Laser Toning

Laser Toning

Lawer toning and tightening is a non-surgical cosmetic correction that utiliazes laser to penetrate the deeper layer of skin.

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Face Treatments Acne Treatments  Pigmentation & Sun Damage Skin Tone & Texture Redness & Veins

Uneven Skintone·

What is laser toning

Laser toning uses both 755 nm alexandrite laser and 1064nm Nd Yag Laser that can reach deep into the skin and break up the pigments, leaving you with a brighter and clearer complexion. Laser toning is very comfortable and incredibly safe; instead of high heat, it uses a very gentle laser that leaves your skin undamaged. That safety also lends a quality of adaptability, so it is perfect for people of all skin types and those with other existing skin conditions like:

  • Uneven skintone
  • Active acne
  • Acne scar
  • Sunspots
  • Vascular problem
  • Roscea
  • Blackhead

For people suffering from skin conditions like melasma and post-inflammatory hyperpigmentation, a flawless skin tone might seem even more elusive. Laser toning is one of the most effective treatments for melasma and post-inflammatory hyperpigmentation.

The benefits of laser toning

Lawer toning and tightening is a non-surgical cosmetic correction that utiliazes laser to penetrate the deeper layer of skin to:

  1. Promote collagen production to increase skin strength, elasticity and radiance.
  2. Restore skin’s ablility to heal and skin barrier.
  3. Fill in fine lines & wrinkles.
  4. Stimulate blood vessels to constrict and function.
  5. Minimal discomfort.
  6. Minimal or no downtime. Only warm sensation to the skin and mild redness, usually fading within couple of hours.

Laser toning VS IPL

Those days,IPL devices work about as well as laser treatments for some cosmetic treatments, such as fading blood vessels treatment,and superficial pigmentation problems .For hair removal, IPL works better on thick, dark hair than on fine, light hair. For other skin concerns,laser treatments require fewer sessions than IPL, and they can be more safely used on dark skin.

Melasma treatment is not as simple as that of sunspots, partly due to the differences in melanocyte behaviour. Melasma—the perennially dark patches of skin caused by excessive melanin—is usually hormone-induced, meaning that it is either something you are born with or something that is triggered by a treatment or health condition. If IPL is used on a case of melasma, the pigmentation will darken and worsen, not go away. A proper melasma treatment, therefore, requires an approach that is less superficial than IPL.
This is where laser toning, which is based on focused penetration, comes in. The enhanced wavelength of a laser toning treatment will pass through the layers of skin and eliminate the unwanted melanocytes. Your melasma will be safely and effectively treated, your sun spots won’t return, and your body will eliminate the dead cells through urination.

What does laser toning treat?


Acne Scars & Active Acne

See other acne treatments

Skin Tone & Texture

The HydraFacial™ resurfacing treatment thoroughly enhances the skin using patented Vortex Technology™ to cleanse, exfoliate, extract, and hydrate simultaneously which brightens and balances skin tone while minimizing the appearance of darks spots and sun spots.

See other skin Tone & texture treatments

Redness & Veins

After one to three treatments, light therapy can get rid of 50%-75% of broken blood vessels for most people. They could completely go away. While treated veins don’t come back, new ones might show up later.

If rosacea causes your face to flush, IPL can be a good alternative to laser therapy.

See other Redness treatments

Dark Spots & Sun Damage

You may see 70% less of the brown spots and redness caused by ultraviolet (UV) rays.

See other pigmentation treatments

Infini Micro Needling RF

Infini Micro Needling RF

It’s a systerm conbines micornedling technology with RF to sitmulate collagen production, helping to treat moderate acne, acne scars, stretch marks, and sagging skin.

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Face Treatments Acne Treatments Stretch Mark Enlarged Pore Skin Tone & Texture Fine lines & Wrinkles

Acne· Stretch Mark·  Skine Tone·  Enlarged Pores·

What is Infini microneedling RF

Radiofrequency is a nonsurgical method practitioners use to tighten skin. These devices deliver electrical energy into your skin and heat a targeted area to stimulate collagen production. Microneedling is a minimally invasive procedure that uses very small needles to cause microinjuries to your skin, which also stimulates collagen production to help repair the injuries.

Unlike microneedling alone, the combination of radiofrequency and microneedling can reach the dermis, making it effective for all skin types, minimizing the risk for hyperpigmentation in darker skin tones.

Why choose Infini microneedling RF

Most patients can see noticible improvements with only three treatments.

Compare to CO2 laser, infini does not damge the epidermis, there is minimal risk of hyperpigmentation, and patients have much less downtime, they can wear makeup the next day.

Patients can see better results with Infini compare to other microneedling RF devices, Infini can reach 3.5mm deep into skin to treat deeper acne scars, stretch marks and see more skin tightening effects.

How does it work

Practitioner will numb treatment area with a topical numbing cream from 40 to 60 minutes before the procedure.

The entire proceduure will take 30 to 45 minutes to complete. Patients will experience temporary mild bleeding, swelling and redness, usually resolves in fewer than 3 days.

A minimum of three treatments is recommended, usually space 4 to 8 weeks apart.

What does Infini microneedling RF correct?


Acne Scars

All types of scars can be treated, but particularly acne scars and Infini is safe for use on darker skin types.

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Fine lines and wrinkles on the face, neck, and around the eyes. Particularly good results can be achieved with cheek lines.

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Skin Tightening

Loose skin can be tightened on the face (non-surgical facelift) with the neck and jawline being most popular. Other body areas such as chest, knees abdomen, and arms can also be treated.

See other skin tightening treatments

Stretch Mark

Infini Micro Needling RF is an excellent treatment available for stretch marks.

See other stretch mark treatments

Enlarged Pores

When microneedling on enlarged pores, the skin, for some days looks a bit rough and the pores appear bigger because of the damage caused by the needles. After a natural wound healing response is activated, that produces new collagen, the skin looks plumped up and tightened and the enlarged pore becomes smaller.

See other enlarged pores treatments

The micro needling technology of the Infini enables the needle to be inserted at variable depths, and hence the energy can be delivered at different levels. This is important to individualise treatment as some areas of the skin are different in thickness than other areas, and also some skin conditions require deeper treatment levels than others.

The Infini can treat at a much deeper skin level than Lasers. By using microneedles, the Infini can reach up to 3.5 mm below the surface of the skin, which is why it can reach the deep dermis layer of the skin and result in collagen production and skin tightening. Lasers used in cosmetic medicine target structures in the epidermis and upper dermis of the skin and do not have much effect below about 1.5mm depth. This means lasers are best for treating the surface of the skin and are the treatment of choice for such things as removing unwanted pigment, blood vessels, hair, and tattoo ink.

The other significant advantage of radiofrequency energy is that it is ‘colour blind’ which means it doesn’t matter how dark the skin is or even if the surface is tanned at the time of treatment. In contrast, Laser energy is very colour dependent, and great care needs to be exercised when using lasers to treat darker skin types and tanned skin, because of the risk of unwanted side effects such as increased pigmentation.

The Infini uses microneedle technology primarily because by delivering Radiofrequency energy through a needle, the heating can be accurately and safely directed and localised into the dermis of the skin.

Various devices in the past have tried to apply radiofrequency energy onto the surface of the skin to heat below the surface, but results were disappointing. This is because to heat the deeper dermis to a high enough temperature to stimulate collagen is difficult without damaging the surface of the skin. Differences in skin thickness, hydration, collagen, and fat make the depth of heating unpredictable. If tissue heating doesn’t occur at the right level at the right temperature, then minimal collagen stimulation occurs, and poor results are achieved.

Trauma from the needles penetrating the skin also causes mechanical stimulation to fibroblast cells in the skin to also help in producing collagen.

The needles used with the Infini are gold plated to minimise any chance of allergy. The needles are very fine, only 200 microns (0.2mm) thick. The Infini uses a tip that has 49 tiny needles (also called pins), and they deliver the energy in what is called a fractional mode. The needles are insulated, which means that the energy is directed through the tip of the needle, and heating can be accurately targeted and controlled.

The Infini is a fractional radiofrequency machine. The idea of fractionating energy was first used in the Fraxel laser in 2005 and essentially what it means is multiple discrete points of skin are treated surrounded by unaffected skin. Fractionated treatment assists wound repair and result in faster skin healing, less discomfort, and greater safety for the patient.

No, everyone cannot have Infini, but in practice, very few patients need to be excluded. Patients with cardiac pacemakers or implanted defibrillators should not have any electric type treatments, including Infini. Patients with cochlear implants should also avoid radiofrequency treatments because of potential damage to the implant.

If there is a metal implant in the area being treated, the skin overlying the metal implant should not be treated. If someone has a known allergy to metals then caution needs to be exercised as the Infini uses metal pins; however, the needles used in the Infini are gold tipped to reduce the chance of any metal sensitivity.

Patients with acute skin disease should not have any cosmetic treatments, including Infini.

Patients who are pregnant or breastfeeding are as a general rule advised against all elective procedures, including the Infini. While there is no evidence, it is not safe, there is also no evidence to prove it is entirely safe. Also, it does involve the use of quite strong topical anaesthetics, and we recommend deferring Infini treatments until after breastfeeding.

Patients with severe medical conditions such as uncontrolled diabetes, autoimmune diseases, or cancer can have Infini but will not get as good a result because of impaired skin healing. Similarly, patients who are unwell or are smokers will not tend to respond as well to Infini compared to healthy patients.

Patients on certain medications need to be more cautious before having Infini treatments such as patients on blood thinners who might bruise more easily and drugs that cause photosensitivity that might have a more severe reaction after treatment.

The Infini needles are virtually painless as they are inserted into the skin because they are so fine and are inserted very fast. Also, the 49 microneedles in the tip of the Infini handpiece do not all punch into the skin at the same time but are inserted serially in rows. However, when the radiofrequency energy is delivered through the needles, it can be felt and cause discomfort from the heating below the surface of the skin. Hence for an Infini treatment, a topical anaesthetic is applied before treatment. When the topical anaesthetic is used, most people rate the procedure as only 4 out of 10 in terms of pain.

If someone has metal pins, implants, or artificial joints in other parts of their body, they can experience a tingling sensation in those areas during an Infini treatment. This is caused by the electric current used in Radiofrequency energy but is not painful.

Topical anaesthetic cream is applied 60 minutes before treatment. During treatment, a cooling machine (such as a Zimmer cooler) can be used but is not essential as the insulated needles used with the INFINI avoid heat damage to the surface of the skin. Treatment of a full face takes about 45 minutes and face and neck about 60 minutes.

Each area is typically treated at different depths with 2 passes for each depth. There can be some pinpoint bleeding when the microneedles penetrate the skin and occasional bruising. After treatment, a cold pack is used, and then a soothing cream applied. Recovery time can be reduced by the use of a special LED light straight after treatment.

The general expectation is to have some downtime for about 48 hours after an Infini treatment. There is some initial redness and swelling after the procedure, this reduces quite quickly in the first few hours then some residual redness typically lasts for about 2 days. There is sunburn-like sensation after treatment due to the heating beneath the skin, and this also gradually dissipates over the first 48 hours.

Typically some early improvement is seen due to collagen contraction and tissue swelling then further gradual improvement continues to occur over the next few months. Full results take 4-6 months, as this is how long it takes collagen remodelling to be completed.

Most patients see improvement with only one treatment, but optimal results in facial rejuvenation, skin tightening, and Hyperhidrosis typically takes 3 treatments. It is important to remember that the Infini is fractional technology, with areas of healthy skin left surrounding the areas being treated to minimise downtime and side effects and allow for rapid healing. These areas of untreated skin are targeted in subsequent treatments. The best results with acne scarring can take 5-6 treatments.

The usual interval between INFINI treatments is 3-4 weeks, but they can be spaced further apart if necessary, and this will not adversely affect the final results. In facial rejuvenation and skin tightening, it is usually recommended to have a follow-up treatment every 12-18 months to maintain results.

The Infini is an ideal treatment to combine with lasers because it is so targeted without damaging the surface of the skin. One example is in the rejuvenation of sun-damaged skin, we can treat with the Infini to improve the elasticity and wrinkles followed with the 1927 Fraxel Laser to treat surface pigmentation.

Topical treatments can also be combined with the Infini. The micro needling creates an opening in the skin for topical products to penetrate and be more effective compared to when they are just applied to healthy skin. Products that have been used successfully include Vitamin A, Vitamin C, Hyaluronic Acid, Growth factors, and Hydroquinone.

Treatments such as anti-wrinkle injections are best not performed on the same day as Infini if they are in the same area. The heat from the radiofrequency can reduce the effectiveness of the anti-wrinkle injections and also tissue swelling after Infini treatment can potentially result in the migration of the anti-wrinkle product and unwanted side effects. Dermal fillers based on Hyaluronic Acid can also potentially be broken down more quickly if the Infini is used in the same area.

Vanquish Me

Vanquish Me

A patented contactless technology for non-invasive fat reduction.

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Body Treatments Volume Loss

Volume Loss·

SculpSure® body contouring treatments

VANQUISH ME is the second generation of contactless technology for non-invasive fat cell disruption. With the largest treatment area in the industry, it treats flank to flank in one session, all with unrivaled patient comfort and safety. Using the patented Selective RFTM technology, VANQUISH ME allows physicians to reduce the circumference of the entire abdominal area, or inner and outer thighs.

Vanquish ME is a non-invasive, non-contact, state-of-the-art radiofrequency (RF) device that was designed for excess mid-section fat reduction where exercise and diet have not worked. It eliminates up to 59 percent of excess mid-section fat. Vanquish is recommended for clients who do not want the risks and downtime from surgical treatments (such as liposuction).

How does it work

During the treatment, an arch extends across the chosen target area that does not touch the client. When undergoing the Vanquish treatment, you lie comfortably on a treatment table as the Vanquish device delivers a controlled type of RF thermal energy to your treatment area. This heats your skin to 38 degrees celsius and heats any underlying fat up to 120 degrees Fahrenheit, thus destroying fat cells. In the next few weeks post-treatment, your lymphatic system works to eliminate any dead fat cells, and this is a natural process that flushes away the excess fat.

What does Vanquish Me correct?

After 4 treatments


Volume Loss

SculpSure treatments are ideal for people with stubborn areas of fat, particularly those that seem resistant to diet and exercise.

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After 4 treatments

After 4 treatments

After 4 treatments

BTL VANQUISH ME treatments are designed for those who want to decrease the circumference of their abdomen and thighs – regardless of their BMI. The BTL VANQUISH ME is an option for those who desire aesthetic improvement without the cost and recovery time of surgery.

Hermosa will tailor a treatment plan for you. Most patients undergo 4 treatments scheduled 1 week apart. Each therapy session takes approximately 30-45 minutes.

Comfort is the main advantage of BTL VANQUISH ME compared to some other shaping therapies. All you will typically feel is a warm sensation in the treated area which may last for a few hours post therapy. The treatment is performed in a lying position so you can easily relax during the procedure.

The whole procedure is non-invasive, contactless, and requires no recovery time. You can easily have the treatment during your lunch break, and return to your daily activities immediately.

Many patients report changes as soon as 2 to 3 weeks after the first treatment, when their body starts to naturally eliminate disrupted fat cells. Optimal results can be usually seen after a couple of months.



The SculpSure device provides treatments for non-invasive body contouring that permanently reduces stubborn fat without surgery or downtime.

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Body Treatments Volume Loss

Volume Loss·

SculpSure® body contouring treatments

With SculpSure body contouring treatments you’re one step closer to the natural-looking, slimmer appearance you’ve always wanted. Whether it’s your belly, back, thighs, or under the chin.

Safely and effectively eliminate unwanted fat cells in just 25 minutes per treatment with our revolutionary SculpSure technology. Now you can provide patients with non-invasive body contouring that permanently reduces stubborn fat without surgery or downtime.

SculpSure is the world’s first FDA-cleared laser device for non-invasive lipolysis of the abdomen, flanks, back, inner thighs, outer thighs and submental area.

How does it work

The 1060nm wavelength’s specific affinity for adipose tissue, coupled with minimal absorption in the dermis, allows SculpSure to efficiently treat areas of troublesome fat in just 25 minutes per treatment. Over time, the body naturally eliminates the disrupted fat cells with results seen as quickly as 6 weeks and optimal results usually seen in as few as 12 weeks.

  • Minimal absorption in the dermis leaves the skin’s surface unharmed

  • Advanced Contact Cooling™ enhances patient comfort

  • Feathering of heat spread provides natural-looking results

  • Mild and transient side effects

What does SculpSure correct?

After 1 treatments


Volume Loss

SculpSure treatments are ideal for people with stubborn areas of fat, particularly those that seem resistant to diet and exercise.

See other volume loss treatments

SculpSure for the body (flanks, abdomen, thighs, and back) is intended for clients with a BMI up to 30. Patients contouring the submental area can have a BMI of up to 49. However, it is also important to consider the body composition of each client and expectations.

There is no recovery period or downtime with SculpSure treatments, so you can have the treatment and return to normal activities immediately.

The SculpSure® device is a non-invasive laser body contouring system intended to permanently eliminate fat cells through non-invasive lipolysis of the chin (submental) area, abdomen, love handles (flanks), back, inner thighs and outer thighs. Individual results may vary and are not guaranteed. SculpSure® treatments are not intended for weight loss results or for people who are obese. Mild side effects may occur including temporary tenderness, swelling or tissue firmness in the treatment area. Please consult with your physician to see if SculpSure® treatments are right for you.

Most patients require a series of treatments to achieve the results they desire. Results can be seen at six weeks after treatment, with optimal results typically seen at 12 weeks.

Thermage® Body Treatment

Thermage® Body Treatment

Smooth, tighten and contour skin for an overall younger-looking appearance.

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Body Treatments Skin Tightening Fine Lines + Wrinkles Treatments Stretch Mark Skin Tone & Texture

No Surgery or Injections · Single Treatment · Patient Comfort · No Downtime · Lasting Results ·

What is Thermage®

Thermage® is a noninvasive skin rejuvenation treatment that’s FDA-approved for skin tightening on the face and body offered at Hermosa Medical Spa. Thermage® works by using radiofrequency (RF) energy to heat the skin’s dermis (under the surface layer) and stimulate new collagen production. It’s a versatile treatment that can be used on the stomach, arms, backs of the hands, thighs, knees, and butt as well as around the eyes and along the jawline

"All the sit-ups in the world can’t tighten loose skin, but Thermage® can."

Tara, Model and Actual Patient

What does Thermage® correct?


Skin Tightening

Softened lines around mouth, eyes, forehead; improved definition on jawline and under the chin.

See other skin tightening treatments

Fine lines & Wrinkles

Reduced wrinkles and decreased “hooding“ for a more awakened look.

See other wrinkles treatments

Stretch Mark

Improved contours and appearance of crepey skin; smoother skin on the abdomen and legs.

See other stretch mark treatments

Skin Tone & Texture

Improved contours and appearance of crepey skin; smoother skin on the abdomen and legs.

See other Skin Tone & Texture treatments

PicoWay works in two ways ·

No Surgery or Injections

Thermage® is non-invasive – no cutting, no needles.

A Single Treatment

One quick treatment (30 to 90 minutes depending on the treatment area) can deliver outstanding results for most patients.

Patient Comfort

Integrated cooling with pulsed RF and vibration to aid in patient comfort.

Little to No Downtime

Go right back to life as usual –no need to miss work or fun.

Lasting Results

Results improve over time and can be long lasting.*

Multiple Treatment Areas

Treats wrinkles and loose skin on the face, around the eyes and on the body.

There’s no downtime afterward, though the treated area may be slightly pink and swollen for a few hours following your session. The redness should go away within 24 hours and shouldn’t hinder your normal activities. Swelling should resolve within five days, though in rare cases it can last a few weeks.

For most patients, measurable results appear gradually in the two to six months following a single treatment session and can last for 1-2 years depending on your skin condition and aging process.*

*Recommended by physicians as part of an annual skin rejuvenation maintenance program.

Unlike many cosmetic procedures requiring multiple sessions, Thermage FLX delivers results after a single treatment. Best of all, results continue to improve over time.

The Thermage® FLX system incorporates vibration on the face and body treatments, which has been shown to help aid in patient comfort.

You’ll feel a brief heating sensation when the treatment device’s tip touches your skin, followed by a cooling sensation to help protect your skin and minimize any discomfort.

Some patients have temporary redness or minor swelling after treatment, but this usually goes away within 24 hours.

Most patients return to their regular activities immediately following treatment. No special care is required afterward, aside from basic skin maintenance and broad-spectrum sunscreens as part of a regular skincare regimen.

Exilis Ultra 360 Body Tightening

Exilis Ultra 360 Body Tightening

Treats skin on both your face and body non-invasively by stimulating collagen formation. No needles or scalpels are used.

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Body Treatments Fine Lines + Wrinkles Treatments Skin Tightening

Wrinkles· Skin Tightening·

What is EXILIS ULTRA 360

A monopolar radiofrequency device offering a non-invasive treatment of different skin conditions such as wrinkles, skin laxity, and excessive fat.

This is the solution for everybody from head to toe with no BMI or skin type restrictions.

How does it work

Tired look, wrinkles, skin laxity: does any of this sound familiar? No needles or scalpels are used. It is suitable for women and men alike. There are no BMI or skin type restrictions and most patients report it feels like a pleasant hot stone massage. Also, it can be used on many body areas.

Tell us what is bothering you and we will find an EXILIS ULTRA 360 solution for you.


Uneven skin appearance caused by loss of collagen due to the natural aging process.


360 Volumetric Heating disrupts old collagen fibers and initiates the process of new collagen formation.


EXILIS ULTRA 360 treatment leads to deep tissue and skin improvement.

What does Exilis Ultra 360 Body Tightening correct?



EXILIS ULTRA 360 combines radiofrequency heating and ultrasound. It treats skin on both your face and body non-invasively by stimulating collagen formation.

See other wrinkles treatments

After 2 treatments

After 4 treatments


Skin Tightening

Saggy skin with loss of elasticity? Whether you are looking for some preventative maintenance or a specific cosmetic improvement, EXILIS ULTRA 360 may be your non-invasive answer!

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EXILIS ULTRA 360 is ideal for anyone looking for a preventative treatment or a more dramatic cosmetic improvement once they begin to notice signs of aging. It is also ideal for those looking for a solution to excess fat or skin in the specific “stubborn” area.

Depending on the treated area and skin condition, most patients undergo between 2 to 4 treatments scheduled 7 to 10 days apart. Each treatment of a specific area usually takes from 4 to 30 minutes.

Most patients describe the sensation of the therapy as being comparable to that of a pain-free, hot stone massage. You can lie down and relax during the procedure.

Some patients report visible results after one treatment. The results will typically continue to improve over the next few months.

Hair Laser Removal

Hair Laser Removal

Removing unwanted hair from the face, leg, chin, back, arm, underarm, bikini line, and other areas.

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Face Treatments Body Treatments Redness & Veins

Face· Leg· Chin· Back· Arm· Underarm· Bikini·

Benefits of Laser Hair Removal

Lasers can selectively target dark, coarse hairs while leaving the surrounding skin undamaged.

Each pulse of the laser takes a fraction of a second and can treat many hairs at the same time. The laser can treat an area approximately the size of a quarter every second. Small areas such as the upper lip can be treated in less than a minute, and large areas, such as the back or legs, may take up to an hour.

Most patients have permanent hair loss after an average of three to seven sessions.

How to Prepare for Laser Hair Removal

Laser hair removal is more than just ”zapping” unwanted hair. It is a medical procedure that requires training to perform and carries potential risks. Before getting laser hair removal, you should thoroughly check the credentials of the doctor or technician performing the procedure.

If you are planning on undergoing laser hair removal, you should limit plucking, waxing, and electrolysis for six weeks before treatment. That’s because the laser targets the hairs’ roots, which are temporarily removed by waxing or plucking.

You should also avoid sun exposure for six weeks before and after treatment. Sun exposure makes laser hair removal less effective and makes complications after treatment more likely.

After Laser Hair Reduction

For a day or two afterward, the treated area of your skin will look and feel like it’s sunburned. Cool compresses and moisturizers may help. If your face was treated, you can wear makeup the next day unless your skin is blistering.

Over the next month, your treated hair will fall out. Wear sunscreen for the following month to help prevent temporary changes in the color of the treated skin.

What does Laser Hair Reduction treat?


Hair Removal

Laser hair removal is one of the most commonly done cosmetic procedures . It beams highly concentrated light into hair follicles. Pigment in the follicles absorb the light. That destroys the hair.

See other hair removal treatments

  • Avoid having tanned skin – Avoid sun in the middle of the day, use sunscreen with a high SPF, and wear sun-protective clothing (eg, a hat and tightly woven clothing).
  • Use numbing cream for 30–90 minutes before the procedure, if recommended.
  • Avoid medications and supplements that make bruising more likely (only if stopping any of the below medications has been discussed with your doctor):
    • Aspirin
    • Ibuprofen
    • Vitamin E
    • Gingko and ginseng
    • Fish oil supplements
    • Prescription blood-thinning medications (eg, warfarin or heparin)