How to failure diagnose when you’re not getting the results you’ve expected

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By Raymond Schoeman.

Laser hair removal remains the most performed aesthetic laser treatment world-wide. For this reason it keeps attracting first-time laser owners and therapist to the industry. Many of these newcomers start with high hopes fuelled by empty promises from equipment sales people. Thus, the question; how do you proceed to discover and eliminate the problem when you find yourself in a situation that you do not get the results you’ve hoped for?

When I started out, I had the good fortune of having a business partner who was an engineer that specialized in system fault-finding. The skills I’ve learned from him made a huge difference in the clinic and helped me delivered the results I’ve promised my clients.

The first step and also the most fundamental step in any fault-finding exercise is the collection of data. The more complete and accurate your data is, the easier and quicker you will find your solution.

It is for this reason that you have to come in the habit of recording complete and accurate treatment data from day one. For each client, each treatment. But what information should you record?

For hair removal the minimum you should know for each treatment is:

  • A short description of the treatment area. You can record this once before the first treatment. Remember to make a note of any treatments where there are deviations.
  • A note on the comfort level of the client during each treatment. If the client is unusually sensitive during a treatment, note that.
  • A note on what the client experienced after the previous treatment.
  • The start pulse count and the end pulse count for each session. Make a note of any extras you may do.
  • The fluence used; and also any changes in fluence during a treatment with a reason why.
  • Pulse length and remember to note if you change the pulse length during a treatment and why.
  • The frequency.
  • If you have an adjustable spot size, the spot size you’ve worked with. Remember to note it if you change the spot size during a treatment and the reason why you’ve done that.
  • The use of any local anaesthetics during a treatment.
  • If your machine has different modes, note the mode you’ve worked in.

The most common reason for absence of results is the fluence — pulse length combination. You need a minimum level of energy on a specific area for a minimum period of time to get the desired results.

Pulse length is the easiest to correct. The thermal damage time for hair removal range between 200 ms and 400 ms. Therefore, you desire to work as near as possible to the 400 ms mark as you can. If your machine only allows 50 ms as maximum pulse length, you work on 50 ms and not 40 ms.

Fluence can sometimes be influenced by hidden factors, such as operators technique. Your client should experience a sensation during the pulse. This should remain tolerable for your client, a painful treatment is also a bad sign.

The sensation your client experience during the pulse is from the heat generated by the melanin in the epidermis and the hair shaft. In the absence of any sensation you will have disappointing results. If the sensation becomes intolerable or painful, you’re over treating and it can cause skin damage.

Factors that influence the fluence are:

  • Gliding or stepping speed. You may move the handpiece too fast, spreading the energy over too large an area.
  • Low pain tolerance of the client causing you to work on a too low energy level.
  • Leave too much space between spots. With a square or rectangle spot you need an overlap of 20% and with a circle you need a 50% overlap on average. Do not overlap with an IPL, but don’t leave space between the spots either.
  • Gel. Anything between the applicator and the skin has an influence on the light.

The first cross-check you can make, is to see if the pulse count matches the treatment area.

If you have a square or rectangle spot size of 2 cm2 and you need to treat an area like axilla, 7 cm x 16 cm = 112 cm2, you need a minimum of 68 pulses. You divide 112 by 2 and add 20%.

With a circle of 18 mm diameter you have a surface of about 2,5 cm2. With this you have to divide 112 by 2,5 and then add 50% = 67 pulses.

When you use the gliding (or pain free) technique it is possible that you have a sufficient pulse count, but that you concentrate the pulses on the outer boundaries of your treatment area, with gaps in the middle.

Given that you’re using a suitable machine, this simple cross-check solves the problem in 80% of cases. The next step is to get advanced training beyond how to operate your machine. It is the only way that you will be able to provide superior results to your client and grow your business to the fullest.