Nd:YAG Laser for Hair Removal
The long-pulsed 1064-nm Nd:YAG laser is safe and effective for hair removal across all skin phototypes (I-VI), with recommended fluences of 30-60 J/cm² and pulse durations adjusted by skin type: 10 ms for types I-II, 20 ms for types III-IV, and 30 ms for types V-VI. 1
Technical Parameters by Skin Type
Lighter Skin (Fitzpatrick I-III)
- Fluence: 50-80 J/cm² 2
- Pulse duration: 10-25 ms 1
- Spot size: 10 mm 1, 2
- Higher fluences (60-80 J/cm²) with longer pulse durations (50 ms) correlate with better hair reduction at 3 months 2
Darker Skin (Fitzpatrick IV-VI)
- Fluence: 30-50 J/cm² 3, 4
- Pulse duration: 15-30 ms 4
- Spot size: 10 mm 4
- The Nd:YAG laser is specifically preferred for darker skin types due to minimal epidermal melanin absorption and deeper penetration, reducing hyperpigmentation risk 2, 3
Treatment Protocol
Number of Sessions
- Minimum 3-6 consecutive treatments at 4-6 week intervals 1, 4
- Success rates improve with successive sessions: 5% achievers after 3 sessions, 15% after 4 sessions, 25% after 5 sessions, and 56% after 6 sessions 4
- Peak hair reduction occurs 1 month post-treatment series 1
Expected Outcomes
- Short-term (1 month post-treatment): 58-62% facial hair reduction, 66-69% body hair reduction 1
- Long-term (6 months post-treatment): 41-46% facial hair reduction, 48-53% body hair reduction 1
- Mean hair reduction: 54.3% in darker skin types 3
- Terminal hairs respond better than intermediate/vellus hairs (57.5% vs 53.8% success) 4
Safety Profile and Adverse Effects
Common Transient Effects
- Mild to moderate treatment pain (reduced with "in motion" technique) 1, 5
- Short-term erythema and perifollicular edema (more severe at higher fluences) 1, 2
- Pain, erythema, and edema are dose-dependent and resolve without intervention 2
Complications in Darker Skin
- Hyperpigmentation is the most frequent complication but remains transient 3
- No permanent complications or scarring reported in 86% of patients 3
- All adverse events are temporary when appropriate parameters are used 1, 3
Clinical Endpoint
- Target delayed post-treatment perifollicular erythema and/or edema as the clinical endpoint for effective follicular destruction 6
- This indicates adequate energy delivery to the hair follicle without excessive tissue damage 6
Key Advantages Over Other Lasers
- Safe for all skin types including Fitzpatrick V-VI where alexandrite and diode lasers carry higher complication risks 1, 3
- Deeper tissue penetration (1064 nm wavelength) targets hair follicles effectively 2
- Lower epidermal melanin absorption reduces burn and dyspigmentation risk in darker skin 2, 3
Patient Satisfaction
- 78.7% of patients rate treatment as good or satisfactory 3
- 79.3% report subsequent hair growth is slower and finer 3
- Satisfaction is significantly higher for non-facial areas compared to facial treatments 3
Important Caveats
- Contact cooling devices are essential for patient comfort and epidermal protection 1, 2
- Higher fluences require careful monitoring for increased pain and erythema 2
- Intermediate/vellus hairs have nearly 50% failure rates compared to terminal hairs 4
- Results are permanent reduction, not complete permanent removal 1