So much of beauty is really fashion. Take hair, for example. Having some facial and body hair is perfectly normal. In fact, most women have some facial and body hair. And most Europeans have no problem with this. Women in France and Germany usually do not shave their legs or their armpits.
But American fashion calls for smooth, hairless women and sometimes men. So most of us in North America dislike the intrusion of hair in places that require a lot of shaving or waxing or that are supposed to be smooth, like the face.
The most striking development in this area is the use of the laser for hair reduction. The lasers make it possible to reduce dramatically the amount and texture of unwanted hair. And this can work for young women, women after menopause, and men who want to get rid of back hair or other unwanted hair.
What are the possible causes?
Please remember that you may have one or more causes for unwanted hair including some that may not be listed here.
- Understanding normal hair growth
- Your family
- Polycystic ovary disease
- Female and male hormones
What are the possible treatments?
We’re all individuals, so there may be variations in treatment depending on your particular needs and your doctor’s style of practice. Here are some of the most common:
- Plucking, waxing, shaving, and hair removal creams
- Vaniqa cream
- Laser hair reduction and maintenance
What you need to know
Understanding Normal Hair Growth
“Why does hair grow more in some areas of the face and body than others?”
We are born with hair follicles all over our bodies, probably a reminder of our primate ancestry. Babies in fact are covered with fine, soft hairs called “vellus” hairs. But as we get older, hair follicles in different parts of the body produce thicker, longer hairs. The triggers for this change are male and female hormones.
Even in childhood boys usually have more longer, darker, slightly coarser hairs on their arms and legs than girls. As puberty approaches, these hairs get signals from hormones to start growing, particularly in areas like the armpit, the genital region, and the beard area in men. As hormones diminish in our 50s, hair growth gradually recedes in many areas. Pubic hair gets lighter in density as does hair on the head.
Hair has a growth cycle. All hairs go through a growth phase, a resting phase, and a falling out phase, after which new hair growth begins again. This is part of normal hair growth cycles.
This hair recycling time is different in different parts of the body. Hair grows faster on the face than other parts of the body; thus its growth cycle is shorter. If you want to have the hair on your face treated with a laser, the treatment interval will often be approximately four weeks.
The hair growth cycle for other parts of the body, by contrast, is from eight to twelve weeks depending on the body site. You may be asked to return for laser hair treatments at longer intervals for the body than the face because of the different hair growth cycles.
Research is very active in the area of hair development and biochemistry. But many aspects of hair texture, quality, and growth are still mysterious. The hormones and genetics of hair development turn out to be more complicated than anyone would think.
“Many of the women in my family have a lot of facial hair growth. Is that something I am likely to develop too?”
Yes, there is definitely a family resemblance in hair growth patterns. In some families many women have fairly long, coarse, dark hair on the arms, on the chin and sideburn area, and sometimes around the nipples and on the abdomen. If this is something that runs in your family, it is perfectly normal and nothing to worry about. The hair can be removed if you wish through laser hair removal, which I talk about later in this article.
Sometimes increased hair growth is associated with something called polycystic ovary disease. This may also run in your family and is characterized by increased hair growth, irregular periods, fairly severe acne, and difficulty getting pregnant. If you have several of these problems, you might want to ask your dermatologist or your gynecologist about polycystic ovary disease.
Polycystic Ovary Disease
“My doctor thinks I may have polycystic ovary disease and says that this may be the cause of my increased hair growth. Can you explain?”
In polycystic ovary disease, the ovaries (which produce our eggs) are full of small, fluid-filled sacks. These sacks, or cysts, interfere with the production of normal eggs, and many women with polycystic ovaries have some difficulty getting pregnant. Women with polycystic ovary disease also tend to have acne and increased hair growth due to more circulating “male” hormones.
Hair may be slightly thicker all over the body, but it is generally most noticeable on the face and in the abdominal area. In polycystic ovary disease, hair can be very stubborn and require more laser treatments than average to remove it and keep it under control.
Polycystic ovary disease is also associated with acne. A medication called spironolactone may be helpful in lowering testosterone levels enough to help keep the hair and the acne under better control. Oral contraceptives may also be helpful in regulating your period and hormone levels if you have polycystic ovary disease.
“I am in my early 50s and going through menopause. Why am I suddenly developing dark, coarse hairs on my chin and upper lip?”
All women have both female and so-called “male” hormones. Our female hormones are predominantly estrogen and progesterone, and our so-called male hormones are primarily testosterone and something called DHEA (dihydroepiandosterone). In menstruating women, levels of estrogen and progesterone fluctuate all month long in a predictable pattern that results in a period approximately monthly. The effects of the estrogen and progesterone in your monthly cycles override some of the effects of male hormones.
Approaching menopause, however, estrogen and progesterone levels drop because periods are starting to become less regular and ovulation does not occur every month. Thus, there is more “male” hormone (also called androgens) around relative to female hormone. And these “male” hormones cause the change in the hair follicles that you have noticed.
Hair on the chin, upper lip, and sometimes the abdomen starts to increase in thickness and length. Hair in the temple area starts to shrink and miniaturize. Since there are fewer circulating female hormones, hair in the armpit and pubic area often gets sparser too. The increase in hairs on your chin is just one sign of a hormonal change going on all over your body.
It is extremely rare, but occasionally increased hair growth indicates other serious endocrine gland imbalances. This can be tested with blood tests if you are concerned. Usually this type of hair growth is associated with severe treatment-resistant acne. Again, discuss this with your doctor if you are concerned.
“I recently began taking a new medication, and I think I am starting to grow more hair on my face. Is this possible?”
Yes, many medications can affect hair growth or hair loss. Some can even cause both hair growth and hair loss because they have different effects on different people.
Most of us who want hair removal are concerned about the coarser, longer, dark hairs that grow where they aren’t wanted. But sometimes the soft, fine, vellous hairs can be a problem as well. Certain medications in particular can cause these blond hairs to become quite thick and begin to look like “peach fuzz.” Vaniqa cream, a new hair growth inhibitor, may be helpful since blond peach fuzz doesn’t respond well to laser hair reduction.
Some of the most common medications that make hair grow more are prednisone, dilantin and other anti-seizure medications, tamoxifin, which is sometimes used for breast cancer treatment, and testosterone. There are also many others, so if you think a medication may be aggravating hair growth, be sure to discuss this with your primary care physician or dermatologist.
The list is even longer for medications that can make hair fall out. If this happens it is almost always temporary. Some of the most common offenders are medications for blood pressure (like atenolol) and Accutane (a medication used for acne – a mild, temporary effect). But there are dozens of others. If you are concerned that a medication might be making your hair fall out, check with your doctor.
Treatments for unwanted hair
Plucking, Waxing, Shaving, and Hair Removal Creams
“What is the best way to remove hair without spending a lot of money?”
The so-called “physical” methods of hair removal are still very effective and inexpensive. Their only real disadvantages are that they are temporary and sometimes painful.
Plucking. It’s an old wives’ tale that plucking hair will make it grow back thicker and coarser. The hair doesn’t grow back differently just because you plucked it. Plucking and waxing last longer than shaving and hair removal creams because they remove the hair at its root rather than just cutting it off at the surface of the skin.
When plucking hairs, make sure that you have good lighting and good quality tweezers. Clean the tweezers with an alcohol wipe before and after each treatment so that you don’t collect unwanted bacteria on the tweezers. It is also fine to pluck hairs out of moles.
If you are planning to have laser hair removal treatments done, be sure to let the hair grow back in for at least three or four weeks before the laser treatment. The laser beam cannot find the hair to zap it if it is not present in the hair follicle.
Waxing. Waxing is also an excellent method of hair removal when done by an experienced and licensed aesthetician. A thin layer of warm wax is applied to the area and allowed to harden for a minute or so. The wax is then quickly pulled off the skin taking the hair and a thin layer of dead skin with it.
Be sure to let your aesthetician know if you are using Vitamin A or it’s relatives (Retin A, Renova, tretinoin, Differin, Tazorac, retinol, and others). Your skin may be more fragile or sensitive. Waxing will generally last about two to three weeks on the face and three to five weeks on the legs depending on how fast your hair grows.
Waxing rarely transfers infections, because the wax is usually kept fairly hot. But some women have trouble with irritation and ingrown hairs after waxing. If you tend to get irritated, try a little hydrocortisone one percent cream, which is available in the pharmacy, once or twice a day for a few days after the waxing. That should help with the irritation. If you have a lot of problems with ingrown hairs after waxing, you may want to opt for laser hair reduction and maintenance.
Shaving. In the United States, shaving is probably the most common hair removal method used by women. To minimize irritation be sure to shave in the bath or shower after the hair is warm and wet for at least five minutes. Shaving cream also helps, as opposed to soap, because most shaving creams are formulated to soften the hair better.
If you don’t use disposable razors be sure to change your blade at least weekly so that you don’t collect bacteria that might infect your hair follicles. If you get mildly irritated or have a few ingrown hairs after shaving, try hydrocortisone one percent cream on those for a few days.
If you have a lot of trouble with ingrown hairs after shaving you may want to opt for laser hair reduction and maintenance instead.
Also, shaving spreads flat warts, so if you have flat warts on your legs, be sure not to use shaving as your method of hair removal. You may end up with them all over your legs. Waxing is fine while the warts are being treated.
Hair removal creams. These are not as popular as they once were. Because they are strong enough to break down the chemical bonds of hair, they are usually strong enough to really irritate the skin surrounding the hair as well. Some women can use these successfully, but many women find that they are too irritating, particularly over the long haul.
Like shaving, hair removal creams are temporary because they remove the hair from the skin surface rather than from the root of the hair follicle.
“In what situations would you still recommend electrolysis for hair removal? Isn’t it less effective than laser hair removal?”
No, actually electrolysis is very similar to laser hair removal in its effectiveness. It’s just that since each follicle must be treated, electrolysis is a slow process and best for small areas. Each individual hair follicle receives an electrical current that is passed down a tiny wire into the follicle. It is usually more painful than laser hair removal.
Electrolysis may still make sense if you have only small areas of hair that you need to have removed, for example, on your chin or upper lip. Electrolysis is also better for gray or silver hair, because laser hair removal still works best on darker hairs.
As with laser hair reduction and maintenance, one treatment will not take care of all of the hair, and multiple treatments are usually required. Infections and scarring may be complications of electrolysis. Be sure to look for a licensed, experienced electrolysist. Your dermatologist may know a good one in your area. It is helpful if the electrolysist has a medical background, but this is not absolutely necessary.
“I have seen Vaniqa cream recently in commercials. What is this and how does it work?
This relatively new cream is an excellent choice if you have a limited amount of hair in an area like your chin, or if your hair is blond or grey. Also try it if you have lots of blond peach-fuzz type hairs on your cheeks. Remember, laser hair removal doesn’t work very well yet on blond or gray hair. Vaniqa is also relatively inexpensive. Since Vaniqa cream works by inhibiting the growth of the hair but not by killing the root of the hair, if you stop using the cream, it will grow back. It is usually rubbed into the area to be treated twice a day.
Laser Hair Reduction and Maintenance
“How does laser hair removal work?”
The laser emits a very specific beam of light targeted at melanin. Melanin is the pigment in our hair and skin that gives it color. Laser hair removal is easiest when the hair is dark and the skin is light because all of the laser beam energy is absorbed by the hair and not by the skin. But with certain types of lasers, tuned just right, dark hair on dark skin can be removed too. It just needs to be done with extra care and may take more treatments.
“Why does the hair grow back?”
Remember that hair grows in three stages – a growth cycle, a resting cycle, and a falling out cycle. The laser will not destroy the hairs in their resting phase. So you have to come back at intervals to make sure that the majority of hairs get treated during their growth phase.
Also, any single treatment may injure the hair bulb (the source of the hair) but not kill it. The effects of the treatments are cumulative over time. Lasers gradually reduce the number of hairs that grow back but also the hair becomes lighter and finer in texture as the treatments progress.
On average five to seven treatments are necessary to achieve the best results. Most people can expect an 80-90% hair reduction after a series of treatments. The next treatment can be done as soon as further hair growth appears. Certain parts of the body require fewer treatments because the hair in those areas cycles through its phases more slowly.
“Who should be performing laser hair removal treatments?”
There is a lot of controversy right now about who should be performing laser hair removal treatments. Currently, each state regulates laser hair removal systems as it sees fit. In many states only physicians, physician’s assistants, or registered nurses supervised by a physician may perform laser hair removal. In other states aestheticians are allowed to own and operate laser hair removal systems.
The problem is that serious complications can occur from a laser hair treatment that goes wrong. These complications can include permanent scarring and discoloration. For that reason, my personal opinion is that only dermatologists or their supervised physician assistants (PA-C – a higher level of training than an R.N.) or R.N.s should do laser hair removal.
There are some clinics that claim to have a physician on staff, but that physician is actually present on site only rarely. This, in my opinion, does not constitute physician supervision. I think the physician should do more than just check in occasionally from an off-site office.
The bottom line is patient safety, and laser hair removal systems are safest in the hands of dermatologists who are physicians who specialize in the care of skin, hair, and nails. Laser hair reduction done by someone who is not medically trained or supervised may be cheaper. But you have to balance the cost with the risks. I think your safety and appearance are reasons not to scrimp on laser hair reduction.
“How long does hair removal/reduction last?”
Many people report that after five to seven treatments their expectations have been met and that the hair growth pattern is much, much less. You can expect to need more treatments if you have any history of irregular periods, polycystic ovary disease, or family history of excessive hair. Maintenance treatments may be recommended.
In some areas of the body the laser will not only decrease the number of hairs but will make the hairs very fine and lighter in color. Not all of the hairs will be permanently eradicated, but the decrease in number and the lightening of the color and texture may accomplish your goals. You may need touch-up treatments one to four times a year initially to maintain the improvement. About 10 percent of people are resistant to any type of hair removal laser.
“Do laser treatments hurt?”
There may be mild discomfort during the treatment. The level of discomfort is about the equivalent of a very light snap with a rubber band. But very few people discontinue laser hair reduction because of discomfort. Most people tolerate it easily. Some dermatologists recommend purchasing a gentle numbing cream like Elamax/lidocaine, which you can apply approximately 30 minutes before treatment. This may make the treatment more comfortable. Also, taking Tylenol the night before and morning of the treatment may help with any discomfort you may have.
“How long do laser hair removal treatments take?”
Treatments can take anywhere from several minutes to several hours or more depending on the size of treatment area and the type of laser being used. Typically small areas on the face might take 15 to 30 minutes. A bikini line may take 20 to 40 minutes depending on the laser system used and the amount of hair. To do both full legs might take from 45 to 90 minutes. Some lasers have special heads or scanners that speed up the treatment. If time is a premium for you, be sure to ask about this before you tackle large areas like the legs or back.
“What do I need to do before having laser hair reduction?”
Below is a list of things you can do to maximize your results:
It is very important that you do not tan. If you have had any sun exposure in the month prior to your laser hair removal treatment, be sure to notify the nurse or doctor doing the treatment. Tanning of any type changes the laser settings and is the most common cause of complications after laser hair removal. This also includes self tanners. Be sure not to use any self tanners for two weeks before any laser hair removal.
Don’t pluck, wax, bleach, use electrolysis or depilatory creams for at least three to four weeks for the face and ten weeks for the body prior to the treatment. The hair must be present for the laser to find it. Laser hair reduction works best when there is short stubble. You may be asked to shave the day before the treatment if the hair is long.
Take off any makeup or lotion prior to your treatment.
If you are taking antibiotics or any new medications, be sure to inform your nurse or dermatologist prior to the treatment. Medications can cause blistering and other complications and your laser practitioner may need to change the settings of the laser to adjust for the medication.
If you are having your bikini line treated, wear light colored panties in the shape you would like your bikini line. The laser is absorbed by dark colors, and you want the hair to absorb the laser light, not your panties. Some offices have paper panties for you to wear.
Check with your doctor before taking aspirin, ibuprofen (Advil), or Aleve for the week prior to your laser treatment. Tylenol may be safely taken for pain or headaches.
“Can I continue to use my normal products during laser hair treatments?”
Yes, most dermatologists will permit you to continue to use Renova cream, other vitamin A cream derivatives, alpha hydroxy acids, topical vitamin C, and any other products that you are used to using. Check with your dermatologist though just to be sure.
“What should I expect during the laser treatment?”
First, you should expect to read and sign a consent form. Photos often will be taken at the first visit. You should also be given appropriate eye protection for safety reasons. If the laser wand does not have a cooling tip built into it, cooling gel may be applied to your skin. The laser practitioner then passes the laser handpiece over the area you want treated.
The laser beam follows the hair shaft down into the follicle and heats it. The injured follicle will produce a weaker, finer hair or no hair at all on the next growth cycle. Some hairs will be thinned during the treatment and some may be shed after one to seven days. Shaving is fine, but the remaining hairs should not be plucked or tweezed.
“What will my skin look like after the treatment?”
Your skin may have a slightly pink or sunburned look and may have tiny red bumps at the site of the hair follicles. This is temporary and is a good sign that the laser has heated the hair follicle. But don’t worry if you don’t see immediate redness. There are also changes that take place under the skin, and lasers can work without causing any redness too.
“Are there specific instructions following the treatment?”
Be sure to follow carefully any instructions your dermatologist gives you. Your skin should be handled very gently. Cool ice packs are usually fine if the area feels slightly warm. If your dermatologist okays it, hydrocortisone one percent, solarcane gel, or aloe vera gel may be applied. You may be asked to use a topical antibiotic ointment like Polysporin if there is a break in the skin.
It is extremely important never to pick, scratch, or scrub skin that has had recent laser treatments as that could cause scarring. Ask your doctor when to resume your normal skin care products. Usually it is a good idea to take a break from products like alpha hydroxy acids or Renova for a week or so if the skin is irritated after your laser treatment. Again, dermatologists vary somewhat on this so be sure to ask yours what she would recommend.
“What problems should I report to my dermatologist after the laser treatment.”
Be sure to call your dermatologist if you have any breaks in the skin or blistering after a laser treatment. Usually the skin will heal just fine, but your doctor should know about it. You may be asked to use special antibiotic ointment or dressings in this instance.
While there is often a little bit of redness for a couple of days, if the redness increases or the area becomes hot, sore to the touch, or if there is any visible pus or yellow crusting, be sure to call your doctor right away. These symptoms may indicate infection. Also, if you have a history of staph infections in the past, it is not a bad idea to let your dermatologist know that before starting treatment.
“I seem to be getting dark marks at spots where the laser is hitting. Is this normal?”
Many different types of laser treatments can produce these dark marks, particularly if you are a darker skin type. By darker skin type I mean skin that ranges from olive or dark golden skin (that tans easily and almost never burns) to the darkest African-American skin. If you do have a darker skin type, your dermatologist will automatically adjust the laser settings to try to avoid temporary darkening of the skin.
If some darkening (post inflammatory hyperpigmentation) occurs, it is almost always temporary and will go away generally in one to six months. Your dermatologist may ask you to take a break from your laser hair treatment schedule in order to let the skin rest. Sometimes your doctor will prescribe a “bleaching cream” to help it resolve faster. See Chapter 5 for more information on bleaching creams.
If this darkening happens to you, be sure to protect yourself well every single day with a zinc containing sunscreen. Any unprotected light exposure will make the dark spots last longer and more difficult to treat. Also, invest in a good, wide-brimmed hat to wear on sunny days.
“What are the best laser hair reduction and maintenance systems?”
There are three main laser hair reduction systems and a number of other systems that are all safe and effective in experienced hands. The three main systems are the alexandrite laser, the diode laser, and the intense pulsed light system (a close laser cousin) sometimes known as the Epilight. Several different companies make each of these lasers under different trade names. Be sure to look for a laser clinic where either a dermatologist-supervised R.N., or a certified physician assistant, or the doctor does the treatment.
There is always some debate about the relative advantages of one system over another. Many of the physician proponents of one particular laser system are consultants to that particular laser company. In my opinion, that makes it difficult for the particular doctor to be completely objective about the other laser systems. Also, physicians tend to prefer systems that they are experienced on and comfortable with, which also creates a slight prejudice.
Keep in mind that laser hair research is very active right now. New lasers are being tested and marketed all the time. Be extremely wary of marketing hype surrounding laser systems. It is best to stick with systems that are tried and true until a new laser has at least a one to two year track record.
Summary of Unwanted Hair: What to Do
If you have a small amount of unwanted hair, the traditional methods of plucking, waxing, and shaving work fine. The two disadvantages to these methods, as we all know, are that they are temporary (because they remove the hair at the surface of the skin) and they can be uncomfortable. If you have a small amount of unwanted hair that is gray or blond, try Vaniqa cream. For a more permanent solution to unwanted hair in limited places, try electrolysis.
To remove larger areas of unwanted hair more effectively, consider laser hair reduction. The cost of laser hair reduction varies so much by the site treated, the geographic area you live in, and the type of clinic you go to, that it’s not possible here to give meaningful cost information.
While laser hair reduction works well, it has some risks associated with it and is more expensive in the short term. But if you added up all the costs of the other methods you’re using over a three to five year period, you might be surprised at how they compare with the laser. And laser hair reduction is the best, most effective solution to larger or stubborn areas of hair. It has given significant relief to many men and women who were painfully self-conscious of their unwanted hair. Read more about laser hair removal.
See Dr. Irwin’s expert answers to other’s reader’s questions on unwanted hair:
Laser Hair Removal- when is it a good option?
Laser Hair Removal for Bikini area
What is the best way to permanently remove facial hair- especially along the lip line?