QCW (quasi-constant wave) Diode Lasers are ideal for deep tissue thermolysis because the laser energy is passed through the epidermis (little reaction takes place on or above the surface of the skin).  This is primarily due to the selective wavelength of 808nm.  Only 5-10% loss of energy per mm of tissue depth occurs, which leaves very high levels of laser radiation at the precise areas to create thermal damage to the follicle.
 

Diode laser hair removal does not require the hair be shaved prior to treatment.  It will actually vaporize growth above the skin and leave a smooth surface behind.  The hair and follicle tissues below the skin will remain as a target for the laser energy.

A variation to this procedure requires the entire follicle organ be removed from the skin by tweezing or waxing. The empty follicle is then prepared with a carbon-based dye. 

Advantages of the carbon dye protocol are substantial.  Melanin (natural pigment) in human hair is generally not an efficient receptor for laser energy. Even black hair has only a 50% efficiency rating for the conversion of photon energy to heat. Carbon dye, on the other hand, has a conversion ratio of over 99%. This produces far greater thermal damage to the follicle itself, which results in permanent destruction of the tissues at faster rates.

Client Pre-Qualifications

The best candidate for laser hair removal has fair skin with dark terminal hairs. Skin typing for exposure to ultraviolet light can be categorized by the Fitzpatrick classification, developed by Dr. Thomas Fitzpatrick of Harvard Medical School.
Skin Type I:  Never tans, always burns (extremely fair skin, blonde hair, blue/green eyes)
Skin Type II:  Occasionally tans, usually burns (fair skin, sandy to brown hair, green/brown eyes)
Skin Type III:  Often tans, sometimes burns (medium skin, brown hair, brown eyes)
Skin Type IV:  Always tan, never burns (olive skin, brown/black hair, dark brown/black eyes)
Skin Type V:  Never burns (dark brown skin, black hair, black eyes)
Skin Type VI:  (black skin, black hair, black eyes)  
Types 1 through 4 are outstanding candidates. Type 5 will have excellent results as well but care must be taken to assure that the laser will not burn the skin. Type 6 should not undergo laser hair removal unless used in conjunction with skin bleaching due to the high risk of burning and hypo/hyper pigmentation issues.

Laser Treatment 1: Deep Tissue Thermolysis With Intact Follicle:

With this procedure, the hair is actually shaved by a razor prior to laser application. This leaves the follicle intact, which provides a target for the laser radiation.

The skin must be thoroughly cleaned.  This allows for nearly 100% of the radiation to be sent deep inside the tissue. Radiation can be partially blocked by dirt or hair, thereby reducing the efficiency of the device.

Place the laser head on the skin as shown. Activate the laser on low pulse frequency setting (start out on the lowest setting: 3 pulses per second). Move the laser and repeat. You should administer no more than 3 pulses per area (1cm2) on the first treatment to determine the patient’s reaction. Applying 30 or more pulses to the same area may result in a surface burn. Do not over treat. Each patient will react differently to the same energy level.

Laser Treatment Variation 2: Deep Tissue Thermolysis With Follicle Extraction and Carbon Dye

Before applying treatment, remove all hair from the area by tweezing or waxing. Laser hair removal is most effective when applied to an empty follicle shaft.  Most human hair does not normally have enough pigment to allow for sufficient heat exchange to cauterize, desiccate and necrotize the cells which produce hair. To compensate for this lack of quantitative and qualitative photon targets, it will be necessary to place a high-density carbon dye inside the follicle prior to treatment.

Using a cotton-tipped applicator, completely cover the treatment area with the special dye included in your kit. Massage the dye into the follicle pore with a firm downward circular motion. Repeat 2-3 times to saturate the follicle pore. Use an ethyl alcohol based wipe (isopropyl alcohol will not dissolve the dye) to lightly clean the excess from the surface of the skin. At this point you will have all desired follicles visibly highlighted with a dark spot (as seen above) and are ready to power up your laser for treatment.

Place the laser head on the skin. Activate the laser on low pulse frequency setting (start out on the lowest setting: 3 pulses per second). Move the laser and repeat. You should give no more than 3 pulses per area on the first treatment to determine the patient’s reaction. Applying 30 or more pulses to the same area may result in a surface burn.