| Abstract|| |
Laser hair removal since its availability has been primarily used for aesthetic purposes. Over the years, it has emerged as an important therapeutic modality in various dermatological and surgical disorders, both as an adjuvant and as a monotherapy. Depending on the skin type, all laser hair removal systems have been used with good results and minimal complications. We hereby review the diverse range of unconventional indications of laser hair removal.
Keywords: Folliculitis decalvans, hairy flaps, hidradenitis suppurativa, laser hair removal, pilonidal sinus, unconventional indications
|How to cite this article:|
Aleem S, Majid I. Unconventional uses of laser hair removal: A review. J Cutan Aesthet Surg 2019;12:8-16
| Introduction|| |
Lasers are indispensible tools in dermatology. Laser hair removal (LHR) remains one of the most commonly availed laser treatments in dermatology practice. It has received great interest because of its noninvasiveness, long-term results, minimal treatment discomfort, and procedure speed. LHR functions on the principle of selective photo-thermolysis with melanin serving as the target chromophore, whereby there is selective destruction of hair follicle resulting in permanent hair reduction. LHR can be performed with ruby, Alexandrite, diode, and neodymium:yttrium aluminum garnet (Nd:YAG) lasers and intense pulse light (IPL) sources, which operate at different wavelengths suitable for different skin types.
The primary indication of LHR is aesthetic removal of unwanted hair in females with hirsutism and hypertrichosis. The efficacy of different laser systems to reduce hair growth, with reduction in the number of hair counts as the endpoint, has been reported by various long-term studies. Improvement in efficacy with repetitive treatments has also been reported.
Over the years, a number of dermatological conditions associated with hair follicular pathology as the primary dysfunction have been treated with LHR. These include chronic inflammatory disorders such as pilonidal sinus disease (PSD), hidradenitis suppurativa (HS), dissecting folliculitis, pseudofolliculitis barbae (PFB), and others. These diseases are thought to result from occlusion, rupture, and inflammation of the follicular unit. Current medical treatment options available for these disorders are frequently associated with partial improvement as well as relapses and recurrences. Laser-induced damage and epilation of hair follicles is a promising therapy for these disorders.
In addition to the disorders associated with follicular inflammation, conditions associated with aberrant hair growth, either congenital or postsurgical, also require permanent hair removal or reduction. LHR is the procedure of choice to prevent recurrence in these cases. LHR for these conditions is a safe and well-tolerated treatment option and has been employed safely even in children resulting in sustained symptomatic and functional improvement. Side effects associated with LHR in these indications are minor, self-limiting, and of low incidence.
| Unconventional Indications of LHR|| |
PSD of the natal cleft is a painful and debilitating condition. Although the standard treatment involves complete surgical excision of the sinus tract, recurrence is common, varying from 11 to 14%. Because of its association with excessive hair in sacrococcygeal region, laser epilation has been reported to be beneficial as an adjunct to surgery [Table 1].,,,,,,,,,,, Four sessions of LHR have been advised to obtain the best results. Relapse rate is high if less than 4 sessions are used; one study with mean of 2.7 sessions reported a recurrence rate of 13.3% over a follow-up period of 4.4 years.LHR in PSD is usually well tolerated and without any major complications. The pain associated with the procedure can be minimized with the use of topical/local anesthetic agents. PSD with frequent disease recurrences, despite multiple surgical interventions and antibiotic treatments, was successfully treated with LHR resulting in healing of persistent sinus, reduction in hair thickness and density, and also improved quality of life [Figure 1]. No disease exacerbations were noted after 6–8 sessions. A long-term follow-up study reported no recurrence in 86.6% of patients following LHR over a period of 5–7 years. Diode laser, Nd:YAG laser, and Alexandrite laser as well as IPL systems have been used in different studies in this indication and all of these devices have shown positive results. The longest follow-up has been of 5.5 years in one study with diode laser. No recurrences were reported in this long follow-up period in the study.,
HS is a chronic disabling disorder, with exacerbations, recurrence, and progression despite medical and extensive surgical treatment. In view of mounting evidence for a primary follicular pathogenesis, LHR has been used in the treatment of HS with promising results.
Significant therapeutic benefit has been reported in this condition after LHR with diode laser, Nd:YAG laser, and IPL devices [Table 2].,, Long pulse Nd:YAG laser has been the preferred laser for this indication because of its deeper tissue penetration. Histopathological changes in 20 patients of HS followed using biopsy specimens obtained at specified intervals before and after treatment correlated with the degree of clinical improvement in them after treatment with a long-pulsed 1064-nm Nd:YAG laser. The patients received two treatments to an affected area; untreated affected areas served as controls. Laser parameters were adjusted based on skin type and ranged from 25 to 50 J/cm2 with a 10-mm spot size and a 20- to 35-ms pulse duration. Double pulse stacking was used at the first treatment, and triple at the second treatment on all inflammatory lesions. By 1 month, inflammation had decreased and broken hair shafts were noted. At 2 months, the investigators found scarring, fibrosis, and minimal inflammation. As measured by a Lesion Area and Severity Index score modified for HS, a significant improvement of 32% in treated areas was noted 2 months after the second treatment. Significant improvement (72.7%) was also observed during the 4 months of treatment and 2 months posttreatment, both clinically and histologically in another study. To be effective, the treatments need to be quite aggressive, as evidenced by the stacked pulses used and the histologic evidence of scarring and fibrosis. Inflammatory lesions healed faster after laser treatment but inframammary region improved the least. No recurrence was observed for a follow-up period of 3 years when LHR was followed by deroofing with carbon dioxide (CO2) laser.
Dissecting cellulitis is a chronic inflammatory scalp condition characterized by pustular nodules, sinus tract formation, and resultant cicatricial alopecia. Current treatments are of limited efficacy. Destructive therapy using X-rays is effective but no longer recommended. LHR has been effective in attenuating the progression of dissecting cellulitis without appreciable adverse side effects. Patients achieve decreased pus formation, reduced reliance on systemic treatments, and a controlled or terminated disease process without dyspigmentation. A severe case of recalcitrant dissecting cellulitis of the scalp had no recurrence in 6-month follow-up after 4 treatment sessions of diode laser as monotherapy. In addition, some patients have reported regrowth of terminal hairs in treatment sites, 1 year after initiating laser treatment.
Folliculitis decalvans (FD) is a group of inflammatory scalp disorders characterized by follicular papules and pustules and tufted folliculitis followed by cicatricial alopecia. Current treatments mainly consist of antibiotic therapies and are often disappointing. Recalcitrant FD has been successfully treated with LHR in a few studies on limited number of cases.,, In all these studies, long pulse Nd:YAG laser was used over multiple sessions and treatment was well tolerated.
PFB affects a large number of individuals with coarse curly hair, and present treatment options are suboptimal. Shaving is a predisposing factor because it results in sharp and short hair stumps, which reenter the skin or retract into the follicular wall. LHR has been shown to be potentially helpful in mitigating disease severity by reducing the number and/or thickness of hair shafts [Table 3]. Greater than 50% improvement has been observed in long-standing PFB after LHR.,,,,,,, In PFB, LHR with Nd:YAG laser has been reported as a safe and effective option for reducing hair and subsequent papule formation. Papule counts performed 90 days after treatment using the highest doses tolerated by the epidermis (50, 100, and 100 J/cm2 for type IV, V, and VI skin, respectively) were significantly reduced in the laser-irradiated area as compared to the control. Another study reported 56% mean reduction in PFB lesions after using three passes of Nd:YAG laser. Five weekly low-fluence (12 J/cm2) laser treatment at 1064nm also achieved significant temporary reduction in PFB refractory to conservative therapy over the anterior neck. Marked decrease in hair density and disease exacerbations at follow-up were noted after Alexandrite LHR for below knee amputation stump PFB.
Acne keloidalis nuchae
Acne keloidalis nuchae is a chronic inflammatory disorder involving hair follicles on the nape of the neck, resulting in disfiguring keloidal scars. Treatment modalities available have been met with limited success. As with other chronic inflammatory follicular disorders, LHR is being evaluated as a first-line treatment modality and is promising to be safe and effective with low recurrence. Clearance of 90–97% of lesions has been reported in a study, after 4 treatment sessions with diode laser. Improvement was significantly higher in early cases as compared to late cases in patients treated with Alexandrite and Nd:YAG lasers.,However, Er:YAG laser proved to be more effective in early as well as late cases as compared to Nd:YAG laser.
Trichostasis spinulosa is a disorder characterized by multiple hairs emerging out of a hyperkeratotic follicular opening, presenting as dark spinous plugs. Available treatment modalities provide temporary relief only. LHR therapy has been used as a definitive therapy, removing the hair responsible for the plugged appearance. Its effectiveness has been reported,,with minimal discomfort and side effects, and no recurrence in 90% of the cases, even after 2 years.
Keratosis pilaris (KP) is a common skin disorder of follicular prominence and erythema that typically affects the proximal extremities. It can be disfiguring and is often resistant to treatment. Shorter-wavelength vascular lasers have been used to reduce the associated erythema but not the textural irregularity. Significant improvement in skin texture and roughness/bumpiness was noted in KP patients after 3 treatment visits spaced 4–5 weeks apart with the 810-nm diode laser.
Axillary hyperhidrosis is a distressing disorder of eccrine sweat glands. The available treatments have limited efficacy and systemic side effects, and there is no ideal treatment option available as of now. Significant subjective and objective improvement in sweating was observed with monthly sessions of LHR using Nd:YAG laser.,In one of these studies, which was a right–left controlled comparison trial, significant subjective and objective improvement was noted in sweating after monthly sessions of LHR. On histopathology, destruction of eccrine glands was noted following LHR. In contrast to the aforementioned studies, no statistically significant difference was seen between the two sides in a controlled left–right comparison trial with 800-nm diode laser. However, both sides did demonstrate reduction in sweat rates, probably indicating a placebo effect.
Becker’s Nevus is an aesthetically troublesome condition. Although a number of lasers have been used in this condition, the response remains unsatisfactory in majority of cases. Reduction in hair density and delayed hair growth over Becker’s nevus has been reported following LHR,,,, [Table 4]. Hypertrichosis with the background of hyperpigmentation poses a challenge for LHR in Becker’s nevus. There is risk of blistering due to pigment absorption by pigmented epidermis. Significant hair clearance was noted at 12 months, with low fluence high repetition rate diode lasers for gradual heating of the hair shaft and perifollicular tissue. Becker’s nevus in a 20-year-old male was successfully treated with 6 sessions of long-pulsed 1064-nm Nd:YAG laser at 6-week intervals followed by 5 sessions of long-pulsed 755-nm Alexandrite laser at 3-month intervals. Use of LHR has been reported in other nevoid conditions also.,, Alexandrite laser has also been used in two cases of nevoid localized\hypertrichosis in children aged 10 and 12 years.
Hair-bearing skin flaps and grafts
Hair-bearing skin flaps and grafts result in hair growth at aberrant body site following surgical reconstruction. LHR has been used after reconstruction in breast cancer, on nose following basal cell carcinoma resection, in fingertip reconstruction following degloving firework blast injury, postburns, and other injuries with good results.,,
Reconstruction of intraoral structures
Reconstruction of intraoral structures in head and neck cancers may often include the transfer of flaps composed of hair-bearing skin. Patients with hairy intraoral flaps often present with irritation, pooling of saliva, and trapping of food. LHR has been used as method of epilation in them.,,,,, Laser treatment resulted in effective hair reduction in intraoral hair regardless of flap type except in one male with white hair. LHR is very difficult in such cases due to poor visibility and the bulky hand piece of laser in the confined oropharyngeal space. Marked symptom improvement was noted in a patient with reconstructed hypopharynx postlaryngopharyngectomy using Alexandrite laser, with a 7-mm hand piece with 90° side-firing fiber-optic attachment passed through the lumen of a suspension laryngoscope [Table 5].
Genital gender affirming surgery
Genital gender affirming surgery (GAS) involves reconstruction of the genitals to match the patients identified sex. The use of hair-bearing flaps in this procedure results in postoperative intravaginal and intraurethral growth hair growth and associated complications.,,, Despite long experience with electrolysis for hair removal prior to GAS,,LHR has been shown to be the superior modality.,It is best to wait 3 months after the last planned hair removal treatment before proceeding with surgery, in order to confirm that no further hair regrowth will occur. Vaginoplasty without creation of a neovaginal cavity generally does not require any hair removal preoperatively. Vaginoplasty with creation of a neovaginal cavity requires that the penile shaft skin be made hair-free (penile inversion vaginoplasty), and in some cases it is the safest to treat the entire scrotum for permanent hair removal. Transgender men undergoing phalloplasty with urethral lengthening (construction of a neourethra) require preoperative permanent hair removal of the skin flap. Skin for phalloplasty with urethral lengthening is commonly harvested from the medial aspect of the entire ventral forearm in radial artery phalloplasty or the middle 2/3 anterolateral thigh (ALT) in ALT flap phalloplasty. No intravaginal hair growth was demonstrated following LHR on scrotal skin prior to genital GAS at 15 months after vaginoplasty.
Urethral repair following hypospadias and stricture repair is carried out using cutaneous flaps, usually hair bearing. Urethral calculi formation, due to the intraurethral hair follicle, is the major complication associated with this surgery. Use of LHR for removal of urethral hair has been described in several case reports with minimal side effects and satisfactory outcomes up to 1 year of follow-up.,, Postoperative transurethral LHR has been performed with diode laser at a power of 15 W through a side-firing laser fiber.
Peristomal hair growth
Peristomal hair growth presents a problem for many people with an ileostomy. Importantly it may cause difficulty for adhesion of the stomal appliance to the skin. Shaving particularly, if frequent, can often be effective, but it may cause folliculitis. LHR has resulted in effective epilation, resulting in improved stoma appliance adhesion and reduced risk of trauma and infection.,
Hair restoration surgery to redesign frontal hairline in women
Hair transplantation for hairline correction in women is often associated with unnatural appearance due to thicker donor hair from occipital region, as women tend to have finer hair in the frontal part of their natural hairline. Various surgical techniques have been used to revise the hairline with their own complications and limitations. However, LHR used as a nonsurgical method for revising hairline following hair transplantation in women, in a study carried out by Park et al., resulted in subjective improvement in 87.5% of the cases as well as significant reduction in hair diameter. To prevent damage to the transplanted follicle, long-pulsed Nd:YAG laser irradiation with short pulse width (35–36 J/cm2 and 6ms) was used. LHR can thus be beneficial as an alternative to create fine hair, for revised hairline in women, and other recipient areas requiring fine hair.
| Conclusion|| |
Although LHR started as a cosmetic modality, it is fast gaining significance as a therapeutic modality in wide range of dermatological and surgical indications. LHR is safe and well tolerated even in pediatric population. It has reduced the morbidity associated with various chronic and recurrent disorders and thus improved the quality of life of these patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Olse EA. Methods of hair removal. J Am Acaddermatol 1999;40:143-55.
Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983;220:524-7.
Gan SD, Graber EM. Laser hair removal: a review. Dermatol Surg 2013;39:823-38.
Hussain M, Polnikorn N, Goldberg DJ. Laser-assisted hair removal in Asian skin: efficacy, complications, and the effect of single versus multiple treatments. Dermatol Surg 2003;29:249-54.
Chicarilli ZN. Follicular occlusion triad: hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp. Ann Plast Surg 1987;18:230-7.
Rajpar SF, Hague JS, Abdullah A, Lanigan SW. Hair removal with the long-pulse alexandrite and long-pulse nd:YAG lasers is safe and well tolerated in children. Clin Exp Dermatol 2009;34:684-7.
Lanigan SW. Incidence of side effects after laser hair removal. J Am Acad Dermatol 2003;49:882-6.
Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 2005;190:388-92.
Schulze SM, Patel N, Hertzog D, Fares LG 2nd. Treatment of pilonidal disease with laser epilation. Am Surg 2006;72:534-7.
Conroy FJ, Kandamany N, Mahaffey PJ. Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 2008;61:1069-72.
Benedetto AV, Lewis AT. Pilonidal sinus disease treated by depilation using an 800nm diode laser and review of the literature. Dermatol Surg 2005;31:587-91.
Lavelle M, Jafri Z, Town G. Recurrent pilonidal sinus treated with epilation using a ruby laser. J Cosmet Laser Ther 2002;4:45-7.
Downs AM, Palmer J. Laser hair removal for recurrent pilonidal sinus disease. J Cosmet Laser Ther 2002;4:91.
Odili J, Gault D. Laser depilation of the natal cleft–an aid to healing the pilonidal sinus. Ann R Coll Surg Engl 2002;84:29-32.
Landa N, Aller O, Landa-Gundin N, Torrontegui J, Azpiazu JL. Successful treatment of recurrent pilonidal sinus with laser epilation. Dermatol Surg 2005;31:726-8.
Lukish JR, Kindelan T, Marmon LM, Pennington M, Norwood C. Laser epilation is a safe and effective therapy for teenagers with pilonidal disease. J Pediatr Surg 2009;44:282-5.
Badawy EA, Kanawati MN. Effect of hair removal by nd:YAG laser on the recurrence of pilonidal sinus. J Eur Acad Dermatol Venereol 2009;23:883-6.
Abbas O, Sidani M, Rubeiz N, Ghosn S, Kibbi AG. Letter: 755-nm alexandrite laser epilation as an adjuvant and primary treatment for pilonidal sinus disease. Dermatol Surg 2010;36:430-2.
Yeo MS, Shim TW, Cheong WK, Leong AP, Lee SJ. Simultaneous laser depilation and perforator-based fasciocutaneous limberg flap for pilonidal sinus reconstruction. J Plast Reconstr Aesthet Surg 2010;63:e798-800.
Lindholt-Jensen CS, Lindholt JS, Beyer M, Lindholt JS. Nd-YAG laser treatment of primary and recurrent pilonidal sinus. Lasers Med Sci 2012;27:505-8.
Ghnnam WM, Hafez DM. Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience. J Cutan Aesthet Surg 2011;4:192-5.
] [Full text]
Oram Y, Kahraman F, Karincaoğlu Y, Koyuncu E. Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg 2010;36:88-91.
Koch D, Pratsou P, Szczecinska W, Lanigan S, Abdullah A. The diverse application of laser hair removal therapy: a tertiary laser unit’s experience with less common indications and a literature overview. Lasers Med Sci 2015;30:453-67.
Tierney E, Mahmoud BH, Srivastava D, Ozog D, Kouba DJ. Treatment of surgical scars with nonablative fractional laser versus pulsed dye laser: a randomized controlled trial. Dermatol Surg 2009;35:1172-80.
Highton L, Chan WY, Khwaja N, Laitung JK. Treatment of hidradenitis suppurativa with intense pulsed light: a prospective study. Plast Reconstr Surg 2011;128:459-65.
Downs A. Smoothbeam laser treatment may help improve hidradenitis suppurativa but not hailey-hailey disease. J Cosmet Laser Ther 2004;6:163-4.
Xu LY, Wright DR, Mahmoud BH, Ozog DM, Mehregan DA, Hamzavi IH. Histopathologic study of hidradenitis suppurativa following long-pulsed 1064-nm nd:YAG laser treatment. Arch Dermatol 2011;147:21-8.
Mahmoud BH, Tierney E, Hexsel CL, Pui J, Ozog DM, Hamzavi IH. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol 2010;62:637-45.
Jain V, Jain A. Use of lasers for the management of refractory cases of hidradenitis suppurativa and pilonidal sinus. J Cutan Aesthet Surg 2012;5:190-2.
] [Full text]
Krasner BD, Hamzavi FH, Murakawa GJ, Hamzavi IH. Dissecting cellulitis treated with the long-pulsed Nd:YAG Laser. Dermatol Surg 2006; 32:1039-44.
Boyd AS, Binhlam JQ. Use of an 800-nm pulsed-diode laser in the treatment of recalcitrant dissecting cellulitis of the scalp. Arch Dermatol 2002;138:1291-3.
Parlette EC, Kroeger N, Ross EV. Nd:YAG laser treatment of recalcitrant folliculitis decalvans. Dermatol Surg 2004;30: 1152-4.
Meesters AA, Van der Veen JP, Wolkerstorfer A. Long-term remission of folliculitis decalvans after treatment with the long-pulsed nd:YAG laser. J Dermatolog Treat 2014;25:167-8.
Harowitz MR. Treatment of folliculitis decalvans with Nd: YAG laser. Surgical and Cosmetic Dermatology 2013;5:170-2.
Kauvar ANB. Treatment of pseudofolliculitis with a pulsed infrared laser. Arch Dermatol 2000;136:1343-6.
Chui CT, Berger TG, Price VH, Zachary CB. Recalcitrant scarring follicular disorders treated by laser-assisted hair removal: a preliminary report. Dermatol Surg 1999;25:34-7.
Nanni C, Brancaccio R, Cooperman M. Successful treatment of pseudofolliculitisbarbae with a long pulsed alexandrite laser. Lasers Surg Med 1999;24:61.
Greppi I. Diode laser hair removal of the black patient. Lasers Surg Med 2001;28:150-5.
Weaver SM 3rd, Sagaral EC. Treatment of pseudofolliculitis barbae using the long-pulse nd:YAG laser on skin types V and VI. Dermatol Surg 2003;29:1187-91.
Yamauchi PS, Kelly AP, Lask GP. Treatment of pseudofolliculitis barbae with the diode laser. J Cutan Laser Ther 1999;1:109-11.
Smith EP, Winstanley D, Ross EV. Modified superlong pulse 810nm diode laser in the treatment of pseudofolliculitis barbae in skin types V and VI. Dermatol Surg 2005;31:297-301.
Leheta TM. Comparative evaluation of long pulse Alexandrite laser and intense pulsed light systems for pseudofolliculitis barbae treatment with one year of follow up. Indian J Dermatol 2009;54:364-8.
] [Full text]
Ross EV, Cooke LM, Overstreet KA, Buttolph GD, Blair MA. Treatment of pseudofolliculitis barbae in very dark skin with a long pulse nd:YAG laser. J Natl Med Assoc 2002;94:888-93.
Rogers CJ, Glaser DA. Treatment of pseudofolliculitis barbae using the Q-switched nd:YAG laser with topical carbon suspension. Dermatol Surg 2000;26:737-42.
Schulze R, Meehan KJ, Lopez A, Sweeney K, Winstanley D, Apruzzese W, et al
. Low-fluence 1,064-nm laser hair reduction for pseudofolliculitis barbae in skin types IV, V, and VI. Dermatol Surg 2009;35:98-107.
Tawfik A, Osman MA, Rashwan I. A novel treatment of acne keloidalis nuchae by long-pulsed alexandrite laser. Dermatol Surg 2018;44:413-20.
Shah GK. Efficacy of diode laser for treating acne keloidalisnuchae. J Dermatol Venerolleprol 2005;71;31-4.
Esmat SM, Abdel Hay RM, Abu Zeid OM, Hosni HN. The efficacy of laser-assisted hair removal in the treatment of acne keloidalis nuchae; a pilot study. Eur J Dermatol 2012;22:645-50.
Gamil H, Khater EM, Khattab F, Khalil MA. Successful treatment of acne keloidalisnuchae with Erbium:YAG laser: a comparative study. J Cosmet Laser Ther 2018;14:1-5.
Manuskiatti W, Tantikun N. Treatment of trichostasis spinulosa in skin phototypes III, IV, and V with an 800-nm pulsed diode laser. Dermatol Surg 2003;29:85-8.
Toosi S, Ehsani AH, Noormohammadpoor P, Esmaili N, Mirshams-Shahshahani M, Moineddin F. Treatment of trichostasis spinulosa with a 755-nm long-pulsed alexandrite laser. J Eur Acad Dermatol Venereol 2010;24:470-3.
Badawi A, Kashmar M. Treatment of trichostasis spinulosa with 0.5-millisecond pulsed 755-nm Alexandrite laser. Lasers Med Sci 2011;26:825-9.
Chavan DK, Chavan DD, Nikam BP, Kale MS, Jamale VP, Chavan SD. Efficacy of 800nm diode laser to treat trichostasis spinulosa in Asian patients. Int J Trichology 2018;10:21-3.
Ibrahim O, Khan M, Bolotin D, Dubina M, Nodzenski M, Disphanurat W, et al
. Treatment of keratosis pilaris with 810-nm diode laser: a randomized clinical trial. JAMA Dermatol 2015;151:187-91.
Letada PR, Landers JT, Uebelhoer NS, Shumaker PR. Treatment of focal axillary hyperhidrosis using a long pulsed Nd:YAG laser at hair reduction settings. J Drug Dermat 2012;11:59-63.
Aydin F, Pancar GS, Senturk N, Bek Y, Yuksel EP, Canturk T, et al
. Axillary hair removal with 1064-nm nd:YAG laser increases sweat production. Clin Exp Dermatol 2010;35:588-92.
Goldman A, Wollina U. Subdermal nd-YAG laser for axillary hyperhidrosis. Dermatol Surg 2008;34:756-62.
Bechara FG, Georgas D, Sand M, Stucker M, Othilinghaus N, Altmeyer P, et al
. Effects of 800mm diode laser on axillary hyperhidrosis: a randomized controlled half side comparison study. Dermatol Surg 2012; 38:736-40.
Nanni CA, Alster TS. Treatment of a Becker’s nevus using a 694-nm long-pulsed ruby laser. Dermatol Surg 1998;24:1032-4.
Downs AM, Rickard A, Palmer J. Laser treatment of benign pigmented lesions in children: effective long-term benefits of the Q-switched frequency-doubled nd:YAG and long-pulsed alexandrite lasers. Pediatr Dermatol 2004;21:88-90.
Glaich AS, Goldberg LH, Dai T, Kunishige JH, Friedman PM. Fractional resurfacing: a new therapeutic modality for Becker’s nevus. Arch Dermatol 2007;143:1488-90.
Trelles MA, Allones I, Moreno-Arias GA, Vélez M. Becker’s naevus: a comparative study between erbium: YAG and Q-switched neodymium:YAG; clinical and histopathological findings. Br J Dermatol 2005;152:308-13.
Choi JE, Kim JW, Seo SH, Son SW, Ahn HH, Kye YC. Treatment of Becker’s nevi with a long-pulse alexandrite laser. Dermatol Surg 2009;35:1105-8.
Lapidoth M, Adatto M, Cohen S, Ben-Amitai D, Halachmi S. Hypertrichosis in Becker’s nevus: effective low-fluence laser hair removal. Lasers Med Sci 2014;29:191-3.
Wulkan AJ, McGraw T, Taylor M. Successful treatment of Becker’s Nevus with long-pulsed 1064-nm Nd:YAG and 755-nm alexandrite laser and review of the literature. J Cosmet Laser Ther 2018;20:211-4.
Mahendran R, Sheehan-Dare RA. Lumbosacral hypertrichosis treated with the normal-mode ruby laser. Acta Derm Venereol 2003;83:142-3.
Cheung ST, Lanigan SW. Naevoid hypertrichosis treated with alexandrite laser. Clin Exp Dermatol 2004;29:435-6.
Ozdemir M, Balevi A, Engin B, Güney F, Tol H. Treatment of faun-tail naevus with intense pulsed light. Photomed Laser Surg 2010;28:435-8.
Moreno-Arias GA, Vilalta-Solsona A, Serra-Renom JM, Benito-Ruiz J, Ferrando J. Intense pulsed light for hairy grafts and flaps. Dermatol Surg 2002;28:402-4.
Thomson KF, Sommer S, Sheehan-Dare RA. Terminal hair growth after full thickness skin graft: treatment with normal mode ruby laser. Lasers Surg Med 2001;28:156-8.
Hall RR, Pearce DJ, Brown T, McMichael AJ. Unwanted palatal hair: a consequence of complex oropharyngeal reconstruction. J Dermatolog Treat 2009;20:149-51.
Shields BE, Moye MS, Bayon R, Sperry SM, Wanat KA. A hairy situation: laser hair removal after oral reconstruction. Ann Otol Rhinol Laryngol 2018;127:205-8.
Conroy FJ, Mahaffey PJ. Intraoral flap depilation using the long-pulsed alexandrite laser. J Plast Reconstr Aesthet Surg 2009;62:e421-3.
Lumley C. Intraoral hair removal on skin graft using nd:YAG laser. Br Dent J 2007;203:141-2.
Shim TN, Abdullah A, Lanigan S, Avery C. Hairy intraoral flap–an unusual indication for laser epilation: a series of 5 cases and review of the literature. Br J Oral Maxillofac Surg 2011;49:e50-2.
Kuriloff DB, Finn DG, Kimmelman CP. Pharyngoesophageal hair growth: the role of laser epilation. Otolaryngol Head Neck Surg 1988;98:342-5.
Kaune KM, Haas E, Jantke M, Kramer FJ, Gruber R, Thoms KM, et al
. Successful nd:YAG laser therapy for hair removal in the oral cavity after plastic reconstruction using hairy donor sites. Dermatology 2013;226:324-8.
Toft K, Keller GS, Blackwell KE. Ectopic hair growth after flap reconstruction of the head and neck. Arch Facial Plast Surg 2000;2:148-50.
Selvaggi G, Bellringer J. Gender reassignment surgery: an overview. Nat Rev Urol 2011;8:274-82.
Bowman C, Goldberg JM. Care of the patient undergoing sex reassignment surgery. Int J Transgend 2006;9:135-65.
Lawrence AA. Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery. Arch Sex Behav 2006;35:717-27.
Fang RH, Kao YS, Ma S, Lin JT. Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: a series of 22 cases. Br J Plast Surg 1999;52:217-22.
Reed HM. Aesthetic and functional male to female genital and perineal surgery: feminizing vaginoplasty. Semin Plast Surg 2011;25:163-74.
Hage JJ, Bouman FG, Bloem JJ. Preconstruction of the pars pendulans urethrae for phalloplasty in female-to-male transsexuals. Plast Reconstr Surg 1993;91:1303-7.
Haedersdal M, Gøtzsche PC. Laser and photoepilation for unwanted hair growth. Cochrane Database Syst Rev 2006;CD004684.
Görgü M, Aslan G, Aköz T, Erdoğan B. Comparison of alexandrite laser and electrolysis for hair removal. Dermatol Surg 2000;26:37-41.
Zhang WR, Garrett GL, Arron ST, Garcia MM. Laser hair removal for genital gender affirming surgery. Transl Androl Urol 2016;5:381-7.
Edgerton MT, Bull J. Surgical construction of the vagina and labia in male transsexuals. Plast Reconstr Surg 1970;46:529-39.
Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg 1984;74:251-8.
Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg 2006;59:153-7.
Singh I, Hemal AK. Recurrent urethral hairball and stone in a hypospadiac: management and prevention. J Endourol 2001;15:645-7.
Crain DS, Miller OF, Smith L, Roberts JL, Ross EV. Transcutaneous laser hair ablation for management of intraurethral hair after hypospadias repair: initial experience. J Urol 2003;170:1948-9.
Beiko D, Pierre SA, Leonard MP. Urethroscopic holmium:YAG laser epilation of urethral diverticular hair follicles following hypospadias repair. J Pediatr Urol 2011;7:231-2.
Kaneko T, Nishimatsu H, Ogushi T, Sugimoto M, Asakage Y, Kitamura T. [Laser hair removal for urethral hair after hypospadias repair]. Nihon Hinyokika Gakkai Zasshi 2008;99:35-8.
Royston SL, Cole RP, Wright PA. Peristomal hair removal with an alexandrite laser. Colorectal Dis 2013;15:1043-4.
Preston PW, Williams G, Abdullah A. Laser hair removal for peristomal skin. Clin Exp Dermatol 2006;31:458.
Park HS, Kim JY, Choe YS, Han W, An JS, Seo KK. Alternative method for creating fine hairs with hair removal laser in hair transplantation for hairline correction. Ann Dermatol 2015;27:21-5.
Cutis Institute of Dermatology, Hyderpora, Srinagar 190014, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]