Opinions on settings for Cynosure Apogee Elite

So I’m 3 treatments down on my bikini and underarms now and 2 on my lower legs with the Cynosure Apogee Elite, and I figured it’d be a good idea to get some knowledgeable opinions on the settings my doctor is using on me. Even though I’ve experienced great shedding after each treatment, to be honest, I’m a little nervous that the settings being used on me are not as strong as they could or should be based on the information I’ve garnered off of this site and online. My doctor is using the 755nm Alexandrite laser on the Cynosure Apogee Elite with a 12mm spot size and alternating between 18-20 joules at a pulse duration of 20 ms. I have very pale skin (type I or II) and very coarse dark hair, but according to cynosure’s website, those are the lowest recommended settings at 12mm (actually 18 joules is lower than the recommended settings for type I and II since cynosure recommends 20-35 joules at 12mm). I’ll admit I don’t know a whole lot when it comes to the technical settings of lasers, but my question is this: are the settings my doctor is using on me going to be sufficient to result in permanent hair removal? I keep telling him to be as aggressive as possible and not to worry about hurting me but he maintains that it’s pointless to use a higher setting that causes more pain when the hair will be just as dead at a lower setting.
So far, almost all the hair grew back in my bikini area after 2 treatments (just had my third this past week), with MAYBE a LITTLE less growth in the bikini line. I’ve told myself that the results after this 3rd treatment will be key (operating under the assumption that each follicle has the potential for an average of 2 or 3 separate growth cycles of hair) and that if I don’t start seeing noticeable results, I should find someone else to go to. My lower legs do seem to be looking better than usual…it’s been about 5 months since my second treatment on them and the hair just started to become noticeable maybe 2 weeks ago but it is somewhat finer than before (I’ll have to see if it stays that way though). This past session I pushed a bit for stronger settings and I could tell he was a little annoyed when he said something like “Trust me, I know what I’m doing” and just did the usual.
So what do you all think? Are these settings o.k. and should I just wait it out to see if I start getting results? I’m anxious because I’ve already invested so much time and money in this and I’ll be MAD if I see less than ideal results…as in, even though I’m an ideal candidate, I just end up with finer hair that has been made untreatable instead of being made hairless like I want and know is possible…

I can’t advise on settings, having been treated with the YAG portion but my bikini was done after 3 treatments. Just before my third treatment there was less than 30% visible hair left. I’m sure my prior waxing contributed to these results because all the hairs at the initial treatment were in anagen. But even if not, 4 treatments should be enough if the settings are aggressive and treatments are 10-12 weeks apart.

At this point, you’re still going through hair cycles, so the hair didn’t “grow back” and should be new hair.

That said, for your skin type, you can definitely handle higher settings, which means both a larger spot size of 15mm if his machine has it and somewhat higher joules. Pulse width can go as low as 5ms on this machine.

These settings aren’t horrible, but your skin type is light enough to handle much higher.

Are you seeing full shedding each time?

Yes, I am experiencing full shedding with the exception of minor patchiness from human error (every time, there are a some patches that he missed with the laser which bothers me probably more than it should). What do you think about his whole stance on “why use higher settings that hurt more, when the hair will be just as dead on lower settings”? I know everyone here is all about using super aggressive settings so there is no doubt that the hair was effectively killed, which I totally agree with. Even though the settings he’s using on me are low, do you think there’s a good chance that they will be effective based on everything you know about this machine and other people’s experiences with similar settings?
The fact that I’m seeing finer hair growth on my legs 5 months after my second treatment concerns me a bit (there’s probably just as much hair growing, it’s just finer in texture). If it was new hair from the third cycle wouldn’t it be just as coarse as usual? Is the fact that it’s finer mean that my previous laser session just damaged the follicle resulting in finer growth but not complete hair death? If that’s the case, I’ll be pretty pissed off since I don’t want to hinder the potential success of future treatments. UGH I feel like printing out Cynosure’s official treatment specifications for their Apogee Elite, waving it in his face, and MAKING him up the settings…though I know that probably won’t go over too well. How does one convince a practitioner to use more aggressive settings when THEY are the expert?

The only way you can make sure you’re killing hair is to treat it at the highest settings you can handle. That’s my perspective because I don’t think the risk is worth it.

Those settings aren’t super low, but they’re relatively low considering your skin type, meaning you can handle much higher.

Legs have long hair cycles, so you’re still maybe not eve in the third one or right around there.

Most people see finer growth after a few treatments regardless, so it’s hard to judge based on that alone.

If they agree to at least use teh 15mm spot size if possible on their machine, with the same other parameters, then it would be already better.

No idea, though I’m having a follow up in a week and I could ask (technically, according to my doctor’s hardass office girl, he doesn’t do touch-ups, but so far, he’s been nice enough to treat any of the patchiness left after the initial treatment…though I’m always hesitant to ask because she kinda scares me). He probably doesn’t use the 15mm because he’s concerned about hurting me, instead opting for the lowest treatment settings possible, which drives me nuts because I could less about minor discomfort if it means permanent hair removal. For example: during my last bikini treatment, when I flinched a bit when the laser moved into an area with denser hair growth, I saw him frown and lean over to adjust the settings to a LOWER, less painfull level which made me yell out “NO, NO, don’t make the settings lower, keep them HIIIIGH!!!”…heh THAT’S what prompted his irritated “I know what I’m doing” comment.

Thanks LAGirl. Next week, when I’m having my follow-up, I’m gonna push for the 15mm spot size at the very least and higher settings overall if I can (and I MAY just have a print out to wave in his face too HA). What settings should I push for? I can tell he likes me, so maybe he’ll give into persuasion…and if he agrees, no matter how painful, I’ll be sure to suck it up and act like it doesn’t hurt much at all