How does this sound?

Hair Removal Methods Laser hair removal
1

Hello everyone. I’m a 24 year old male, and I recently committed to laser hair removal after years of pondering what I should do.

I’ve done my homework, and I had my first of several consultations today. I brought and filled out the consultation sheet, but I wasn’t really sure how to evaluate the responses I got. I was hoping someone here could offer their opinion.

First about the clinic:
This practitioner is a med spa attached to a dermatologist’s practice. Before any treatment, the doctor evaluates the site of treatment, assesses the skin type, and sets power levels for the initial treatment. The doctor doesn’t perform the treatment (although she has performed them herself in the past), so an LPN certified by the laser manufacturer does. The nurse in question has been acknowledged by the state board of nursing as a cosmetic nurse that uses lasers. She has been using the device for 4 years. They use a Candela GentleYag.

Pricing seems good. For the entire chest (including abdomen and shoulders), the first treatment is 300, the second 250, the third 200, and the fourth, fifth, and sixth 150 (total 1200). After that, any further treatment is 75. They also offer a package deal that’s about 15% total if you pay upfront for the six treatments.

They were willing give me some client referrals, but in terms of approximate statistics, they said that about 80% are extremely satisfied with the results, 15% see a good reduction, but are looking for more to be done, and 2% are completely dissatisfied.

A little more about me:
I’m about a quarter Italian, so my hair is very dark, dense, and coarse everywhere I seek treatment. There is almost no noticeable vellus hair present. My skin type is probably somewhere around a III. I don’t go in the sun, so right now, I’m a pale sort of ruddy color that verges on a faint yellow. But, if I did make an effort (as I did when I was younger), I would tan very deep brown. Perhaps I will post a picture later if that is too vague.

Based on what she saw, the nurse estimates that they would be using a setting somewhere between 26-30 on the initial treatment (possibly working up to more based on my reaction) out of a potential 40 for people of my skin color.

I scheduled a test spot, but based on this, does it sound like I might be in good hands?

2

If you’re a type III, you should be using an alexandrite laser such as Gentlelase, Apogee Elite, etc. The alexandrite will give you significantly better results than an Nd:Yag laser such as a GentleYag. If you do use the Nd:Yag, you need to use much higher fluences (around 40-60 J/cm^2) to get similarly good results. As you get more treatments, some hairs will be destroyed while the ones left will get more lighter and finer with each treatment. Once the hairs become really light brown and fine, you will need to switch to an alexandrite laser because the Nd:Yag will not be able to destroy those hairs. Basically, it will be a complete waste of your time and money to use a setting of 26-30 J/cm^2. That setting might be good for an alexandrite laser, but not for an Nd:Yag. I would suggest that you go to many consultations and ask them a lot of questions specifically about what fluences, pulse durations & spot sizes they will use.

3

  • To address seattlegirl’s post, Yags are not all the same. GentleYAG has a higher spot size than any other Yags on the market at 18mm. So slightly lower joules produce the same amount of power as other machines. On GentleYAG, 30J is max on 18mm spot size and 40J is max on 12mm. So 25-30 J is not necessarily low, but can actually be very high. We just need to know other parts of that setting. See below.

  • We need more information on the settings. Just one number doesn’t tell us much. On this machine, they’re settings a spot size, joules, and pulse duration settings. So we need to know all three. Variations in all makes a huge difference in the final outcome.

  • Now, if you’re truly a type III, an alexandrite laser would be more powerful and still safe on your skin. However, if there are no good clinics with an alex near you, a Yag at good high settings will still be fine if the hair is very coarse.

  • Have you checked out other clinics yet or this is the only one? Are you planning on it?

  • Where are you located?

4

I 2nd Seattle girls remarks. If your a skin type III do not use a Yag. NDYag is not as effective as an alexandrite laser. Find a practitioner with a Gentlelase machine.

18mm spot size - 16j minimum. You may want to use a numbing cream like EMLA.

5

I’m in Richmond, VA. I found 3 clinics all-together that I was checking into. I restricted my search to those that had obvious connections to doctors/medical establishments. Two were found through Candela, and one from Cynosure. The one discussed above is one of the two from Candela, and it is called “The Medi Spa” and run by Doctor Yvonne Knight.

I have an appointment with the second Candela place (called Commonwealth Dermatology), but the soonest appointment they had was October 25th, rolls eyes. This was a little off-putting, but it’s an actual doctor (who specializes in laser treatments) who treats patients there. The consultation itself was $100 (which counts to any treatment I have). I understand they are only looking for serious clients, but it does put me back months. I’m a little concerned that they will be expensive, but it’s probably too early for me to make such assumptions

The Cynosure place is called Lee Davis Medical Associates. They use an Apogee Elite. Don’t know anything about them, but I did make an appointment to consult with them as well.

I was a little leary about the places that showed up named “Ageless Remedies” or “Skincare Plus Spa” and such. I understand that skilled people can work anywhere, but I think I’d personally be more comfortable with a place that has an associated doctor, at least. Maybe this is unfounded.

I left word with the Nurse from the Medi Spa, so I might (or might not) be able to get back with the other two settings.

Also, in a moment I’ll post some pictures of me so that maybe you can advise me on skin tone. You know, I really don’t think I’m as dark as a III or IV…

UPDATE: The nurse called me back, and she said in my case, they would probably use a spot size of ~15 and a “pulse width” (which I guess is the same as “pulse duration”) anywhere between 20 and 30.

6

Pictures. Whee. They may seem darker than I really am because there was very little flash used except in the abdomen shot.

Where does this lie on the skin tone chart?

By the way, thank you for the quick and thoughtful replies. It really puts my mind at ease to have access to this community and its resources.

7

Based on your pictures, you look like you are somewhere between a II and III. Your skin looks a bit too light for a III but your hair is dark and dense like a III. You look closer to a III than a II (a skin care professional who has examined you can tell you for absolute certainty.)

8

Your ethnic makeup is more important than your skin tone in determining your Fitzpatrick skin type. There are type IV who are as pale as ghosts and using an Alexandrite laser would burn them. What is your ethnic makeup?

I would not limit myself to doctor owned facilities. Doctors receive no LHR training in med school and are not forced to attain any formal LHR education. I am not sure of the laws in your state regarding who can and cannot perform LHR. Go to as many clinics as possible. DO NOT PAY FOR A CONSULTATION. Consultations are free. A clinic may charge a fee for a test spot, but having a consult is free. If a clinic cannot spare 15 minutes to gain your business you should go elsewhere.

9

Oh, I see. I’ve misunderstood. Skin type isn’t skin tone. Whenever I saw skin type defined, it was generally defined by specific tones like “olive” or “pale bluish.”

My ethnic makeup is 3/4 Irish and 1/4 Italian. For me, the Italian side seems more dominant given the dark hair, etc. Although, I am no where near as dark as my more fully-bloodied relatives.

10

  • I also wouldn’t recommend paying for a consultation. You should be able to find plenty of places that don’t charge one, never mind one where you have to wait several months for an appt as a new potential client. I wonder how long it takes to get an appt if you’re already a paying client.

  • I agree with above. Based on your pictures and your ethnic background, you’re probably right around a type III as you originally mentioned. This means that an alexandrite would be best.

  • Apogee Elite is an alexandrite and a Yag in one machine, so that would be fine for you (the alex setting).

  • Did you use Candela’s provider search? Anyone with GentleLASE or GentleMax in your area? Otherwise, many Apogee machines are alexandrites as well, though Candela’s machines are somewhat better due to larger spot size.

11

I did use Candela’s provider search. It’s quite useful.

Unfortunately, there were only two providers that have the GentleLase. One is the one that requires you to pay for consultation and months for appointment.

The other, I haven’t gotten in touch with yet.

I’ll check into the ones that are closer by. If they’re not an option, would driving 50 miles away to get to a GentleLase be worth it over the GentleYag?

Edit: I also found a nearby center that houses a Lumenis Lightsheer. Although I usually see people talking about Apogee and GentleLase, I’ve read that this can be an effective device depending on the skill of the user. (Am I on track with this?)

12

Another important thing you should know about is the different cooling systems. Both the Gentlelase and the GentleYag use cryogen cooling systems. The Apogee Elite and other lasers use cooling systems such as cryo-5 zimmer. The reason I mention this is because the cryogen cooling system can be controlled by changing the setting and it can be responsible for hyperpigmentation (if it is turned up high) because cryogen freezes the melanin. People tend to turn up the cryogen setting in the thought that it decreases the discomfort (which is true) but then it can also increase the risk of hyperpigmentation. So, the cryogen cooling system along with a darker skin type and any recent tanning raises the risk of getting hyperpigmentation. In most cases, hyperpigmentation is transient but it can last up to a year. I’m sure this side effect will be listed in the informed consent that you will sign.

13

  • All things being equal, an alex would produce slightly better and faster results than the diode. However, if the diode person is experienced and knows what they’re doing (or more experienced and knowledgeable than the one using GentleLAST), then it could be an option. However, in that case, GentleYAG is also an option. For very coarse dense hair the difference wasn’t be big. The differences plays a bigger role once the hair gets finer after a few treatments.

  • 50 miles away is not a big deal in my opinion. You’ll only need treatments once every 2-3 months.

  • In the end, you should decide based on your opinion after visiting all clinics you are considering. It’s usually pretty easy to pick the one you’re most comfortable with and who you feel has your best interests in mind.

  • I find that entering various other zip codes in your search can help on the Candela site. Also, GentleMAX is a new machine that’s both an alex and a Yag in one. So that one would work too.

Seattlegirl - can you post any articles or studies on the hyperpigmentation cryogen issue?

14

There are no studies documenting this. Lagirl–you of all people know that most laser hair removal studies out there are biased studies (and articles for that matter) that are paid for by the manufacturers/companies who are trying to sell their products (lasers). Candela corporation is not going to bring this cryogen issue out in the open. Why would they do that and what do you think will happen?

Anyways, that’s my only criticism of the Gentlelase or Gentleyag. I’m sort of speaking from personal experience because I know of several people who had hyperpigmentation issues with the Gentlelase. I certainly hope and know they will make cooling system improvements in the future.

I found a copy of the Gentleyag treatment guidelines online that someone posted (who knows why?) that states: “DCD (Dynamic Cooling Device that sprays cryogen) settings set too high or low may cause pigmentary problems.” But nobody knows how high or low you can go before you risk complications.

Here is the link: Yag Protocol | PDF | Hair | Laser

15

Have you also looked on the cynosure website? They list Zinsser Plastic Surgery in Richmond as having the apogee elite. http://www.cynosure.com/patients/practitioner-locator.php

16

EDIT 1 : Seattlegirl, The consultation below is for Zinsser Plastic Surgery. Yeap. I checked.

Consultation 2 down:

I had my first test patch done: my first experience with the laser in general.

The Person: the technician for this clinic is younger than the last. She’s been doing light-based hair removal for 2 years. She was doing IPL at a previous office, and she’s been working at the current office since May using the Cynosure Elite. That said, she was very vocal (with no prompting from me) that IPL is much worse than laser for hair removal. She is a certified aesthetician and she said she was also certified by Cynosure for use of the Elite. For what it’s worth, she seemed fairly knowledgeable.

She has seen 20 clients like me since May, and she claims 100% patient satisfaction (using the Elite, and much lower when she was using IPL).

She put me at a type III, and she referred to a chart on the laser for initial settings. Spot size: 10, Joules: 20, Pulse: 20. Her policy is to start at these cautious settings for the initial treatment and to scale up based on the clients reaction. We did three test pulses at 18, 19, and 20. At those settings, I actually found the cooling more unpleasant than the laser itself. After the test, I was slightly pink, and she applied some witch hazel. The pinkness subsided within 30 minutes.

I understand these settings are fairly low?

Pricing: for chest, it’s 5 treatments for 1000 (4 treatments of $250/each and a free 5th included), but she didn’t want to quote a price for a touch up. She said it would depend on where we were at in terms of overall reduction, but she said she it would be less than any of the initial treatments. For full arms (including shoulders, arms, and hands), it was 1400.

How does that sound?

As per Lagirl’s advice, I went ahead and scheduled a consultation with the clinic 50 miles away. I’m heading there tomorrow to check it out.

EDIT 2: I’m wondering if May, June, July, August is really enough time to put her 100% client satisfaction into perspective…

As a side note, the clinic I mentioned before that wouldn’t give me an appointment for several months–Well, I looked them up and apparantly the doctor that does all their treatments (This guy: http://www.richmondlaserskinsurgery.com/documents/GHF%20Work%20CV%20June-%2008.pdf) is actually an instructor for Candela and has published research specifically on using lasers in dermatology. I mean, I guess I can’t dispute his expertise, but man that’s a long wait. But, given that he’s probably pretty good, I may call just to see what it’s like for appointments once you actually become a patient. Still don’t want to wait so long unless the others are all shoddy.

17

It surprises me why she would use a spot size 10??? You want to use the largest spot size possible and on the Apogee Elite the largest is 15. Why didn’t she use the 15? By the way, did she use the alexandrite or the Yag laser since the Apogee Elite is a combination of both lasers? Why is the cooling unpleasant? What do you mean by that?

According to the SUGGESTED parameters for the Apogee Elite (see the link below), they recommend using 18-30 Joules/cm^2 (fluence) and a 10-20 pulse duration (for a skin type III using a 15 spot size). They state: “the variances in fluence, pulse durations & spot sizes are determined by individual examination, test spots and the anatomical region to be treated. It is always best to use the HIGHEST FLUENCES which are safe and tolerable to the patient. LARGER SPOT SIZES are preferable when large areas need to be treated and hair is of larger diameter and deeper seated.” Basically, with larger spots sizes, there is less scattering of laser light and the light penetrates deeper and is able to destroy hair follicles that are deep.

You can get more information about the Apogee Elite and read about their suggested parameters here: www.cynosurelaser.co.uk/ATTEliteReview.pdf

As far as the prices, the east coast has the most expensive prices, while the south has the least expensive. I think $250 per treatment for the back is a reasonable price.

The aesthetician’s “100% client satisfaction” comment sounds like she is trying hard to sell laser hair removal to you. I don’t understand why she needs to do that. I personally don’t trust salesperson-type people. I guess if people have reasonable expectations and know that they will not have 100% hair removal after 5 treatments and maybe not even 70%-90%, then they will be satisfied. It depends what you will personally be satisfied with.

18

Well the elite is a combination of both, but it’s my understanding that it’s either in Yag-mode or in Alexandrite-mode. It can switch between the two, but it doesn’t do both at once.

I basically consider this place sub-optimal. I’m really looking for someone who’s been doing this for at least 2 years.

19

A spot size of 10 @ 20j is very low. Results would be minimal if any. I would go someplace else. The low settings may of been the reason why the cryogen hurt more than the laser. LHR hurts.

You dont need a ton of experience, you need to be competent. Unfortunately the industry is way to easy to get into and there are too many incompetent people performing laser hair removal. It is truly scary.

10mm @ 20j is incompetent IMO

Your also going to need more than 5 or 6 treatments. Some woman can get away with 6 treatments and have complete success, man have a lot more testosterone and need a couple more. Just so you know what your getting into.

20

So consultation 3 down, IMO, the best yet. Definitely worth the 50 mile drive.

GlowMD Laser Medspa–Fredericksberg, VA

Technician: 6 years experience using GentleLase. Certified Medical Assistant and certified by Candela. Although she has treated many male patients for back and beard, but none for the specific areas I’m interested in (chest and arms). Of course, I’m not sure that really matters.

Machine and Settings: Candela GentleLase (2nd generation). She did 7 pulses (5 chest, 2 arm). All were at 18mm spot size and 18J . These would probably be the settings for the first treatment, and she increases the joules by 2 each treatment–or if the client handles it particularly well, she will ramp up faster. How do those settings sound?

EDIT: I should be more specific. She said that we could work from an 18 spot and 18J to 18 spot 20 J…And then maybe switch to 15 spot and take the joules to 24-30 or so. I don’t know how this would be strategically, since most posts seem to say that 18 @ 20 is about as much energy as you can get.

. They also have a GentleYag and a Diode, but because she puts me somewhere between a type 2 and 3, so we’d be using the GentleLase.

Pricing: The price for chest alone was higher than I’ve been quoted (1500). But, the arms were the lowest I have seen @ 925. The total price is pretty much the same as I’ve been seeing at each location so far.

I have one more consultation coming up next Tuesday. Unless they are stellar, I’ll probably be going with the above. Although she lacks experience with the specific areas, she has the best laser and the best experience so far. Lagirl made a really good suggestion. Really appreciate the advice.