Bare No Hair

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host Summer Hardy,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator, and technology innovator.

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The title of today's
episode is Bare No Hair.

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On a previous episode,

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we've talked about growing thinning
hair and hair transplantation.

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Today we're going to talk
about removing unwanted hair.

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What should I know to start with Dr. Bass?

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Well, the first thing to
understand is the biology of hair.

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We think of hair being on our
heads, but we know hairs fall out.

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Then there's something going on there.

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So hairs go through a growth cycle,

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and there are different
stages of that growth cycle.

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So there's a growth phase
called antigen when the

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hair follicle wakes up,

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starts to become active and
starts to produce a hair shaft.

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Then there's catagen when
the hair is present there

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and then the hair is
shed and the hair goes

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into a resting phase
called telogen. Actually,

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most of the hair follicles
are in telogen or

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resting even on top of our head.

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As we go onto other areas of our body,

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the amount of time that
hairs are in telogen

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is longer and the percentage of
hairs that are in telogen is greater.

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So on top of our head, as I said,

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most of the hairs are probably resting
most of the time and they rest for about

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four months and then they perk up and
start growing in a young adult person.

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So that affects what happens

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when we try to start treating hair
that we don't want to see anymore.

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Okay. Now that I'm up to
speed on hair biology,

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what are some of the treatment methods?

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So we all know the traditional
methods that are basically not medical

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methods. There of course,
is shaving and men,

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if they're clean,

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shave and shave typically every
day of their adult lives or

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every day that they want
to look clean and groomed.

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And shaving works very well,
but it's very temporary.

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And then there are things like
waxing, sugaring and threading.

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So these are all mechanical
hair removal or hair

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reduction methods.

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So shaving cuts the outside
visible portion of the hair

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away, so you can't see it.

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There's still a hair shaft in
the hair follicle under the

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skin, but it's not on the outside. You
can see it so you don't care that much.

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And things like waxing sugaring
and threading latch onto

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the hair and yank it out
of the hair follicle.

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So the hair follicle is temporarily
empty and it will take a

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period of time depending on what part
of the body and how fast the hair is

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growing,

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but period of a couple
of weeks to maybe a month

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for hair to show up
again. So that's again,

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a temporary but very
commonly used approach

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that's doesn't require a
visit to the doctor's office.

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Got it. So I have to ask, does shaving
make the hair grow faster or thicker?

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Is that a myth or is it reality?

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So shaving does not
actually make a bigger,

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fatter or faster growing hair,

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but what it does do is cut the hair

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sharply and leave the blunt,

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thick part of the hair
visible when the hair next

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grows. So the hair that's not shaved,

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that sits outside the body over time,

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that hair gets worn down
and it thins and softens,

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and the edge of that hair is
tapered instead of being blunt

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and sharp when the hair has been shaved.

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So that makes the hair appear
finer and a little bit less visible

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compared to a shaved hair.

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So you're not actually changing
what the hair follicle is doing,

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but you change a little bit the
external appearance of the hair.

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Thanks for explaining. Now, back to
hair removal and reduction methods.

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What else is there?

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So the gold standard is electrolysis.

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Electrolysis is a technique
where the tiny needle

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is introduced down the
hair follicle itself.

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You follow down from the opening in
the skin where the hair shaft comes out

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down into the hair follicle and
then apply an electric current

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slowly until the hair follicle is killed.

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That sounds great.

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Doesn't that mean the problem is
solved or are there disadvantages?

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So the advantage of
electrolysis is it's the most

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reliable and the most permanent
hair method that we have.

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Occasionally a hair regrows
a little bit in a few years,

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a little finer and thinner, but mostly
the hairs are permanently removed,

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permanent,

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the way you and I think of permanent
because the way FDA thinks of permanent

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when they talk about
permanent hair removal with

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lasers or energy devices,

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they mean longer than the
growth cycle of the hair,

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which is not really what you
and I think of as permanent,

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it just means long term.

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Or in another definition they
sometimes use is six months,

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which again, since we're
going to live decades,

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is not really permanent
the way we think about it.

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So long-term is a better way to look at
that. But getting back to electrolysis,

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the big disadvantage is it's a
single hair at a time. So if you

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have three hairs growing on your chin
and you don't want to look at them,

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electrolysis is a really
good way to get rid of them.

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But if you have a full male beard,

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like some ladies have so much
hair growing on their face,

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it's like a man's beard,

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or if you're a man trying to
get rid of your hairy back

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or your hairy belly,

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there's just no way electrolysis
would be a lifetime project.

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So it's too slow to deal with large areas.

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Sometimes you get scarring if a little
too much energy is applied and it's

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very slow and very painful
typically has to be done in

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multiple sessions doing only
so many hairs at a time.

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So it's not practical for big areas,

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even though it's very effective
if you only have a few.

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That makes sense. So are there
more alternatives, Dr. Bass?

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So there are a variety of
other things that are done,

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and one thing is pharmacologic.

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Basically a topically applied skin
lotion that contains a medication

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called Vaniqa.

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And Vaniqa is a medication
that's used in ladies that

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slows down the growth of the hair.

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So it doesn't take the hair out
and it doesn't eliminate the

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hair from growing, but it
slows it down dramatically.

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So if you were shaving twice a week

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or every other day because of
hair on your face and you're

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a lady and you want
that hair to slow down,

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you go on Vaniqa and you might only
have to shave every two or three

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weeks a single time to
keep the hair controlled.

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So that is the right
fit for some people for

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some areas on their body,
principally the face.

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The other big thing that
you used nowadays since the

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1990s are lasers and other light sources

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that can be used to zap
the hairs and create hair

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reduction that way.

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Lasers sound very cool,
but will they work?

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I know there have got to be advantages
and disadvantages. So lay it out for me.

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So you're exactly right.

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Any technology is going to have
advantages and disadvantages,

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really important to
understand what they are,

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so if it's a good fit for you or not.

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So the first thing to understand
when we turn to the light-based

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devices is to understand a
little bit about how they work.

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So hairs contain melanin
pigment and the way

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all of these devices work,

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they're wavelengths or colors of
light that are heavily absorbed by

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melanin.

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So the melanin in the hair shaft itself

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absorbs the hair, the hair shaft heats up.

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That heat is conducted into the adjacent

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cells of the hair follicle that grow hair,

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damaging those cells.

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And if the follicle
can't grow hair anymore,

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the hair grows out a little
more and then falls out.

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So that's the mechanism by which

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light-based devices help reduce hair.

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The issue is, remember I said many,

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many of the hair follicles
are in telogen resting face,

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so they have no hair shaft.

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So the telogen follicles or
resting hair follicles are not

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treated in any given treatment.

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So that means there's always a series
of treatments because even if you

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succeed at treating a hundred
percent of the actively growing

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hairs that contain a hair shaft,

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you're not going to treat any
of the resting hair follicles.

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All of that makes sense to me. But
isn't there melanin in my skin? Also,

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how does my skin color and hair
color affect the treatments?

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So that's the million
dollar question, Summer.

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Skin is the other main item that

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contains melanin.

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And so your skin is also targeted by these

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light or laser-based sources along

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with the melanin and the hair shaft.

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And so it's a competition
between the melanin in the hair

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shaft and the melanin in your skin.

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What's going to absorb the energy
and what's going to get potentially

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affected by the laser light.

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We want a lot of light and energy
in the hair follicle to get

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a lot of heating there in the
hair shaft and the hair follicle.

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We don't want a lot of
light or energy in the skin.

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And melanin in the skin is at
the base of the epidermal layer.

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So it's relatively superficial where
hair follicles are a little bit deeper.

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So the trick of laser treatments for hair

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is to get the light deep into the hair

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follicle with a very mild effect,

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ideally no effect on the skin.
And this is done a couple of different

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ways. At the same time,

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how much your skin absorbs is going to
be affected by your skin pigmentation,

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how much your hair absorbs is going
to be affected by how dark the

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hair is. So the fatter the
hair and the darker the hair,

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the better it gets zapped and the lighter

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the hair or the thinner the
hair, the less it absorbs,

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the less it gets zapped. And
the lighter your skin is,

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the less your skin will potentially
be affected by the laser treatment.

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So the ideal patient has
a big, thick, dark hair,

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black hair or dark brown and very fair

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skin.

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Okay, that's really interesting.

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Could I get my hair lasered if I
have white or gray hair? And if not,

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couldn't it just be dyed
to absorb the laser then?

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Well,

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the problem with dyeing hairs
is it's too superficial.

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So when you dye your hair,

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it's the hair outside your
body that's absorbing the dye,

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and we need dye in the hair
shaft that's inside your

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skin, still inside the hair follicle,

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and it's really sealed in there.

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And at the very dawn
of laser hair removal,

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they tried to zap hairs
by putting on a carbon

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paste and getting it
down into the follicle.

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But studies eventually revealed
that you could not get the

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carbon particles successfully
down deep enough into the hair

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follicle to effectively

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target the carbon pigment
instead of the hair pigment.

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And there was other research
trying to use nanoparticles of gold

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thinking that the very tiny particles
would succeed in getting down there,

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but it still didn't really work
out to be a usable hair removal

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system.

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So what that means is if you have white

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hair or gray hair,

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that's not going to work
well for laser hair removal

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and we have to look at other strategies.

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Gotcha. And then what
about any peach fuzz?

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So that's another important
question because a lot of people

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have little fuzzy hairs
on their upper lip or

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in front of their ears
and their sideburn area,

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and those hairs are so fine
and they're often very light

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that they don't get enough melanin
absorption to be treated by

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light-based devices.

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So those are hairs you're going to have
to chase with waxing or threading or

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sugaring or you go on the
medication Vaniqa that I described

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before and try to slow down
the growth of those hairs.

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Okay. So let's turn to more
practical considerations.

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What areas are people treating?

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So that's an important consideration.

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So the main light-based
treatment areas are

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areas that are also commonly treated
with waxing and things like that,

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areas like mustache areas, chin,

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neck and jawline areas and
sideburn areas. For ladies,

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they don't want to see a lot of
hair in those areas. And as I said,

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some ladies have so much hair,

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it's like a man's beard and
they're shaving every day

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or every other day, and the hair
is still a little bit visible.

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They really want to try
to get rid of that hair.

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And light-based devices are
a good way to chase that.

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There are a lot of body
areas, the tummy area,

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the bikini area, instead of waxing,

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you can treat that area currently
with laser treatments and get the hair

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gone from those areas.

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And armpit areas are also very common
to either eliminate the hair so you

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don't have to shave or just
reduce it tremendously so

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that shaving becomes a
very infrequent event.

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And another common area
are our arms and legs.

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So ladies love to treat legs so
they don't have to shave their legs.

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If they choose to be bare and hairless,

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they can get the laser,

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get the hair off and not have to
go through the recurrent process of

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shaving the legs.

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That makes sense. Is
this mostly for women?

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Well, it's really for everyone.

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And men also chase a lot of areas.

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So men that are very hairy and
body areas that have a hairy

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back or chest or abdomen,

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which they or the person they're
with does not find attractive,

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may look to reduce the amount of
hair or sometimes eliminate hair

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in those areas. If they have
hairy years, which some men have,

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particularly as they age, this
can be another application area,

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although not all laser
devices have a delivery

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system or applicator that can
target a small and curvy area like

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that. They tend to do better
on big flat open areas.

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And then there are other
small niche areas like hairy

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knuckles and hairy toes that
often men and women find

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unattractive and they chase with lasers.

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Okay, Dr. Bass, thanks for explaining.

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So time to share your
takeaways with our listeners.

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So the main thing is to plan
enough sessions and start early

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enough to be ready for summertime
or whenever you're planning

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to show your skin.

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That's going to depend on the area
you're treating, how much hair is there,

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and how dark and thick the hairs
are, and how dark your skin is.

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So all skin types can be treated,
but if you have darker skin,

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we have to use a little
bit lower energies.

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We have to use different
wavelengths typically on dark skin,

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but we have figured out how to
treat even very dark skin patients.

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Typically you do a treatment once a
month for three months and then you

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do another treatment a few months later
and another treatment a few months after

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that to catch any straggler hairs as
they wake up from the resting phase.

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But even with that,

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there may be some touchups required
long-term with these lasers.

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So you may come back in six months,

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a year or two years and do another
treatment just if a few hairs

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that got missed or skipped or were
resting are now showing themselves.

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Even when hair grows back though,
it tends to be thinner, finer,

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and slower growing.

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There are a lot of systems
out there for hair reduction,

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but the medical office systems
tend to be more powerful

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and they also have more
sophisticated cooling options.

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So some use contact cooling,

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some use cryogen cooling where a little,

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the laser pulse fires and
five to 20 milliseconds

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later a little pulse of
cryogen fires to cool the

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skin. Or you can pre-cool the
skin with a little cryogen.

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You have a lot of control over
timing the cooling compared to the

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laser, so the skin is not damaged,

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but the hair can be targeted effectively.

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For any area with a lot of

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hair, this is probably a good candidate

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area for treatment with laser
and light-based devices.

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Thank you Dr. Bass for sharing the ins
and outs of hair removal technologies.

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Definitely good to have these technologies
available if you want to go bare.

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Thank you for listening to the
Park Avenue Plastic Surgery Class

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00:20:30,330 --> 00:20:33,090
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00:20:33,150 --> 00:20:35,370
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00:20:42,630 --> 00:20:43,830
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00:20:43,950 --> 00:20:48,780
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