scalp expectations (and: ow!)

Hair Removal Methods Laser hair removal
1

It’s been hard to find any information about laser hair removal for the scalp. What I’ve read seems to indicate that it will be unusually effective, simply because it’s almost always growing.

For me, I’ve lost most of the hair on top of my head. After years of fighting it (occasionally giving up and closely trimming it for awhile, then trying again to find a decent hairstyle with thinning hair), I recently shaved it all off for the first time, and it was bliss. Not only is it a cathartic experience, but it’s also a much better look for me than anything I’d done before. I was thrilled.

So I started thinking about permanent removal (hey, as a guy with thinning hair, you’re going to live your life fighting against nature whether you’re trying to keep your hair, or just trying to keep enough gone to look good day to day without it). Laser seemed like an interesting option. I was surprised how inexpensive an initial visit could be, and given my expectations of a higher success rate, it seemed very affordable as well.

After my first visit (today) all I can say is: OUCH!

Good grief that was painful. I’m afraid I got less than great coverage just because of the nurse’s reaction to my squirming due to how intense the bursts of pain were with each shot in the thicker areas (though I’ve lost most of the hair on top, the sides have always been, and still are, very dense). My skin is light (probably midway between 2-3)and my hair is very dark brown. I can see where the treatment areas were targetted (a bit stripy on one side, and round spots elsewhere – they switched nurses when they realized I would need much more time for the anesthetic to work).

Some things I’m wondering:

  • how does the scalp really compare, on average, with more typical removal targets as far as the number of sessions goes?
  • is there any overlap outside of visibly red areas (as seen shortly after treatment) that one can expect loss, or is whatever red pattern you see pretty much exactly what you’ll end up with once you shed?
  • is that much pain typical in a thickly-haired scalp treatment? It was intsense.

thanks :slight_smile: I’ve enjoyed reading the forum so far – lots of good posts going back years. Very informative.

2

what machine are they using? what settings?

most clinics won’t do this area because it’s pretty painful and because the hair is deep and you will require many many treatments, and even then, results are up in the air. you can also end up with patchy results. it’s hard to tell. there are a few others who did this but havent posted about it in a while, so we don’t know what the results were like.

3

It was a lightSheer, and they started off with 12j, then after it was causing so much pain, went to 15j but with a larger radius(?) (I don’t know what those settings were in either case). The first setting was used in a sliding sideways pattern (I could see the stripes, though they were very close together), and the second nurse took her time more and used the spot method, also going back over some spots she thought were missed the first time.

Next time I will be handling my own numbing, after finding out about EMLA from this forum and then finding a very informative clinical study about EMLA from rxmed:

The depth of analgesia, as measured by the insertion of a needle through the skin, is about 3 mm after a 60-minute application, about 4 mm after a 90-minute application and about 5 mm after a 120-minute application.

Looks like 2+ hours in saran wrap for me.

4

http://cosmeticenhancementsforum.com/forum/viewtopic.php?t=6798&sid=e72bb9a8778ad74038478a53cfc030f4

this is another recent thread on this which should give you another indication to why this isn’t such a good idea.

topical cream is not the same thing as the injection. you’re supposed to leave the cream on for 1 hour covered with serran wrap. i woudn’t do more than that. it can be dangerous.

those settings are extremely low for LightSheer and would almost certainly not produce any permanent damage to the hair in my opinion. Anything under 25 joules on a LightSheer is usually not permanent.

I guess you can look into trying a Yag laser like GentleYAG that penetrates the deepest, but I would suppose that it is even more painful due to that. GentleLASE is one of the best machines with a large spot size too.

5

I’m very interested in the success/failure topics. In my case, 1 day after treatment (my scalp hair is not only very dense where it hasn’t already vanished – it also grows very quickly, even for scalp hair), I can see some clear demarcation lines, especially in the areas treated by the first nurse. There are a couple of thin strips in the wider gaps between stripes where it looks like normal growth for this amount of time, while other large areas still look like they were recently shaved. I can tell the difference between various shaving methods (rotary, disposable razor, good cartridge razor) after a half day to a day, and the difference between these zones is much greater than that. I wonder how relevant that observation is.

Regarding pain mediation (I think this is really worth reading closely):

In adults, a thick layer of EMLA cream (corresponding to approximately 150 g) has been applied to intact skin areas of up to 1 300 cm for application times of up to 3 hours. The highest individual plasma levels observed were 1.1 µg/mL lidocaine and 0.2 µg/mL prilocaine. These levels were below those at which symptoms of toxicity would be expected to occur (5 to 10 µg/mL either agent; see also Adverse Effects).

Other studies went even farther:

After application to the thigh in adults (60 g cream/400 cmfor 3 hours), the extent of absorption was approximately 5% of lidocaine and prilocaine. Maximum plasma concentrations (mean 0.12 and 0.07 µg/mL respectively), were reached approximately 2 to 6 hours after the application.

I think that, given the limited amount available discussions of direct experience with this treatment area, and a frequently repeated bit of conventional wisdom about limiting the use of topical anaesthetics that I see on the majority of the laser treatment sites, which all seem to cite cases of adverse reactions without really examining the details of those cases (drug interactions in combination therapies, alergic reactions, size of treatment area, skin condition, etc – all of which is addressed in these studies), I’m not convinced of the veracity of those recommendations. It’s the cautious approach, and given the typical treatments involved, it’s more than adequate advice: you don’t usually need particularly aggressive pain mediation for these treatments. But the evidence of controlled clinical studies is quite clear – we know the exact blood plasma levels of these drugs at various application levels and durations.

Some of the reservations expressed by the practitioners seem to be aesthetic: what if you change your mind? For a balding person, that’s not really that much of a concern: you have very little say in the matter – it’s going away, and the only variable is how long it takes, and how much you try to work against the system (either treating it or trying to go with the flow and maintain a good no-hair look). Given that plus the limited window of opportunity (when it goes gray, you no longer have the option), it’s a very compelling idea. I could be wrong on this, but my impression of the practitioner comments about this fall into one of three areas:

  1. aesthetic
  2. worries about pain and aenesthetic
  3. effectiveness concerns.

Mostly I see 1) and 2), and I take both of those with a big grain of salt given what I’ve seen so far – in one case they’re not really demonstrating the patient’s point of view on the realities of the situation for the patient, and in the other they’re repeating conventional wisdom that has been inadequately (albeit erring on the side of safety) conveyed. #3 I’d really like to see more about. I’ll try to post my experience as I go as well.

6

we’d love for you to report on your experience.

a couple comments:

  1. the hair takes 3 weeks to shed after the treatment. what you’re seeing is probably hair coming out to shed, not grow. you can read the FAQs to learn more about the process : www.hairremovalforum.com/faq.cfm

  2. I don’t think you are fully realizing just how painful effective treatments are just yet. The settings you mentioned are very low, so the pain associated is also relatively low. Treatments at effective settings are much more painful. I would wait until you have a chance to try the treatment at those effective settings before judging whether you can handle the pain.

  3. Were they using gliding method or compression? Compression is very important with this particular machine for effective results. Also, if you can find out spot size and pulse settings, that would be very helpful as well as the joules alone do not mean much.

  4. The fatal cases of using anesthetic creams usually involved high % lidocaine compounding and applying to a large area like the legs and leaving it on for an hour or so.

could you take pictures? still very interested in following your results.

7

I’m trying to get those settings from the company (they’re pulling my chart and will call me back), and I’m charging my camera battery :slight_smile: will post again in a little while.

8

Ok here we go (each image links to a larger version):
Spots on one side (Day 1):

Stripes on the other side:

the stripes with less hair are where it was recently red and swollen a bit (the areas with hair were less red and sensitive after treatment)

More of the striped side:

Typically by now, all of the hair would be evenly about as long or a bit longer than the longest hair you can see in a couple of those images above. Most areas of treatment don’t have as much growth as I’d expect by now. Shaving your head is about like shaving your beard (for me at least) – there’s a very heavy 5-o-clock shadow by the end of the day. Down in my sideburn area you can see where it all would normally be by now – it was shaved at the same time and is usually very even all over my head and down to there.

9

stripes are usually due to technique. you should have them use the up and down method with this machine, not glide it against the skin, and also press down with each zap. overlapping by 10% or so is also important. at this point, you should wait 3 weeks to see how shedding goes. after that you can go in to touch up missed spots, though I don’t know how effective these low settings were at all.

10

They called me back just now. The settings were “12j on Auto, sliding”, and 15j @ 30ms, mixture of spot pressure and sliding.

Next time I’ll be much better numbed. Since I’m mostly just waiting for healing before touch up, is something like 2 weeks too soon? Keeping in mind that I’m not that concerned about whatever hair isn’t currently growing at this point (since that’s only around 10% anyway here) – I can go back for that a bit later. The reason I ask is that it’s going to be ~2 weeks, or something like ~6 weeks (due to a trip coming up).

11

you need to wait 3 weeks for shedding to complete. whatever didn’t shed by that time and just grows as usual, wasn’t affected. all hair treated should shed after an effective treatment. I doubt this will happen here because the settings are very low and they didn’t use compression. You can get a touchup on whatever was missed or wasn’t affected at 3-4 week mark.

please read the FAQs if you haven’t already to learn about the process and what to expect: www.hairremovalforum.com/faq.cfm.

12

I’ve read the faqs :slight_smile: there are differences with treating the scalp, though, and I have yet to find an FAQ that discusses it in detail. I think there just isn’t much experience out there.

Anyway, an update at the 4-day point: The hair on one side is only growing back in narrow strips; the areas between the strips hasn’t grown any since then. The other side, though, is another matter. There are lots of patches with no hair, but they are all small circles, and they are still swollen and purplish. These are the spots that were treated at 15j, and it seems to suggest that the scalp is quite different from other areas in terms of the amount of energy absorbed. These spots got cooked. This nurse had no previous scalp experience, whereas the first one (who chose 12j, and kept it moving) has done several. Her side came out much better… looks like lots of hair dead, and the redness/swelling went away within a couple of days as expected.

At any rate, I don’t think that the settings were too low for the area being treated, given the outcome so far and what I understand about how the laser works. That setting determines how much energy the laser puts out – not how much the hair within the target area absorbs in total. More hair? More total energy absorption. You can’t determine the energy put to use without considering both factors. Since the laser’s effectiveness is completely dependent on the hair’s absorption to generate the heat involved, it follows that the much denser areas of the body would absorb much more energy, given the same laser output. It seems clear to me that experience with other areas is just not directly applicable.

I’ll be going back on Wednesday for a check-up on the still-swollen spots, but for now I’m just treating with benadryl and hydrocortisone.

13

Redness is all but gone, appt. for next visit set for post-vacation. Expecting shedding to start soon, should be interesting.

Had a follow-up with the clinic on about day 5. Made plans for much more numbing time next time around, probably along with some extra cooling (ice pack) for reducing the swelling.

Some more about scalp:

  • since you are absorbing more energy per area treated, you should anticipate more skin irritation than usual
  • although the skin absorbs more energy, and it’s easy to prove through simple heat transfer algorithms that the hair shafts themselves retain more energy longer than with other areas due to the decreased difference in temperature with the surrounding skin (and possibly absorb more to begin with, depending on some parameters I don’t have access to and others that I can’t measure), whether or not that is enough to have an impact on the treated follicles is not clear

We’ll definitely be sticking to the original 12j setting next visit, though the reduction I’ve had so far should make it less painful and damaging this time around.