Patient Guide: Cynosure Elite+ Laser for Hair Removal and Vascular Concerns

The Cynosure Elite+ is a dual-wavelength laser platform. That single sentence is the most important thing in this article, and it’s the reason we chose it for the clinic. Most laser systems offer one wavelength and force you to treat every patient through the same physical lens. The Elite+ combines two: Alexandrite 755nm and Nd:YAG 1064nm. Those two wavelengths cover the full Fitzpatrick range of skin types and the full clinical range of targets we treat, from unwanted hair on the face and body to facial telangiectasia and leg veins.

This guide explains what each wavelength does, why we sometimes use one and sometimes the other, what the device can and cannot treat, and what to expect from a course. My background in vascular surgery informs how I think about the vascular indications in particular, and I want to be precise rather than promotional about what we can deliver.

Why Dual-Wavelength Matters

Selective photothermolysis is the principle underlying every cosmetic laser. Light of a specific wavelength is absorbed preferentially by a specific chromophore in the skin. The energy converts to heat, the heat damages the target, and surrounding tissue is largely spared. The art of laser medicine is matching wavelength to target while respecting the patient’s skin type.

The challenge is that melanin, the pigment in skin and hair, absorbs across a wide range of wavelengths. The shorter the wavelength, the more strongly melanin absorbs. In Fitzpatrick skin types I to III, where there’s relatively little melanin in the epidermis, this isn’t a problem: shorter wavelengths reach the target without significant epidermal heating. In Fitzpatrick skin types IV to VI, where the epidermis is melanin-rich, the same shorter wavelengths cause unacceptable absorption in the skin itself, leading to burns, hypopigmentation and post-inflammatory hyperpigmentation.

This is the reason most lasers are either “for light skin” or “for dark skin”. A single-wavelength platform forces you to choose.

The Elite+ doesn’t force the choice. The two wavelengths serve different patients and different targets:

• Alexandrite 755nm is preferentially absorbed by melanin. It’s highly effective for hair removal and pigmented concerns in Fitzpatrick skin types I to III, where superior melanin absorption translates to fewer sessions and stronger results.
• Nd:YAG 1064nm penetrates more deeply and is less strongly absorbed by epidermal melanin. This makes it the wavelength of choice for darker skin types (IV to VI), for deeper vascular targets including leg veins, and for hair removal in patients where Alexandrite would be unsafe.

In some treatments, we use both wavelengths in the same session to target different structures at different depths.

For a broader treatment of how laser differs from intense pulsed light, the laser vs IPL guide sits alongside this article.

Hair Removal: How It Actually Works

Laser hair removal works by targeting the melanin in the hair shaft and follicle. The light energy is absorbed, converts to heat, and damages the follicle’s regenerative capacity. The hair sheds over the following one to three weeks and, in successfully treated follicles, doesn’t grow back.

The reason hair removal requires multiple sessions is straightforward. Hair grows in three phases: anagen (active growth), catagen (regression) and telogen (rest). Only follicles in active anagen contain the melanin-rich shaft that the laser can target effectively. At any given moment, only a proportion of follicles in any treatment area are in anagen. The rest are dormant and won’t respond.

Each session reduces the population of follicles in anagen at that moment. Successive sessions, spaced to catch follicles cycling into anagen, progressively reduce the total hair count. The cycle length varies by body site:

• Face: approximately 4 weeks between sessions
• Underarms and bikini: 4 to 6 weeks
• Body, including legs and back: 6 to 8 weeks

Most patients need 6 to 8 sessions to achieve significant clearance, with the understanding that hormonal changes and androgenic activity can drive new growth from previously inactive follicles. A small number of maintenance sessions a year tends to keep results stable.

Which wavelength for which patient. Alexandrite is generally more effective for Fitzpatrick skin types I to III. It treats more rapidly, with fewer sessions, and tends to produce more thorough clearance. Nd:YAG is the safer and more appropriate choice for skin types IV to VI, and we’ll often use it for tanned skin in lighter patients where Alexandrite would risk epidermal injury.

What the laser doesn’t treat well. Hair removal requires melanin in the hair shaft for the laser to target. Blonde, white, grey and red hair contains little or no melanin and responds poorly or not at all. This is a physical limitation of the technology, not a failure of the device, and we’ll tell you at consultation if the colour and contrast of your hair make laser unlikely to deliver.

For more on the broader picture of hair concerns, the hair loss and thinning guide sits alongside this one.

Vascular Treatment: Where the Elite+ Excels

The Elite+ is one of the most capable lasers available for vascular work, particularly when both wavelengths are used. The targets are quite different from hair removal: instead of melanin, we’re targeting oxyhaemoglobin and deoxyhaemoglobin in blood vessels of varying sizes and depths.

Facial telangiectasia. The small visible vessels around the nose, cheeks and chin respond well to either wavelength, with the choice depending on vessel size, depth and skin type. Most patients see significant improvement in 1 to 3 sessions, spaced 4 to 6 weeks apart. The treated vessels coagulate, the body absorbs them over 2 to 6 weeks, and the redness fades. For diffuse background redness associated with rosacea, Lumecca IPL is often a better option, while Elite+ targets discrete, defined vessels.

Cherry angiomas, spider naevi and small vascular lesions. These often respond in a single session, with the target lesion blanching during treatment and clearing over the following weeks.

Leg veins. This is where the Nd:YAG 1064nm wavelength comes into its own. Spider veins and small reticular veins on the legs sit deeper than most facial vessels and require the deeper penetration of the longer wavelength. We treat selectively: not all leg veins are good laser targets, and patients with significant varicose disease are referred for vascular assessment before any cosmetic intervention. My background in vascular surgery shapes this threshold: there’s no aesthetic justification for treating a cosmetic vein when the underlying vascular pathology hasn’t been addressed.

What we don’t treat with laser. Larger varicose veins, vessels with reflux on Doppler assessment, and any vessel where the patient has signs or symptoms of underlying venous insufficiency are referred for vascular surgical assessment. Treating these with laser alone is poor medicine.

Other Indications

The Elite+ has applications beyond hair removal and discrete vascular work, and we’ll discuss these at consultation where they apply:

• Pigmented lesions, including solar lentigines, with appropriate assessment first
• Pseudofolliculitis barbae (ingrown hair from shaving), particularly in patients with curly hair, where laser hair reduction reduces the underlying cause
• Post-inflammatory hyperpigmentation in selected cases

For the differential diagnosis of brown spots, the hyperpigmentation guide is the right reference. For under-eye darkness with a vascular component, the under-eye concerns guide discusses where laser fits in a wider plan.

Who Suits Laser Treatment

The honest answer depends on what you’re treating, but a few principles apply across indications.

Skin type and hair colour. For hair removal, we need contrast between hair and skin, or the wavelength flexibility to manage darker skin safely. The Elite+ allows us to treat across Fitzpatrick I to VI. We don’t, however, treat blonde, white, grey or red hair successfully, regardless of skin type.

Sun exposure. Lasers can’t be performed on recently tanned skin. We ask patients to avoid sun exposure for four weeks before any session, to use broad-spectrum SPF 50 daily throughout treatment, and to avoid sunbeds and tanning products entirely during the course. Tanned skin loses the contrast between target and surroundings, and increases the risk of burns and pigmentary change.

Medication. Photosensitising medications, including some antibiotics, retinoids and isotretinoin, are relative or absolute contraindications. We take a careful medication history at consultation and may defer treatment until courses are completed. Isotretinoin requires a six-month window after the last dose for hair removal and most other indications.

Pregnancy. We don’t treat pregnant patients with laser.

Realistic expectations. Hair removal results in significant reduction, not the absolute elimination of every hair. Hormonal influences can drive new growth over time, and a small annual maintenance is sensible. Vascular results vary by vessel and by patient: facial telangiectasia generally responds well, leg veins less predictably.

The Consultation and Test Patch

Every patient considering laser treatment with us has a consultation first. For hair removal, this is usually combined with a test patch in a small, discreet area at the planned treatment settings. The test patch tells us how the skin responds, allows us to refine parameters, and gives us a 24 to 48 hour window to confirm there’s no unexpected reaction before treating a larger area.

For vascular work, the consultation includes assessment of the vessel pattern, a discussion of which wavelength is appropriate, and where relevant a referral for vascular Doppler assessment before any cosmetic intervention.

What to Expect During Treatment

Sessions vary in length depending on the area, from 10 minutes for the upper lip to an hour or more for full legs. The laser handpiece is applied to the skin in measured pulses. Most patients describe the sensation as a hot pinprick or an elastic band flick, more intense than IPL but brief. The handpiece’s integrated cooling system reduces both discomfort and the risk of epidermal injury. Topical anaesthesia is rarely needed for hair removal, occasionally helpful for larger or more sensitive areas.

Immediately after, the skin looks pink and may feel warm, like mild sunburn. For hair removal, you’ll often see a slight redness around the follicles, which settles over 24 to 48 hours. The hairs themselves shed over the next 1 to 3 weeks as the skin pushes them out. For vascular treatment, the treated vessels may darken slightly before fading, and the surrounding skin may be pink for 24 to 48 hours.

Aftercare

• Cool compresses or aloe vera if the area feels warm in the first few hours
• Broad-spectrum SPF 50 daily, with strict sun avoidance for the first week and ongoing protection of treated areas throughout the course
• No retinoids, AHAs or BHAs on the treated area for 5 to 7 days
• No exercise, hot showers, saunas or hot tubs for 24 to 48 hours
• No picking or rubbing of treated vessels: let them fade in their own time
• Gentle cleanser and barrier-supporting moisturiser for the first week

If you notice anything that concerns you, get in touch. We’d much rather review a question early than discover an issue later.

What This Treatment Cannot Do

Laser doesn’t change skin tone or texture beyond its specific targets. It doesn’t tighten skin or address volume loss. It doesn’t treat pigmentation that isn’t melanin-based. It doesn’t permanently eliminate every hair follicle in every patient: significant reduction is the standard outcome, and hormonal drivers can prompt new growth over time.

For larger varicose veins, signs of venous reflux, or any vascular concern with associated swelling, pain or skin changes, the right path is vascular surgical assessment before any cosmetic intervention. We’ll refer where that applies.

Pricing

Pricing depends on the area treated and whether you’re booking a single session or a course. We confirm current pricing on the Cynosure Elite+ treatment page when we publish it. Courses are typically priced at a discount to single-session pricing.

Frequently Asked Questions

Is laser hair removal permanent?

Significant, lasting reduction is the standard outcome. Most patients achieve 70 to 90 per cent reduction after a full course of 6 to 8 sessions. The remaining follicles, and any new ones prompted by hormonal changes, can drive some regrowth over time. A small number of maintenance sessions a year tends to hold the result. We frame it as long-term reduction rather than absolute permanent removal.

Why does laser hair removal need multiple sessions?

Hair grows in three cycling phases, and only follicles in active growth (anagen) absorb laser energy effectively at the time of treatment. The rest are dormant and unaffected. Spacing sessions to catch follicles cycling into anagen progressively reduces the total hair count. Most patients need 6 to 8 sessions, with session spacing varying by body site.

Does laser hair removal work on blonde, grey or red hair?

Generally, no. Laser hair removal targets the melanin in the hair shaft. Blonde, white, grey and red hair contains little or no melanin and responds poorly or not at all. This is a physical limitation of the technology rather than a failure of the device. We’ll tell you at consultation if the colour of your hair makes laser unlikely to deliver.

Is laser safe for darker skin?

Yes, when the correct wavelength is used. The Nd:YAG 1064nm wavelength on the Elite+ is the appropriate choice for Fitzpatrick skin types IV to VI. It penetrates deeply and is less strongly absorbed by epidermal melanin, reducing the risk of burns and pigmentary change. We don’t use Alexandrite 755nm in darker skin, where it would be unsafe.

Can the Elite+ treat my leg veins?

It depends on the vein. Small spider veins and reticular veins often respond well to Nd:YAG treatment. Larger varicose veins, or any vein with signs of underlying venous reflux, require vascular surgical assessment before cosmetic treatment. Treating cosmetic veins without addressing underlying venous disease is poor medicine. We screen carefully at consultation and refer where appropriate.

Does it hurt?

Most patients describe a hot pinprick or elastic band flick sensation, more intense than IPL but brief. The integrated cooling on the handpiece reduces both discomfort and the risk of skin injury. Sensitive areas (upper lip, bikini) feel slightly more. Topical anaesthesia is rarely needed for hair removal and occasionally helpful for larger or more sensitive areas.

How long until I see results?

For hair removal, the treated hairs shed over the following 1 to 3 weeks, and the reduction becomes obvious over the course of treatment. For vascular work, treated vessels fade over 2 to 6 weeks. Most patients see meaningful change after 2 to 3 sessions and full results after the planned course.

What’s the downtime?

Most patients return to normal activity immediately, with sun avoidance and gentle skincare for the first week. The skin may look pink for 24 to 48 hours and feel like mild sunburn. We ask patients to avoid exercise, hot showers and saunas for 24 to 48 hours and to wear broad-spectrum SPF 50 daily throughout the course and afterwards.

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Related reading

• Laser vs IPL: a treatment comparison
• Patient guide: Lumecca IPL
• Hyperpigmentation: types and treatment
• Rosacea: causes, treatment and management
• Under-eye concerns: causes and treatment
• Hair loss and thinning
• Sun damage prevention and SPF guide
• What to expect at an aesthetic consultation