You are in: eMedicine Specialties > Dermatology > COSMETICS Nonlaser Hair Removal TechniquesArticle Last Updated: May 27, 2008AUTHOR AND EDITOR INFORMATIONSection 1 of 9
  Author: Alicia Barba, MD, Consulting Staff, International Dermatology Research, Inc Coauthor(s): Leslie Stafford Baumann, MD, Director of Cosmetic Dermatology, Assistant Professor, Department of Dermatology, Cedars Medical Center; Esperanza C Welsh, MD, Cosmetic Dermatology Division, Department of Dermatology, University of Miami School of Medicine Editors: Zoe Diana Draelos, MD, Clinical Associate Professor, Department of Dermatology, Wake Forest University School of Medicine; Primary Investigator, Dermatology Consulting Services; Private Practice; David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic; Christen M Mowad, MD, Associate Professor, Department of Dermatology, Geisinger Medical Center; Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center Author and Editor Disclosure Synonyms and related keywords: shaving, plucking, waxing, hair reduction, laser hair reduction, permanent hair removal, laser hair removal, temporary hair removal, electrolysis, bleaching, depilatory, depilatory creams, depilation, depilatories, epilation, sugaring, threading, electrolysis, electrology, intense pulsed light sources, IPLs, galvanic electrolysis, thermolysis, eflornithine INTRODUCTIONSection 2 of 9
  Background Many men and women choose to remove unwanted body hair for cosmetic, social, cultural, or medical reasons. Medical indications for hair removal include hirsutism, which is excess terminal hair in the distribution of hair growth influenced by androgens (ie, face, chest, back, abdomen),1 or hypertrichosis, which is congenital or drug-induced increase in hair growth in areas that are not androgen dependent. Other medical indications include pseudofolliculitis, hair growth from a grafted donor site, preoperative hair removal, and sex-change operations performed in men. Many methods are available for temporary or permanent hair removal, each with its own relative efficacy and adverse effects. Different methods for the removal of body hair include the following:
The Medscape Aesthetic Medicine Resource Center may be of interest. TEMPORARY HAIR REMOVALSection 3 of 9
ShavingShaving is the method used most frequently to temporarily remove unwanted hair. Shaving is fast, easy, painless, effective, and inexpensive. The results are temporary, lasting 1-3 days, and shaving requires a constant commitment to maintaining a hair-free appearance. Shaving is performed with a razor on wet skin using shaving cream or other lubricants, with the razor oriented against the direction of hair growth. For sensitive areas, shaving with the direction of hair growth may reduce cuts. Contrary to a widespread misconception, shaving does not result in increased hair growth. The primary disadvantages and/or adverse effects of shaving include skin irritation, cuts in the skin, ingrown hair pseudofolliculitis, the need to shave daily, and stubble. EpilationEpilation involves the removal of the entire hair shaft and is the most effective method for temporarily removing hair. Epilation includes waxing, plucking, threading, sugaring, and using abrasives or mechanical devices (eg, Epilady). For epilation to be effective, treated hairs should be long enough for the device to grasp them. The long-term effects of epilation on the hair follicle are not known. Epilation wounds the hair follicle; therefore, repetitive epilation over several years may result in permanent matrix damage, resulting in finer or thinner hairs and, perhaps, as anecdotal evidence suggests, long-term permanent reduction in hair growth. Long-term clinical trials demonstrating the effects of repetitive epilation are lacking. Plucking is best performed using tweezers and is a beneficial and economic method for removing the occasional coarse hair or a small group of hairs, such as those found on the eyebrows, chin, or nipples. The results of plucking last longer than shaving because hair is pulled from the hair shaft, as in waxing. This method is time consuming, tedious, and painful. The reaction of the hair follicle to plucking can be unpredictable, possibly resulting in folliculitis, hyperpigmentation, scarring, ingrown hairs, and distorted follicles. Adverse effects from plucking include pain, hyperpigmentation, scarring, folliculitis, and ingrown hair pseudofolliculitis. Waxing Waxing is similar to plucking and involves applying warm or cold wax onto hair-bearing skin and quickly stripping off the hardened wax and embedded hairs against the direction of hair growth. Waxing is the most expensive yet most effective method of epilation because hair is removed completely from the hair shaft in large quantities. Often, hair can take 2-3 weeks to regrow. The effects on the hair follicle of long-term waxing are unknown. However, theoretically, this modality may reduce regrowth because repeated waxing may destroy follicles. Although many kits are offered for use at home, faster and more successful results are obtained by an experienced salon-based operator who is able to apply large quantities of wax quickly to a large body surface area for faster removal. Although no formal studies have been conducted, the recommendation is that patients using systemic retinoids (ie, isotretinoin [Accutane], acitretin [Soriatane]) refrain from waxing until treatment has been discontinued for a minimum of 6 months to 1 year to avoid tearing of the skin and scarring. Patients using topical retinoids (ie, tretinoin [Retin-A, Avita], adapalene [Differin]) should also be careful when waxing to avoid injuring the skin. It is recommended that a sign be visibly placed in waxing salons adverting clients not to wax if using systemic or topical retinoids. Threading is an ancient manual technique, popular in many Arabic countries, that involves the use of a long twisted loop of thread rotated rapidly across the skin. By maneuvering the twisted string, hairs are trapped within the tight entwined coils and are pulled or broken off. Adverse effects from threading include pain, hyperpigmentation, scarring, folliculitis, and ingrown hair pseudofolliculitis. Abrasives Abrasives such as pumice stones and devices or gloves made of fine sandpaper work by physically rubbing the hair away from the skin surface. This method can be irritating to the skin and is not commonly used today for hair removal. Sugaring Sugaring is similar to waxing. The sugar mixture is prepared by heating sugar, lemon juice, and water to form a syrup. The syrup is formed into a ball, flattened onto the skin, then quickly stripped away. Similar to waxing, the hair is removed entirely from the hair shaft, and sugaring is an alternative to waxing for people sensitive to wax. Adverse effects from sugaring include pain, hyperpigmentation, scarring, folliculitis, and ingrown hair pseudofolliculitis. DepilationChemical depilatories remove part of the hair shaft and are easy and painless to use. The standard chemical depilatory agents, available in gels, creams, lotions, aerosols, or roll-on forms, are the salts of thioglycolic acid (sodium or calcium thioglycolate) that were patented in the 1930s for removing the hair from cattle hides. Thioglycolate depilatories work by hydrolyzing and disrupting disulfide bonds of hair keratin, causing the hair to break in half and allowing the hair to separate from the skin. Depilatories are good for use on the legs, bikini line, face, and underarms, and they perform best when hair is at a reasonable length. Before using a depilatory, carefully read the manufacturer's instructions. Test a small site before use to assess for irritation or allergic reactions. Do not use these agents on eyebrows, near mucous membranes, or on broken skin. Adverse effects include skin irritation, burns, folliculitis, ingrown hairs, and allergic contact dermatitis to either thioglycolate or fragrances. BleachingBleaching is not a method of hair removal, but many women use bleaching as an inexpensive method of disguising the presence of unwanted hair by removing the hair's natural pigment. Common sites for bleaching include the upper lip, beard area, and arms. The active ingredients in over-the-counter bleaching agents are hydrogen peroxide and sulfates as activating agents, a combination that bleaches, softens, and oxidizes hair. A variety of commercial bleaches are available, and the manufacturer's instructions are easy to follow. As with chemical depilatories, perform a small patch test to assess for allergic reaction. The disadvantages of bleaching include skin irritation, temporary skin discoloration, pruritus, and the prominence of bleached hair against tanned or naturally dark skin. Reports exist of generalized urticaria, asthma, syncope, and shock in reaction to the persulfate activator added to boost the effect of hydrogen peroxide bleach. TEMPORARY HAIR REDUCTIONSection 4 of 9
Eflornithine Eflornithine (see Medication), a novel method for temporary hair reduction in women, is a topical cream available by prescription only and has been approved by the US Food and Drug Administration for the reduction of unwanted facial hair in women.3 Eflornithine is not a hair remover or depilatory, but is a topical cream that decreases the rate of hair growth. It works by inhibiting the enzyme ornithine decarboxylase, an enzyme in human skin that stimulates hair growth. When this enzyme is blocked by the medication, metabolic activity in the hair follicle decreases and hairs grow in more slowly. It has been studied only on the face and the adjacently involved areas under the chin; therefore, it should be used only in those areas. Because eflornithine does not remove hair, it must be used in combination with the patients' normal hair removal methods (eg, shaving, waxing, plucking). It is rubbed onto the affected areas on the face twice daily. MEDICATIONSection 5 of 9
Drug Category: Topical Skin ProductApproximately 32% of 393 female subjects showed marked improvement (reduction of unwanted facial hair) compared with only 8% of 201 control subjects who used placebo. Results are based on prerelease clinical trials in which eflornithine was used twice daily for 24 wk (6 mo). Improvement often occurred in as few as 4-8 wk. After discontinuing treatment, facial hair growth was similar to pretreatment levels within 8 wk.
PERMANENT HAIR REDUCTIONSection 6 of 9
Laser-assisted hair removal Laser-assisted hair removal is a method available to achieve permanent reduction of unwanted hairs. The various lasers now most commonly available for hair removal are the alexandrite laser (755 nm), diode laser (810 nm), and Nd:YAG laser (1064 nm). These lasers target melanin and subsequently produce selective photothermolysis of the hair follicles. The longer wavelengths, such as with the 1064-nm Nd:Yag laser, are safer for darker skin types IV-VI. The risk for adverse events such as dyspigmentation, blistering, crusting, edema, and scarring is greater with darker skin types.4 See Laser-Assisted Hair Removal for more information. Intense pulsed light sources use the same principle of selective photothermolysis used with lasers to target melanin in hair follicles; however, a noncoherent filtered flashlamp that emits wavelengths ranging from 500-1200 nm is used in this process, rather than one wavelength. Different cutoff filters are used to select the appropriate wavelength for each patient; however, intense pulsed light subjects the skin to a wider range of light energies of varying absorption coefficients for the chromophores, which may expose the patient to some unnecessary wavelengths. A disadvantage of intense pulsed light is that some machines have capitated maximum energies, which can hinder those patients needing higher energies in order to achieve better results. PERMANENT HAIR REMOVALSection 7 of 9
Electrolysis Electrolysis, also termed electrology, is an effective method for permanently removing hair, especially in small areas. Electrolysis involves the insertion of a small, fine needle into the hair follicle, followed by the firing of a pulse of electric current that damages and eventually destroys the hair follicle. Multiple treatment sessions are required to achieve a clinically significant result. The 2 types of electrolysis are galvanic electrolysis (direct current electrolysis) and thermolysis (alternating current electrolysis).
Most modern electrolysis machines use thermolysis or the blend method, a combination of galvanic electrolysis and thermolysis. Unfortunately, no controlled clinical trials have compared the 2 methods, and claims of superiority of one method over the other are based on anecdotal evidence. Significant evidence indicates that the region of the erector pili muscle insertion is the site of the stem cells responsible for hair regeneration. More research is needed to determine the effects of electrolysis on this region. Electronic tweezer devices have been developed for home use; however, because hair is not an electric conductor, current cannot be transmitted via hair to the hair bulb. In addition, no published data prove that damage occurs in the hair follicle or that these devices produce permanent hair removal. Likely, they represent a means for temporary hair shaft removal similar to waxing or plucking, but do not work well as a means of permanent hair removal. Important and potentially permanent adverse effects of electrolysis include scarring (ie, keloid formation) and postinflammatory hyperpigmentation or hypopigmentation, adverse effects that are dependent on technician experience and the duration and intensity of the current. Pain, a primary adverse effect of electrolysis, can be diminished with the use of new topical anesthetic creams (eutectic mixture of local anesthetics [ELA-Max]) 1 hour prior to the procedure. This should be performed in a monitored setting and only to limited areas of skin. Maintaining some sensation is desirable because pain is related to the amount of damage to the hair follicle. Other adverse effects include local bacterial and viral infections. The spread of hepatitis or HIV has not been reported with electrolysis. Electrolysis is not safe for patients with pacemakers and should not be used on these patients. SUMMARYSection 8 of 9
Temporary and permanent methods of hair removal or reduction are important components in the treatment of patients with unwanted hair. No single method is perfect for all patients. Factors such as the underlying medical conditions causing excessive hair growth, size and location of treatment area, desire for temporary versus permanent hair removal, and expertise of the technician providing treatment should be considered when choosing a method for nonlaser hair removal. REFERENCESSection 9 of 9
Nonlaser Hair Removal Techniques excerpt Article Last Updated: May 27, 2008 |
