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Hair Removal Methods – The Old & The New plus some

A magnificent mane of hair crowning your face does wonders for self-confidence and over all well-being but unwanted hair growing in various other parts of the body (especially in women) may become an embarrassing issue that warrants serious attention as there may be an underlying medical condition that requires a complete check-up. Often, excessive hair where it’s not wanted can also become a source of significant cosmetic distress.The main reasons for getting rid of unwanted hair (excessive terminal hair) may be traced to cultural, racial, social and cosmetic factors. Over 20 million women in US alone have to deal with excessive hair growth.

There are medical indications for hair removal that can be grouped into androgen dependent areas such as beard, upper lip, sideburns and lower abdomen in females and non-androgen dependent areas of the body such as limbs, chest, shoulders and upper back

Few important points to remember:

  • Damage to the hair papilla (rich in blood vessels and nerves) and hair bulb (area where hair cells are multiplying) will result in hair death and hair will not grow back.
  • Damage to the hair follicle may temporarily disrupt and delay hair growth, hair will grow back. Although repeated injuries to the follicle may result in finer hair and less aggressive growth.
  • Removal of the hair shaft and root will have no effect on hair growth and hair will grow back as usual.

Here are some causes of unwanted hair but it must be noted that often no cause is found (idiopathic).

  • Hirsutism – This is a male pattern type of excessive hair growth occurring in women after puberty. The incidence is about 5-10% in women and it causes significant cosmetic disability. There will be excessive, thicker and darker mature (terminal) hair appearing in the beard, side-burns, upper lip, inner thigh and lower abdominal areas. It may result from a condition known as Polycystic Ovaries which affects about 3-10% of women. Medical conditions such as Cushing Syndrome, Congenital Adrenal Hyperplasia and tumors of the adrenal gland or ovary can also result in an excessive male pattern type of hair growth in women. Androgenic medications are another common cause of hirsutism. Menopause will result in a hirsute type of hair growth due to diminished estrogen levels. In certain instances, after all diagnostic procedures have been performed, no cause can be found and this is known as idiopathic hirsutism and may be attributable to racial or genetic factors.
  • Hypertrichosis – This is where hair growth in abnormally more in relation to the race, gender and age of the individual. Excessive hair can be distributed all over the body or appear as clumps of either vellus (immature unpigmented hair) or terminal (pigmented mature hair) hair in a specific area. Hypertrichosis can be present at birth (congenital) or present itself later in life (acquired) and may be caused by drugs (androgenic steroids, minoxidil, and phenytoin), malnutrition, malignancy, repetitive rubbing, or applications of topical iodides.
  • Folliculitis barbae -This is an infection of the beard area in men caused by Staphylococcus aureus. Often, no infection can be detected in which case the condition is known as pseudofolliculitis barbae which results as an inflammatory response to ingrown hair. Also known as razor bumps, it can occur at any shaved site. Both pseudofolliculitis barbae and folliculitis barbae can co-exist and can become very persistent and painful at times leading to deep seated infections and scarring.

So now that we are faced with a hairy conundrum what can be done to rectify this problem?

First and foremost, if you notice unusual and excessive hair growth in the areas mentioned above, its’s highly advisable to get a full medical check-up. After diagnosis has been established, your doctor will take appropriate measures to treat the underlying cause.

Your doctor may suggest various methods of hair reduction or permanent hair removal which we will discuss in more detail below. But before we delve into hair removal methods, here is an easy quick guide on how fast your hair will grow back depending on the length of hair:

  • Areas with shortest hair like eyebrows and thighs, hair will grow back slower.
  • Areas with longer hair like beard, underarms and scalp, hair will grow back faster.

So now that we are faced with a hairy conundrum what can be done to rectify this problem?
First and foremost, if you notice unusual and excessive hair growth in the areas mentioned above, its’s highly advisable to get a full medical check-up. After diagnosis has been established, your doctor will take appropriate measures to treat the underlying cause.
Your doctor may suggest various methods of hair reduction or permanent hair removal which we will discuss in more detail below.
 But before we delve into hair removal methods, here is an easy quick guide on how fast your hair will grow back depending on the length of hair:
Areas with shortest hair like eyebrows and thighs, hair will grow back slower.
Areas with longer hair like beard, underarms and scalp, hair will grow back faster.

Another important point is the growth cycle of hair. Here is a quick fact update with a bit of my quirks added in for good measure:

  • Anagen Phase (summer days for hair) – This is a crucial active or growing phase where the hair cells are multiplying within the germinative hair bulb. The duration of this phase is largely dependent on gender, age, body site, hormonal factors and genetics. It typically lasts between 2-6 years, with hair growing about 0.5-1 cm every 28-32 days. This is the most important phase in relation to light assisted hair removal. A great outcome with long lasting results will depend on the total number of hair that are zapped in this phase of the hair cycle. This is why multiple sessions are required so that we can vaporize all those little buggers! At any given time, hair throughout your body will exist in various phases of the growth cycle, with the majority (about 85%-95%) existing in the anagen phase.
  • Catagen Phase (autumn perhaps) – This typically lasts a few weeks and is a transitionary in-between phase between anagen and telogen. This is where the telogen or club hair starts to form, ready to be shed.
  • Telogen Phase (winter phase) – This is the resting phase and lasts a few months, being shortest for the beard area and longest for the pubic area.
  • Exogen (shedding phase) – About 25-100 telogen hair or club hair are shed every day. This phase is where the old telogen hairs are shed making way for new hair. And the cycle continues with old hair being shed, making way for new ones.

Now let’s look at some of the common age old and new age methods of hair removal. Hair removal techniques can be classified into temporary hair removal and reduction and permanent hair removal.

TEMPORARY HAIR REMOVAL TECHNIQUESTEMPORARY HAIR REDUCTION TECHNIQUESPERMANENT HAIR REMOVAL TECHNIQUES
Shaving  
Chemical depilation  
EpilationEflornithine HCl creamElectrolysis
PluckingLaser-assistedGalvanic
WaxingIntense pulsed light sourcesThermolysis
Threading  
Abrasives  
Sugaring

The video highlights some important points related to shaving. 

  • Shaving is the most common method of hair removal.
  •  The sharper the blade, the better the shave with lesser side effects like razor bumps or irritation.
  •  The hair shaft is cut like grass just as it emerges from the surface of the skin, the hair root underneath the skin surface is left intact so the hair will grow back. 
  • Be sure to shave in the direction of the hair and not against it. Proper pre-conditioning, hygiene, moisturization and high quality blades will prevent irritation.

Contrary to popular belief, shaving does not lead to thicker hair regrowth. This is a temporary hair removal method and hair will start to appear 1-3 days after shaving. Just think of it like mowing your grass!

https://youtu.be/8UDCTMTrKzA

Epilation

This process involves removal of the entire hair shaft and root. This is an excellent method for temporary hair removal and repeated epilation will result in finer and thinner hair regrowth but it will not destroy the hair follicle, hair bulb or hair papilla, therefore hair will grow back depending on the epilation process you are using. A quick fact- if the hair bulb and hair papilla are destroyed the hair will permanently die.

Plucking

Usually used to remove coarse hair such as ones under the chin or eyebrow area, this method is slightly more effective than shaving and hair will grow back in about 3-8 weeks, as the hair root is plucked out. It’s a tedious rather painful process and takes care of a few hairs at a time. Outcome of plucking is rather unpredictable. Some people experience irritation, ingrown hair, hyperpigmentation, whilst others do well by using this technique. Electrical epilators might be a better choice when removing hair from a large surface area as opposed to manual plucking with a tweezer. It’s really a personal choice.

Waxing

This is the most effective technique of temporary hair removal, whereby large areas of hair are yanked out by the application of warm or cold wax. Clinical observation and data for this method is scarce, but repeated waxing may result in wounding of the hair follicle, leading to finer and less aggressive hair re-growth. Usually 2-3 sessions per month might be required to stay completely smooth and hair-free. Hair will regrow in about 3-6 weeks depending on area being waxed. Although many individuals perform waxing at home, it’s better to opt for salon waxing to prevent side effects such as burns, irritation, ingrown hair, infection and damage to the skin. It is painful and does require a correct technique, but it remains without a doubt a popular method for hair removal. It’s important to note that individuals on topical retinoids may suffer from side effects such as skin tears so it’s best to avoid waxing for at least 6 months in order to avoid this issue. Waxing is a no no if your skin is infected, burned or irritated or if you are sensitive to any component in the wax itself.

Sugaring

This is an ancient and very effective method of temporary hair removal similar to waxing where chunks of hair are removed using a paste made of sugar, lemon and water. It’s an excellent alternate for those individuals who are sensitive to wax. Side effects are similar to those of waxing such as pain, irritation, burns, ingrown hair, infection and hyperpigmentation. Hair will regrow in about 3-6 weeks.

Abrasives

Sandpaper, pumice stones, abrasive gloves can aid in hair removal. This method actually rubs off the hair shaft from the skin. It is an uncommon method and is mostly redundant.

Threading

A very popular and age old method especially in the Asian subcontinent and the Middle East, threading is a novel technique whereby a long twisted loop of cotton thread is rolled across the hair bearing area, effectively catching the hair in the loop and plucking it. Less painful than waxing, and certainly more economical, this is a highly effective method for achieving sharp, precise clean lines when shaping eyebrows. It is also very effective in removing the finest of facial hair. Some women adopt this as their method of choice for shaping eyebrows. Hair will grow back in about 4-6 weeks.

Bleaching

More of a disguise than hair removal, many women prefer this method as it leads to a total vanishing effect of unwanted hair quickly and painlessly. The melanin pigment of the hair is removed by bleaching agents such as hydrogen peroxide and sulfates activated by oxidizers. It’s best to perform a patch test prior to bleaching. There have been reports of serious reactions such as fainting, triggering of an asthma attack and local or generalized allergic reactions to the bleach activator. However, this does remain a popular method of controlling the appearance of unwanted hair temporarily. It might result in an unflattering fuzzy effect due to the bleached hair. Depending on the area being bleached, pigmented normal hair will start to appear as soon as new hair shafts push their way upwards.

Chemical Depilation

Economical, quick, easy and painless, chemical hair removal is a popular method of hair removal where the hair shaft is dissolved using chemical depilatory (sodium or calcium thioglycolates) agents. Available at your local drug store, this quick solution can melt away large chunks of hair on the legs, underarms, bikini area and upper lip. Small more delicate areas like the eyebrows should be avoided. Allergic reactions and contact dermatitis might occur due to the depilatory agents, hence a patch test is advisable before attempting to remove hair on larger areas of the body. Hair will regrow with 2-4 days.

Temporary Hair Reduction

Vaniqa

Eflornithine hydrochloride (HCL) 13.9% known as Vaniqa is an FDA approved prescription cream that decreases the actual rate of hair growth. Ornithine decarboxylase (ODC) is an enzyme in our skin that stimulates hair growth. Vaniqa blocks this enzyme, hence slowing the rate of hair growth as shown by animal and human studies. Facial hair has responded well to Vaniqa as demonstrated by clinical studies. A randomized double-blind clinical study conducted on 594 females where 393 were treated with Vaniqa and remaining with a placebo, concluded that approximately 32% of patients showed marked improvement after 24 weeks of treatment with Eflornithine hydrochloride cream 13.9%, compared to 8% treated with the vehicle. Side effects are rare (less than 1%) and mainly limited to the skin where most women noticed acne, ingrown hair, tingling and rashes in the area being treated. Vaniqa is applied twice daily to the affected facial area and can be used in combination with normal hair epilation techniques for smooth hair-free skin as Vaniqa will only retard skin growth and not remove the hair shaft or root. It’s best to apply Vaniqa a few minutes after epilation and avoid washing the face for at least 4 hours after application for optimal absorption. Make-up and sunscreens can be applied as usual.

Intense Pulsed Light Sources for Hair Reduction

This is a non-invasive form of hair removal where multiple high intensity pulses of light are applied to the skin where the melanin pigment of the hair picks up the light and is subsequently destroyed by heat energy (selective photothermolysis). IPL has become very popular due to the fact that it is non-invasive, relatively pain-free, and there are minimal to no side effects. However, people with darker hair and lighter skin respond best to IPL hair removal whereas individuals with darker skin tones or lighter hair will respond poorly to this method of hair reduction. Lumenis® Quantum IPL, EpiLight® and Ellipse® are a few of the IPL devices in the market today. The treatment lasts 20 minutes and a total of 4-6 sessions every 3-6 weeks will be required before desired results can be achieved. Various clinical studies concluded that over 75% success was achieved after 6 sessions of IPL treatment with long lasting results of up to 8-12 months. IPL hair reduction is a professionally administered modality that does require a high level of operator expertise and hence it’s important to keep this mind when you decide to opt for this method of hair reduction. A few companies such as Braun have recently launched a novel hand held home-based IPL device that uses the same principles as professional devices, and users are seeing noticeable differences in just a few sessions. If you want to test out home-based IPL devices, why not give it a try? IPL hair reduction is great for all areas of the body such as facial, trunk, limbs and underarms. Microscopically, IPL treatment results in damage to the hair shaft and follicle but not the hair bulb or papilla, hence hair will grow back and re-treatment will be required.

Laser Assisted Hair Reduction

This method is targeted and focused, just like the precise beam of laser light that is aimed at the hair follicle, subsequently destroying it and preventing new hair growth. As with IPL, the ideal client profile will be one of darker hair and lighter skin, however a skilled laser technician can deal with a more varied client profile without the feared side effects of pigmentary changes and damage to the other skin structures. Lasers deliver precise single wavelengths of light unlike IPL systems that deliver multiple wavelengths of light, hence chances of side are greatly reduced with optimal results. Many different types of lasers exist and results will depend on the type of lasers used. Numerous short term studies indicate that this method of hair removal is promising with long lasting results of up to 12 months or more, delegating it as the number one choice for hair reduction. Zapping actively (anagen or growth phase) growing hair will require 6-8 laser sessions, 4-6 weeks apart with results lasting anywhere from between 6-12 months. Touch-ups will be required when hair starts to grow back. The downside is that it is an expensive procedure and high levels of technical experience are required to achieve desired results. Darker skinned individuals will have more chances of side effects such as pigment changes, swelling, blistering and scarring. However, darkly toned individuals can also be successfully treated with lasers if the appropriate lasers are selected and level of operator experience and training is high. It is best to rely on experts in the field of laser hair removal and be vigilant when selecting a laser clinic as many ‘bad’ cases are on the rise due to lack of experience or simple negligence.

Permanent Hair Removal

Electrolysis

This is the only proven method of permanent hair removal. As with all technical modalities of hair removal, a high level of operator expertise will ensure optimal results with fewer side effects. An ultra-fine filamentous needle is inserted right into the hair follicle until it reaches the hair papilla through which low-level electrical currents are introduced creating a highly saline (caustic) environment within the hair follicle, destroying the hair bulb and hair papilla (the area where hair cells are formed and derive nourishment). This method is painful, requires a high level of skill, and is time-consuming. However, it has been reported that 25% of hair will not grow back. Electrolysis will target any hair type, even fine light hair can be tackled with this method as long as they are in the growing (anagen) phase. A combination of electrolysis and laser or IPL hair removal is ideal as the light will destroy darker hair and electrolysis can destroy fine or lighter hair that the light devices might have missed.

 

The main objective of electrolysis is to identify, target and destroy the hair papilla and hair bulb. The hair papilla is where the hair derives nutrients and oxygen. Once it dies, the hair dies.

 

There are 3 known types of electrolysis as discussed below. Current data available for determining which method fares better than the other is scarce. However, clinical observation does show that the blend method might prove more effective and quicker with a higher level of permanence.

  • Galvanic – This method delivers an electrical current that alters the normal tissue saline to caustic sodium hydroxide that destroys the hair bulb and papilla. The electrologist will push the pedal that controls the duration of the current dependent on the level of pain tolerance of the individual. Usually a minute or two is required per hair. It is a slow and uncomfortable process but a skilled technician will apply topical anesthetics and make the procedure a tolerable one. This is a chemical process.
  • Thermolysis – This method uses high frequency alternating currents passed through the hair follicle leading to high levels of molecular vibrations that will thermally destroy hair structures such as the hair follicle, hair bulb, and hair papilla. This is a thermal process.
  • Blend Method – This is a dual method combining both chemical and thermal processes to destroy the hair bulb, hair papilla and other vital structures of the hair.

So dear readers, here we have it- the entire package on how to manage your hair dilemmas with pros and cons laid out in a precise and easy manner so that you can navigate and decide which method is the best for you. If you opt for more professional methods of hair removal, make sure to select a highly qualified practitioner and go in with realistic expectations. Hair tissue is a growing living part of your skin and body and therefore it’s best not to expect instant fixes or miracles. Each procedure comes with its own set of side effects which you should be aware of.

 

Your skincare expert will decide on which modality is best for you once diagnosis of the underlying cause of unwanted hair has been established.

 

Hair removal technology has advanced in leaps and bounds, but it is a good idea to be aware of all kinds of outcomes so that you are not disappointed.

I hope this article sheds some light on concerns and questions you might have on solving issues related to unwanted hair. On an ending note:

I would like to mention that not everyone cares for completely smooth alabaster like skin, so in the end it’s a personal choice that is determined by various social, ethnic, and cultural factors.

Stay well and stay informed.
Consultants at Cuticonscious
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