Laser hair removal consultation and contra-indications

The four jobs of a consultation

A consultation does four jobs at once, and most people only think about the first.

• Screening for risk: is it safe to treat this person, and on what terms?
• Setting the parameters: skin type, hair, the area and previous reactions all come from this conversation.
• Setting expectations: course length, a realistic result, cost and aftercare.
• Creating the record: six months from now, nobody can see how careful you were. They can only see what you wrote down.

Absolute and relative contra-indications

Most contra-indication lists mix genuine evidence, manufacturer instructions, and insurer requirements or convention. Your governing documents are your device's instructions for use, your insurance policy and your clinic protocol. Knowing where an item comes from helps you explain the "why" to clients, but it's never permission to go against your policy. These are treated as absolute by most policies, so check your own:

• Pregnancy and, in most policies, breastfeeding
• Active skin cancer, or an undiagnosed pigmented lesion in the area (refer, don't treat around it)
• Active infection in the area, including a cold sore outbreak
• Photosensitive epilepsy and other conditions triggered by light
• Broken skin, open wounds or recent surgical scars in the area
• Tattoos or permanent make-up in the treatment area

Relative contra-indications change how or when you treat, rather than whether. Recent sun, sunbeds or fake tan means postpone, re-patch test and rebook. Recent peels, injectables, waxing or plucking are time-limited, so postpone rather than refuse. With anticoagulants, immunosuppression or poorly controlled diabetes, treat with caution and consider asking the client to check with their GP. That's staying inside your scope.

Medication, skincare and the isotretinoin question

Photosensitising medication doesn't change a client's Fitzpatrick type, but it may change how the skin tolerates treatment. Ask at every session: "What's started, stopped or changed since I last saw you?" gets a real answer where "Still the same?" just gets a yes. Ask about skincare separately, because retinoids and acid exfoliants on the treatment area matter too, and clients rarely think to mention them. If a drug is uncertain, the answer comes from the prescriber: "I'd like you to check with your GP before we go ahead" is a complete, professional answer.

Isotretinoin, often known as Roaccutane, is the contested one. A 2017 systematic review with expert consensus recommendations, published in JAMA Dermatology, found insufficient evidence to justify delaying laser hair removal during or soon after isotretinoin. But a study is not permission. If your insurer or your device's instructions specify a waiting period, that period applies. Know the evidence, follow your policy, and never swap one for the other.

Getting honest answers and setting honest expectations

Screening only works if the answers are true.

• Ask open, then closed. "Tell me about any medication you take" gets more than "Are you on anything?"
• Say early that honesty changes the plan, not the welcome.
• Normalise awkward questions, such as sunbeds or fake tan.
• Write answers down in the client's own words.

Then say the important things out loud before the client pays: reduction, not removal; a realistic number of sessions, with the possibility of maintenance; and that blonde, red, grey and white hair have little or no pigment for the laser to target.

Consent and records that stand up to scrutiny

Valid consent is informed (specific risks named, not implied), specific to this treatment and these areas, voluntary, and ongoing, so it can be withdrawn at any time. Keep photography and marketing consent separate from treatment consent. Consent comes before the patch test, because the patch test is a treatment in its own right.

Your record should show what you asked and what the client told you, what you found (with photographs), what you decided and why, what you told the client, and signed, dated consent. Keep it for the period your clinic policy sets.

Learn it properly: Consultation and Contra-indications

Consultation and Contra-indications is a 16-minute online masterclass for laser technicians and for clinics training their teams. It covers the four jobs of a consultation, absolute and relative contra-indications, medication and isotretinoin, getting honest answers, tattoos and moles, setting expectations, and consent and records.

• 16-minute video masterclass
• Short quiz at the end
• Certificate of completion for every learner who passes
• £25