Hair Removal Methods

Shaving

Drawbacks and benefits of shaving are well known. Electric razors may minimize the skin irritation, but generally do not shave as close as sharp razor blades. Skin should be shaved wet, not dry. Contrary to popular belief, shaving does not lead to thicker, coarser hair, and does not increase the rate of hair growth.

Bleaching

Although bleaching does not remove hair, it removes the hair pigment rendering the hair nearly invisible. Hydrogen peroxide, 6%, is often used for this and many commercial preparations are available.

Depilatories

These are highly alkaline chemicals (usually calcium thioglycolate) which when applied to the skin can destroy the exposed hair. They can be effective for some, but for most individuals the drawbacks are appreciable. These creams can cause skin allergic reactions and can leave the skin quite irritated. They are messy to use, and often have an unpleasant odor. The benefits are very brief, perhaps only days before hair stubble is again noticeable. Frequent treatments can become expensive, and repeated use over time increases the likelihood of developing a reaction.

Depilatories should never be used near the eyes, or on inflamed or damaged skin. Do not use them after a recent exfoliation treatment such as a loofah rub or salt rub.

Hair Pulling Methods

The following methods all involve hair pulling and/or extensive rubbing: plucking, tweezing, waxing, threading (khite), sugaring, sandpaper mittens. Consequently, they all have similar risks and side effects. These include skin irritation and/or reddening (treatable with 1% over-the-counter hydrocortisone cream), possible folliculitis (infection), scarring, and skin pigmentation abnormalities. Ingrown hairs can develop which in turn can cause folliculitis.

Folliculitis means that a bacterial infection has developed in one or more hair follicles. It may initially look like acne, but without treatment pustules or abscesses can develop, and the infection can spread. Early recognition is important and antibiotics are usually necessary. Extensive scarring may result.

Plucking and Tweezing

These time-honored methods of hair removal are effective for removal of sparse, scattered hairs, especially from the facial area. For many women, however, a lot of time is spent almost daily to keep the situation under control. Plucking has been reported in some cases to lead to scarring, ingrown hairs and distorted follicles. Over time coarser hairs may result. Also, plucking is painful and must be practiced practically forever.

Waxing (also known as "masochist's delight")

Warm wax is applied at most salons, and then a linen paper strip is placed on the warm wax. After the wax cools, the linen paper is quickly ripped off the skin against the direction of hair growth. The procedure is hygienic, safe but exquisitely painful. It is not known if the hair is actually pulled from the root or just broken off at a point beneath the skin.

The skin does becomes smooth and hairless for a short while; however, some hair has to be allowed to grow out in preparation for the next waxing, usually four to six weeks later. Consequently, hair-free skin is only present for a portion of the time between waxings.

Side effects include the pain of the procedure and skin irritation and reddening immediately afterwards. Bruising, skin burns, bumps, welts and crusting or scabbing can occur and there can be even be some skin bleeding after waxing. Not all hairs are removed. After repeated waxing, due to damage to the hair follicles, the hairs may become thicker and coarser and ingrown hairs may begin to develop, which can make waxing ineffective at hair removal. Follicultits can develop (see above).

Waxing should not be done over varicose veins (they can bleed), moles or warts. It should not be done to the eyelashes, inside the nose or ears, on the nipples or the genital areas, or on irritated, chapped sunburned or cut skin.

Avoid waxing one week before your expected menstrual period. Skin swelling or edema is pronounced at this time in the cycle.

Case reports have been published of severe widespread folliculitis in teenagers requiring antibiotic treatment and which can lead to permanent thick scarring known as keloids. (Cutis, Vol. 59, Jan. 1997, pages 41-42).

Threading (also called Khite)

This ancient hair-removal technique that is widely practiced in the Middle East is now starting to show up in Western society. The practice is tedious, time-consuming, but fascinating. The word "khite" translates to "thread". The technician, who must be highly trained, holds one end of a long cotton thread in her mouth, and manipulates the other end into a loop or "noose". The loop is formed around the base of each individual hair shaft, it is tightened and then the hairs are yanked out, one-at-a-time. Some say it hurts less than waxing, but others say it "hurts like hell!" It is relatively inexpensive like waxing, but the hairs grow back, requiring treatments every 3-4 weeks. As with other hair pulling techniques, khite may cause skin reddening, folliculitis (infection of a hair follicle), or skin pigmentation changes.

Sugaring

This method originated in Egypt thousands of years ago. A paste of sugar, lemon and water is made and carefully rubbed on the area of skin to be treated. The "sugaring" material is applied and removed with a flicking motion. The sugar sticks to the hairs, pulling them out. The effects are similar to waxing, so treatments need to be repeated every four to six weeks. Side effects include skin irritation and/or reddening due to the sandpaper-like effect of rubbing the paste on the skin.

Hair removal gloves

A mitten made of fine sandpaper is worn. It is rubbed in a circular motion over hair stubble up to several times a day. This method is not widely used in the U.S. A pumice stone can also been used for this purpose, but it can cause skin irritation.

X-Rays

In 1897, x-ray therapy to the skin was found to cause permanent suppression of hair growth, but the risk to the skin from the radiation was felt to be too great to ever use x-rays for this purpose. However, in 1920, Dr. Albert Geyser began using x-rays to treat excessive hair at his "Tricho Institute" (so named because hypertrichosis is the medical term for excess hair growth). He claimed to have perfected the method so that it became "harmless." This turned out to be a public health disaster. It took 20 years to prove that these x-ray treatments were causing skin cancer, and this treatment modality did not disappear until the late 40's.

Do-It-Yourself Electrolysis Tweezers

These devices have been around since the early 70's, and they are rarely used nowadays. The authors of a recent review article concluded that electronic tweezers absolutely do not work. There is no permanence. Hair does not conduct electricity; therefore, tweezers cannot hold onto a hair above the skin, administer electricity and destroy the hair follicle deep below the skin surface. If the follicle is not destroyed, the hair can regenerate. (Electrolysis: Observations from 13 years and 140,000 hours of Experience, Journal American Academy Dermatology, 1995; 33:662-66, 1995.)

The FDA declared that these devices were no better than ordinary tweezers they also concluded that this method could lead to cataracts.

Electrolysis

This method of achieving permanent hair removal has been practiced for over 100 years. The practice of electrolysis involves the placement of a long, thin needle into the hair follicle, followed by some type of electric current so that the follicle is heated up and destroyed. The hairs are treated one at a time. The process is generally painful and takes many sessions over a months to years to achieve desirable results.

On the face, there may be from 500 to 750 hair follicles per square centimeter of area (a square inch is 6 square centimeters). An experienced electrologist can treat about one hundred hairs during a one hour session with fees from $60 to $100 per hour (close to one dollar per hair!). At all times, some hair follicles are in their active growth stage (anagen) and thus there is a visible hair present. Others follicles are in a dormant stage and remain invisible (and untreatable) until they cycle into their active growth stage, so multiple sessions over time are required to treat all of the follicles in a given area. To effectively remove the hair from just an upper lip can take ten to twenty sessions, about 30 minutes per session, over the course of one to two years. The total amount spent for just the upper lip might be $500 to $750. It would take hundreds or thousands of hours to treat large areas of the body.

There are other drawbacks to electrolysis besides the pain, cost and time-consuming aspects. Some individuals experience scarring, seen as pale dots on the skin in the treated areas. Diminished pigmentation may occur. Improperly performed, electrolysis can lead to incompletely damaged hair follicles. These follicles may produce a sideways hair which becomes an ingrown hair, leading to pain, infection ad/or scarring. Also, if not performed correctly, there may be no damage at all to the follicle resulting in complete hair re-growth. Electric shock can occur and infection can occur if the needles used are not properly sterilized.

Lasers and Intense Pulsed Light (IPL)