Excess Hair

For excess hair treatments, please see our special section on hair removal.

Hair is present over the entire body with the exception of the soles of the feet and palms of the hands. Hair serves several important functions, including protection and sensation. For example, eyebrows and eyelashes, along with hair in the nose and ears, all filter out dust, bugs and airborne debris.

Androgens are the main regulator of normal human hair growth. An androgen is defined as any hormone that stimulates male characteristics. The two main androgens are androsterone and testosterone. These hormones are manufactured mainly by the testes in males and to a lesser extent by the adrenal glands in both men and women, as well as by the ovaries in women. Women normally have a small percentage of male hormones, in the same way that men’s bodies carry some female sex hormones, (estrogens). The androgens are responsible for the secondary sex characteristics we see such as beard growth in men and deepening of their voices at puberty. Androgens also stimulate growth of muscle and bones throughout the body and thus accounts in part of the greater strength and size of men compared to women.

Hair itself, consists of a root (follicle) formed in the lower layers of the skin and a hair shaft that grows out beyond the skin. The hair follicle is the only permanently regenerating organ in the body. The actual “hair shift factory” contains one of the most rapidly proliferating cell populations of the body. Its life-long cyclic regression and regeneration activity makes the hair follicle unique among all the body organs.

Hair grows in a cyclical fashion, undergoing cycles of growth (anagen), regression (catagen) and rest (telogen). Different areas of the body have varied rates of growth…facial beard growth is the most rapid; hair on the scalp is next, followed by axilae (underarm), thighs and then eyebrows.

Hair color is the result of varying amounts of melanin within the hair shaft. White or gray hair is the result of loss of pigment.

No other organ in the body is subject to additional regulatory influences by so many different factors as the hair follicle. Most major hormones have been demonstrated to alter hair growth and or hair cycles. Many things including endocrine disorders, neural and vascular influences and nutritional factors can affect hair quantity and distribution. Hypothyroidism, or underactive thyroid causes changes in hair texture and can account for excessive scalp hair loss. Medications, along with chemotherapy and radiation therapy as a treatment for cancer, can cause hair thinning or loss.

The term “hirsutism” defines the presence, in women, of hair growth, in a pattern more typically seen in males. This is related to an increase in androgen levels. At the time of puberty, the secondary sexual characteristics develop and as stated above, in men includes the appearance of hair on the face, (mustache and beard), chest, shoulders, back, buttocks, arms, thighs, lower abdominal and pubic area. If this is seen in women, it means that there is an increased secretion of androgens by the ovaries and/or the adrenal glands. There are multiple causes for hirsutism, including genetic, and many clinical features. The most common acquired cause of this condition in women is polycystic ovary syndrome (PCOS), which accounts for 70 to 90% of all cases.

There are a large number of women who visit physicians for this problem. Depending upon the particular case and cause of hirsutism, hormonal therapy may be advocated. Excessive facial hair in particular, can be a source of great psychological distress in women and can lead to problems with self-esteem, anxiety and depression. It is believed to affect between 5 and 15% of women and probably higher. Current cosmetic methods of hair removal include shaving, depilatories, waxing, bleaching, plucking, electrical depilation, lasers, and intense pulsed light (IPL). The choice of removal method depends upon the type of hair, the area being treated and previous treatment history.

Tweezing/plucking and depilatory wax should be used with caution as some data suggests that this can potentially cause inflammation and trauma to the hair root with the subsequent development of ingrown hairs and further skin damage. Shaving does not affect the hair root and therefore has no inflammatory effect. There is a common misconception that shaving the hair causes more and coarser hair to grow. This is absolutely not the case. The hair whether shaved or plucked or waxed or left alone, continues to get coarser with age, especially after menopause when female hormones disappear but male hormones continue to be produced, albeit in a lesser amount.

The use of lasers to remove unwanted hair is the fastest growing, most efficient and safe method for long-term hair removal currently available. In most cases, laser hair removal provides longer lasting hair growth delay compared to other conventional methods such as shaving, wax, epilation and depilatory creams. Lasers target hair follicles to alter the growth cycle and provide the opportunity for rapid treatment of large areas with long lasting results. In contrast to electrolysis, lasers are associated with lower treatment discomfort and allows for quicker treatment of large areas of the body without the need for targeting each individual hair follicle.

Laser light passes through the surface of the skin, is absorbed by melanin located in the follicle and is converted into heat energy, destroying the hair tissue. The target region is the stem cell population, which consists of modified outer root sheath cells. In this region, the cells multiply very quickly during the growing phase (anagen) of the hair cycle. Pigmented cells are concentrated in this cell population. This would indicate that laser hair removal is most effective when hair is in the anagen phase although conflicting results have also been reported.

There are various laser systems available for removal of unwanted hair. Skin type/color is an important factor in choosing the type of laser best suited for you. If the laser pulse is too long or too intense, this can result in heat damage to tissue, which can cause scarring. Clinical data suggests that darker skin is best treated with longer wavelength lasers. The ideal person for treatment with laser hair removal is a fair skinned individual with dark hair, however, people with dark colored skin can be treated effectively with comparable results to those with lighter colored skin. Suntanned skin is less responsive to laser treatment and has a high risk of blistering and scarring. It is recommended that treatments be postponed for 3 weeks after sun exposure to ensure no problems occur. Likewise tanning products interfere with laser treatments as well. Candidates for laser treatments should discontinue use of self-tanning products for two weeks prior to and after treatments as well.

Hair growth is succesively reduced with each laser treatment, allowing for long-term hair reduction after a series of laser treatments. Partial hair regrowth typically occurs after 6 months requiring additional maintenance treatments necessary.

Advanced in laser technology over the past decade have spawned the development of numerous red and infrared lasers and light sources for use in the treatment of unwanted facial and body hair. Lasers enable selective “photothermolysis” in which specific wavelenghts of laser light produce selective heating in skin targets such as blood vessels or hair follicles to promote destruction of the particular target.

Contraindications for laser treatments are as follows:

• Any active skin infection
• History of Herpes Type I or II – prophylactic antibiotics for 1-3 days prior to treatments to prevent likelihood of an outbreak
• Tanning lotions – off for two weeks prior to treatment
• Sun Tanning should be avoided between treatments
• No Retin-A for two weeks prior to treatments
• Blood thinners may be a problems with certain lasers
• No Doxycycline or other light sensitizing drugs for 4 days prior to treatment
• Immunosuppressive drugs are light sensitive – check with your physician
• St. John’s Wart (herb/supplement) – taken in conjunction with laser treatments can cause severe burns
• No deodorant can be worn for treatments in the axilae area
• Hair should be shaved prior to treatments
• Pregnancy and nursing
• Patients who have used Accutane within the last six months
• Broken or extremely dry skin
• A history of keloid scarring should be taken into consideration

Will it hurt?

Laser treatments for hair removal are generally well tolerated by patients and do not usually require anesthesia. However, because the hair follicle is surrounded by nerve endings, topical anesthesia may be preferred when large surface areas of the body are treated or sensitive areas such as the upper lip or bikini area. In these cases, topical application of anesthetic cream for 1-2 hours prior to laser treatment is adequate. Inappropriate administration (prescribed or self applied) of topical anesthetics has been reported to cause severe complications and even death in an extreme case (Both legs and thighs treated with topical anesthetic for a long time with occlusion under saran wrap, to enhance penetration). Careful application, under the supervision of a Board Certified Dermatologist or Plastic Surgeon is advised, in order to ensure complete safety. In our offices, we have not had a single problem with topical anesthetics in over 6 years and hundreds of treatments.