Ruby laser medical data Ruby lasers for hair removal were cleared by FDA to market in
the U.S. in 1997. Ruby lasers have the best published documentation
of results. [1] Arguably the best overview is Topping.
[2] There are also two excellent papers by practitioners on optimizing
treatment parameters. [3, 4]
Studies with short-term follow-up have observed 20% to 60%
reduction at 3 months. [5, 6, 7, 8] Another found a fluence-dependent
relationship at a range of 38% to 49% reduction at 3 months, which
compared favorably to electrolysis and waxing. [9] A large short-term
study observed that about two-thirds of subjects had over 50%
reduction at 3 months. [10, 11]
Long-term follow-up with ruby is better documented than other
lasers. As discussed in the section on “permanent hair reduction,”
the pilot study observed 4 of 13 patients had 42% to 60% reduction
at 24 months. [12, 13]. Several studies since then have also shown
a significant number of non-responders among “ideal”
subjects, for reasons that are unknown. Two well-designed studies
had almost identical non-response rates of 29% and 28%.
Responders had apparently permanent reduction in hair color and
diameter, and one observed 22% reduction 7 months after a single
treatment. [14, 15] Another study had similar findings of less
than 25% reduction at 6 months.after an average of 2 treatments.
[16]
Other studies have observed better results: One found 61%
reduction at 9 months after 4 treatments. [17] Another noted
63% of patients had sparse regrowth at 8 months. [18]
Several well-designed British studies by Liew and colleagues
make interesting observations about ruby laser safety and effectiveness.
One large study found an average of 56% reduction at an average
of 6 months after an average of 2 treatments. [19] However:
- Histological examination found damage only went to about 1.5
mm at 20 J/cm2 “The laser damage did not seem to extend
far enough down the hair shafts to result in permanent hair
destruction.” [20]
- Although success was observed to correlate with hair follicle
eumelanin content. [15] the reasons for the “unpredictable
response” in laser treatment could not be attributed
solely to melanin content or growth cycle.[21]
- Another series of histological examinations after treatment
found damaged follicles were “randomly dispersed amongst
intact follicles.” [22] The authors note that “the
exact mechanisms of hair destruction and the potential damage
to other structures of skin are not known,” which is
further evidenced by recent data suggesting laser affects oil
(sebum) production in almost all patients. [23]
- One well-designed measurement of hair follicle temperature
found a range from 5 – 30 degrees C. but only in those
hair shafts that showed damage after treatment. This might explain
the “uneven outcome.” [24]
- Although some anecdotal observation and histological samples
have suggested treated hair can come back finer in texture [13,
25], a quantified analysis found no statistically significant
change in follicle diameter at 7 months [26]. A second histological
study found “no evidence of permanent follicle death”
after one ruby laser treatment. [27, 28] A third study observed
some follicles were clearly damaged and suggested hairs in early
anagen were not affected. [29]
They also found no histological evidence of cellular hyperproliferation
[30] or oxidative stress [31], suggesting laser is safer in comparison
to UV radiation.
Although side effects are generally rare, [32] skin discoloration
rates have been reported from 1% to 10%, with darkening
being more common and often taking several months to resolve [33].
Histological evidence shows that darker skin has higher side effects,
especially hypopigmentation [34]
Preheating or precooling the skin before treatment may help reduce
side effects. [35, 36] Lower fluences have been observed to cause
higher rates of double hairs as regrowth. [37] As with electrolysis,
there is a chance of isomorphic phenomena like trauma-induced
lesions, [38] and, patients should avoid sun following treatment
to avoid significant and persistent pigment changes to the skin
lasting several months. [39]
References
- Please see hairfacts.com for a list of ruby laser medical data.
- Topping A, Linge C, Gault D, Grobbelaar A, Sanders R. A review of the ruby laser with reference
to hair depilation. Annals of Plastic Surgery 2000 Jun;44(6):668-74.
- Williams RM, Christian MM, Moy RL. Hair removal using the long-pulsed ruby
laser. Dermatologic Clinics 1999 Apr;17(2):367-72.
- VanderKam VM, Achauer BM. Hair removal with the ruby laser (694
nm). Plastic Surgical Nursing. 1997 Fall;17(3):144-5, 137.
- Lask G, Elman M, Slatkine M, Waldman A, Rozenberg Z. Laser-assisted hair removal by selective
photothermolysis. Preliminary results. Dermatologic Surgery
1997 Sep;23(9):737-9.
- Solomon MP Hair removal using the long-pulsed ruby
laser. Annals of Plastic Surgery 1998 Jul;41(1):1-6.
- Williams R, Havoonjian H, Isagholian K, Menaker G, Moy R.
A clinical study of hair removal using
the long-pulsed ruby laser. Dermatologic Surgery 1998 Aug;24(8):837-42.
- Sommer S, Render C, Burd R, Sheehan-Dare R. Ruby laser treatment for hirsutism: clinical
response and patient tolerance. British Journal of Dermatology
1998 Jun;138(6):1009-14.
- Polderman MC, Pavel S, le Cessie S, Grevelink JM, van Leeuwen
RL. Efficacy, tolerability, and safety of
a long-pulsed ruby laser system in the removal of unwanted hair.
Dermatologic Surgery 2000 Mar;26(3):240-3.
- Bjerring P, Zachariae H, Lybecker H Evaluation of the free-running ruby laser
for hair removal. Acta Dermato-Venereologica 1997 77:1-4.
- Zachariae H, Bjerring P, Lybecker H. Laser depilation using a free-running
long pulse ruby laser. Experimental Dermatology 1999 Aug;8(4):301-2.
- Grossman MC, Dierickx C, Farinelli W, Flotte T, Anderson RR.
Damage to hair follicles by normal-mode
ruby laser pulses. Journal of the American Academy of Dermatology
1996 Dec;35(6):889-94.
- Dierickx CC, Grossman MC, Farinelli WA, Anderson RR. Permanent hair removal by normal-mode
ruby laser. Archives of Dermatology 1998 Jul;134(7):837-42.
- Lin TY, Dierickx CC, Campos VB, Farinelli WA, Rosenthal J,
Anderson RR Reduction of regrowing hair shaft size
and pigmentation after ruby and diode laser treatment. Archives
opf Dermatological Research 2000 Feb-Mar;292(2-3):60-7.
- Liew SH, Ladhani K, Grobbelaar AO, Gault DT, Sanders R, Green
CJ, Linge C. Ruby laser-assisted hair removal success
in relation to anatomic factors and melanin content of hair
follicles. Plastic and Reconstructive Surgery. 1999 May;103(6):1736-43.
- Wimmershoff MB, Scherer K, Lorenz S, Landthaler M, Hohenleutner
U. Hair removal using a 5-msec long-pulsed
ruby laser. Dermatologic Surgery 2000 Mar;26(3):205-10.
- Sommer S, Render C, Sheehan-Dare R. Facial hirsutism treated with the normal-mode
ruby laser: results of a 12-month follow-up study. Journal
of the American Academy of Dermatology 1999 Dec;41(6):974-9.
- Campos VB, Dierickx CC, Farinelli WA, Lin TY, Manuskiatti
W, Anderson RR. Ruby laser hair removal: evaluation of
long-term efficacy and side effects. Lasers in Surgery and
Medicine 2000;26(2):177-85.
- Gault DT, Grobbelaar AO, Grover R, Liew SH, Philp B, Clement
RM, Kiernan MN. The removal of unwanted hair using a ruby
laser. British Journal of Plastic Surgery 1999 Apr;52(3):173-7.
- Liew SH, Grobbelaar AO, Gault DT, Sanders R, Green CJ, Linge
C. The effect of ruby laser light on ex vivo
hair follicles: clinical implications. Annals of Plastic
Surgery. 1999 Mar;42(3):249-54.
- Liew SH, Grobbelaar AO, Gault D, Green C, Linge C. Ruby laser-assisted hair removal: a preliminary
report of the correlation between efficacy of treatment and
melanin content of hair and the growth phases of hair at a specific
site. Annals of Plastic Surgery. 1999 Mar;42(3):255-8.
- Liew SH, Cerio R, Sarathchandra P, Grobbelaar AO, Gault DT,
Sanders R, Green C, Linge C. Ruby laser-assisted hair removal: an ultrastructural
evaluation of cutaneous damage. British Journal of Plastic
Surgery 1999 Dec;52(8):636-43.
- Manuskiatti W, Dierickx CC, Gonzalez S, Lin TY, Campos VB,
Gonzalez E, Anderson RR. Laser hair removal affects sebaceous glands
and sebum excretion: a pilot study. Journal of the American
Academy of Dermatology 1999 Aug;41(2 Pt 1):176-80.
- Topping A, Gault D, Grobbelaar A, Green C, Sanders R, Linge
C. The temperatures reached and the damage
caused to hair follicles by the normal-mode ruby laser when
used for depilation. Annals of Plastic Surgery 2000 Jun;44(6):581-90.
- Lin TY, Dierickx CC, Campos VB, Farinelli WA, Rosenthal J,
Anderson RR. Reduction of regrowing hair shaft size
and pigmentation after ruby and diode laser treatment. Archives
opf Dermatological Research 2000 Feb-Mar;292(2-3):60-7.
- Liew SH, Ladhani K, Grobbelaar AO, Gault DT, Sanders R, Green
CJ, Linge C. Ruby laser-assisted hair removal reduces
the coarseness of regrowing hairs: fallacy or fact? British
Journal of Plastic Surgery 1999 Jul;52(5):380-4.
- McCoy S, Evans A, James C. Histological study of hair follicles treated
with a 3-msec pulsed ruby laser. Lasers in Surgery and Medicine
1999;24(2):142-50.
- McCoy S, Evans A. A histological study of hair follicles
treated with a 3 msec pulsed ruby laser. Experimantal Dermatology.
1999 Aug;8(4):352-4. No abstract available.
- Omi T, Honda M, Yamamoto K, Hata M, Akimoto M, Asano G, Kawana
S. Histologic effects of ruby laser hair
removal in Japanese patients. Lasers in Surgery and Medicine
1999;25(5):451-5.
- Liew SH, Grobbelaar AO, Gault DT, Green CJ, Linge C The effect of ruby laser light on cellular
proliferation of epidermal cells. Annals of Plastic Surgery
1999 Nov;43(5):519-22.
- Haywood RM, Wardman P, Gault DT, Linge C. Ruby laser irradiation (694 nm) of human
skin biopsies: assessment by electron spin resonance spectroscopy
of free radical production and oxidative stress during laser
depilation. Photochemistry and Photobiology 1999 Sep;70(3):348-52.
- Nanni CA, Alster TS. Laser-assisted hair removal: side effects
of Q-switched Nd:YAG, long-pulsed ruby, and alexandrite lasers.
Journal of the American Academy of Dermatology 1999 Aug;41(2
Pt 1):165-71.
- Haedersdal M, Egekvist H, Efsen J, Bjerring P. Skin pigmentation and texture changes
after hair removal with the normal-mode ruby laser. Acta
Dermato-Venereologica 1999 Nov;79(6):465-8.
- Liew SH, Grobbelaar A, Gault D, Sanders R, Green C, Linge
C. Hair removal using the ruby laser: clinical
efficacy in Fitzpatrick skin types I-V and histological changes
in epidermal melanocytes. British Journal of Dermatollogy
1999 Jun;140(6):1105-9.
- Topping A, Gault D, Grobbelaar A, Green C, Sanders R, Sibbons
P, Linge C. Successful reduction in skin damage resulting
from exposure to the normal-mode ruby laser in an animal model.
British Journal of Plastic Surgery 2001 Mar;54(2):144-150.
- Raulin C, Greve B, Hammes S. Cold air in laser therapy: first experiences
with a new cooling system. Lasers in Surgery and Medicine
2000;27(5):404-10.
- Ye JN, Prasad A, Trivedi P, Knapp DP, Chu P, Edelstein LM
Pili bigeminy induced by low fluence therapy
with hair removal alexandrite and ruby lasers. Dermatologic
Surgery 1999 Dec;25(12):969.
- Wimmershoff MB, Hohenleutner U, Landthaler M. Isomorphic phenomenon: adverse effect
after epilation with the long-pulsed ruby laser. Archives
of Dermatology 2000 Dec;136(12):1570-1.
- Hasan AT, Eaglstein W, Pardo RJ. Solar-induced postinflammatory hyperpigmentation
after laser hair removal. Dermatologic Surgery. 1999 Feb;25(2):113-5.
Summary of data with links to abstracts
 = recommended only for in-depth researchers
= may be worth ordering
= strongly recommended
Human clinical studies
 Grossman (1996): Six months after being treated once at various
energy levels, 4 of 13 ideal laser patients (light skin/dark
hair) had less than 50% regrowth. These four patients were followed
and reported on in Dierickx (1998), below.
Lask (1997): Twelve weeks after one laser treatment to their
arms, 20 patients saw 40-80% regrowth.
Dierickx (1998): Demonstrates reduction in number of terminal hairs
in 4 of 13 ideal laser patients. This widely cited study was
submitted to FDA as clearance to market as "permanent hair
reduction" based on these 4 patients. Recommended reading
for all considering ruby laser hair removal. A follow-up to
Grossman (1996), it appeared
in the same journal as an overview critical of the study-- Tope
(1998) below.
Solomon (1998): 72 patients received 1 to 4 laser treatments.
Methodology is very vague, but at an average of 14 weeks after
last treatment, patients observed reduction in hair density,
with at least one patient still pleased at nine months. No quantitative
data on efficacy is presented, just patient assessment.
Williams (1998): Reports on two 12-week tests, one involving 25
patients, and one involving 12 patients. Patient experiences
are very detailed, but quantitative data on efficacy is lacking.
Sommer (1998): 43 pateients each had two sites treated:
a site with one treatment and a site with four treatments, once
a month. Observation three months after treatment showed the
single-treated site with 21% reduction in hair count vs 56%
reduction on the multi-treated site. Comparative 6-month data
not available.
McCoy (1999): 24 patients received 1 to 3 treatments to the
armpit or groin, followed by biopsies at 0 to 8 weeks. There
was no histological evidence of permanent follicle death after
one ruby laser treatment, but the authors conjecture that multiple
treatments may alter or inhibit the growth cycle.
Hasan (1999): Reports on an unsuccessful attempt to
clear up blotchy darkening of the skin (hyperpigmentation) in
a laser patient who tanned her legs against doctor's instructions.
Bjerring (1998): 133 female patients received 1 to 9 treatments
(average 2), followed by at least 13 weeks of observation. At
13 weeks, 60% of patients had over 50% hair removal.
Liew (1999): 48 patients were treated once and observed at
3 and 7 months. This well-designed study demonstrated 14 non-responders,
13 temporary responders, 18 semi-responders, and 4 delayed responders.
Liew also demonstrates that succes corresponds with eumelanin
levels (the darker of the two types of melanin in human hair.
He reports average reduction at 7 months at 22% after a single
treatment.
Lin (2000): 47 patients were treated and observed either 9
or 12 months after treatment. This study showed 13 non-responders
and 34 subjects with hairs that had reduction in color and diameter
compared to pretreatment measurements.
Side effects
Ye (1999): * Reports that low-fluence
ruby treatment can cause more than one hair to grow from the
same follicle (pili bigemini).
Overviews and summaries
Grossman (1997): A one-page summary.
Dierickx (1997): A brief article.
Tope (1998): This overview of clinical data takes a critical
look at the problems in many laser hair removal studies, especially
Dierickx (1998). Appears in the same journal issue
Williams (1999): This is a very good overview of before, during
and after instructions for laser patients, from a clinician's
viewpoint.
VanderKam (1999) Another good overview of before, during and after
instructions for laser patients, from a clinician's viewpoint.
Animal studies
Lin (1998): This study on mice suggests laser treatment might
be more effective on hair in the early growth stage.
Dover (1989): This guinea pig study demonstrated whitening of
hair and skin treated with a Q-switched ruby laser. Skin whitening
cleared up by four months, but hair remained white at that time.
Polla (1987): This guinea pig study demonstrated that pigment
in skin is a target by lasing albino and non-albino animals.
Albino animals did not respond, indicating pigmented lesions
can be targeted with the laser.
Other conditions treated with ruby laser
Achauer (1996): Demonstrates superior results in removal of traumatic
tattooing in a male patient.
Ashinoff (1993): Demonstrates superior results in removal of traumatic
tattooing in six patients.
Chang (1996): About half of 47 patients receiving three of more
Q-qwitched ruby laser treatments for pigmented facial lesions
had excellent results 15 months after treatment.
Chui (1999): Three patients with severe follicular disorders
(disfiguring conditions that cause massive hair loss and scarring)
responded well to ruby laser after medications failed.
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