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Hair Removal

Dr Vivian Oputa

Hair which is an appendage of the skin forms in a pouch-like structure below the skin known as the hair follicle. The hair shaft that is visible is made of hardened keratinized tissue that grows from the follicle. Humans have more hair follicles per square inch of skin than most higher primates such as gorillas and chimpanzees.

Most of the hair known as Vellus Hair is fine and pale making it invisible to the naked eye. The forehead, for instance, actually has more hair follicles than any other part of the body. Thicker fully pigmented visible hair is known as Terminal Hair and it is found on the scalp, eyebrows, legs, underarms, back and pubic area. Hormonal influences in men are responsible for the growth of facial and chest hair.

Everyone has different hair growth patterns depending on age, weight, metabolism, ethnicity, hormonal balance and medication. Genetics also determines hair quality, distribution, colour, thickness, texture and rate of growth.
There are 3 distinct phases of hair development namely: growth, resting and shedding. Not all hairs are in the same stage at the same time. About 90% of hair is in the growth phase while the other 10% is in the resting phase after which it is shed.

The growth or Anagen phase can last between 2 and 6 years and the hair shaft is at its thickest. The resting or Catagen phase lasts 2 to 3 months and the shedding or Telogen phase lasts five to six weeks and with this process, new hair begins to grow to replace shed telogen hair which is very fine.
Men and women alike may have unwanted hair that requires removal and there are various procedures available to handle this problem. There are temporary, long term and “permanent” methods. Note that no method of hair removal is 100% effective in all clients. Long term hair removal may leave an individual hair free for 6 months while Permanent hair removal essentially refers to a treatment that prevents hair growth for a year or more.

Temporary Methods

Shaving: Is quick and affordable but can cause cuts, irritation and ingrown hair. It only lasts a few days.
Chemical Depilatories: These are creams, pastes, powders or sprays made of chemicals that dissolve the hair. They are also quick and affordable and are generally used to remove leg, face and underarm hair. They usually smell offensive, can cause irritation and results typically last a few days. A patch test is advisable before use to check for allergies. If irritation is a problem, 1% Hydrocortisone cream may be applied before the chemical depilatory.
Waxing (Physical Depilatories): This method has become increasingly popular in the salon and spa settings. It is quick, painful, may cause ingrown hairs, irritation, folliculitis and pigment change. There are soft and hard wax treatments (which may be costly) with results lasting 4 to 6 weeks. Patients on Accutane should avoid waxing while on medication and for 30 days after completing treatment because skin becomes delicate and the waxing process may remove the skin.

Threading: In this procedure, thread is twisted in a way to catch hairs and pull them out. It is quick, may be expensive, painful, causes ingrown hairs, folliculitis, irritation and pigment change.
Bleaching: Hair bleach is generally used for facial hair to reduce its visibility. Often times this process results in hair lighter than the skin making it even more visible. Irritation may be a problem.
Tweezing: Is affordable, time consuming, may be painful, causes ingrown hair and pigment change. Results may last a few days to at few weeks.

“Permanent” Methods

Electrolysis: This procedure is effective in most cases. An electric current travels down a needle which is inserted into the hair follicle destroying the papilla that provides nourishment to the hair. This process is time consuming, painful and expensive. It can also cause hypo/hyperpigmentation.

Light Hair Removal: This method is also known as laser assisted hair removal. Pulsed light disables the hair root. Hair removal may be long term and this process may be as effective as laser hair removal if performed properly.
Laser: A beam of laser light is sent to a group of hair follicles with enough power to destroy the root but not enough to damage surrounding skin. This is known as selective photothermolysis. The laser identifies the hair follicles by targeting the pigment (melanin) that gives the hair and skin colour. The laser is also attracted to dark skin due to its melanin content thus increasing the risk of pigmentation problems as a side effect. The laser is typically not effective in people with red, blonde or grey hair colour and should be avoided in dark skinned or tan individuals. The ideal candidate typically has dark coloured hair and light skin. Some laser surgeons apply Meladin dye to fair hair to darken its colour in order to improve the efficacy of the procedure. 3 treatments are usually required. Hair removal may not be permanent but the amount of unwanted hair is significantly reduced and subsequent hair growth is finer in texture and lighter coloured which satisfies most patients. It is an expensive procedure which may be painful enough to require a topical anaesthetic or sedation. Laser only destroys hair in its active phase of growth (Anagen phase).

Prescription Oral Medication: When unwanted hair growth is due to hormonal imbalances such as the high testosterone levels seen in polycystic ovarian syndrome (PCOS), drugs like Spironolactone and Cimetidine are prescribed. These inhibit hair regrowth after removal and are effective for as long as they are used.
Prescription Topical Medication: A relatively new prescription drug known as Vaniqa helps prevent hair growth. This is generally prescribed for unwanted facial hair in women. Regular use reduces the frequency needed to perform your hair removal method of choice until the hair growth stops completely. Hair regrowth will occur about 8 weeks after stopping treatment.

Hair Regrowth generally takes 8 to 13 weeks from papilla to the surface of the skin. You should discuss any problems with excessive hair growth with your doctor.


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