A light bulb went off in my head a couple weeks ago. I have been so puzzled by a young woman who had laser hair reduction on her bikini line and underarms. The reduction had been great, probably 90%, but over the course of three years now, I am still removing sporadic hairs! The hair structures are not small. I would say they are medium to coarse to very coarse… When treated, they slide out with no traction whatsoever. Like clockwork, every 6 weeks, she’s back for another clearing. This is not the same hair. My best guess is, either new hair is sprouting or laser caused some hairs to go dormant and the are waking up bit by bit.
I know how to permanently disable hair follicles. I do not feel that I am ever going to reach the bottom of the barrel for this case. We are both frustrated. I do think it has something to do with her previous laser treatments. Good thing she is a very patient person.
" you seem to be saying that since there is no “scientific basis” for “paradoxical hair stimulation,” these observations are worthless, mistaken and should therefore be dismissed."
That is not quite a rational rebuttal. As a consumer, if something does not have a scientific basis, it is that notion, or product, which should be dismissed.
“So, when did you become the anointed arbiter of “truth?””
Adult and professional conversation requires no arbiter of truth other than truth itself. Simply asking when I became the arbiter of truth doesn’t actually challenge my statements- only facts do.
“aren’t we allowed to ASK questions based on our observations?”
Of course you are “allowed” to ask questions. Am I not “allowed” to answer questions factually?
“Real scientists question everything”
First of all, I’ve never claimed to be a scientist. Second, scientists operate by the scientific method. When they question their own notions, it is due to new evidence, not anecdotal speculation.
“How does laser “induce” an entire field of body hair to completely REVERSE the normal hair growth cycle that then results in more than 97% of the hairs now being in telogen stage?”
While I believe your question is cynical in nature, and not truly inquisitive, I will answer nonetheless.
First, it is common sense that photothermolysis is the primary function of the laser in laser hair removal. The monochromatic light is attracted to specific chromophores, and this attraction is converted into heat energy, damaging any chromophores attracting the laser light.
When performing hair removal, you must be aware of this, as well as the natural cycle of hair growth, but more specifically, the cycle of hair growth per body part.
25% of the average chest and back hair is anagen at any given time, while 75% is telogen vs. 85% anagen in the scalp (not necessarily an area you want to treat for hair removal- just using an example) and 15% telogen. The duration of telogen in the scalp is 3 months on average, and 9 months on the chest and back.
At least two responses occur to hair removal treatment:
1- Sublethal injury to the bulge with induction of long term or permanent regression to a vellus hair (miniaturization).
2- Sufficient energy is delivered to the bulb and bulge to completely and selectively destroy the follicle.
There are various limitations- in most cases, telogen follicles will be shocked, and recur as anagen follicles; not every anagen hair will be affected; treatment parameters, technique, appropriate wavelength, adequacy of coverage- a myriad of factors may affect the efficacy of treatment.
Typically, after the first treatment, both anagen and telogen hairs are shed; the longer duration of telogen in the treated area, the longer the interval before visible hair appears; a greater percentage of follicles enter anagen synchronously, etc.
After the second treatment, follicles will enter anagen before visible hair shafts appear. You can either treat at an interval equal to half the telogen phase, or treat when visible hair makes a reappearance.
“Paradoxical hair growth” is best understood as sublethal thermal stimulation and resultant hyperemia. This can be prevented by double passing, or appropriate peripheral cooling. It’s not so much “paradoxical” as it is poorly understood.
While laser hair removal is not regarded as “permanent,” the length of hairlessness in large areas has been known to extend, in many cases, upwards of 11 years- the standard for consideration as “permanence,” after 5-10 treatments.
I’m certainly not cynical, but “your tone” from your first comment was (and is) haughty and condescending; we have all reacted to this (private emails). It’s probably just a personality trait. But no problem really. (I’ve taken “classes” from Anderson and Goldman and both fellows were kind, sincere and interested in my “silly” comments … and were never condescending.)
I’m pretty sure that you got your hair growth “statistics” from a textbook. In reality, the amount of hairs on a young person’s body (such as the back) is more like 70% anagen (young male). I have seen all the various textbook charts and some are close to reality and others are way off.
As a “worker in the trenches” some of the results from laser have been wonderful … but also very odd and inexplicable. Time will sort this all out.
Indeed, I understand TOTAL thermal destruction of a hair follicle but (as you say):
“1-Sublethal injury to the bulge [causes] with (sic) induction of long term or permanent regression to a vellus hair (miniaturization).” (I changed your sentence, because it didn’t make any sense the way you wrote it. Actually, it wasn’t a sentence.)
Anyway, how do you suppose that this “regression” takes place? How do germ cells in the bulge, having been “sublethally” injured, create a progressively smaller hair … or, for that matter, a major shift in hair growth cycles. THAT’S MY QUESTION!
Just being picky, but your first statement makes no sense. You are actually agreeing with me. You DID dismiss “paradoxical hair stimulation” (as well as the observer herself) because it had no “scientific basis.” But I do agree with your second sentence.
Anyway, it really doesn’t matter since the MARKETPLACE is going to decide what it wants. Over the years, I have read countless “scientific papers” (from “famous” reputable physicians) that endorsed all types of truly stupid devices and techniques (frauds?). If you’re in “the business” you know how this works.
In the end, clients are only interested in what WORKS for them and could “care less” about you and me “ranting” at each other. (It is sort of fun, however! Well, maybe not “fun” … )
“I’m certainly not cynical, but “your tone” from your first comment was (and is) haughty and condescending”
Mr. Bono, while I appreciate your taking the time to respond, understand that I am not A- your employee, B- your child, or C- in any way your inferior. As such, it is not your place to tell me how you perceive my factual premises to be haughty and condescending. If my responses are inaccurate, then please point out their inaccuracies. Your personal assessments are both unnecessary and completely irrelevant.
“we have all reacted to this (private emails)”
I’m glad to hear a couple of you have joined hands and exchanged emails concerning a topic placed right in public view on the internet, and by someone who has neither a need to hide behind a computer, nor the reason to. My statements are out in the open, and I am fully responsible for every word I say.
“I’m pretty sure that you got your hair growth “statistics” from a textbook”
Again, Mr. Bono, I’m sure in your education as a school teacher, and in your experience educating other human beings you, at some point, learned there are logical fallacies in arguments. If my information is incorrect- then please state so, and how so. If it is correct- the source is irrelevant, is it not?
“In reality, the amount of hairs on a young person’s body (such as the back) is more like 70% anagen (young male).”
And this just proves you didn’t take time to read my statements. The length of anagen and telogen would make a young male’s back a similar percentage anagen some times as it is telogen at other times. A young male’s back hair doesn’t continuously grow of it’s own accord, now does it? And if the typical male’s back is 70% anagen all the time, wouldn’t that imply most young males have hairy backs??? Or are you merely singling out a particular group in the overall scale of my statistical analysis of human backs in general so as to attempt to make a point?
“I have seen all the various textbook charts and some are close to reality and others are way off.”
And as a historian, you would know this is why we call this data statistical analysis. You would also know that anecdotal evidence may account for a reduction in statistics with regard to an overall total, but don’t account for truth beyond the statistical analysis to begin with. So if I say, for example, the average back is 75% telogen for 9 months, and you say “the amount of hairs on a young person’s body, such as the back, is more like 70% anagen in a young male,” my statistics would agree with your suggestion at least 3 months out of the year. Of course, your information is incorrect, and your point is moot… but we will let others decide for themselves, shall we not?
“results from laser have been wonderful … but also very odd and inexplicable.”
There are very few results from lasers that can be considered “very odd and inexplicable”- especially from the point of view of an esthetician vs. that of a dermatologist. They may be odd and inexplicable to you, but not to everyone… such as the flight of a bumble bee is a miracle to some, yet a bumble bee flies completely within the confines of physical law.
“Sublethal injury to the bulge with induction of long term or permanent regression to a vellus hair (miniaturization)”
Let me break down my statement for you so you understand it. I will try to use 8th grade English as much as possible.
My statement was made as follows-
“At least two responses occur to hair removal treatment:
1- Sublethal injury to the bulge with induction of long term or permanent regression to vellus hair (miniaturization)”
Let me break it down for you… At least two responses (to laser) occur to hair removal treatment…
This means that at least two responses occur during laser hair removal. The hair is doing the responding. It is responding to the laser energy.
The first possible response is sublethal injury to the bulge (this means only part of the follicle is damaged). This induces long term, or permanent regression of the hair to vellus (fine) hair. This is called miniaturization.
The second possible response is, when sufficient energy is delivered to the bulb and bulge (the whole of the follicle), the follicle is completely destroyed.
I didn’t originally write them as complete sentences, rather bullets… but thanks for your attempt at correcting my grammar. I see your desire to challenge me is not limited to your self perceived offenses against your profession as an esthetician.
" How do germ cells in the bulge, having been “sublethally” injured, create a progressively smaller hair … or, for that matter, a major shift in hair growth cycles. THAT’S MY QUESTION!"
I don’t believe this is a very honest question… but I will answer it as best I can. It is commonly known that Telogen Effluvium, or “thinning hair” is a natural process caused by stress, DHT, and other known and unknown causes. In any case, the hair enters either extended or permanent periods of telogen. I believe I did explain the treatment cycles of hair removal, and that one of the effects is, well, Telogen Effluvium. In this case, damage to the follicle causes shock and regression to anagen, and after every treatment, anagen is less aggressive, while telogen becomes extended over time. This is a DESIRED effect of laser hair removal, and I guess I truly don’t understand your confusion. Are you asking for a common sense answer, or are you looking for a scientific answer down to the cellular level? What, exactly, is the point of your question???
“Just being picky, but your first statement makes no sense”
You mean you don’t understand my first statement. It makes perfect sense.
“You are actually agreeing with me”
I’m not agreeing with you at all.
“You DID dismiss “paradoxical hair stimulation” (as well as the observer herself) because it had no “scientific basis.””
I did… and I haven’t retracted that dismissal.
“the MARKETPLACE is going to decide what it wants”
We ARE the market place.
“Over the years, I have read countless “scientific papers” (from “famous” reputable physicians) that endorsed all types of truly stupid devices and techniques”
So how should this reflect on me? My reputation is solid throughout the industry. My statements are out in the open, and within their context stand on their own as completely rational, and justified by both science and statistical analysis. I’ve never endorsed a stupid technique, idea, or device. I am well known for challenging even the most common notions, and for concisely and accurately making my point. Your experience does not reflect on me at all, and this is a double logical fallacy- ad-hominem+ tu qoque.
“If you’re in “the business” you know how this works.”
I am in the business of healthcare. I am a Certified Biomedical Equipment Technician, and a Certified Laser Repair Technician. My reputation as a consumer advocate, my reputation for regulatory compliance, and the service and products my company renders and sells stand on their own within the industry.
“In the end, clients are only interested in what WORKS for them and could “care less” about you and me “ranting” at each other.”
Consumers care about the truth. They care about reliability, efficacy, cost effectiveness, and most of all- safety. That is all I am concerned about, and by engaging you in this conversation my only goal has been to expose the truth while correcting misconceptions. I don’t “rant”…
I did not ignore your post- I merely did not assume it was meant for me, and did not read it. I only saw there had been a response to one of my comments from the person I originally addressed.
With that said:
“How many years have you personally performed laser reduction”
None.
“people observing laser hair stimulation.”
As I have already noted, “paradoxical hair stimulation” is not paradoxical- it is a natural process of hair removal resulting from poor treatment parameters resulting in sublethal stimulation to vellus and telogen hair. This usually occurs around the periphery of treated areas in darker skin types. This isn’t “paradoxical hair growth”- it is part of the normal cycle of hair removal. If vellus hair, which is more difficult to remove (not impossible, as some have stated) with laser, is sublethally stimulated, it may become anagen, and grow thicker. This makes it easier to remove during the next treatment.
“There is at least one scientific paper copied and pasted on this forum noting this fact.”
I would like to see this paper, but does this paper note the fact, or does it document the fact scientifically through study of what is perceived as an unexplainable phenomenon?
“there have been more than enough that swear they have more hair than when they started their laser treatments.”
As a Biomedical Engineer, I often get called in to repair equipment in which I am considered an expert. Oftentimes the practitioner will contradict what I have noted as the fault, and will give me their 30 years of experience worth of explanation as to why they are right, and how I am wrong. If consumers were experts, they wouldn’t require them.
“If you are profiting from the sale of lasers, then I can see why you would make the statements you made.”
I do profit from the sale of lasers. I also profit from reporting laser manufacturers for violations of the law. I also profit from assisting attorneys in defending their physician/medspa/esthetician clients from lawsuites. I also profit from serving as a consultant with medspas, physicians, hospitals, clinics, magazines, regulatory bodies, standards organizations, and more.
Do you profit from electrolysis? Ridiculous question… of course you do. I wouldn’t use that fact in a rebuttal as it means nothing if what you’re saying is true. I don’t govern my statements with my ego- I govern them with reason. If you have reasonable information that would make me retract my statements, I will do so willingly. There is no need to beat your chest, and sound the drums of war as if someone came to walk all over your territory. I am not “invading” Hairtell. I am attempting to enhance it. If you do not appreciate my input, I’m sure there’s a way you can ignore my future posts.
The use of lasers to remove hair has become very popular in recent years. However, there are sometimes strange phenomena that occur when lasers are used to remove unwanted hair. On rare occasions, instead of removing hair, laser treatments can actually promote hair growth. This phenomena, known as hypertrichosisis, is paradoxical effect of laser epilation. The new hair growth is actually created in part by the effect of the laser although this effect and how it occurs is not yet completely understood. Scientists are now searching for a better understanding of the mechanism behind this paradoxical effect of laser induced hypertrichosis so as to prevent it in future cases.
In order to better understand this phenomenon, scientists set up an experiment using an alexandrite laser to remove the unwanted hair of 489 patients. The patients had all been customers at a single laser hair removal clinic at the University of British Columbia Dermatology Division in Canada, and were treated by trained nurses and supervised by board certified dermatologists. Out of these 489 patients, only 3 cases of laser induced hypertrichosis were identified, but these cases were enough to offer further information on this rare phenomenon.
The three patients who had experienced an increased amount of hair growth instead of a decrease became the focus of further study. Paradoxical hypertrichosis had been seen before in other cases, but it had not been so carefully watched. Scientists first identified the hypertrichosis in each of the three patients by noting an increase in hair density, hair color or hair coarseness after laser application. Once this definition was established, they began to examine each individual case more closely.
One of the patients who experienced this increase was a 39 year old Mediterranean woman with black hair. At first, when the laser was applied to an area with unwanted hair, the hair growth decreased just as it was supposed to. However, the continued applications of the laser resulted in increasingly stubborn hair that would simply not respond to the treatment. Eventually, the woman reported a gradual increase in hair density around that area rather than a decrease.
A second patient who experienced an increased quality of hair growth was a 30 year old white man with black hair on both his arms and his back. The man had wished to have some of this hair removed from his back, but the treatment was not successful. During the first three sessions, he experienced a positive result where the unwanted hair began to slowly disappear. However, further treatments began to require higher and higher intensities of laser light in order to be successful. After six visits to the clinic, the man began to notice an increase in hair growth rather than a decrease. This was only noticed at the specific locations where he had been receiving the treatments. Even with a further increase of laser intensity, there was no success and the man abandoned the treatment entirely.
The third patient who experienced laser induced hypertrichosis was a 21 year old Chinese man with black hair. Besides the common factor of black hair, which existed in all three of these patients, there was a similar skin type amongst them known as Fitzpatrick “Skin Type IV”. Skin type IV indicates a darker level of skin that rarely burns with sunlight exposure (as opposed to skin type I, which is very white skin that easily burns when exposed to sunlight). Out of six different skin types in the Fitzpatrick skin type classification; this skin type IV was the only type of skin that was known to have been adversely affected by laser hair removal treatment in any of the 489 patients. Hair color and skin type may have obviously contributed to the hypertrichosis because, just like the other two patients, this third Chinese man began to notice an increased growth after 11 days of the laser epilation.
The results of the testing were compiled and analyzed so that the most obvious cause of the hypertrichosis was determined to be a result of the laser epilation itself. This was evident from the fact that the increased hair growth only occurred in the areas that were treated by the laser but, more specifically, scientists have determined that the problem may be a result of the wrong intensity of laser light rather than just the laser light itself. These ideas are being tested further and it is the hope of scientists that a solution to this rare adverse hair growth occurrence can be corrected in type IV patients.
Paradoxical hypertrichosis after laser epilation references
Alajlan A, Shapiro J, Rivers JK, MacDonald N, Wiggin J, Lui H. Paradoxical hypertrichosis after laser epilation. J Am Acad Dermatol. 2005 Jul;53(1):85-8. PMID: 15965
From PubMed:
Copied and pasted the link:
Display Settings:AbstractSend to:
J Cosmet Dermatol. 2006 Dec;5(4):274-6.
Paradoxical effects of hair removal systems: a review.
Lolis MS, Marmur ES.
Source
Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10029, USA. margarita.lolis@mssm.edu
Abstract
Although a variety of lasers have proven to be clinically effective for long-term hair removal, the use of these lasers has also been associated with undesirable side effects, such as hyper- and hypopigmentation, crusting, erythema, and edema. One notable side effect that seems to be underreported in the literature is the growth of fine dark hair in untreated areas close to the treated ones. This contradictory hypertrichosis is known as the paradoxical effect. In this paper, we review the published reports of the paradoxical effect and offer some possible explanations for this effect. The paradoxical effect has been documented most commonly after the use of induced pulse light and alexandrite lasers. One possible explanation is the activation of dormant hair follicles by suboptimal fluences. Another mechanism may be the synchronization of hair growth cycles by direct light stimulation.
PMID: 17716243 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms
Mickey, can you clarify your statement? So the people that complete laser hair reduction will only have “permanent” results that will last about 11 years and after that they should expect to see hair regrow to the same hair density and pattern before laser treatments?
While I appreciate your posting of this study, I cannot accept the results of the study as scientific for various reasons. I know you will not like those reasons, so I’ll just leave it at that.
As for consumer observations, have you considered the perfectly viable explanation I have offered, which is also a speculation considered in the “study”… which wasn’t actually a study (you can’t perform a scientific study with only three individuals).
How do we know, for example, the paradoxical hypertrichosis wasn’t caused by some other factor? Did they compare patients with natural paradoxical hypertrichosis with those that had undergone laser hair removal? What are the treatment parameters used for those who experienced paradoxical hypertrichosis vs. those who did not? What size hand piece was used? What was the overall average power of the laser system used? Have these parameters, spot sizes, and laser systems been compared with others?
The answers seem pretty clear to me. There is a common sense natural cycle of hair that laser seeks to interrupt. There are portions of the cycle that cause decreased, miniaturized hair, and there are portions of the cycle with thicker, darker hair. Laser acts like a defibrillator- if the heart is experiencing atrial or ventricular fibrillation, the current will shock the heart and cause it to resume normal rhythm. If the heart is not pumping at all- a shock may cause either atrial or ventricular fibrillation, or cause it to go back into a normal rhythm. If the hear is experiencing normal rhythm, the defib may cause fibrillation, or stopping of the heart.
The only statement I find compelling is where the new hair growth on one patient was not responsive to further treatment. I would request the treatment parameters, spot size, laser system, and a pre-treatment power output test before taking ANY of this information too seriously.
“Mickey, can you clarify your statement? So the people that complete laser hair reduction will only have “permanent” results that will last about 11 years and after that they should expect to see hair regrow to the same hair density and pattern before laser treatments?”
LOL! No. That’s not what I meant. 11 years is the legal threshold for “permanent hair removal” using any system available. Though lasers have been documented to produce “permanent” laser hair removal per this 11 year criteria, none have been approved as such because of the inability, or difficulty of laser to remove vellus hair (which electrolysis does not miss).
Let me clarify something - the FDA CLEARS laser for hair reduction , not hair removal.
Okay, Mickey, you said you have no experience actually performing laser hair reduction. I assume you read through the thread where consumers have reported laser hair stimulation. That is just the tip of the iceberg of negative concerns. All accounts have not been recorded there. Keeping that in mind, you also have electrologists like me and Mike reporting our observations . I know I am being honest and Im sure Mike is, too.We also report laser successes. I refer my clients to a laser specialists, when appropriate.
I’m sure you do your job well, but you have no contact with consumers to even know what what is actually occurring , good or not so good. All your education and training to fix lasers can’t replace real world happenings with consumers.
You are absolutely incorrect. I not only have contact with consumers, I have contact with scientists- some at manufacturer locations, some at the FDA, some are just Biomedical Engineers with a PhD who have dedicated themselves to scientific studies- physicians, estheticians, nurses, pediatricians, plastic surgeons, dermatologists, etc., including patients- the end consumer.
I not only contribute to Hairtell (which I just started doing so… and am on the verge of regretting), but I contribute to many other sites speaking of not only laser hair removal and cosmetology, but medical devices in general. You may not know who I am, and you may not respect my expertise (just yet), but if you’re willing to consider the facts we shouldn’t have any issues.
Again- it is not my intent to look for arguments, or to get into a urinating contest with individuals who are so enamored with their own speculations that they would be offended by a suggestion in opposition. It is my intent to contribute to this website as best I can, and if I am proven to be incorrect about something, I can be the most graceful in accepting new knowledge as I am not diminished in humanity by learning a little something every day.
With that said- anecdotal speculation does not adequately refute scientific data. There is a scientific explanation for what may seem paradoxical to some. It has not been proven as the cause of all instances of new hair growth after laser treatments, but obviously- the problem is not reported enough, followed up enough on, or treated with enough concern for there to be a rational rebuttal to the scientific default speculation I have presented.
Dee, please read my original statement: While laser hair removal is not regarded as “permanent,” the length of hairlessness in large areas has been known to extend, in many cases, upwards of 11 years- the standard for consideration as “permanence,” after 5-10 treatments.
The exact terminology is laser hair reduction. I saw you state laser hair removal twice. Just a correction again for preciseness, as I’m sure you can respect.
What is your contact with consumers entail if you are not actually performing laser hair reduction. I only ask because I’m not sure how much you can possibly hear about their disappointments and observations about laser hair stimulation. Would you mind clarifying that? I am having trouble figuring out how a repair person hears from the the LHR consumer.
As a scientist myself, I would like to lend my full support to this statement.
Dee, as you may recall, you and I had a debate about whether or not someone reporting an increase in growth of about 10-15 hairs counted as induced growth. I said no and you felt yes it did. Again, I’m not picking sides here, but as you can tell Dee, we did have several cases of people claiming induced growth when there were doubts about it. Unfortunately, in the science world, that consumer report thing has next to no validity.
