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Hair Removal

The methods of hair removal vary between simple inexpensive means of home treatment (shaving, plucking, depilatories) to expensive and potentially time-consuming means used by paraprofessionals, nurses, and/or physicians (electrolysis, lasers, x-ray). The ways in which these different methods induce hair removal, the duration of such removal, and the nuances between devices within the same category of methods are discussed. There are different control mechanisms for hair growth and the different means of hair removal affect these mechanisms. These mechanisms must be considered in planning a strategy of permanent removal of hair.

Before removing hair, it helps to know about the different types of hair on our bodies. Get to know your hair.

Hair Removal Techniques

  • Waxing
    • Warm wax treatments are gentle and virtually painless, and can be done in a salon or by yourself at home. They are particularly suitable for legs. Hot waxing involves some tooth gritting, and can only be performed by a trained practitioner. The heat of the wax causes hair follicles to dilate, making hot wax much more effective than warm at removing coarse, strong and stubborn hairs. Hot waxing is suitable for bikini lines, underarms and men's torsos.
  • Cosmetic technique
    • As an alternative to hair removal, hair bleaching is inexpensive and works well when hirsutism is not excessive.
    • Bleaches lighten the color of the hair, rendering it less noticeable.
    • Several types of commercial hair-bleaching products are available. All contain hydrogen peroxide as the active ingredient.
  • Mechanical and chemical hair removal
    • Depilatories (eg, shaving, chemicals such as thioglycolic acid) remove hair slightly below the surface of the skin.
    • Shaving removes all hairs superficially but is followed immediately by growth of hairs that previously were in the anagen phase, which produce rough stubble as they grow in. No evidence exists that shaving increases the speed or coarseness of subsequent hair growth; however, most women prefer not to shave facial hair.
    • Chemical depilation may be suited best to treatment of large hairy areas in patients unable to afford more expensive treatments such as electrolysis and laser epilation.
    • Chemical depilatories separate the hair from its follicle by reducing the sulfide bonds found in abundance in hairs.
    • Irritant reactions and folliculitis may result.
  • Temporary epilation
    • Epilation involves removing intact hairs and their roots.
    • Plucking or tweezing is performed widely. This method may result in irritation, damage to the hair follicle, folliculitis, hyperpigmentation, and scarring.
    • Waxing entails applying melted wax to the skin. When the wax cools and sets, it is peeled abruptly off the skin, removing embedded hair along with it. This method is painful and sometimes results in folliculitis. Repetitive waxing may produce miniaturization of hairs, and, over the long run, it may reduce the number of hairs permanently.
    • Certain natural sugars, long used in parts of the Middle East, are becoming popular in place of waxes. They appear to depilate as effectively, but less traumatically, than waxing.
    • Threading, a method used in some Arab countries, is a technique in which cotton threads are used to pull out hair by the roots.
    • Home epilating devices that remove hair by a rotary or frictional method are available. Both threading and home epilation may produce traumatic folliculitis.
    • Radiation therapy formerly was a popular method of hair removal; however, it has fallen out of favor and is no longer an acceptable method.
  • Permanent epilation - Techniques of permanent epilation, including electrolysis, thermolysis, and laser epilation
    • Hair destruction by electrolysis, thermolysis, or a combination of both, is performed using a fine flexible electric wire that produces an electric current after being introduced down the hair shaft.
    • Thermolysis (diathermy) uses a high-frequency alternating current and is much faster than the traditional electrolysis method, which uses a direct galvanic current.
    • Electrolysis and thermolysis are slow processes that can be used on all skin and hair colors, but they require multiple treatments.
    • Electrolysis and thermolysis results depend on the skill of the operator. No good control exists to evaluate electrolysis and thermolysis results. Skill of operators varies significantly. State-to-state standardization of licensing requirements is minimal for practitioners in the United States.
    • Electrolysis and thermolysis can be uncomfortable and may produce folliculitis, pseudofolliculitis, and postinflammatory pigmentary changes in the skin.
    • Electrolysis is generally considered the most effective method of permanent hair removal, electrolysis is also the only one suitable for grey, white, blond and red hair. It works by delivering electricity to the hair follicle through a fine metal probe. But treating each follicle individually is a lengthy process.
  • Laser epilation
    • Lasers can treat larger areas faster than can electrolysis and thermolysis. Lasers have skin-cooling mechanisms that minimize epidermal destruction during the procedure.
    • Lasers with wavelengths of 694-1064 nm are commonly used for hair removal.
    • Skin and hair color often determine if a laser can be used effectively. Lasers are most effective on dark hairs in fair-skinned people. In these patients, lighter skin does not compete with darker hairs for the laser, which selectively targets the pigmented melanin. In dark-skinned people, a newer approach that delivers more energy to the hairs over a longer period of time may prove safe and effective.
    • As in electrolysis and thermolysis, multiple treatments may be necessary for long-term hair destruction.
    • Folliculitis, pseudofolliculitis, discomfort, and pigmentary changes may result from laser therapy.
    • Laser treatments are the most expensive method of hair removal and have yet to be proven more effective than traditional methods.
      More on laser hair removal...
  • Nonlaser treatment - Lamps, which use an intense pulsed light, are a new epilating method still in the experimental stage. Photodynamic therapy uses a topical application of aminolevulinic acid followed by red-light exposure.

  • Other treatments - In patients with drug-induced hirsutism, discontinuation of the responsible medication should help excess hair to resolve.


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