Help Needed!

Hair Removal Methods Laser hair removal
#1

Hi,

I’ve been lurking on these forums for quite a while, and It’s time that I sought some professional help. I apologize for the length of this post.

I’m quite a hairy guy, shoulders, back, chest…etc. Thick and long hair all over. I don’t have a before picture, but we’re roughly talking a similar density to the below picture, with some difference in the distribution:

My back also has an acne issue. Whenever I get acne it leaves a dark mark in that place and it has built up over the years. I started doing laser in August 2011, and due to the fact that I move on projects a lot, I had to go to another country to get laser done. I started with an an Alexandrite (Gentlelase) at 18mm Spot Size, 16 fluence. The results I saw at the beginning were excellent as expected. By the time I hit the 8th session I was feeling that I was not making an improvement at all for the past 3-4 sessions, and even had some regrowth. Laser was no longer painful at all, literally just tinkling. The technician who was doing the laser absolutely refused to vary the laser parameters she started off with, not to increase power, or reduce spot size…etc. Her reasons were the acne marks on my back, which were getting darker.

That’s when I decided to switch to another place, where a relative already did laser and had good results (male, back, similar complexion, even same acne problem…etc.). They had an nd:Yag laser (GentleYag). I already did some homework and read that combining nd:yag after Alexandrite doesn’t lead to the same results, but I figured I was moving backward on Alexandrite! Anyway, initially the technician was terrified of using proper power settings (again). She started on 18mm, 20 fluence and 3 ms pulse duration. I did 4 sessions working up to a fluence of 28 on the 4th session, and saw some improvement.

The last session I had (5th on nd:yag), I was planning to have it as the final session before I started hunting for an electrolysis place. I had it six days ago. Two things happened:

A- The technician was on holiday, and another lady took over.

Although it’s early, I am expecting the results to be bad. The old technician used to heat an area up quite well by hitting adjacent points repeatedly. All the hair sheds, and even the finer hairs would see results on nd:Yag. The replacement technician was afraid of the power settings (I literally had to argue with her), and just started doing random points, and she even did some areas on reduced power. Inactive hairs seem to have been activated.

B- I went to another place which offered both thermolysis and laser for a consultation to start thermolysis. I gave the lady a full history, and showed her my back. Her input was that I ought to do two more laser sessions on a Diode laser with high settings (didn’t get what those were, she just said “24”)! When I asked why, her reasoning was:

1- Alexandrite at 16mm was too weak.
2- Both Alexandrite and Nd:Yag are “old”.
3- Nd:Yag isn’t a strong laser (she even said “It’s IPL”, when my eyebrows went up, she retracted and just said it’s weak).
4- I still had black hair.
5- The hairs are too close to each other for thermolysis.
5- My skin type can handle a diode.

She also said that much of the hair left doesn’t have roots (she determined that by just looking), and that even thermolysis will not have an effect on it. Overall the vibe I got was that she was trying to sell more laser sessions, although I’m in no position to assess her reasoning.

To give yo an idea of my skin, this is a picture I took today (bear in mind the skin is still somewhat inflamed, it does lighten up a bit in 2-3 weeks). Most of the dark spots are acne leftovers, although some are laser (in one session the cooling parameters were wrong). There are also areas that are darker than the rest. I’ve circled a few typical acne marks. If you enlarge the image and look closely you can just see the areas where there is hair left.

Although I don’t have a full picture of the back with the hair grown, this is an image taken before the last treatment, 6 weeks after laser to give you an idea of the remaining hair on the lower neck/Upper back. Other areas were there still hair are just about the same with some few darker hairs.

So now, I wouldn’t say I am absolutely satisfied with laser. Judging by the fact that I started off with really thick hair, I feel after 13 sessions, the results could have been better in the hands of more capable technicians. It did thin the hair quite well, and some areas are absolutely hair free. However, I still have some black hair, and the ratio of hairs that are seem to be really gone isn’t as high as I’d hoped.

My questions are:

1- Is it worth going for 2 more sessions? Would diode show any effect this far into the treatment? I’m also doing my chest and abdomen (5th session so far on Nd:Yag), so I’m already travelling to get it done.
2- Is the technician’s assessment regarding thermolysis correct? Is there such a thing as hair without roots?
3- Would the dark spots be an issue with electrolysis/thermolysis?
4- What would be a reasonable estimate for how long it would take thermolysis to cover the back area with the above hair density?
5- I realize this isn’t a dermatology forum, but from experience are there any suggestions for the brown spots? Every laser place I went to tried to sell me laser sessions for the spots which were worsened by laser :grin:

Again apologies for the length, and thanks for any input!

#2

The Gentlelase at 18mm/16J is VERY strong. Around the 6th session, the hair is much thinner and laser has a hard time hitting that. Based on what you’re at now, I would finish up with electrolysis. You’re most likely at the point where your hair is too fine for laser. I believe Chris (the one big laser expert here who doesn’t show up much anymore) at one point said on pale skin, the most a YAG will do is permanently thin out the hair whereas the Alex will permanently remove it. So to answer your questions:

1 - No
2 - No (you should go start with electrolysis to finish up)

The other questions you would be better off having an electrologist answer. But honestly, your hair density looks so much less that people may not even notice it unless they’re looking for it.

#3
#4

Jad I was curious on what your overall result is with the picture above before laser treatment and how much hair growth you would have now if you did not have any further treatments?

#5

Electrolysis. My suggestion is abandon anything that the technician has told you involving electrolysis. To give you a time frame on the back completion, as long as you keep up with regularly scheduled appointments you should be done within a year. Electrolysis may or may not worsen your dark spots given you are invasively attacking an area that is healing. Yes there is a hair without root '“technically” but the Galvanic modality could put any claim to rest, it uses acidic lye to kill a follicle and can also full destroy the root/sheath. Remember, many of these technicians you visit are probably telling you a one-sided story because they are only trained in one area of the field.

Laser is a money trap… just a couple words of advice :slight_smile:

I rarely extend myself to this area of the forum because I realize that laser is a ‘quick fix’ for most. With the modalities available and your growth of hair you probably would be better off choosing an electrologist over the laser.

And yes you do have a skin problem, the darker spots 95% of the time means the area is healing (thus no permanency) and as long as they aren’t skin deep will not leave scars. I have a bad case of eczema that leaves my skin looking horrible so I know what you’re going through!

With the pictures I also notice a thick patches of hypopigmentation, whitening of the skin.
I know this type of skin damage is experienced at the Subcutaneous level, other than that I really have no experience with laser, anyone care to give me any insight?

#6

Thanks all for the replies.

Brenton, for what it’s worth I feel obliged to say that I did see improvement with the Yag. Many of the areas where the hair is completely gone were the Yag’s doing. The chest area (picture below) was done solely on the Yag. Although that last session felt like it maxed out.

Josefa, thanks. I’ve seen your work on this forum, and would hope to find an electrologist who works near your efficiency! I will post full back pictures to get your opinion once the hair grows a bit, as it tends to grow fairly quickly. So far I’ve only managed to find two places so it doesn’t look very encouraging.

I have a question: What determines what modality I should go for? Is it simply a case of trying them and seeing which one works best?

Keith,

The hair growth is very uneven. I’m afraid a back picture wouldn’t do the situation justice as it’s still too early after the last session, so here’s the next best thing. This is the inside of my upper left arm. The area hasn’t been treated for 3 months now. This is the area (on both arms) that responded best to the treatment (alexandrite 14 fluence on 18mm). You can see the density before from the shaven area right on the left edge.

Or if you prefer, the hair that was there before, was pretty much an extension of my lower left arm:

So that’s a good result. The problem is on the other side of my upper left arm and shoulder (specially back shoulder), the hair was of a similar length, but blacker and coarser. That area didn’t respond as well. I’m left with patches similar to what I have on my chest after 5 sessions, although they number less.

So I hope that helps. The patches where the hair is gone, it seems to be really gone. However, I still feel that I did not get my money’s worth specially since there are areas which clearly responded very well even though they were less ideal. The variance in results is mostly due to laziness and even incompetence sometimes (doing a darker area on reduced power, only to keep using that reduced power on other areas, or not switching spot sizes…etc.)

ILikeDIY, thanks for the input. I actually tend to agree. Had I resided in area where an electrologist was easily accessible, I would definitely reconsider my approach. My major issue now is finding a good electrologist. As I said I have to travel to get things done, and so I’m looking to find someone who’s willing to do longer sessions which is not easy. With the travel arrangements and all, this whole thing is turning up to be quite the expense.

The areas you describe as hypo-pigmentation are actually just awkward lightening with camera flash. The lighter areas are my natural color, while the darker areas are hyper-pigmentation. I tend to get a “tanned” effect after every laser session.

I’m still interested in whether any specialists have a recommendation for the dark spots problem :slight_smile:

#7

Hi Guys,

I am close to my next treatment date. I am gonna continue with doing chest/abdomen area which has been treated 5 times so far (last treatment was pretty much useless). Since I am going to begin electro on the back, I am going to switch places to the places which offers both electro and laser for the last 2 laser sessions. Unfortunately, the laser they have is a diode lightsheer, which I’ve never experienced before. You’re recommendations as to what would be reasonable settings on this machine would be highly appreciated.

I did 22J 18mm Nd:Yag at 3ms pulse width so far. Skin type can handle alexandrite at 16J well (did that on the whole back + shoulders)

#8

Which LightSheer is it? 12mm or 9mm spot size?

#9

Hi LAGirl,

Just called the place to confirm, they have both the 9mm and 12mm, but they said they would usually use the 12mm for body areas.

#10

Ok. It’s not a bad machine. It’s just harder to use than Candela machines. They need to use compression and ideally up and down method versus gliding. Settings are hard to say because they could use the auto setting. I would ask them what they would use on you and share with us. We can advise whether they seem aggressive enough for your skin type.

#11

I know internet recommended settings are not a good idea, but as I stated in the beginning, I am travelling to get treatments. Which means I don’t have the option of going there and asking them which settings they’ll use. They wouldn’t answer anything on the phone, they just said to come in for a consultation, which I already did.

I’d really appreciate if you were to at least let me know what would be reasonable settings for my skin type.

#12

Hi I’m new to this site, but I thought I should share some insight on this problem. First off I was wondering if you we’re seeing a doc for treatment of the acne. That is most important, no more hyper pigmentation. While your in their office get a prescription for hydroquinone 4% bleaching cream(large amount!). This must be used during treatment and will speed fading time of existing pigmented remnants. You can never discuss settings over the phone with anyone-that’s craziness. Its just not that simple, but i wish it was. I need to look at and talk to someone before every treatment : tan? new medications? ethnicity and blah blah. But I would also have all the hair off your back by now. Look for Lightsheer Diode or Vectus lasers and find nurses who hopefully know how to use them. We have the Yag too, its just not as good, we never use it for LHR. Our clinic always researches the hell out of every new laser on the market as soon as the research in journals looks good.

#13

Thanks for the advice. Yeah, I went to see a dermatologist concerning the acne issue, he did prescribe vibramycin for a start, to be followed by Benzyl peroxide. I’m nearing the end of the vibramycin course, gonna stop it 10 days before LHR session.

I’m not asking for settings to be used blindly. Obviously I had a consultation, and I’m gonna discuss with the technician what would be the appropriate setting, do a spot test…etc. I just need a benchmark of what are usually effective settings used for my skin type on this particular machine. The idea of going there and wasting another session is frankly out of the question, and as I stated I don’t have the luxury of multiple visits. So this would really be helpful!

The fact of the matter is, over the course of many LHR treatments, I’ve walked into some 10 clinics in total for consultations. Only 2 were willing to use the correct settings, and even then, barely.

#14

http://www.aesthetic.lumenis.com/pdf/highpower_lhr_system.pdf

Check page 7

#15

Thanks :slight_smile:

I assume those ranges would be considered appropriate when using a 12x12mm?

#16

More than likely those are the recommended ranges for the 12x12mm spot size. There’s not much reason not to use that spot size.

#17

That document should be very helpful. Please keep in mind that skin types are approximate, so ideally they should test somewhere closer to these ranges as well. Please make sure they use compression too. Let us know how it goes.

#18

Thanks all.

I had the treatment. Settings used were 20 J, pulse width set to auto and they had no idea what compression is (actually I am hoping someone can clarify what is that).

My initial reaction is that that the decision to switch to Lightsheer was definitely a good thing. I could tell the hair was being targeted very effectively.

#19

Compression = pressing down when applying the machine to the skin and firing.

#20

Oh ok, yeah in that case I guess it was used. Are the other settings OK?