With so many salons, medspas and clinics advertising permanent hair removal, there’s a lot to look for if you want your money’s worth.

Both IPL machines and lasers are good for hair removal depending on hair type, skin type, growth rate and a variety of other factors. Lasers will most likely require fewer treatments, they are less painful, more suitable for darker and tanned skin, and generally safer than IPLs.

Costs of laser hair removal will vary greatly depending on a location, provider competition and the type of provider. Google “laser hair removal new york” and “laser hair removal maitland” – and you’ll see the point.

What is truly important is to research clinics and machines before getting started. It’s not just about price, it’s about cleanliness and the pain-factor and permanence. Do a consultation, get a patch test, and see if the office is well-educated and can answer your questions. 

Look for a clinic or spa with experienced providers, updated equipment and strong anti-septic practices. Alcohol is not sufficient to kill herpes, hepatitis C or the flu virus. Cleanliness is critical in this industry, especially if they will be working on intimate areas of your body.

Botox and dermal fillers are household terms these days and people are no longer shy to talk about it. In fact, according to survey statistics released today by the American Society for Aesthetic Plastic Surgery (ASAPS), nearly 9 out of 10 respondents (87 percent) openly discuss their dermal filler treatments with others, and 7 out of 10 (70 percent) receive support from the people they told.

This trend shows that aesthetic injectable treatments continue to evolve into mainstream and widely accepted options for the everyday use. Survey results found that the typical aesthetic injectable patient is a married, working mother between 41-55 years of age with a household income of under $100,000. The survey also found that women receiving aesthetic injectable treatments are health-conscious and philanthropy minded, with the majority incorporating exercise (95 percent) and healthy eating habits (78 percent) into their lives, and many volunteering with charitable organizations that matter to them (32 percent).

In addition, nearly seven out of 10 respondents believe that BOTOX® Cosmetic (72 percent) and hyaluronic acid dermal fillers (65 percent) are important parts of their aesthetic routine. “Most people have great success with BOTOX® Cosmetic and dermal fillers; however, we need to make patients aware that even though injectables are not ’surgery,’ their administration is a medical procedure with risks that depend on the training and experience of the clinician, the clinical setting and the technique used,” says Laurie Casas, MD involved in the survey.

Hyaluronic acid dermal fillers ranked as the third most popular procedure performed last year. The most common injectable dermal fillers are Restylane, Juvederm, Sculptra, Zyderm and Zyplast, and Bio-Alcamid.

Dermal fillers are being used to reduce or eliminate wrinkles, raise scar depressions, enhance lips, and replace soft-tissue volume loss.

Types of Dermal Fillers

Several classes of dermal fillers are marketed in the United States today. They include:

• collagen based fillers (i.e. Zyplast and Cosmoderm),
• hyaluronic acid based fillers (i.e. Restylane and Hylaform), and
• calcium hydroxyl apatite fillers such as Radiesse.

New promising dermal fillers are in development that will offer superior capabilities in the future.

Autologous (your own) fat is also used as a dermal filler. Your surgeon can take fat from one area (where you do not want it) and inject it into another (where you want it, such as facial wrinkles, or any other area with a loss of volume). This procedure is called lipoinjection or lipografting.

Injection of fillers usually requires the use of either a topical numbing cream or a local injection of numbing medication. Then, using a small needle, the dermal filler is injected into each wrinkle or scar that requires treatment. Some mild burning and stinging is normal and quickly resolves.

The results can last from three months to five years, depending on the filler being used. Collagen provides the shortest duration with effects lasting anywhere from three to six months. Restylane tends to last a bit longer with effects lasting from six months to one year. Radiesse can provide results that last greater than 3 years.

Dermal Fillers and Lasers

These two are very compatible. In fact, if your aesthetic physician is trained and has lasers, he or she can enhance your results dramatically by doing a combination treatment, which may stimulate the growth of new collagen and improve the skin texture. Typically IPL or laser photo rejuvenation (photo facial) is done as a separate procedure. An advanced aesthetic clinic will be able to offer a dermal filler-laser treatment combination in one seating.

IPL, photo-facial, light treatment, laser treatment – whichever name you use, intense pulsed light systems have become the single most popular and affordable light-based device for many aesthetic practices. Their sales are largely unregulated, with most of the devices being used in spas, “medi-spas” and “rejuvenation facilities.” Though universally offered, can IPL treatments differ at these “non-physician facilities” and physicians’ offices?

IPLs are not lasers, and they use a flash lamp to emit noncoherent, nonmonochromatic light. However, if used properly, IPLs can deliver good results for many indications. Understanding how to manipulate your IPL system via pulse numbers, pulse widths, filters, cooling and proper patient selection can let you completely reinvent your laser practice.

Wavelength

The range of wavelengths will depend on the system and on which handpiece or filter you use. There are two types of filters: cut-off and cut-on.

Cut-off filters are the most common and block all wavelengths below that filter number. For example, a 560 nm filter would allow all wavelengths above 560 nm and less than 1,200 nm to be emitted.

Cut-on filters block all wavelengths except for a small range right around the filter number. For example, a 1,064 nm filter might emit light from 1,060 nm to 1,066 nm.

Note that these are not lasers, as they are not mono-chromatic or coherent.

Choosing the right filter is one important parameter in a successful treatment. When thinking about which wavelengths to use, you must consider both the condition being treated and the patient’s skin color.

Since the highest absorption of melanin is at lower wavelengths, higher-wavelength filters — which are less absorbed by melanin — offer protection for darker skin types.

Higher-wavelength filters may also be used for better penetration when doing procedures such as hair removal, when penetration to the dividing cells is crucial for permanent removal. Lower-wavelength filters offer more absorption by melanin and are safe to use on lighter skin types.

Adjust for skin type

The darker the lesion, the easier it is to remove, even with longer wavelengths. When treating lighter lesions, you may need to adjust to a more pigment-absorbing, shorter wavelength. The lower limit will be determined by the patient’s skin type.

In addition to filters, IPL systems can also be adjusted, just as lasers are adjusted, using fluence and pulse widths. The pulse width adjustment parameters and the number of pulses in a row are two of the variables that set IPLs apart from other laser and light systems.

Thousands of pulse sequence variations can be formed by adjusting number of pulses, pulse width and the delay between each pulse. This is one thing that makes IPL systems so user-dependent. One operator may obtain great results using a system, while another may have no success.

Pulse widths

Pulse widths, the length of time of each pulse — milliseconds for IPLs — can be increased or decreased depending on the indication. For darker skin types, longer pulse widths offer additional epidermal protection, as the peak heat is lower than with short pulses of the same fluence, avoiding permanent damage to melanocytes. Longer pulse widths can also be helpful when treating larger vascular lesions. On the other hand, shorter pulse widths are preferred when treating pigmented lesions.

Remember, melanosomes are tiny and have a short thermal relaxation time; the desired pulse width should be as close to the thermal relaxation time as possible.

Small telangiectasias also respond well to short pulse width treatments. By programming a system to string pulses together, the operator is able to deliver more energy while keeping the peak temperatures below the point of epidermal burning. This can be important when treating vascular lesions, which are deeper in the skin.

Cooling

Cooling is another important variable in the proper use of an IPL. The mechanism for cooling the epidermis during treatment will vary depending on the device. Some use contact cooling, while others rely on air cooling. Proper cooling can increase the treatment possibilities and versatility of your device.

It’s important to note that more epidermal cooling is required when treating lesions below the epidermis, while little epidermal cooling is needed when treating epidermal lesions, such as solar lentigines.

Most cooling is operator-controlled, solely by how long the cooling apparatus is exposed to the skin. A few systems have temperature adjustments on the IPL itself. When using a contact dynamic cooling device, the cooling window will heat up as shots are fired through it.

The temperature of the cooling tip will be much warmer at the end of the session than it was at the beginning. Be sure to give the cooling apparatus time to cool itself down again. Inappropriate cooling due to rapid pulsing can lead to complications.

Applications

The clinical applications of IPLs are virtually endless. The classic indications for IPL treatment are the clinical signs of photoaging, including hyperpigmentation, telangiectasias and rhytids.

However, IPL devices have also shown success in treatment of rosacea, acne, melasma, port wine stains, hemangiomas, hair removal, angiokeratomas, hypertrophic scars, poikiloderma of Civatte and lesions of pigmented purpura.

In addition, IPL devices can be used as the activation source for photodynamic therapy. PDT can be used to treat actinic keratoses as well as verrucae.

Studies have also shown that when compared to IPL alone, the addition of aminolevulinic acid to an IPL regimen increases the production of collagen and the improvement of the signs of photoaging. (Marmur et al.) (Gold et al, Dermatol Surg. 2006.)

Safety

Two separate groups have examined the use of IPL after filler injections and found that there was no sign of interaction between the light and the fillers. IPL has also been shown to be safely administered immediately after botulinum toxin injections. (Farkas et al. Aesthetic Surg J. 2008.) (Goldman et al, Dermatol Surg. 2007.) (Semchyshyn, Kilmer, Dermatol Surg. 2005.)

Varieties

IPL systems come in many varieties. Most now come with other attachments, such as hair removal, ablative and nonablative fractional resurfacing handpieces, acne treatment, radiofrequency (RF), infrared tightening attachments and even IPL paired with RF. Choosing the IPL that is right for your practice will depend not only on the IPL portion of the device, but also on what other laser and light procedures you want to offer your patients.

As our understanding of these broadband light sources expands, we are able to offer our patients more tailored treatments. If you aren’t getting the results you are looking for, think about adjusting parameters other than fluence. Lighter skin types can tolerate shorter pulse widths, which may better target pigmentation. More cooling can further protect the epidermis when treating dermal targets using higher fluences.

With more applications than ever, these multipurpose, tunable light devices are likely to remain the workhorse of the aesthetic industry.

More about laser skin treatments on LaserOffers.com

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Based on an article published by Joely Kaufman, M.D. in Dermatology Times, May 1, 2009.

Joely Kaufman, M.D., is assistant professor of clinical dermatology at the University of Miami Miller School of Medicine and director of lasers for the University of Miami Cosmetic Group. The Cosmetic Group is involved in research and development of lasers and light devices as well as other aesthetic procedures, such as fillers and toxins.

The economy is bad, consumers have no cash for elective procedures and things are not looking up as we all embrace ourselves for a long recession.

Many cosmetic surgeons and aesthetic physicians are thinking about cutting fees.

With big ticket surgeries, such as facelifts, there is no price tag for experience, and aesthetic physicians should consider alternatives to stay competitive, to stay afloat.

Cosmetic practice marketing experts are hesitant to use the term “price reductions,” but they’re quick to point out that, in today’s economy “value” is key, and recommend that cosmetic surgeons find creative ways to retain patients who are shying away from the big ticket procedures — whether by cutting fees, offering alternatives, bundling services, offering volume discounts or providing incentives with coupons. Surgeons who have built their reputations on surgical excellence generally have fees that reflect their expertise and should keep those fees where they are.

Become more competitive on noninvasive procedures, such as injections, fillers, laser treatments and peels.

Botox and injectable dermal fillers may not be the treatment that gives you the most profit, but it is getting people in the door. Instead of doing three areas of Botox for $1,400, make it more competitive and start the first area at $400, the second at $300 and offer a little more sensitivity to volume discounts.

Smart bundling noninvasive procedures to offer a limited-time opportunity to get more value.

An individualized treatment plan with the use of a combination of affordable treatments may retain current customers and acquire new ones. Add value to a procedure, e.g. include lymph drainage massage treatments after liposuction or offer different facials or peels after facial rejuvenation with laser or facelift.

Offer zero-interest financing.

Dentists and LASIK surgeons have long used this financing approach, offered by CareCredit and a few other financial institutions, with success. Cosmetic surgeons’ doing their own brand of in-house financing is typically a bad idea as doctors do not have access to the information that a financial institution does, as far as who to approve…how to collect from that patient, etc.

Introduce a new simple procedure to forge long-term patient relationships and create a pipeline of patients.

Glycolic acid peels or a similar low-cost medspa service offering ensure regular “face time” with patients, building loyalty that can pay off once patients feel more fiscally at ease and able to opt for more involved procedures. Staff training and practice costs are minimal, and patients are quickly in and out of the office, so surgeons have nothing to lose and everything to gain.

Satisfied patients.

Customer service and excellent results creates word-of-mouth ripple by many truly satisfied patients. Whatever it takes.

Hidradenitis is a chronic disease of the apocrine glands (a form of sweat gland found on certain parts of the body). For unknown reasons, people with hidradenitis suppurativa develop plugging or clogging of their apocrine glands. It causes chronic scarring and pus formation of the underarms (axilla) and groin/inner thigh areas. In women it can also occur under the breasts. It is similar to acne, which is also a disease of the sebaceous glands. Hidradenitis is more common in people who have had acne. It may be an unusual type of adult acne.

Hidradenitis suppurativa is slightly more common in women and African-Americans. Hidradenitis usually starts as one or more red, tender, swellings in the groin or armpits. Over a period of hours to days the lesions enlarge and often open to the skin surface draining clear to yellow fluid. The involved area then heals with scarring. The condition usually continues for years with periods of flare and remission.

See hidradenitis suppurativa pictures

Available medical treatments for hidradenitis suppurativa, including systemic antibiotics, retinoids and biologics, have limited efficacy and significant side effects. Although surgery can be effective, it is associated with significant morbidity, including risks of infection and permanent scarring.

The long-pulsed 1,064 nm Nd:YAG laser provides safe and effective treatment for hidradenitis suppurativa, according to a study conducted by dermatologists Bassel H. Mahmoud, M.D., Ph.D.; Emily Tierney, M.D.; Camile Hexsel, M.D.; David Ozog, M.D.; and Iltefat Hamzavi, M.D., of the Henry Ford Medical Center, Detroit. The study group enrolled 22 patients (skin types II-VI) with Hurley stage II / III hidradenitis suppurativa that was bilateral and symmetric in distribution. Treatment sites included the axilla, inframammary region and/or groin.  Areas of involvement on one side of the body were treated with topical antibiotics only, and the contralateral side was treated with topical antibiotics and the Nd:YAG laser. A total of four laser treatments were performed at monthly intervals and patients were followed for an additional two months thereafter.

Study results

• At the six-month visit, the mean modified LASI score for all laser-treated sites combined was reduced significantly from baseline, and was significantly lower compared with the mean score for the control sites.
• The laser treatment was associated with pain in 40 percent of patients, but didn’t interfere with their daily activities. There were no significant adverse events related to its use.
• Patient satisfaction with the treatment was favorable and exceeded levels of satisfaction with previous medical therapy.
• Although multiple lasers are available for performing photoepilation, the 1,064 nm wavelength of the Nd:YAG laser makes it a rational choice for treating hidradenitis suppurativa thanks to its ability to penetrate to the site of disease involvement in the deeper dermis; in addition, and due to the fact that the 1064 nm wavelength is relatively less absorbed by melanin, it is safer for use in darker skin types.

Mechanism of action

The investigators speculate that the mechanism of action for the treatment benefit involves laser-induced hair removal and a photothermolysis effect leading to ablation and destruction of inflammatory lesions in the reticular dermis. These hypotheses are supported by findings from clinical evaluations and histopathologic studies.

Patients reported an early reduction in pain accompanied by an increase in discharge, which suggests the laser treatment worked similarly to surgical incision and drainage, ablating the hair follicle and allowing the discharge to escape through the follicular unit. “Our histopathology studies showed an early inflammatory reaction around the hair follicle, and evidence of follicular destruction at one month post-treatment,” Dr. Mahmoud says.

Differential responses

The differential responses of the three anatomic sites treated — the axillae, inframammary region and groin — are also consistent with the concept that hair removal is a primary mechanism of action.

Although improvement occurred at all three sites, when comparing the percentage changes from baseline LASI score, there was a statistically significant benefit for the combination treatment with the laser compared to the control only for the axillae and groin.

“Hairs in the groin and axillae are darker, terminal coarse hairs that respond better to photoepilation treatment than do the finer, vellus type hairs located in the inframammary region,” Dr. Mahmoud says.

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This study is another example of the expanding diversity of treatments that can be performed with the 1064 nm wavelength. 

Recent ads about home-based laser hair removal has left many consumers wondering about optimal and effective permanent hair removal options.

There are several home-based devices heavily advertised for their obvious advantage: you can use it at home. A couple of thoughts to add to your laser hair removal directory.

For $200 you can get a no!no! – a hair remover used at home that gives about 64 percent reduction in hair growth “over time.” The no!no! device uses a thermacon tip containing “Hot Blades” (which are not really blades) that house thermodynamic wires. While gliding the device over the skin, the thermal transference conducts a gentle pulse of heat to the hair resulting in crystallized hair. 

Zap it — with the Tria Laser, which uses “Diffuse Radiance Technology,” which transforms the Class IV laser diode used in a professional setting into a Class I laser diode. The Tria’s photothermolysis system targets the dark pigment of the hair causing it to gradually fall out or stop growing after six to eight treatments. For $795, you’ll see results in six to eight months.

no! no! and a few other devices that recently popped up in the U.S. market, are not lasers, to start with. These devices with similar promises may give you a 64 percent reduction in hair growth. The key word in the advertising is “over time”, which I interpret as “use it as often as possible for a long period of time”. Lifetime?

Tria is a laser. To get some results, you must have naturally medium brown, dark brown, or black hair and your skin color must be white, ivory, beige or light brown. I have seen so many people qualifying for good laser hair removal results and yet struggling for many months to endure multiple painful treatments with high power Class IV medical lasers to achieve desired 80-85% reduction, that I find it hard to believe in this low power diode. I can rate it a notch above no! no! but not far above waxing.  

The most effective, and therefore appealing of the hair-removal options on the market is professional laser hair removal. Why? Because it is the only one that really works! Do your local search, e.g. “laser hair removal new york”, “laser hair removal ny”, “suffolk laser hair removal”, “laser hair removal DC”, or “laser hair removal NJ”. Get serious! You are doing this for your own self!

I have always been sceptical about marketing hypes created by laser manufacturers. It has taken me years of watching thermages and fraxels of the laser industry to come up with a solid body of research that would confirm the real efficacy and worthwile benefits to the patient. There is no doubt that laser technologies are advancing. Does the pace of marketing advances reflect the technological advances that would deliver improved results for the customer? No. Marketing is getting better faster than results for the cash paying patient.

Here is a link to a strong opinion by an experienced doctor who questions the efficacy of the fractionated lasers.

More about fractional lasers on LaserOffers.com