After 6 months of deliberation and research (largely on the HairTell forums), I finally took the plunge and had my first treatment about 2.5 weeks ago. The results so far are promising, but I feel that there is also definate room for improvement. I’m hoping I can get some advice from you guys as to what direction my subsequent treatments should take.
BACKGROUND:
Before I present my specific questions and concerns, some background information might be helpful. I am a male caucasian, age 29, probably skin type II (fair skin, dark brown hair, medium brown/green eyes) with almost no tan. I grow decidely dark and stiff/coarse facial hair which has ever been the bane of my existence. The growth is sparse on the cheeks, but dense on the chin and upper/lower lips and fairly dense on the neck as well. Before considering laser depilation, I had given up on shaving every day as it tends to tear up my face, and resigned myself to looking like the suspect in an ongoing investigation having my face feel like crap on my “off days”. My long-term goal for treatment is not 100% reduction (although that would be great too), but at least enough reduction so that I could shave two days in a row without irritation, and so that even if I didn’t shave for two or three days, the growth would not be highly apparent.
DEVICE AND SETTINGS:
After much research, I selected a clinic which uses the GentleMAX system with DCD cooling. I convinced them to use the YAG side for my treatment, as I understand that the longer YAG wavelength better penetrates to reach the deeper follicles of the male beard. For my first treatment, the doctor recommended starting at a low fluence of 22J in consideration of the density of hair in the regions to be treated. Although I was doubtful of the amount of reduction we would get at such low energy, it was my first time so I thought it would be a good opportunity to get a feel for the procedure. Also, if I did get some reduction, it would make it easier to up the Joules on the next visit. The spot size used was 15mm, and the pulse duration was 3ms.
THE PROCEDURE:
Irradiation was performed on my entire face and neck, with a cooling gel pack being applied before and after a group of shots in addition to the DCD cryogen cooling. The pain was quite tolerable. There was a lot of stinging on my neck, and the shots on my upper lip were more startling than anything, but it was quite a bit less that what I was bracing myself for. The smell of burnt hair added to the impression that the shots might be having an effect, and the practitioner seemed to be overlapping quite well.
POST OP:
About an hour afterwards my face was still fairly red and irritated, but much less so than I had anticipated it would be. I have certainly had worse shaving. The stinging was limited mostly to my neck, especially right below my jawline. I was surprised to find almost zero discomfort on my upper lip, even though it has the densest growth. It was almost as if it had not been treated at all (although it definately was).
As for complications, there were no blisters, burns, or whiteheads. The redness and irritation was almost 100% cleared after three days. Shaving on the second day after treatment, I noticed that the texture of my skin was decidedly bumpy, like goosebumps. No real impediment to shaving though. The only complication to speak of was a little red discoloration in the tip of my chin, like a pooling of blood under the skin. It dissapeared in a couple of days as well.
RESULTS:
Patiently waiting the three weeks that I had heard so much about on these forums, I have noticed a considerable reduction in growth in all areas. The most drastic reduction has been on the neck, where there is little growth remaining in the regions treated. The same holds true for my cheeks, but they were never very dense to begin with. There is also over 50% reduction of dark hairs on my chin, and noticable reduction on the upper and lower lips. Overall, I am encouraged by the results, especially considering the low fluence used.
CONCERNS:
It seems that the treatment has turned a significant number of the remaining hairs white. After some research into the matter, I have found that the medical term for this is leukotrichia, and that it is indeed a complication of laser hair removal for a minority of patients. It is seen most often in IPL, but there are also mentions of it for Alex and YAG. The theorized mechanism is that in some individuals, the pulse is enough to destroy the melanocytes but not the follicle. Although the hairs are nearly invisible unless the light hits them at a specific angle, they are still coarser than vellus hair and will require shaving. They are certainly better this way than before, but my concern is that I doubt that hairs transformed in this manner will ever respond again to further laser treatment, meaning I will be stuck with them unless I invest in electrolysis to get rid of them.
My other concern is that there is a large very clean almost deliberate patch on my neck that was not treated. Seems odd considering that the rest of the regions were done with what seemed like a lot of attention to detail and overlapping. It might have been intentional; perhaps she was instructed to do so for some reason by the doctor (I should note that I live in Japan, and although I am fluent in the language I still miss things said in spoken conversation, especially when not directed to me).
Questions:
I am considering a significant increase in the fluence on my next visit. My reasoning is as follows:
- My skin type should be able to handle a lot more, especially from a YAG
- I already have had decent reduction (and depigmentation of hair >_<) so the impact should be less this time around
- I didn’t get 100% shedding last time, especially on the upper lip
- I want to limit the amount of hairs that undergo leukotrichia by ensuring total destruction of the follicle–hairs that turn white will forever be lost to laser treatment
I also understand that longer pulse durations are more suited to coarser hair, but I haven’t been able to find much concrete information on this matter. What I have surmised is that while shorter pulse durations are always more effective, they also place a greater burden on the skin. Therefore longer pulse durations can allow for higher fluence to be used. For finer hair, the loss in effectiveness on longer pulses (due to thermal relaxation) outweighs the benefit of being able to use higher fluences, but for coarse hair, the impact of going to longer pulses is smaller, so that the net effect of longer pulse+higher fluence gives an overall increase in effectiveness. This is how I have interpreted the little info I have been able to find.
So my questions are these:
- What fluence should I use?
- Should I request a longer pulse width, and if so, what length would be appropriate?
I am thinking of going with maybe 35J on the next treatment (up from 22J). That is based on my comfort level at the settings used last time, as well as the Candela YAG guidelines for my skin type at 15mm. However if I go with a longer pulse length (like say 10ms), perhaps the fluence should be pushed up even more (to like 40J?). Normally I would be okay with taking it slow, but I really don’t want to accrue any more white hair.
Any other info or advice regarding the leukotrichia, the mysterious untreated patch, or anything else would be greatly appreciated.
Sorry for the superlong post! Thanks a ton for your help!
PHOTOS:
Whitebeard. There are a lot of them, but you can only see the ones which are at a particular angle with respect to the light.
Missed a spot.
Both photos taken roughly two weeks after treatment.