People may choose to remove unwanted hair from the face or body for aesthetics – as dictated by the latest cultural fashion, or for medical reasons. Laser, IPL, hair-removal creams, waxing and shaving are hair removal options available and deciding the most suitable may involve how long treatments last, efficiency, suitability and cost.
Excess hair growth can be triggered by normal hormonal activity (puberty, pregnancy and menopause) hormonal imbalances or dysfunction (polycystic ovarian syndrome (PCOS), thyroid irregularities); medical conditions (hypertrichosis); medications (such as steroids); and stress can also play a role in how hair growth performs. In other instances, the removal of unwanted hair is necessary for phycological health, gender dysphoria, for example.
Hair removal options
There are various options available for hair removal. Some common choices include:
- Laser and intense pulsed light (IPL) systems
- Electrolysis
- Epilation – plucking and waxing
- Shaving
- Chemical depilatories
- Medical cream – such as eflornithine cream
Hair growth cycle
There are three phases the hair follicle cycles through: anagen, catagen and telogen. A new baby starts life with hair in the anagen stage of growth.
Anagen phase (proliferation phase) is when the hair follicle is growing a new hair shaft. The dermal papilla signal matrix cells in the bulb to proliferate, differentiate and grow upwards, resulting in a new hair.
- Scalp hair may take 2-6 years to grow
- Eyebrows and lashes may only take a few months to grow
- Arm and leg hair has a cycle of about 30 to 45 days
Catagen phase (transition or regression phase) – this short phase only lasts but a few weeks. It signals the end of cell division and regression of the inferior segment of the hair follicle - which eventually ceases to exist. A club hair with a hard, white node is formed.
Telogen phase (resting phase) – dead club hairs are held on the scalp for approximately 100 days, eventually releasing (hair falls out) … and so begins the antigen phase again.
- Point of interest. Head hair may contain over 100,000 hairs, mostly found in the anagen phase. Scalp hair grows about 1cm a month – (very annoying when having it dyed a different colour). Hair loss is continuous, at a rate of about 100 hairs per day – (often noticed in the shower due to frequent hair washing).
Options for hair removal
Laser and intense pulsed light (IPL) systems
Laser and IPL are considered the most efficient option for the long-term reduction. These systems emit light waves which result in destruction of the hair matrix and hair stem cells. They do this by targeting the melanin within the hair shaft.
- Melanin is the colouring pigment found in the follicular epithelium (cells of the hair shaft) and the hair matrix (the matrix is the part of the hair follicle where the hair shaft forms). Melanin-producing cells (melanocytes) are mixed amongst the matrix cells to provide the hair shaft with colour.
The light wavelengths emitted ranges from 600 to 1200 nanometers (nm), which is the wavelength selectively absorbed by melanin. Melanin captures the energy from the laser and distributes it to surrounding follicular structures. Melanin is found in highest amounts in the hair matrix and the hair shaft.
The main difference between IPL and Laser – whilst they both use the same principle (using a light source for hair removal), IPL uses a broad spectrum of a visible light wavelength which has a broad cover of the skin whilst Laser uses a controlled target beam to direct light to a specific area (in this case, the hair follicle).
The hair matrix is only sensitive to laser treatment during the anagen phase of growth with many treatments needed to capture hair follicles at this stage at the beginning of treatment (approximately 4 - 6 treatments every 4 – 6 weeks). Maintenance treatment may be needed every 6 -12 months.
Side effect to Laser and IPL treatments can include pain, burning and erythema (redness). Use of sunscreen is important after treatment. Complications can occur if the surrounding area of epidermis (skin) absorbs the laser energy. The skin contains melanin also – this is why laser can be used for skin pigmentation.
Laser and Intense Pulse Light should be performed by professionally trained personal and the correct machine used for different areas of hair removal and particulars of the patient being treated. This method of hair removal is particularly good for ancillary hair (under arms) and pubic hair.
Electrolysis
Electrolysis is a permanent method for hair removal. It involves the discharge of a small amount of energy through a small probe (about the size of a hair) inserted in to the hair follicle. Three main methods are used:
- Galvanic – chemical reaction
- Thermolysis – heat
- Blended method – using both galvanic and thermolysis
Epilation (plucking or waxing)
Epilation is the removal of the hair from the roots. Soft new hair appears 4-6 weeks after treatment and can be quite effective and efficient for all areas of the body, especially larger areas such as back and legs. Two common forms of epilation are waxing and plucking.
Waxing. There are a number of different waxing methods available, either through a beauty salon, or for home use. Warm wax can be applied directly to skin, covered with cloth strips, and quickly removed with hair attached. Wax strips, ready for use, are an alternative to having to warm wax and apply. Waxing can be pain-full particularly for first time users, or when there is much hair in need of removal. Hair has to be a certain length for waxing, but once established, can last for around 4 -6 weeks before needing to be repeated.
Waxing is contraindicated for diabetics, the elderly and for people on certain medications. It should not be performed on areas which are sensitive, broken or irritated, or where there are varicose veins, scars, moles or sunburn.
Plucking uses tweezers to remove hairs one at time or a epilator (electrical device which uses a mechanical means to grasp and remove multiply hairs simultaneously). This action is similar to the action of waxing, removing the root. Epilators can be used dry or specific models can be used in the shower (wet). Removing hair using an epilator can be a painful, especially in sensitive areas. The more an epilator is used over time will often result in less hair, softer hair and skin, and less pain. They can also grasp shorter hairs which the waxing method cannot. If you can cope with the pain, they are a good option for needing to remove unwanted hair so often.
Shaving
Shaving uses a blade (in most cases a razor) to cut the hair off at the level of the skin. Razors are availbable as disposable or with disposable blades, elecrical or battery options. Electric or battery shavers are a razor with a rotating or oscillating blade which can be operated without the use of shaving cream/soap (standard razors require a lathering agent - soap or shaving cream).
Shaving can be quick and easy but does need to be performed regularly and regrowth hair (stubble) can feel sharp or rough. Skin moisturising is needed after shaving as the natual skin oils are removed along with hair.
Chemical depilatories
As the name suggest, chemical depilatories use chemicals to remove hair from the skin. They are a temporary method of depilation. Hair is made of fibrous strands of proteins called keratin. Chemical depilatories use ingredients such as salts of thioglycolic acid – potassium thioglycolate or calcium, sodium or potassium hydroxide, which absorb into the hair and break the protein’s disulfide bonds, degrading the hair and allowing it to just wipe away. Chemical depilatories need to be used as often as you would shaving as they only remove the hair above the surface of the skin. Chemical hair removers can cause chemical burns for some people and should be used according to directions.
Eflornithine cream
Eflornithine cream works by inhibiting the enzyme, ornithine decarboxylase, in hair follicles, which is thought to slow hair growth. It is used after depilation for the management of hirsutism particularly for females with unwanted facial hair.
In-grown hairs and moisturising
In-grown hairs can occur after depilation if the hair grows into the skin instead of out and results in bumps, irritation and sometimes infection. Ingrown hairs will often resolve on their own, however a facial or body scrub will often help. Moisturising skin after hair removal treatment can soothe irritation.
References
- The role of lasers and intense pulsed light technology in dermatology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745852/
- Laser Hair Removal https://www.ncbi.nlm.nih.gov/books/NBK507861/
- Anatomy, Hair Follicle https://www.ncbi.nlm.nih.gov/books/NBK470321/
- A review of laser and light therapy in melasma https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418955/
- https://www.nps.org.au/australian-prescriber/articles/eflornithine-hydrochloride
- Topical eflornithine https://pubmed.ncbi.nlm.nih.gov/11705097/
- https://www.mayoclinic.org/diseases-conditions/ingrown-hair/symptoms-causes/syc-20373893
- https://en.wikipedia.org/wiki/Epilator
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