Robert,
When laser hair removal devices were introduced, they were typically
promoted as offering painless, or low-pain treatments. The FDA does
not allow such claims unless objective scientific and clinical evidence
is provided. None of the four currently FDA-cleared lasers provided
such data, so they may not make such claims.
In the case of Thermolase's SoftLight, there does seem to be quite
a bit of anecdotal evidence that the laser portion of the treatment is
not very painful; however, the pre-laser waxing IS part of the treatment,
and IS painful. I experienced waxing a couple of times about 10 years
ago, and I recall it was VERY painful.
SoftLight relies on a black carbon activating lotion as the chromophore to
abosorb the laser's energy. Waxing is an integral part of the treatment,
in order to make it easier for the lotion to be absorbed into the hair
shaft.
In a local TV "news" story (more like an infomercial, than journalism)
on a SoftLight doctor, there was a demonstration of a treatment on a
woman's upper lip. The pre-wax was shown, but tightly focused on the
upper lip, and edited down to only the one or two seconds it takes to
perform, and with no audio. So the viewer got no indication of the
patient's reaction. The laser treatment was shown, complete with audio,
and the patient was asked to comment, and of course raved about the
comfort. This is an example of how the laser treatments are being
misrepresented to the public, in this case through incompetent journalism.
The ruby lasers, such as Palomar's Epilaser do not rely on a pre-wax,
because their much higher energy density permits them to attempt to
target the melanin in the hair, as a natural chromophore. However, this
higher energy density appears to make the laser treatment much more
painful than SoftLight's.
Here is what the Massacusetts General Hospital advised in its March 1997
Epilaser patient letter:
Regarding treatment comfort/sensations they state:
"The treatment produces bearable but signifcant pain and our recommendation
is to apply a topical anesthetic (EMLA) 1.5 hours before the procedure ...
The area can also be anesthetized with injectable xylocaine in the office."
Also, "During the treatment there will be an offensive odor produced by the
burning of the hairs but it will be reduced significantly by the use of an
air evacuator."
Regarding the immediate post-treatment period they state:
"Immediately after the prodcedure the area will look dark and will turn red
and swollen; in rare instances, there may be blister formation. There
should be no bleeding and, so far, we have observed no infections, although
we recommend the application of a typical antibiotic preventively for 4-5
days. The pain after the anesthetic effect wears off is comparable to a
sunburn reaction, and should not require more than a mild analgesic in
patients with a low pain threshold."
Regarding complications:
"Increased pigmentation at the treated site is evanescent [quickly fading]
but can last for approximately three months in about 25% of the patients;
in all subjects, so far, all pigmentary changes have been reversible. No
scars have been observed in any of the subjects but the possibility, albeit
remote, has to be considered."
Clearly, the higher energy output produces considerable pain, and the
fairly high probablity (about 25 percent) of skin darkening lasting
three months. Unfortunately, the same patient letter also reported that
about 80 percent of test subjects "have shown hair removal that lasts 2-3
months", which appears not to be materially different than that of the
SoftLight.
So I believe that the issue of treatment comfort has become moot because
the laser hair removal systems have proven not to produce permanent, or even
long-term results, and are not permitted to make such claims by FDA. Laser
treatments are most fairly compared with waxing, which costs 10 to 20 times
less.
As for electrologists, my impression is that they have always been careful
to minimize treatment discomfort. I see references to EMLA quite frequently,
so it appears that it is fairly widely used. However, I suspect that the
majority of treatments are performed without any anaesthetic. I had quite a
bit of electrolysis treatment, and found the pain quite bearable, and never
once used anaesthetic. Five years later, with zero regrowth, I can say it was
short term pain, for permanent gain.
Hair removal consumers are prepared to tolerate quite a bit of pain, both
physical and financial, but only when justified by the results. Waxing has
proven its worth as a safe and inexpensive temporary treatment for centuries.
After more than 120 years, electrolysis continues to be the only method
of permanent hair removal, and it is safe and affordable. I believe that
when fairly and accurately represented, laser is not competive with either
waxing or electrolysis.
Ted Molczan |
