Safe Start Protocol for BBL
Hair Reduction
Filter selection
Refer to Hair Reduction Treatment Starting Parameters for
appropriate filter selection.
Melanin in the skin competes with the targeted hair for absorption
of the BBL light. Therefore, a deeper penetrating filter should be
chosen for patients with darker skin types.
Fluence
Refer to Hair Reduction Treatment Starting Parameters for
appropriate fluence selection.
Targets that are darker absorb more energy/heat and will reach
higher temperatures. Therefore darker more concentrated areas
of hair growth require less fluence than lighter coloured, less
concentrated areas of hair growth to reach the same therapeutic
level.
Pulse Width
Refer to Hair Reduction Treatment Starting Parameters for
appropriate pulse width selection.
Pulse width should be shorter than the cooling time of the target
to make sure that all the energy is confined to the target. Smaller
objects cool faster than larger ones. Therefore, the smaller or finer
the hair being treated the less time on, or a shorter pulse width.
Conversely, the larger or coarser the hair being treated the more
time on with the heat, or a longer pulse width should be selected.
Areas of hair growth that are less densely populated will cool down
quicker than more densely populated ones. Therefore hair that is
finer and in areas with less dense growth should be treated with
shorter pulse widths and coarser more concentrated areas of hair
growth should be treated with longer pulse widths. Darker skin
absorbs more light and heats to a higher temperature, therefore
pulse width should be longer for darker skin.
Cooling
Refer to Treatment Starting Parameters for appropriate
temperature selection. Although absorption of the BBL light in the
hair follicle is desirable, some epidermal cooling is essential to
protect the skin. The
amount of cooling required will vary with skin type, amount of
target present, and area treated.
The temperature of the BBL crystal should be colder when treating
areas where hair is darker and more densely populated.
When treating darker skin types temperature should be colder.
Treatment
Hair to be treated should be shaved 0 - 24 hours prior to treatment.
Hair should not be waxed or plucked for 4 weeks prior to
treatment. Apply thin layer of colourless gel. Select appropriate
settings. Treat test area to establish safe treatment parameters and
desired endpoint. Once appropriate settings are selected,
complete treatment area
BBL Hair Reduction
Starting Parameters
Skin
Typ
e
Fluency J/cm2
Pulse
Width
(msec)
Filter
(nm)
Cooling
(°C)
Blac
k
Dark
Brown
Light
Brown
I – II
5–10
7-15
10-20
15-20
590
5-10
III -
IV
5-10
7-15
10-20
20-30
640
5-10
V
5-12
7-18
N/A
30-50
695
5-10
VI
N/A
N/A
N/A
N/A
N/A
N/A
Note: Increase fluence 1 - 2 J/cm2 when using any of the
BBL snap on adapters.
Endpoint
1.
Smell of success (SOS) – hair has a unique and very
noticeable odor when it is heated during the light pulse.
2.
Slight follicular edema and erythema that resolves within
1 - 4 hours of treatment.
3.
Slight patient discomfort.
Post Treatment
1.
Observation
– Erythema for several hours after
treatment. Treated hairs can take up to 7 - 14 days to
exfoliate from the follicle and may appear to be
“growing” during this time.
2.
Intervention
– Cool compresses or ice packs can provide
some comfort after treatment. If blistering occurs,
aggressive wound healing measures should be
implemented.
3.
Interval
– Treatments are performed 4 - 8 weeks apart. 5
- 7 treatments may be required.
4.
If performing hair reduction treatments in conjunction of
other procedures such as MLP or ProFractional, perform
hair reduction first.
5.
Check with manufacturer for guidelines on using
injectables in conjunction with hair reduction
treatments.
The theory of Selective Photothermolysis explains how
wavelength, energy and pulse width in relation to Thermal
Relaxation Time (TRT) all play a role in the destruction of a target
and the preservation of surrounding tissue.
Using the theory of Selective Photothermolysis, unwanted hair can
be treated with the appropriate BBL filter and settings that will
cause selective absorption of light in the melanin of a hair. The
light travels down the hair shaft and into the bulb of the follicle
where the blood supply to the follicle is located. The absorption
converts light into heat energy, which raises the temperature of
the bulb causing the blood vessels that supply blood and other
necessary nutrients to the follicle to be cauterized. As a result, hair
growth is no longer possible. This process should happen
selectively and without damage being done to the epidermis or
surrounding tissue.
Hair revolves through three phases of growth: anagen, catagen
and telogen. It is only during the growing phase, anagen that hair
reacts to BBL light. Not all hair present in an area is in the anagen
phase at the same time. Duration of hair growth cycles depends
on the body location being treated. Multiple treatments are
necessary over a time span of typically 4-8 week intervals to
remove hair from most areas. Reference Richards-Merhag Chart
in the appendix of this manual.
Hair Growth Cycle
Anagen:
the phase
of the hair
cycle
during
which
synthesis
of hair
takes
place. This
is the
active
growing
phase in
which the
hair bulb is
intact.
Catagen:
brief intermediate phase between anagen and
telogen. During this phase, the body absorbs the lower third
of the follicle.
Telogen:
this is the resting phase. The hair bulb is no longer
present. It is now a club hair, which will fall out or be pushed
out of the follicle by a new an anagen growing hair.
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