LHR for a Teenager (urgent)

Hair Removal Methods Laser hair removal
#1

Hello,
My teenaged son has a cyst on his lower back and his doctor recommended getting laser hair removal for his buttock area to prevent the need to surgically remove the cyst. The surgery could result in a year of pain and no sports or exercise. He needs LHR as soon as possible. He has skin type 4 according to the Fitzpatrick scale and he has coarse black hair. I talked to multiple dermatologists about my son’s condition. One of the laser hair removal centers that I talked to told me that they would use the Cynosure Apogee Elite Plus laser, (ALIX and YAG). They told me that they don’t use laser for patients under 16 years old, and my son is 15 years old. However, they agreed to do the laser hair removal for him because there is a medical reason for it. They said that they would begin the treatment process by using 6-9 Joules and they would apply a numbing cream with 20% Lidocaine. They said he requires 6 sessions six weeks apart.
My questions are listed below.
1- Does anyone know if starting at 6 joules is effective and safe in elimination of the hair?
2- What is a good percentage of lidocaine in a cream or spray for numbing?
3- Does anyone know or recommend a skilled specialist and a good place for LHR in OC?

Thank you for your time; any help or suggestions are really appreciated.

Regards,
Alba

#2

The laser machine is good and 20% lidocaine sounds decently high. Is the cream an Rx compounded cream? I’m familiar with EMLA cream which is 5% prescription and LMX 5% which is over the counter none prescription. Are dermatologists recommending laser to treat the existing cyst as laser heat therapy or the goal is to permanently remove hair that is causing the cyst? Is this a Pilondinal Cyst?
You mentioned that he is Skin Type IV so is the laser center going to treat him with Alexandrite Laser or ND:Yag? 6-9 joules is not enough info because joule setting corresponds with spot size setting. Will they be treating in 10mm, 12mm, 15mm, 18mm spot size?

#3

Hi fenix,
Thank you for your response. The laser center did not mention whether the cream is prescription or over-the-counter. The goal is to permanently remove the hair, as this is a pilondinal cyst. The center said that they will use a machine that utilizes Alexandrite and ND YAG lasers. They only said that they would do a testing spot the size of three fingers placed together. Do you think this is right?

#4

Your son has a pilonidal cyst. Why, in heaven’s name, doesn’t your physician recommend electrolysis … with local anesthetic? Once again, physicians just “go with the flow … and don’t know!” Why subject the kid to the pain of laser? (Or the pain of electrolysis?) My suggestion: start checking highly skilled electrologists in your area and have the dermatologist provide local anesthetic. Dear fellow electrologists: WHY is our profession still “in the closet?” With electrolysis, 3-clearings and no question as to “if it will work or not!”

#5

3 fingers spot size is vague but looks like a large spot size and honestly 6-9 joules is not sufficient at all to induce permanent hair removal. If treatment is in Alexandrite it should start at 14 joules with larger spot sizes. Perhaps the center is being very cautious due to an active cyst and him being skin type 4. Boston Children’s Hospital has a treatment program where they do use lasers for pediatric pilonidal cysts. Maybe it wouldn’t hurt to try reaching out to them for advice? Electrolysis can be an option too since the treatment area is not large.

#6

Hi Bono and fenix.
The surgeon did mention electrolysis as an option and he said it will take too long and it’s very painful and very expensive to clear that area, also he didn’t recommend it, what you mentioned was right they don’t give any recommendations.He only want this to be done ASAP. I’m so happy this forum exists because even medical spas they don’t give much information when trying to now more about LHR.
Since he is 15 years old many med spas are refusing to do LHR until he turns 16. I was able to find one place they use ALMA ,RN nurse explained its a diode laser she started by 7j /cm2 and increased to 13j / cm2which was painful to him even when using there med. grade numbing cream (23% lidocaine, 7% tetracaine). Would you think that was good for skin type 3-4?
Thank you Felix for the info about CCH.
Any recommendations for Electrologists or LHR in the OC area is really appreciated.

#7

OC area? Do you mean Orange County (California)?

(Note to the associations: I find it fascinating, if not frustrating, that even though one of the main stated goals is to provide solid information to the medical profession, the associations (USA) have largely failed. This “closet” has certainly been occupied for way too long!)

#8

I’m not familiar with diode lasers like I am with Alexandrite. But I do know that diode lasers are very good and safe on darker skin tones as well. If you do a search on diode lasers in the forum, there is a discussion on alma laser which mentions setting guide for skin type IV between 16-20j, and some even go above. If your son cannot tolerate the lower settings now, he won’t tolerate higher settings. There needs to be a better coordination between his MDs on pain management.
You should be seeing hair shedding process by 2 weeks after each laser treatment session. At this point the goal should be inducing hair shedding from the cyst area to promote some healing process, even if hair removal won’t be permanent now. Once the cyst heals you may proceed to seek proper treatments in the future to prevent reoccurrence.
Can you describe how you apply the numbing cream and do you use plastic wrap as occlusion? How long the cream stays in area before laser treatments start?

#9

Hello BONO and FENIX
By OC I mean Orange County, CA.

. The numbing cream was applied by the RN nurse 30 min before treatment. ( she said it numbs in 15 min) , my son was on antibiotics for more than a month , she said that makes him more sensitive plus having a lot of hair would also make him feel more pain. She didn’t wrap the area or anything just rubbed it on and she applied a think layer . Ill attach a pic for the numbing cream as well.

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#10

For lidocaine tetricatine combo creams I’ve seen literature where it’s also left on for 60-120 minutes. Ask the nurse if it’s ok to try leaving the cream on for longer and see if it gives a stronger pain relief.
Have you seen hair shedding after treatment your son already had?

#11

If that’s working for you that’s excellent. I cannot speak to laser treatments, because I am not a laser operator. Good luck and I hope it goes well.

#12

I will ask her thank you for the tip. For shedding the RN said he would see it from 10 day to 2 weeks , it has been only 6 days.

#13

Thank you Bono.