Skin & Allergy News, Jan, 2003 by Heidi Splete
NEW YORK — Patients’ unrealistic expectations are the major pitfall of laser hair removal, Dr. Eric F. Bernstein said at the 11th International Symposium on Cosmetic Laser Surgery.
In the context of laser hair removal, very intelligent people revert to a 7-year-old’s mentality and hear what they want to hear-not what doctors have to say, said Dr. Bernstein, president of Laser Surgery and Cosmetic Dermatology Centers Inc., Marlton, N.J.
If you tell patients that “it always requires maintenance treatments to keep the hair away,” they will hear, “one treatment, and I’ll never be bothered again,” he said.
Dr. Bernstein tells patients they will need a minimum of three initial treatments 6 weeks apart, plus additional maintenance to keep all the hairs away.
The three initial treatments 6 weeks apart will expose all the hair in a given area to the laser. The laser sees only pigmented hair-anagen hair-not the tiny telogen hairs that even patients can barely see.
Once an area is treated with a laser, the inflammation will drive the telogen hairs into the anagen phase, and the laser will catch them at the next visit.
“The reality is that you need multiple laser treatments to have all the hair [in a given area] seen by the laser,” he said.
Maintenance treatments are always required to keep the hair away in a given area-a statement that Dr. Bernstein has in bold type on his consent form. After only one treatment, hair may be thinner or partly reduced in a certain area, but it won’t be totally gone. That’s an important distinction to make with patients.
“I do nothing but laser 5 days a week, and it doesn’t take long to find out if you’re not doing the initial consult properly,” he said.
Dr. Bernstein described several other potential pitfalls and how he handles them:
* White or blond hair doesn’t respond well to laser hair removal. It doesn’t hurt to do a test spot, but in general, he tells patients that it won’t work.
* Everyone forgets what they looked like prior to treatment. Dr. Berstein takes a preprocedure photo, and it immediately goes in the chart.
* All hair is not created equal. It may only take two treatments to get some hair under control, but other areas may need several more before the patient is satisfied.
* Plan ahead for time-consuming cases such as backs and legs. Price treatments accordingly.
* Respect melanin. Assume patients may not be honest about sun exposure, and assume they aren’t going to follow instructions.
* Do spot tests. Hyperpigmentation or blistering is much worse on a large area than a small area.
* Folliculitis can be a problem
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