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ABOUT EPILIGHT.NET EpiLight.net's mission is to provide a comprehensive resource about EpiLight, a machine developed in 1996 to remove unwanted hair. This Web site and its content are maintained by Harvey H. Jay, M.D., a Board-certified Dermatologist and Clinical Assistant Professor of Dermatology at Cornell Medical School, with a private practice in Manhattan. HOW DO EPILIGHT AND LASERS WORK?
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Observations and conclusions expressed here are based on Dr. Jay's own experience and knowledge at this point in time, and will, we are certain, need to be updated as newer developments occur. |
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History of EpiLight
EpiLight resulted from the clinical observation that during treatment of blood vessels with the PhotoDerm pulsed light machine; hair was not regrowing in areas being treated for unwanted blood vessels. I had been using PhotoDerm to treat Leg Veins, Facial Blood Vessels, Rosacea, Port-wine Stains, and Hemangiomas since 1995. Patients were returning after PhotoDerm treatment of their blood vessels stating that in addition to blood vessel reduction, they had noted concomitant hair reduction in the treated areas. Patients were requesting that I treat areas that had no unwanted blood vessels, but where the patients wished to have fewer hairs. The manufacturer of PhotoDerm, currently Lumenis, decided to produce EpiLight to specifically target hair follicles. The pulsed light technology of PhotoDerm was used to develop a new machine, named EpiLight, which was more tailored to hair removal than the original PhotoDerm. EpiLight has evolved to where it is now approximately 40 times faster than the original PhotoDerm. In the original version of the Superfast EpiLight, which I have used for several years: a one square inch area of light is used to treat an area of hair that frequently contains approximately 150 hairs. Light flashes approximately once every 1½ seconds, and lasts for less than 1 second. This machine enables me to treat an entire man’s back in approximately 30 to 45 minutes. Obviously the time required varies directly with the size of the area being treated. My understanding is that a few of the Superfast EpiLights were produced. The standard EpiLight is half as fast, and flashes only every 3 seconds. EpiLight was licensed by the FDA in the United States in July 1997 for hair removal. The manufacturer later modified the PhotoDerm machine, which was originally developed to treat blood vessels, to also treat unwanted hair. I own both EpiLight and PhotoDerm. However, I find that the EpiLight, which was created specifically for hair removal, is faster, and has a different range of settings that are more specific for hair removal than the adapted version of the original PhotoDerm. PhotoDerm modifications include the following:
The Quantum machines are essentially less costly and are smaller versions of PhotoDerm. These machines were developed to compete with cheaper versions of lasers, and to be utilized by operators who would like a reduced range of settings at a lower price. The Quantum machines have a very limited range of settings and uses. In my opinion, based on over 11 years of PERSONAL pulsed light use in treating my patients, EpiLight’s distinct advantage over lasers is its wider range of settings that enables the expert Physician (preferably a Dermatologist) to customize settings, optimize results, and minimize side effects for the specific hair and skin combinations presented by the patient. Restricting those settings merely oversimplifies the machine and will produce less of an advantage over the relatively limited settings already available on other hair removal devices.
How do lasers work?
The concept behind the use of light to treat skin tissue is that light that is absorbed by tissue generates heat. By using specific colors (or wavelengths) of light to treat specific parts of the skin we can target and therefore treat a distinct part of the skin and spare surrounding tissue. Light can pass completely through non-absorbing tissue and effect subsequent tissue that absorbs its energy and thereby produces heat. A “red” pen appears “red” because it reflects the color “red” back to the eye of the observer. This same “red” pen absorbs other colors such as blue, green, yellow, etc. Shining a “red” light, or laser on this “red” pen would produce no light absorption, and therefore no increased heat in the “red” pen. However, shining a “yellow” light or laser on the “red” pen would result in absorption of the “yellow” light and a heating of the pen. The amount of light and the duration of the beam of light would correlate with the rise in temperature of the pen. Above a certain temperature threshold the pen might be damaged. However, if the energy was delivered over duration of time that was too long, the heat produced might have sufficient time to spread beyond the pen and start to damage the paper or table on which the pen rested. The basic principles involved require that the light delivered be at a color (or wavelength) that the target can optimally absorb, that the duration of the light enable the entire target to be heated to a proper level, without damage to, or wasting of energy on, the surrounding tissue that needs to be preserved. The basic difference between pulsed light and lasers is that pulsed light in EpiLight or PhotoDerm etc. has hundreds of wavelengths (colors) of light in each burst of light, whereas lasers produce 1 wavelength (color) of light at a time. The colors delivered by EpiLight or PhotoDerm range between the frequencies of 515nm and 1200nm. This includes blue, green, yellow, and red colors. The expert operator can modify the wavelength to deliver a combination of wavelengths that can be longer (and thereby go deeper into the tissue) or shorter (and thereby penetrate less deeply into the tissue). Pulsed light EpiLight and Photoderm enable the expert user to adjust the duration of pulses over a wide range, and to deliver these bursts of light in varying combination and numbers. Each of these adjustments enables the operator to more specifically treat the target and spare the surrounding structures. Lasers, on the other hand, produce one light color that is coherent (in phase) but which has a specific depth of penetration that usually cannot be adjusted, or have a very limited 15nm range of adjustment as compared to the 700nm range of pulsed light EpiLight or PhotoDerm.
The duration of the burst of light delivered is also a fundamental difference between pulsed light and lasers. Lasers were originally designed to deliver bursts of light in millionths of a second duration to treat microscopic sized particles such as tattoo pigment, melanin pigment (melanosomes), or the hemoglobin in red blood cells. These durations have produced less beneficial results when treating hair since the targeted “hair follicle” is far larger than the pigment, or even the “hair shaft” itself and, therefore, requires longer pulse durations of light than were originally available with lasers. As a result of these short durations, lasers have produced pigmentary changes of the remaining hair, or simply burnt the hair without adequately damaging the ”follicle” that continues to produce new hairs.
Lasers are now scrambling to correct their too short pulse duration. Newer lasers are being developed to increase the duration from the original microseconds (millionths of a second) or shorter. A laser developed by Palomar named the SLP1000 is a 810nm wavelength Diode laser that can increase the pulse duration of its 1 pulse up to 1,000 millisecond = one thousand thousandths of a second; which is equal to a 1 second duration. EpiLight, by comparison, can deliver up to 5 pulses, each of which has a maximum duration of 7 milliseconds, with four 300 millisecond intervals between the 5 pulses. Thus, EpiLight’s total pulse duration is 1500 (5x300) +28 (4X7) = 1528 millisecond = or 1.5 seconds. Since EpiLight has had this longer duration for almost 4 years ahead of the competition, there is much more experience using their settings. This experience and longer durations appear to improve the responses of larger hair follicles and to produce fewer side effects in darker skin types. For over 9 years I have personally been safely and effectively treating even the most difficult to treat type 6 (Black) skin types patients who have unwanted hair, using my own settings on EpiLight. I am currently using special settings and techniques for testing tanned skin safely. However, when possible it is preferable to treat skin that has not been tanned in the past 1-2 months.
Safety
SKIN COOLING
Most, if not all, pulsed light or laser hair removal machines should be used with a cooling gel, spray, or device to cool the surface of the skin and thereby protect it from unnecessary damage from the light that passes through it to reach the hair shaft and hair follicle.
In the real world, treating patients using hair removal pulsed light or lasers should ideally be performed by an experienced board certified Dermatologist. However, this ideal is rarely attained since there is more profit in having a lesser trained and lower paid technician treat patients. Discussing hair removal capabilities of various machines should always include the warning that we are discussing optimal results in the hand of an expert physician - usually a dermatologist! Whether it is better to be treated by an “experienced” technician or by an “inexperienced” physician is in my opinion a heads you lose, tails you lose situation. The assumption that you are saving money by being treated by a suboptimal person is not necessarily accurate since experts may treat you more effectively, more safely, with less treatment and at a lower total cost. Each machine has its advantages and disadvantages. Ensuring that your machine operator can optimize your machine’s capabilities, treat any unforeseen results, and minimize or eliminate any pain or discomfort that you may experience, is no easy task. You are best off in using all means in ensuring that your operator has these capabilities. Examining actual before and after unretouched photographs of treatments that your physician performed on patients with similar conditions to your own, and evaluating your comfort and security level with that physician are good starting points. The physician should satisfactorily answer all of your questions, review your medical history (including your past, present, and future medications), perform your treatment, and fully discuss the likely outcome as well as potential side effects.
Treatment and Recovery
EpiLight treatment should be virtually painless and not require the use of any form of oral or topical pain medication or anesthetic. If your treatment is painful, then something is wrong! I have never used any local anesthetic in over 11 years of using pulsed light EpiLight and PhotoDerm. My patients have reported that in my hands, EpiLight is much more comfortable than waxing, electrolysis, and all 4 of the current type of lasers: Ruby, Alexandrite, Diode and Neodymium - yttrium – aluminum garnet (Nd:YAG)!
Immediately after EpiLight treatment you should usually not feel pain or burning. Any discomfort should be relieved by cool water compresses or cold ultrasound gel applied to the symptomatic area. Persistent symptoms are very rare and can be treated with short-term topical steroids (cortisone) applications. In my hands, even when treating all 6 skin types (black to white), I have less than a 1% incidence of side effects. These side effects are mainly temporary pigmentary change (increased or decreased skin color) usually lasting for up to several weeks. My EpiLight patients usually return immediately to their normal activities. However, I advise them to avoid irritation of the treated areas with acne medications, abrasive cleaners, or sun exposure – especially during the 48 hours after EpiLight treatment.
Added Benefits
Hairs usually fall out one to two weeks after treatment. A second course of treatment can usually be performed 3 to 4 weeks or later after treatment. I have reported approximately 50% average hair reduction after these first two treatments. Hair of all colors (except for White) responds to treatment. Hair density is the best predictor of response. Greater pre-treatment hair density usually has a higher average hair reduction after EpiLight treatment. Hair counts performed 3 to 4 months after EpiLight treatments have remained unchanged when re-counted approximately 2 years after treatment. These results have usually been stable when patients return for later post treatment examinations. Hair treated can be completely removed, but in most cases it appears that the standard size “Terminal” hairs are replaced with baby-type "Vellus" hairs. These Vellus hairs are barely visible and usually present a “hairless” appearance. After EpiLight treatment, remaining terminal hairs are frequently noted to be lighter in color, finer in diameter and slower growing. Patients report that the remaining hairs are usually easier to maintain and are less likely to ingrow.
Some of the most dramatic results have been in my patients with INGROWN HAIRS (RAZOR BUMPS or PSEUDOFOLLICULITIS). EpiLight treatments have produced a dramatic reduction, and in many cases complete clearing of these INGROWN HAIRS. Shaving, especially in areas such as women’s bikini and chin areas, and men’s beard and chin areas, tends to cut the hairs below the surface of the skin and allows the sharp hair tip produced by shaving to puncture one side of the hair follicle and thereby produce an inflammation of the skin. This inflammation can persist, and frequently produces large pimples or cysts, and subsequent scarring and pigmentary changes, such as skin darkening. Curly hairs tend to be oval in cross section. Straight hairs tend to be circular and round in cross section. Curly hairs are far more likely to ingrow when shaved, plucked, waxed, tweezed, or broken below the level of the skin surface. For more information on ingrown hairs and possible treatments, please visit www.ingrownhairs.com.
In addition, the scarring and pigmentary change (usually skin darkening) that result from the chronic irritation and inflammation of ingrown hairs rapidly improved or cleared with pulsed light EpiLight treatment! In some patients, the frequent irritation from shaving, waxing, and/or plucking of hairs produces a skin darkening that responds to Epilight pulsed light treatment.
Other Information
Acne of all forms has responded to EpiLight treatment of associated hairs. Just as we noted with PhotoDerm treatment of blood vessels that the areas’ hairs responded to pulsed light treatment, patients frequently report that Epilight treatment of unwanted hair produces an improvement or clearing of ACNE present in the treated areas. A possible mechanism behind this acne response is the reported ability of visible light to destroy bacteria that are usually associated with acne, and by the probability that miniaturization of standard terminal hair follicles includes the smaller oil glands that are involved with acne, and are attached to, and drain into the hair follicles. For more information on acne and possible treatments, please visit www.acne.net.
My over 11 years of experience using EpiLight, and my over 9 years of successful and safe treatment of the most difficult to treat type 6 Black skin has convinced me that EpiLight is at present, the most effective and safe means of long term hair removal. Although the term permanent hair reduction has been allowed by the FDA for the description of EpiLight and several other laser modalities, I feel that even though EpiLight’s results will probably be permanent or forever - it is still too soon to say for certain that any form of hair removal will last forever.
EPILIGHT COMPARED TO ELECTROLYSIS
Electrolysis was grand fathered by the FDA and allowed to claim permanent hair reduction without the need to produce studies documenting this claim as was required for pulsed light or laser machines. My patients strongly prefer Epilight hair removal to electrolysis for the following reasons:
Waxing is painful, temporary hair removal and frequently produces ingrown hairs, folliculitis (or inflammation of the hair follicle), skin darkening and or scarring. Its low cost is the only positive statement that my patients report about all forms of waxing. Plucking, tweezing, ripping, or pulling out hairs with any device or substance are similar to waxing in that they are painful, temporary, and produce frequent side effects. In my opinion, which is shared by most of my Dermatology colleagues, there is NO convincing scientific evidence that microwaves, or any of the many over the counter hair removal devices work effectively to produce satisfactory long-term hair removal.
Depilatories can be an effective short-term method of hair removal. Their application, however frequently produces irritation and burning. The hairs quickly regrow. Very few of my patients have utilized depilatories. The strong odor produced during depilatory treatment is often cited by many patients as the reason for not using these products. Those patients that try depilatories frequently use them for a very short time, before replacing them with an alternative method of hair removal.
Shaving is the method that is most commonly used by my patients before EpiLight and for the hairs that remain after EpiLight treatment. Contrary to the widespread belief, there is NO scientific evidence in humans that shaving hairs produces an increase in hair density, coarseness, or rate of growth. Shaving is an effective and economical method of short-term hair removal. Some patients report that shaving produces an irritation of their skin which may be accompanied by darkening of the skin with or without ingrown hairs. Many of my patients, however, find that they must shave twice daily or that their dense beard appears unshaven immediately after shaving. These patients want a longer-term method, such as EpiLight for hair reduction. As I mentioned earlier, EpiLight treatment of these patients’ denser hair results in a dramatic improvement in their appearance. Patients with physical disabilities may find it difficult to shave themselves. Certain areas of the body are difficult to shave for many people. EpiLight’s long-term hair removal can make a significant improvement in the quality of life of these patients.
There are 4 types of lasers available for hair removal. Since many manufacturers produce and name each type, I will give you their generic names. However, the issue is also complicated by the fact that although these 4 types are distinguished by their wavelength of light, each manufacturer may vary the cooling device, duration (length) of the pulse of light, or the energy produced by their machine. My outline will assist you, but you really need to find an Expert Physician to treat you and advise you if you decide on having laser hair removal.
Nd:YAG lasers have been reported to be the most painful of all four laser types. EpiLight pulsed light, in my hands is virtually painless and has never required any form of local or topical anesthetic. My patients who have been treated with all 4 lasers, and/or with waxing or electrolysis - report that EpiLight pulsed light in my hands, is the most comfortable and least painful of all of these hair removal methods. EpiLight treatment usually feels like or even less than a mild rubber band snap.
It has taken 8 years for pulsed light to be recognized by the laser industry and community for its safety, effectiveness, gentleness, and versatility. Several recent products are now being marketed to imitate Epilight, Photoderm, and Vasculight. It will take at least several years for these imitators to amass the extensive experience already gained with the original pulsed light products. Until that time arrives, my Ultimate Light method of utilizing Epilight, Photoderm, etc. remains the "Gold Standard" for pulsed light treatment when performed by an experienced Dermatologist.
In terms of safety, comfort, experience, effectiveness, and speed, in all skin types, EpiLight pulsed light in an experienced expert Dermatologist's hands, has the clear lead in hair removal. Lasers, however, appear to be trying to catch up with EpiLight, but they require years of clinical experience to evaluate their recent modifications. As the past has shown, theory and reality frequently do not agree. Practical results are what count. Marketing of cosmetic products such as hair removal lasers or pulsed light sources cannot replace clinical results that satisfy patients' needs. Please remember that equipment and marketers do not produce hair removal. The skill of the operator determines the ultimate success or failure for each patient. As is usually the case in medicine, medical equipment is probably secondary to the skill of the operator in determining patient satisfaction. Select both wisely. Dr. Jay has been treating patients with Pulsed Light technology for
over 11 years, and has patients whose hairs have not regrown for 10 years
and counting. Dr. Jay has been treating all skin colors with
Epilight for over 9 years.
For a comparison on different laser hair removal techniques, including EpiLight,
Dr. Jay recommends visiting
LaserHairRemovalReview.com.
CONTACT US I hope that this site has been helpful. I invite you to phone (212)755-2237 or write to Dr. Harvey Jay, 45 East 62nd Street New York, NY 10065 with your questions and comments about epilight and this web site. Please do not send email. |
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