Complications of Laser Therapy for hair removal

The use of lasers to remove hair has become very popular and has been vigorous promoted by the laser companies. It has been promoted as the ultimate in the hair removal centers or saloons. These laser machines are majority of times handled by the untrained personnel who have no or little knowledge about the mechanism of action of laser. They fail to tell their prospective clients about the complications of laser use.

The four major complications of lasers are laser burns and its sequellae, leukotrichia, paradoxical hypertrichosis and folliculitis. The other adverse effects reported after laser-assisted hair removal include erythema and perifollicular edema, which are common, and crusting and vesiculation of treatment site, hypopigmentation and hyperpigmentation (depending on skin color and other factors). Most complications are generally temporary. The occurrence of hypopigmentation after laser irradiation is thought to be related to the suppression of melanogenesis in the epidermis (which is reversible), rather than the destruction of melanocytes. Methods to reduce the incidence of adverse effects include lightening of the skin and sun avoidance prior to laser treatment, cooling of the skin during treatment, and sun avoidance and protection after treatment.

Majority of the laser hair reductions are done by technicians unsupervised by the physicians, that is the reason for majority of the laser hair reduction complications6 (Ref:complications of non-physician supervised laser hair removal; Canadian Family Physician:Vol 55: january • janvier 2009)

 

Paradoxical hypertrichosis after laser epilation (Paradoxical hair growth after laser hair reduction)

The laser sometimes can have strange phenomena over the unwanted hairs. In some persons, instead of removing hair, laser treatments can actually promote hair growth. This phenomena, known as hypertrichosisis (increased hair growth), and is paradoxical effect of laser hair removal (epilation). The new hair growth is actually created in part by the effect of the laser although this effect and how it occurs is not yet completely understood. It is believed that all laser and light sources have the potential to cause hair induction, especially in individuals with darker skin types (III-VI); with dark, thick hair; and with underlying hormonal conditions. Possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. Treatment for paradoxical hypertrichosis is laser therapy of the affected area. The mechanism of hypertrichosis (increased hair production) is similar to the effect of Low level laser therapy effect, which acts at the cellular level and is based on the absorption of monochromatic radiation by components of the cellular respiratory chain in mitochondria. It increases adenosine triphosphate production and cell division in matrix of hair.

Paradoxical hypertrichosis (increase in hair growth) has a low incidence, ranging from 0.6% to 10%, and most commonly occurs on the face and neck. All laser and light sources have the potential to cause hair induction, especially in individuals with darker skin types (III-VI); with dark, thick hair; and with underlying hormonal conditions. Possible causes include the effect of inflammatory mediators and subtherapeutic thermal injury causing induction of the hair cycle. 5, 13, 14.

Laser therapy for hair removal if does not destroy the hair follicles, it stuns its growth or just resets the hair growth.The hair growth of the follicles is synchronized and the end result is instead of hair removal there is increased hair growth. Though some of the thick hairs which have absorbed energy and have undergone complete photothermolysis do not grow back, but the rest of hairs which have received sub-optimal energy will grow back even thicker. The regrowth after laser hair reduction now becomes resistant to the laser treatment and cannot be now removed with lasers rather it will increase the growth of the hairs with lasers.

The hair growth after laser treatment is now wavy, fine, thin and irregular and becomes more and more difficult to be removed even by electrolysis.

 

Damage to Eyes

The risk of damage of the eyes is rare but a dangerous and dreaded complication of laser hair removal done on face8, 9, 10, 15, 16, 17, 18, 19, 20. There has been documented damage to cornea, retina and macula. People have lost vision or considerable damage to vision has occurred with laser hair ablation of the face specially around eyebrows. 

 

Damage to female private parts

The damage to female private parts (labial adhesions) by laser hair removal has also been documented 11.

References

  1. Alajlan A, Shapiro J, Rivers JK, MacDonald N, Wiggin J, Lui H. Paradoxical hypertrichosis after laser epilation. J Am Acad Dermatol. 2005 Jul;53(1):85-8. PMID: 15965427
  2. Burning, paradoxical hypertrichosis, leukotrichia and folliculitis are four major complications of intense pulsed light hair removal therapy.Mohammad Radmanesh, Mohsen Azar-Beig, Arash Abtahian, Amir H. Naderi. J Dermatolog Treat. 2008; 19(6): 360–363.
  3. Gupta G. Diode Laser: Permanent hair “Reduction” Not “Removal.” International Journal of Trichology. 2014;6(1):34.
  4. Liew SH. Laser hair removal: guidelines for management. Am J Clin Dermatol. 2002;3(2):107–115.
  5. Radmanesh M. Paradoxical hypertrichosis and terminal hair change after intense pulsed light hair removal therapy. J Dermatolog Treat. 2009;20(1):52-4.
  6. Gupta G. Diode Laser: Permanent hair “Reduction” Not “Removal.” International Journal of Trichology. 2014;6(1):34.
  7. Bernstein EF. Hair growth induced by diode laser treatment. Dermatol Surg. 2005;31:584–586
  8. Complications of nonphysician-supervised laser hair removal; Canadian Family Physician, Vol 55: January 2009.
  9. Balyen L. Inadvertent macular burns and consecutive psychological depression secondary to Alexandrite laser epilation: A case report. Saudi J Ophthalmol. 2019 Jan-Mar;33(1):105-108. doi: 10.1016/j.sjopt.2018.03.006. Epub 2018 Apr 11. PMID: 30930674; PMCID: PMC6424673.
  10. Parver DL, Dreher RJ, Kohanim S, et al. Ocular injury after laser hair reduction treatment to the eyebrow. Arch Ophthalmol. 2012;130(10):1330‐1334. doi:10.1001/archophthalmol.2012.1988
  11. Fadul-Elahi T, Janjua NB. Laser-induced synlabia, cryptomenorrhea, and urine retention: A case report and literature review. Urol Ann. 2017 Oct-Dec;9(4):380-383. doi: 10.4103/UA.UA_7_17. PMID: 29118543
  12. Atta-Motte M, Załęska I. Diode Laser 805 Hair Removal Side Effects in Groups of Various Ethnicities - Cohort Study Results. J Lasers Med Sci. 2020 Spring;11(2):132-137. doi: 10.34172/jlms.2020.23. Epub 2020 Mar 15. PMID: 32273953; PMCID: PMC7118507.
  13. Desai S, Mahmoud BH, Bhatia AC, Hamzavi IH. Paradoxical hypertrichosis after laser therapy: a review. Dermatol Surg. 2010;36(3):291‐298. doi:10.1111/j.1524-4725.2009.01433.
  14. Radmanesh M, Azar-Beig M, Abtahian A, Naderi AH. Burning, paradoxical hypertrichosis, leukotrichia and folliculitis are four major complications of intense pulsed light hair removal therapy. J Dermatolog Treat. 2008;19(6):360‐363. doi:10.1080/0954663080213262
  15. Anbar F, Flood M, Shaikh S. Optical Coherence Tomography Angiography Findings in a Case of Cosmetic Laser Induced Retinal Injury. Cureus. 2019 Sep 25;11(9):e5760. doi: 10.7759/cureus.5760. PMID: 31723519; PMCID: PMC6825437.
  16. Plăcintă IA, De Freitas RA, Rahhal-Ortuño M, Udaondo P. Retinal toxicity after facial laser epilation. Rom J Ophthalmol. 2020 Jan-Mar;64(1):70-74. PMID: 32292862; PMCID: PMC7141925.
  17. Crowell EL, Jampel H, Berkenstock M. Alexandrite laser induced uveitis & pigment dispersion: A case report and review of the literature. Am J Ophthalmol Case Rep. 2020 Mar 2;18:100632. doi: 10.1016/j.ajoc.2020.100632. PMID: 32181413; PMCID: PMC7063328.
  18. Shulman S, Bichler I. Ocular complications of laser-assisted eyebrow epilation. Eye (Lond). 2009;23(4):982‐983. doi:10.1038/eye.2008.436
  19. Herbold TM, Busse H, Uhlig CE. Bilateral cataract and corectopia after laser eyebrow [corrected] epilation [published correction appears in Ophthalmology. 2006 Jun;113(6):984]. Ophthalmology. 2005;112(9):1634‐1635. doi:10.1016/j.ophtha.2005.03.032.
  20. Huang A, Phillips A, Adar T, Hui A. Ocular Injury in Cosmetic Laser Treatments of the Face. J Clin Aesthet Dermatol. 2018 Feb;11(2):15-18. Epub 2018 Feb 1. PMID: 29552271; PMCID: PMC5843357.

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