Why Laser Really Does(Not) Work

OK…I’m really sick of seeing the pettiness on this forum. From many people. I had thought when I first came here that this was a great place to get information and help from others – it’s looking very much like I was wrong on that. Too many people here seem to have their own agendas – they don’t want to help others, they just want to shove their opinions down the throat of anyone that dares to disagree with them.

I was thinking about just walking away. I probably should. But instead I’m going to do something foolish and try to start a rational discussion about LHR. Some of us have been having great results from it. Others not so great. It’s not magic, it’s science. It just happens to be science that many don’t seem to understand terribly well (I can likely be lumped in with that group, compared to some I’ve seen here).

So…let’s start with the basics and something that I think everyone can agree on:

Electrolysis works. It works by effectively burning out the base of the hair follicle (electricity is turned into heat either internally to the probe or in some other methods upon entry into the rather poor conductor that is us). It works well because it is highly targeted – the base of the follicle can be affected every time by a skilled practitioner. But it is slow, since each follicle needs to be handled individually. For small areas, this doesn’t matter too much, for large areas (or the whole body), it matters a fair bit.

LHR is actually very similar to electrolysis in what it is looking to do – burn out the base of the hair follicle. It just takes a different approach.

When light is absorbed by an object, it is converted (typically) into heat. Walk out in the sun, you get hot, that kind of thing. Lasers contain a rather large amount of energy – they can burn through things rather well. But this does very little good at first, as it’s little more effective than taking a blowtorch to your skin.

But lasers are also very tightly controlled in terms of their scatter and their wavelength. If you take a bright light and hold it against your palm, you can see the light on the other side of your hand – we are somewhat translucent by nature. Different wavelengths penetrate different amounts in our body.

In particular, our skin is a rather non-homogenous area – especially in the vicinity of hair follicles. Hairs and the base of the follicle in particular (during anagen) contain a large concentration of pigment. Much more than the surrounding skin on many of us (light skin/dark hair). This allows the possibility for a laser which is highly absorbed by the pigment in the follicle (much more so than the surrounding skin). The laser passes through a fair bit of skin, gradually dissipating and imparting relatively low levels of energy to any particular tissue (heat spread out over a large area, if you will). But when it strikes a hair follicle, it imparts a great deal of energy in a relatively small area – burning out the follicle.

That’s the idea, at least.

The key is to have a laser which will be absorbed much more strongly by the hair follicles than it will be by the surrounding skin and to then set the intensity of that laser (the fluence, or amount of energy over time) as high as possible without burning the skin (you want to burn the follicles).

As an idea, it’s pretty sound. For many individuals, that’s as far as it needs to go – we’re “common” enough that no special considerations are necessary.

Others have problems…why?

I can see several reasons:

Bad settings on the laser. Set the intensity too high, you burn the skin. The hair follicles will also burn, but you end up with burns deep in the tissue of the skin that take a long time to fade.

Set the intensity too low and you may create some trauma to the hair follicle, but not actually burn it out. Trauma is one of the few things shown to send a follicle into anagen. So, too low of an intensity and you may end up with “more” hair in an active growth phase. None of us want to get burned, but neither do you want to go through all of this for nothing – it’s a balancing act.

I’ve been using a GentleLASE at near the maximium settings (18 J/cm2, 18mm spot size) – my skin is red and inflamed for 2-3 days after a treatment before fading back to normal. But it does fade back to normal, so the trauma to the skin is minimal (what you want).

Bad laser for your skin type. If you have a dark skin type, you have a lot of pigment in your skin. Selecting the right laser is important – different lasers target different molecular structures/colors/substances. There are many things which distinguish hairs/follicles from surrounding tissue. Light skin/dark hair is an easy combination as you maximize the differences between the hair follicles and the surrounding tissue.

Deep hair follicles. This is a biggie. It is why (in my opinion) laser works well on some people (or on some areas of some people) and not so well on others. As the light from the laser passes through the skin, it loses intensity (scattered, diffracted, absorbed). If it has to pass through too much tissue before reaching the base of the follicle, it loses too much intensity to get the job done.

What do you guys think (particularly the doubters on laser)? What other reasons are there that lasers may not work on someone?

I feel that by knowing why laser does or does not work, knowing the science by which it operates, you can make the best decision as to whether or not it is right for you.

I don’t think anyone knows why laser works on some people and not on others. Sometimes, people with the ideal skin type, hair types, and best practioner possible don’t get any results. Why, I don’t have a clue. Even those who initially get good results, however, often present later with complete or even additional hair growth.

I know everyone is always going on about how fast laser is supposed to be, but it doesn’t matter how quick it is if it all grows back. My big beef with laser is that it’s a gamble, with really no way of knowing if it will pay off or not. Unlike electrolysis, where you are guaranteed a permanent, safe result, laser is anybody’s guess when it comes to effictiveness and safety. It’s been on the market for a relatively short time, and there is virtually no research on long-term effects. Even “permanent hair reduction” is meaningless, since that could mean 3% less hair for 6 months. Hardly a result to write home about. Even worse, there isn’t any long-term data about possible side effects. It zaps hair by passing through the skin, but what else is it doing in there? Nobody knows.

Trust me, nobody would be happier than myself if they could make a permanent hair removal method faster and easier than electrolysis. I’ve had lots and lots of hours under the needle. However, I know too many people who’ve been ripped off, burned, or otherwise cheated by the laser hair removal process to be able to recommend it to anybody. Maybe in several more years they’ll have some kind of consistency, but right now it’s just not worth it to me.

Wow, thanks for the dumbed down explanation. I’ve understood how it works, but couldn’t explain it to friends and family. I love your explanation.

Gryffin, do you perform laser hair reduction?

Oh, and by the way, one has to be pretty patient and thick-skinned to post on any board and it’s good that you can look beyond the playground stuff and still share your thoughts.

There is no doubt that people like yourself have been helped with laser, but what ticks me off is the language and glossy pictures that are used to promote laser as the messiah of hair removal. A consultation probably never includes a paper to sign saying one understands that laser can be a dice shoot for some people. It should be the consumers decision as to whether to proceed after hearing the other side of the story. Most of us work very hard for our money and don’t like surprises after a year of treatments.

Dee

Thanks for posting this, and I appreciate your comments. To date, this forum has only had to ban about 6 people, all of whom were spammers. However, we have recently had a few people start to get a little belligerent. I have removed some posts and written to some of those people, but if anyone finds someone being less than civil, let me know and I will deal with it quickly and decisively.

I have frankly been amazed at how great everyone has been so far, all things considered. I am involved in another forum without about one-twelfth as many members, and that thing is a battleground that needs constant attention.

Thanks to all who contribute productively, even though we all have widely varying opinions. Let’s try to keep the forum going in the spirit in which it was created-- as a place for people to share first-hand reports and get answers from practitioners. It’s what makes this forum popular and unique, and it wouldn’t happen without everyone, regardless of viewpoint.

This is an excellent thread and well overdue!

OK…I’m really sick of seeing the pettiness on this forum. From many people. I had thought when I first came here that this was a great place to get information and help from others – it’s looking very much like I was wrong on that. Too many people here seem to have their own agendas – they don’t want to help others, they just want to shove their opinions down the throat of anyone that dares to disagree with them.

I agree completely, and it has been especially bad recently! This is one reason I have been posting a lot less recently. I sure this is why others like balius, vulpes, and others have quit posting altogether. I’m enjoying the results of my hair removal and I have no real need to post here but I would like others to benefit from my experience. But I’m not going to sit here and waste my time on others that just want to get into flame wars.

I was thinking about just walking away. I probably should. But instead I’m going to do something foolish and try to start a rational discussion about LHR. Some of us have been having great results from it. Others not so great. It’s not magic, it’s science. It just happens to be science that many don’t seem to understand terribly well (I can likely be lumped in with that group, compared to some I’ve seen here).

Good points here also! The rest of your post also makes a lot of good points. And I think you’re onto something here:

Deep hair follicles. This is a biggie. It is why (in my opinion) laser works well on some people (or on some areas of some people) and not so well on others. As the light from the laser passes through the skin, it loses intensity (scattered, diffracted, absorbed). If it has to pass through too much tissue before reaching the base of the follicle, it loses too much intensity to get the job done.

This may explain why some people that would seem to be ideal candidates (light skin and dark hair) don’t get good results at all.

There may be other factors that are not known. A lot of times those in the medical field don’t like to admit they don’t know all the answers. IMHO that’s why you hear some, even doctors, just throw up their hands and say that laser really doesn’t work that great after all, and “everyone’s hair is going to grow back eventually.”

RJC2001

I don’t perform any form of hair removal myself. I’m a computer programmer by profession, a materials engineer by training (been out of that and into programming for the past 10 years). My background has always been in science and I tend to obsess about things, so I do a lot of reading and try to understand the science behind things.

I truly hate statements like “it doesn’t work on some people – noboody knows why.” I have no problems with the first part of the statement, huge problems with the second part. I accept that the individual may not know why. I accept that the technician may not know why, but this is not magic – the reasons that it does/does not work on some people is really pretty straightforward.

On myself (I’m still going through treatments), I’ve seen differing results over my body (having everything done for somewhat medical reasons). The areas that do the best are not necessarily those with the darkest hair (I’ve got naturally light skin with dark brown hair). The areas that do the best are the areas with the thinnest skin. To an extent.

My back has done surprisingly well. I say surprising, because I know that I have remarkably thick skin on my back (it’s been commented on by a couple of surgeons taking out small moles/cysts for checkups). One of them had to get a new scalpel (he was pissed). <img src="/ubbthreads/images/graemlins/wink.gif" alt="" />

I suspect that the hairs on my back are not as deep as those on, say, my chest (where I’m showing some resistance to the treatments). The chest hair has been there for 20+ years now. The back hair has just started to come in over the past 5-7 years.

I’m not putting this out there as answers. I’m positing possible reasons.

The nature of LHR is not mysterious. The reasons it works or doesn’t work are no less mysterious – it’s just a matter of knowing enough about the individual to assess them.

The woman that I’ve been seeing has her background in electrolysis (she’s been doing that professionally for over 25 years now). She was skeptical as to how well I would respond to electrolysis. The reason: I have HUGE number of multiple hairs (the main part of the reason I’m having to have this done). This has led to folliculitis, cystic acne and a whole slew of ingrowns over the years. Many of my follicles are distorted, making electrolysis difficult (as it is difficult to reach the end of the follicle where the heat needs to be applied).

So we’re going with laser and I’ve been showing good results.

Due to the nature of LHR, I know not to expect complete removal – I expect a reduction. I’m working with her to maximize the settings on me…and will likely get burned once or twice by this (may have been on my neck…still waiting to see how long it takes to fade).

I’m certainly curious to hear any differing opinions from folks…but I really don’t want to hear the standard diatribe of “it’s a sham – it never works.” The fact that LHR works has been established over the past 30 years. It doesn’t work on all people and the reasons it won’t work on an individual are what I’m trying to get at here. If you don’t know, then let’s just leave it at that…if, however, you’ve got some input and/or experience on the matter, then by all means, let’s talk it over and see if we can’t get down to the underlying science and determine why things didn’t work out.

This may explain why some people that would seem to be ideal candidates (light skin and dark hair) don’t get good results at all.

There may be other factors that are not known. A lot of times those in the medical field don’t like to admit they don’t know all the answers. IMHO that’s why you hear some, even doctors, just throw up their hands and say that laser really doesn’t work that great after all, and “everyone’s hair is going to grow back eventually.”

RJC2001

Certainly, but when you get down to it, there’s really only a few things to take into account:

  1. Depth of the follicle

  2. Physical characteristics of the follicle vs. what the laser’s specific wavelength is targeted against

  3. Physical characteristics of the surrounding tissue (controlling how high of an intensity you can use on the laser)

2 & 3 are very vague. That’s what I would really like to get into a little bit.

The obvious part of it is the color/pigment. Laser is light, typically in the visible spectrum – meaning that we can see what it’s going to affect and what it won’t. Similar coloring between the hair and surrounding tissue means you’ve got a problem. But laser doesn’t need to be just in the visible spectrum of light. It’s possible create lasers which target material that to us appears transparent.

I believe (based on what I’ve read) that most lasers in use for LHR are targeted to the red end of the visible spectrum. Greater pigment in the hair == greater amount of red absorbed == more heat.

What are the other ways for someone to get dark hair? Is there a common trend for some folks to have more blue darkening their hair than red? It would still look dark (maybe even black)…but what color is dominant?

Among the different lasers out there for LHR, what are the colors/ranges of the spectrum that they target?

Once we start to answer these questions (note: the answers are certainly out there…just a matter of locating the research), we start to be able to select the laser that is best for an individual rather than for that individual’s “general type” (which relies far too heavily on averages).

thanks for the post. being open-minded and unbiased considering both sides is what’s important. and one of the reasons i personally take a lot of my time to contribute is to help people understand exactly what you’re saying as well as help them make the best selection of laser and clinic if they do decide to go with laser, as well as advise to turn to electrolysis when it’s definitely the best method, as it is in many situations. the battleground is not helpful to anyone on the forum and wastes everyone’s time. this should be an information-sharing forum that helps people make the best decisions for themselves as it was intended and let’s keep it that way.

I do have some experience, probably more than most, when it comes to hair removal. I don’t think laser is a sham, or doesn’t ever work. I DO think it should not be considered as a first method, unless you are willing to potentially waste a lot of money and time and accept regrowth.

Maybe laser doesn’t work on somebody because they have deep follicles. Maybe it’s because it’s the wrong laser. So far as I know, they’ve yet to release anything stating “this is why some people don’t get good results.” Since you claim to know, maybe you have information the rest of us don’t. When it comes down to it, though, the fact that it doesn’t always work is more important to the lay person than why that might be so. Laser is presented as the cutting edge, trendy thing to do. Complete with hokey endorsements like “hair is gone…in a flash of light!” etc, it’s being pushed to anyone and everyone as the only sensible way. Little or nothing is ever said along the lines of “there is a very good chance that you will get little to no results, and you’ll have spent a lot of money for nothing.” And yet, that is so often what happens.

I’ve tried 3 lasers myself, with no permanent results. I know many, many people who were sadly disappointed by laser hair removal. I know that laser apologists on here always say “well, you only ever hear from the unhappy ones!” but I don’t think that’s so. Transsexual people such as myself talk, and had many of us gotten results, I would have heard about it. We depend on hair removal, and I know dozens if not hundreds of people who’ve tried laser hair removal. Some of them did ok with body hair, but not a single one was happy with beard work.

Laser is touch and go, and as far as I know, nobody ever knows what result they’ll get. You claim to know why laser doesn’t work in some people. Could you please back that up with some proof? For example, medical studies, clinical trials, or the like? I’ve never heard anything about that until now. You also said “it’s just a matter of knowing enough about the individual to assess them.” What do you think is being missed in assessments, and why haven’t we heard anything about this before? Do you mean that EVERYONE could get good results if they were properly treated? Or that some people shouldn’t even bother? I’m a bit confused.

If we get this cleared up, maybe more of us would know before hand who should/should not try laser.

That’s exactly what I’m pushing for here – I see too much of what I guess would be “backlash” against LHR here.

It’s one thing for someone to post for information about LHR and for you to caution them saying that it didn’t work well for you and (even better) to give your reasons why you think it didn’t work. It’s quite another to say “laser doesn’t work, don’t waste your money.” The latter is patently untrue and misleading…as well as doing a rather large disservice to these forums.

There really isn’t anything that I can see that is “remarkably complex” about LHR – it’s actually a pretty low-tech thing – on a part with “fire burn!”. There are a number of factors to consider in determining if LHR is “right” for you and how to approach treatment, and (IMO) a lot of practitioners that really don’t have the knowledge necessary to help you with this.

Hence this thread.

I know dozens if not hundreds of people who’ve tried laser hair removal. Some of them did ok with body hair, but not a single one was happy with beard work.

Once again, most of your post is completely fine, but once again you choose to simply ignore the fact that it DOES work for some people and on some areas as you even say yourself (your quote above). that is why posts like yours are frustrating. they’re not completely unbiased and i think to be helpful, they should be. Instead of saying “laser doesn’t work for most I know on the BEARD area, but works on some other areas”, you say it pretty much doesn’t work most of the time at all. Which is simply untrue. And once again, you simply ignore other contributors with great results even 6 years down the line who stopped posting exactly due to this, like RC2001, NoHair, hairlessinla etc. This would be a lot more unbiased as Gryffin says if you accepted that it does work, but with some unknown factors.

Well, it has been my experience (my personal one, and that of friends) that it usually DOESN’T work at all. I know a few people who did have good results, so I was fair and said it did work sometimes on a few other areas. That’s not bias, it’s just the truth. And most of the medical evidence supports that, as I posted in another message.

I’m sorry, but I will not be held accountable for other people choosing not to post. That has nothing to do with me or anyone else, so far as I can tell. If they can’t handle different opinions, maybe it’s for the best. At any rate, I never said nobody ever had good results, even 6 years later. However, in my experience many more people get poor results, which is often conveniently ignored. I cannot and will not promote laser or suggest anyone have it, when I’ve seen so much failure and negative results. As I say time and time again, it might be useful for body hair, if you’re willing to accept there are no guarantees. However, I think most people are better off with electrolysis.

those are not meaningful studies. when no information is provided (what laser, settings, what type of hair they had, even how many treatments they’ve had – this can be very well after 1 treatment, which is meaningless- etc etc), it’s absolutely impossible to get anything out of those “results” of a study.

and yes, you’re not responsible for anyone not posting. the problem is that people who are happy already have no reason to post due to just that. they’re not looking for answers or to make themselves feel better after not getting results. you’re alienating these people, which furthers your point that “noone gets results”. yes, it will seem like noone is getting results if the people who are don’t post because they don’t feel like defending themselves every time they do. they’re not bitter. they have no motivation to do that.

Another thing I hear frequently from LHR’s detractors: there are no long term studies to see the effects 10 years down the road.

First off, I question this statement. LHR has been around long enough at this point that there are plenty of folks to “study” for it.

Secondly, I find that the basic premise of the statement is somewhat flawed. Or (just as likely) that I’m missing something. Let me explain:

One possibility: you have a treatment that does nothing. The hair remains and continues on its normal cycle.

Another: you have a treatment that works as advertised. The hair follicle is destroyed and will never again produce a hair.

Another: you have a treatment which destroys the hair, but does not remove the follicle’s ability to create more. Basically, you end the hair for that cycle, but when the follicle gets around to its next anagen phase, a new hair will grown.

Another: you may or may not destroy the hair, but you create enough trauma in the follicle to cause the body to rush blood and nutrients to the capillaries and you send the follicle into anagen, creating immediate growth.

Question for the pros out there: is it possible to have another outcome, one in which the follicle is (for lack of a better word) stunned? The hair is destroyed and the follicle is affected in such a way as to not produce hair for several cycles?

With my admitedly limited knowledge, I find that scenario a bit hard to swallow, as it seems to run contrary to the way the body normally works – normally something is either functioning or it is damaged. If damaged, the damage is either repaired (with repair starting immediately) or it is “dead”. I’m not really aware of any examples of this other alternative, in which something is damaged, but not repaired for some time (for whatever reason).

most professionals agree that any NEW growth you see when the hair has presumably been damaged is new body-stimulated growth, i.e. follicles that were dormant becoming active. similarly, this happens during menopause, after bith of child, etc, during body changes in a lifetime. no professional has mentioned that laser stimulates “follicles into prolonged dormancy”. that’s just what the several people who didn’t get the results they wanted refer to what happened here. there is no clinical data, research, or statements by any professionals in the industry stating that due to the reasons you mentioned.

That’s pretty much what I’m getting at:

I’m perfectly content in the knowledge that the treatments that I’m going through now may need to be repeated 5-10 years down the road (as more hair becomes active as I age). Heck, that’s part of the reason I started treatments in the first place (growing hair on my back, increased hair on chest, arms, legs, etc.). Just part of life and not much I can (or would) do about that end.

The same would happen with electrolysis, unless I am horribly mistaken.

I’ve been confused by some of the statements that I’ve seen repeatedly where someone claims to have gone through laser and “it worked for a couple of years, but then everything came back” – it just doesn’t quite jibe with what I understand of the way our bodies work. I can see “it worked for a couple of years, but then I went through another one of those life changes and started growing more hair again” or “it worked at first, but 3 months later the hairs that were burned out hit their growth cycle again and came right back in.” — both of those statements jibe with what I understand of the biology that drives our bodies and hair growth.

There’s a truly horrid pun about Occam’s Razor floating around here somewhere…but I’m going to let that be.

at least in the last 1.5 yrs, there have been no posts from anyone who didn’t have any hair after laser treatments for 1-2 years or whatever and then “everything came back”. usually, any additional growth stabilizes at around 6-8 months post last treatment. you can read RC2001’s older posts as he had this experience.

and yes, electrolysis is the same way. it will kill hair that’s currently there, no way to prevent NEW hair from developing years down the line and all electrologists will tell you that people DO come back a few years later for some touchups on a new hair here and there.

OK…well then let’s talk about those folks that go through the full regimen with LHR and have the hair come back just as before 6 months (or so) later.

One of the things that I’ve seen quite frequently is folks posting about their experience and stating that it was uncomfortable (I’ve seen phrases like “being snapped with a rubber band”) but the redness was gone within an hour or so. To me, that sounds like too low of a setting.

I’ve got a high pain tolerance, but this is nearly excruciating. The best analogy I can come to with it is like burning your hand on the oven rack when pulling out a pizza…but the pain fades faster. I’m very red and swollen for a day, with the redness going away generally over the course of a week.

Going by the process that I outlined in the first post of this thread, if someone is going through very little redness, it’s likely that the technician is not setting the laser high enough for them, which means that they may be burning the hair, but not destroying the follicle (hence the regrowth during the next anagen phase after treatment ends).

On the technician side, I find this to be a very understandable thing – the last thing you want to do is burn someone. They come back with a lawsuit and you’re out of business. Better to give them too low of a setting than too high of one.

On the patient side, I’d (personally) like to err on the side of going too high – find that upper limit. I may have found it at 18 J/cm2 (18 mm spot size), as my neck is still sore about 5 days in…but the redness is still fading daily, so who knows? It was also the first treatment in that area with a LOT of hair, so I generated more heat from the laser hitting the hairs. I’m also entirely understanding that I’m pushing things…so if I get burned, I’ll just make sure we tone the fluence down a bit on the next round…I’m not going to blame the technician.

More thinking (told you I was obsessive) <img src="/ubbthreads/images/graemlins/smile.gif" alt="" />

Question for the electrologists out there:

Are you able to determine the depth of a follicle when you insert the needle/probe? Do you actually feel it hit bottom or do you just go in a certain distance? I’m assuming the former, which leads to:

Do you think it would be worthwhile for someone to determine the relative depth of their hair follicles prior to considering LHR? Let’s say I’m interested in having LHR on my chest/abs – but I go into an electrologist and they determine that I have very deep-seated hairs. It sounds to me like LHR would be a bad choice (regardless of skin type/hair color). If, however, I have very shallow hairs in the area that I want to have treated, LHR may be a great choice (assuming a good skin type/hair color for the laser in question).