Getting patchy results on males beards using syneron aurora and comet (ipl+RF and laser+RF). How normal is this? Have been told its due to the unusual density of follicles (compared to say legs where hair is more sparse).

Have approached 80 percent clearance after one patient stuck it out for received 12 treatments, but a few months later same as others--patchy regrowth!

Note on regrowth--not talking sparse regrowth here. This is patterned and gridlike.

Beards are very difficult. We actually have them sign an extra waiver. This makes sure that they understand it will take more treatments as well as likely will have patchy re-growth. We also tell them they will have some maintenence visits. I have thought about adding Vaniqa for those patients that are male and want 100% clearance which is impossible.

How "permanent" have your results been, LH? Have several patients upset with the patchiness and lamenting having had treatment. They demand to know if and when their beard will return to normal...

Likely, they will have some permanent reduction and some patchiness. They may see some re-growth as late as 2 years out. This is the reason we have them sign a special waiver. Most of the men that are done at our facility want a reduction so they do not have to shave 2 times per day. We do have a few transsexuals that want permanent removal but we tell them they will likely need some maintenance 1 or 2 times per year.

Interesting, never considered those other uses. I treat mostly for pseudofolliculitis barbae. The US military has a strict (read ridiculous) grooming standard. Sadly it is out of line with needs of servicemen whom are predominantly African American. Treatment does help clear pre-existing PFB.

Ironically, most patients still have continuing problems with folliculitis. Apparently after laser hair removal they want to shave even MORE often to avoid looking patchy.

I personally find the patchiness to be an aesthetic concern only on light skinned-dark haired patients. I've treated a handful of Fitzpatrick types I-III. In these patient's faces the patchiness really is evident, even in the beard shadow right after a close shave. This presents a clinical problem since I can neither advise them to grow a beard nor to stick to a strict shaving regimen.

Does anyone know how chronic alopecia or telogen effluvium of the beard is dealt with in terms of reducing the patchiness? A specialist suggested Rogaine applied directly to the affected areas might help some--but I'm hesitant, this could lead to even more uneven growth or side effects...

What wavelength of laser/rf are you using? 1064 would be best for the fitz 4-6. One option I would think about trying is to use topical then treat with as normal using a short pulse duration on the entire area and then increasing the energy level and extending out the pulse duration to say 200 to 300. Some studies have shown increased clearance by doing this. Or you could try the IPL and laser on the same day. Make sure to do test spots on an inconspicuous area before treating the entire area. They will likely have a little more swelling than with the usual treatments.

When I was in the USAF we were able to write a waiver so that the patients could maintain their beard at 1/16 to 1/8 inch. Of course, it was the Air Force and not army or marines.

"No shave chits" are generally frowned upon and reserved for extreme cases like acne keloidalis nuchae. I've written them and had patients come back saying the beard gets them hassled by most every superior they pass by.

We've played around with the laser parameters quite a bit but patchiness remains a constant. Personally I've concluded the RF has little to no effect on efficacy. Double dosing IPL and laser is an idea I will approach.

I had a follow up recently with one of the dark haired Fitzpatrick type II's. He is one year and 9 months post treatment (Same patient I mentioned above who stuck it out for 12 treatments). The client was instructed not to shave for one week. We assessed the amount and pattern of his regrowth.

The greatest clearance is in the submental area and neck where hair regrowth is sparse. The sideburns are thinned terminal hair mostly uniform in appearance down to the pinna. Patchiness is evident on the cheeks with areas of clearance alternating with dense terminal hair areas in a grid-like pattern. Unresponsive throughout treatment, hair on the upper lip directly under the nostrils remains irregularly bordered and of unchanged texture and density from baseline. Also, virtually unchanged from baseline is the chin - dense and terminal hair irregularly bordered at the corners of the mouth and the submental region.

Both the patient and I noted an increase in hair density and texture from the previous follow up six months ago. This regrowth was limited to the cheeks, mustache, and chin. Regrowth of thick black terminal hairs have moderately blended the patchiness in cheeks and almost back to baseline in the mustache and chin areas. Upon close inspection, many intermediate state and vellus hairs have also filled in the cheeks making all areas of total clearance less than 2 cm.

Of particular note were sparse colorless intermediate hairs on the cheek area only. Upon questioning the patient revealed OTC Minoxidil use on cheeks from two weeks prior. Patient noted this change previously and believed it was drug induced anagen. Patient is in mid twenties and has no graying of the beard, scalp, or body hair.

Patient disclosed regret over laser beard removal and desire to return to baseline. No side effects of Minoxidil where noted or reported. Follow up in six months.

LH, wondering if you could let me get a look at the waiver for beard removal. Have a fairly large transexual population who have been asking for beard removal. I hav eexplained about the poor results, but some are insistent.
Sev

The waiver I was talking about was for active duty personnel. The waiver was so that they could maintain a short beard without having some officer chew them out for not shaving.

We do have an extra waiver for beard removal at my clinic and basically it just says that the beard is more difficult to remove and they may have patchy results. We also tell them it will take more than the normal treatment. You will find many transexuals are OK with it as long as you are upfront. To them some results are better than nothing.

Is anyone using Vaniqa along with LHR? How is it working for your patients? Studies show that results are better if you use it in conjunction with LHR but are these better results "long lasting" or just while someone continues to use Vaniqa?

One study was only done through 24 weeks! I am not sure any of the studies were published in forms other than "posters" at the ASLMS Meetings.

If you are unfamiliar with Vaniqa, the companie's website is excellent. Vaniqa inhibits an enzyme necessary for hair growth. My concern is that if hair growth is inhibited while doing LHR, the long term results will be worse since you need hair in the hair follicle for the LHR treatment to work!

The result might SEEM better in the short term (at 6 months), but less hairs will be removed permanently and results will be worse if you ever stop the Vaniqa.

Any comments and ideas would be appreciated!

We have over 4 years experience in beard reduction and removal, having treated pfb (pseudofolliculitis barbae), successfully, with no downtime, and no side-effects. Contact us directly, if you are interested in the special techniques we've developed.

Hello.... I have been receiving treatments for hair removal close to 4 years now on all my face, I have always been hairier that usual but nothing serious, removed my mustache using waxing and had short, fine hairs on the sides of my face, all this changed once I got pregnant and I started growing hairs on my neck on the baseline on my chin following a beard like pattern and the hairs on the sides of my face actually start it moving closer to the cheeks, after I spoke to my gynecologist he told me this was normal on some women after the pregnancy and basically told me to wait around until got better, which I didn't... I first started with the Palomar IPL system, got my whole face shaved (as part of the procedure as I was told) which made my problem worse, the hairs are longer now and I have hairs in places that I didn't before, I did the treatments for 2 years and then moved on to laser treatments ( Lumenis dyode laser) which are not working either, I asked my dermatologist not to shave my face anymore and he told me it was fine that the treatment still worked ( Is this true??) By now I feel kind of desperate and I dont know what else to do.. Should I try another type of laser? electrolysis? I'm on birth control pills to control a PCO problem, nothing serious and I have gotten at least 5 hormonal tests (T3,T4, estrogen, free testosterone,and many more....) that show no hormonal unbalance ... ANY SUGGESTIONS? please help.... By the way, I live in San Jose, Costa Rica...