
6:56small spot test has not reached to such
6:58a great extent here okay and pulse
7:00duration of pulse width it's the amount
7:02of time
7:03through which the laser energy is
7:05applied or the duration of exposure of
7:08the target get tissue to the
7:09electromagnetic radiation or the laser
7:11light that is amount of energy amount of
7:14time in which you give the pulse Q
7:15switch lasers have got short pulses that
7:17may induce thermal destruction of the
7:19melanosomes but they may not effectively
7:21damage the follicular tissue so that's
7:23another other disadvantage here longer
7:25pulses will not only heat the melanosome
7:27gently but also allow thermal conduction
7:29from melanosome to the surrounding
7:30follicular structure causing effective
7:32destruction so longer pulses um a better
7:34option here so longer pulsive duration
7:36would be good ideal would be around 10
7:38to 50 milliseconds can be used
7:40so longer pulse duration has gone deeper
7:42and destroyed it completely
7:44then you have cooling effective cooling
7:46is again a very important thing in laser
7:48hair removal better cooling of the less
7:51epidermal injury so if you cool the
7:53tissue before giving the pulse and after
7:55giving the pulse it'll effectively
7:57prevent any epidermal injury and the
7:59more fluency also can be used with this
8:01and it produces it gives us increased
8:03efficacy of the treatment as well for
8:05cooling you can use cold Sapphire or
8:07copper window or air cooling or external
8:09application of cryogen spray cooling
8:11jellies or ice packs can be used for
8:13cooling of the skin before the procedure
8:15and after the procedure as well
8:17number of settings that are required for
8:19allergen hairs it has got maximum
8:20melanosome so animation has a mostly
8:22effective around into uh six to ten
8:25settings are required it depends upon
8:27the thickness of the hair the site
8:29wherein it is removed all of that and it
8:32varies from Patient to Patient so when
8:33you are telling a patient about this
8:35make sure you tell them clearly that it
8:37might range from six to ten and it might
8:39be less so it might be more also
8:40sometimes
8:42factors which affect the outcome of the
8:43laser hair removal it depends upon the
8:45hair color and the skin type of the
8:46patient the type of hair that we are
8:48treating if the patient has any hormonal
8:50imbalances also the site through from
8:52which we are removing there has also
8:53matter here
8:54so the hair color and the skin type if
8:56you're seeing about that light skin and
8:58dark hair is best suited for laser hair
9:00them all because here light skin people
9:03will have less epidermal melanin and
9:05dark hair will have more melanin in the
9:07hair follicle thereby will be damaging
9:09effectively the hair follicle without
9:11causing any epidermal injury so this is
9:14one of the very good combinations to
9:15treat hair removal okay then higher
9:18fluency less epidermal damage hot pulse
9:20duration needs to be used absorption
9:21happens at the follicular melanin level
9:25is important here and 10 to 15 percent
9:27have will be in Cartesian or delusion so
9:29you can't remove all the 100 hair at one
9:31sitting this happens
9:33and terminal here is better affected
9:36with laser than the velocir because of
9:38more pigment again hormones of the
9:40patient has any hormonal issues like
9:42highest autism or hormonal assays need
9:43to be done that has to be treated along
9:46with the laser hair molar spell
9:47testosterone levels in them has to be
9:49checked and treated accordingly
9:51site of hair removal it's it is said
9:53that axial and bikini areas respond
9:54better than the arms and the chest for
9:56laser hair removal
10:01for cosmetic purposes for therapeutic
10:04purposes and for grafted hair bearing
10:06flaps it is done
10:07Contra education not done with the in
10:10children less than 15 years in
10:11hypertrophic and keloidal scarring the
10:13history of the patient has don't go for
10:15it and if the patient has any active
10:16infection of the local side like half a
10:18simplex virus or staphylococcal
10:19infection don't go for it if the patient
10:21is an aspirin or anticoagulants if the
10:23expectation is too high from the
10:25patient's side and if the patient is
10:26unwilling to cooperate then no use of
10:28doing this superficial wounds in the
10:30procedural area should avoid and um can
10:33occur at the site because of cobner's
10:35phenomenon
10:36management preprocision and patient
10:38selection adequate history to rule out
10:40any infections scarring history drug
10:42history needs to be taken topical
10:43retinoid treatment area should be
10:45stopped one or two days prior to laser
10:47treatment physical examination need to
10:49be done determine the skin and the type
10:50of the hair and determine which laser
10:52which lays a parameter which laser is
10:54suitable for the patient hormonal
10:55evaluation needs to be done if the
10:57patient has any higher suitism
10:58sunscreens four to six weeks prior to
11:00the procedure again help in the Expo
11:02sites bleaching of the hair is avoided
11:05plucking waxing electrolysis of their
11:07six weeks priorities to be stopped
11:09patient counseling is important test
11:11patch may be tried before doing the
11:13actual treatment now if you should take
11:16an informed pencil obviously and
11:17clinical photographs before and after
11:19treatment to know the efficacy to check
11:20for the efficacy shape the area day
11:22prior to the procedure to avoid any pain
11:24procedure you have to clean the local
11:25area with soap and water to remove any
11:27uh to remove other creams ornamental
11:30elements or the makeups that the patient
11:31is using and position the patient and
11:33treatment or the chain in the treatment
11:35chair or the table and emila came that
11:37is the topical anesthetic is applied
11:39term 30 minutes to one hour under
11:41occlusion cooling Jelly's ice packs
11:43biogens need to be ready safety goggles
11:45for the patient as well as for the
11:46operator a presence of any metallic
11:48reflecting object should be avoided in
11:50the vicinity of the laser beam so as to
11:51avoid any untoward side effects
11:53appropriate parameters of the lasers
11:55need to be selected press the handpiece
11:56gently and firmly perpendicularly to the
11:59skin to decrease the blood supply to the
12:01local area also to bring the follicles
12:02closer to the skin surface okay
12:04post procedure ice packs need to be used
12:06to reduce swelling and pain topical
12:08antibiotics avoid sun exposure use of
12:10sunscreens again is a very important
12:11tropical steroids can be used for short
12:13duration if there's local a rhythm or
12:15swelling this is the post procedure
12:16thing
12:17adverse effects of laser sometimes can
12:19be burning scarring so it can be
12:21pigmentary changes post treatment
12:23erythema can be seen that is reduced
12:25with effective cooling pain popular
12:28ocular complication paradoxical
12:29hypertrichosis sometimes can be seen so
12:32certain laser systems that are in use
12:34are we have this Ruby laser
12:36um which is AP laser e2000 epipuls Ruby
12:39Ruby star it Elvis red light at
12:41wavelength of 694 and more effective and
12:44light skin individuals this is with the
12:45dark hair
12:46long pulse Alexandrite laser wavelength
12:49755 nanometer it has got greater
12:51penetrines and safer and darker skin
12:53types diode laser is a 810 nanometer and
12:56it has got deeper penetrance better
12:58fluence and less epidermal damage
13:05wavelength and good penetrance more
13:07effective in Darker skin tones you can
13:09use this because there'll be deeper
13:10penetration because of the increased
13:12wavelength so less epidermal damage
13:13again because they will have increased
13:14melanin in the epidermis
13:17so this was a pre and post procedure
13:19picture of a patient with hypertrichosis
13:20on the chin and that's cleared here
13:22again in a patient here it's been
13:24cleared here
13:26intense pulse light laser also can be
13:28used um these are high intensity pulses
13:30of non-coherent light in the range of
13:31500 to 1200 nanometer here the laser
13:35beam is polychromatic and non-coherent
13:37whereas normal lasers would be
13:38monochromatic and coherent this is the
13:40Ulta of that and these use different
13:42filters for different penetration dark
13:44tones in larger areas can be rated with
13:46intense pulse light system
13:48combination therapy also is effective
13:50for hair removal that is underlying
13:51higher suitism hypertechosis need to be
13:53addressed along with the treatment here
13:55tcos if there that has to be treated
13:57topical that is um this cream can be
14:01used topically for uh when where
14:02parental causes irreversible inhibition
14:04of L or within Noddy carboxylase again
14:06reduces hair growth that can be used
14:08along with treating them with laser uh
14:11combination of this cream again with
14:12laser can be used if the light hair
14:15white hair and gray hair needs to be
14:16deleted
14:17um combined light or bipolar radio
14:19frequency devices along with the use of
14:21photosynthesizers are available now and
14:23external application of melanin to the
14:25hair through liposomal technology has
14:27been dried to treat these light or white
14:29colored or Gray colored hair

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