INTRODUCTION
The main indication of laser hair removal is hirsutism i.e, presence of hairs in a male pattern distribution in a female. This article covers the main causes of hirsutism, various methods of hair removal and basic knowledge a patient should know before starting laser hair removal treatments.     

HIRSUTISM
Hirsutism is defined as presence of dark coarse hair in a male pattern distribution in a female. The most common site affected is face mainly over upper lips and chin, other sites include chest( sternum, breasts), back, abdomen( linea alba and upper pubic triangle).

CAUSES OF HIRSUTISM

The causes of hirsutism are many and varied, including:

• Heredity
• Pregnancy
• Hormonal imbalances (PCOS, adrenal or ovarian tumours, cushing’s syndrome,          thyroid disorders )
• Insulin resistance states (eg. obesity)
• Reactions to certain medications (eg. steroids)
• Normal aging processes
• Idiopathic.

Doctor should explore a possible underlying reason of the extreme hair growth before starting laser because if there is something in the body consistently triggering hair growth, laser treatments might seem ineffective because the body will keep developing new hair. So, it will always seem like there is not reduction, when in fact it’s NEW hair your body is producing that you are seeing, not that treated by laser growing back. Women with PCOS hair growth patterns (upper lip, chin, cheeks, etc) should see an endocrinologist and have hormonal tests taken. Men can get tested for insulin resistance etc. Laser can affect the hair that’s currently present, but cannot prevent NEW hair from developing.

VARIOUS METHODS OF HAIR REMOVAL & THEIR SIDE EFFECTS

Hair removal methods can be broadly classified into two types:

A. Depilatory methods i.e removal of hair from the skin surface like hair removal creams and shaving.

B.  Epilatory methods like plucking, waxing, electrolysis and lasers.

Skin irritation and redness are the most common side effects of hair removal. Shaving can cause skin cuts and may lead to ingrown hairs. Plucking can hurt, especially if a lot of hairs are removed. Using hot wax can burn your skin. Chemicals that dissolve hair often smell bad and can cause allergic skin reactions.

Regrowth of hairs is very rapid with these methods & in due course of time the growth may become thicker.  

Electrolysis hurts and in some people can cause thick scars (called keloids). It may also change the color of the skin around where the hair was removed.

Laser hair removal can also cause burns and color changes in the skin. But side effects are minimal if done in the best hands by an expert dermatologist.

.LASER HAIR REMOVAL

Laser hair removal (LHR) is a procedure by which hair is removed from the body by utilizing a long pulse laser. Actually, the right term would be Laser hair reduction rather than Laser hair removal since hundred percent clearance of hairs can’t be achieved. The laser parameters are carefully defined by studying the anatomy of the hair follicle. LHR should be performed by a specially-trained dermatologist.

MECHANISM OF ACTION

Lasers are optical devices which produce single color beams of light. Laser light energy creates heat as it passes through the skin and targets darker colored pigment, melanin, found in the follicle and hair. By heating up the hair follicle during its active phase (anagen), the laser disables the follicle's ability to produce hair without affecting surrounding tissue.

Lasers designed for long term hair reduction emit wavelengths of light that are absorbed by the pigment in the hair (melanin). If the surrounding skin is relatively light compared to the color of the hair, then the entire energy of the laser will be concentrated in the hair shaft, effectively destroying it without affecting the skin or follicle. Hair removal lasers target the dark pigment in the hair. That’s why laser hair removal works best on light skin (so laser passes right through) and dark coarse hair (has most pigment). Lasers don’t work on white, brown and very thin black hair.

NUMBER AND SPACING OF TREATMENTS             

Most people need at least 6-8 initial treatments spaced 4-8 weeks apart. This is because hair grows in 3 phases and is killed only in the first “anagen” active growing phase. Several treatments are needed to target ALL hair in the active growth phase. Approximately 4-8 weeks after every treatment, additional treatment is required to eliminate the hairs that came out of the dormant phase and are now active. After 6-8 treatments or so, patients should experience a considerable percentage of hair reduction. Depending upon hair type, genetic and hormonal factors, some cases may require additional treatments beyond these initial treatments.

PREPARATION BEFORE TREATMENT

Sunlight should be avoided by proper use of a sunscreen in the weeks prior to a hair laser removal session, since tanned skin will inhibit effectiveness. If you are taking any medication, tell your doctor. The area in which LHR is to be done should be shaved ideally 1-2 days prior to treatment. No waxing or removing hair with the root with any other way is allowed 3 weeks before and throughout the course of treatment as hair needs to be in place to be targeted by laser.

LASERS USED

Long pulse Nd.Yag Laser ,long pulse alexandrite laser, Diode laser and IPL (Intense pulse light).