Hair Removal & Reduction - Canadian Dermatology Association (2024)

Topical
Over-the-counter depilatory products or hair removal creams are available without a prescription, and should be used as directed because misuse can burn the skin. It’s important to do a patch test before using a depilatory cream to test for any type of skin irritation or intolerance.

Procedural
Shaving is the most popular hair removal method among men and women. It is inexpensive, fast, convenient and relatively painless. However, the possibility of nicks, cuts, fast regrowth and ingrown hairs has prompted consumer demand for smoother, long-lasting results.

For best results with shaving the following can be helpful:
• Wet skin before shaving, dry shaving can increase risks of cuts and ingrown hairs.
• Use a shaving cream or gel.
• Shave only in the direction of hair growth.
• Avoid going back and forth in two or more directions over shaved sites.
• Store your razor in a dry area.

Threading is a method of hair removal originating in Asia, now popular in Western countries. In threading, a thin (cotton or polyester) thread is doubled, then twisted. It is then rolled over areas of unwanted facial hair, plucking the hair at the follicle level. Threading can be more painful than waxing but the effect lasts for six to 10 weeks.

Waxing involves applying a layer of melted wax to skin, then pulling it off quickly in the opposite direction to hair growth. This pulls hair out by the root and thus slows hair regrowth, which may occur after two to three weeks depending on the individual.

Both warm and cold wax techniques are available. Extra caution is necessary with warm wax to ensure it is not so hot that it burns skin. Redness and sensitivity can last hours after hair removal. Repeated damage to hair follicles, some believe, may eventually result in diminished hair growth at the site of repeated waxing.

Negative side-effects include pain during removal, as well as ingrown hairs or folliculitis, scarring, hyperpigmentation and dermatitis. Waxing should be avoided on irritated, sunburned or broken skin. Also avoid waxing if you use certain types of prescription acne creams or take isotretinoin (Accutane) ; the wax can make skin more prone to injury.

Sugaring is similar in its process to waxing. It consists of a soft paste that is applied to skin at the site of desired hair removal, then pulled off.

Electrolysis is the only hair removal method that can permanently remove hair. This method of hair removal can be used in patients of all skin colours. The process involves insertion of a small, fine needle into the hair follicle, followed by use of a small electrical current to damage and then destroy the follicle.

There are two main methods:

  • Galvanic electrolysis uses a direct electrical current to create a chemical reaction that destroys the hair follicle.
  • Thermolysis, a high-frequency alternating current, creates vibrations strong enough to heat and destroy hair follicles.

A blend of the two methods is sometimes used. Effectiveness depends on the technician’s skill. Each treatment lasts between 15 minutes and an hour. This method can be painful; a topical anesthetic cream applied an hour before the procedure can reduce discomfort.

Electrolysis can cause redness in treated areas, as well as scarring and increased or reduced pigmentation. It should not be used by people who have pacemakers.

Intense pulsed light (IPL) machines are not lasers. These machines use a highly concentrated beam of light, often in conjunction with a cream or gel, to burn the hair shaft. IPLs produce a wide bandwidth of light that can heat all the surrounding tissue, making it less effective in disrupting hair growth and a higher risk for burns, especially on darker skin.

Risks of IPL include eye injury, skin pigmentation changes, scarring, and paradoxical hair stimulation.

Given the significant risk of injury, it is advisable to undergo this procedure after consultation with a dermatologist, or under a dermatologist’s supervision.

Hair Removal & Reduction - Canadian Dermatology Association (1)Laser hair removal consists of using a targeted laser beam to penetrate and destroy hair follicles that produce hair. Results can last three to six months or longer before hair grows back visibly. A series of six to eight treatments, spaced eight to 12 weeks apart, is usually required for permanent results.

Potential side-effects include blistering, skin discolouration, redness, swelling and scarring. Pigmentation problems, such as white spots where lasering has occurred, tend to be a greater risk with tanned or darker skin.

Due to the significant risks involved in laser hair removal which can include, eye injury, skin pigmentation changes, scarring, skin burns and paradoxical hair stimulation, it is advised to undergo this procedure after consultation with a dermatologist, or under a dermatologist’s supervision.

Am I a candidate for this procedure?
Laser technology works by targeting dark pigment in the hair follicle. Certain lasers work best on pale skin and dark, coarse hair. Darker-skinned patients with black hair will require a different type of laser. Blond, red or white hair does not readily respond to laser therapy.

In general, the lighter the skin and the darker/coarser the hair, the better the results.

How does laser hair removal work?
Lasers designed for permanent hair reduction emit wavelengths of light that are absorbed by the pigment in the hair (melanin). If the surrounding skin is lighter than the colour of the hair, the energy of the laser is concentrated in the hair shaft, destroying it without affecting the skin or the follicle.

Is laser hair removal permanent?
Hair removal lasers have been in use since 1997, and are approved for “permanent reduction.” They permanently disrupt hair production, provided the right type of hair is treated with an appropriate kind of laser, at effective settings.

However, hair removal lasers do not remove 100 percent of the hair in an area. With proper treatments, laser can remove most of the coarse hair on a body area, but it cannot remove finer hair. To achieve total hair removal in any area, most people need follow-up electrolysis treatments to remove remaining finer hairs.

Any hair that grows in after 12 months is new hair that can develop due to numerous factors such as age, medical conditions or hormonal changes.

Is laser hair removal painful?
Generally, laser hair removal is not much more painful than waxing, but the sensation is different. Each pulse resembles the feeling of a rubber band snapping against the skin for a moment. Pain is only felt while the laser is hitting the skin; it doesn’t last. Most people do not require anesthetic cream, though one can be prescribed to more sensitive patients to apply prior to the procedure.

Topical
Eflornithine hydrochloride works by blocking an enzyme that stimulates hair growth. Eflornithine HCl cream has been shown to slow the rate of growth, and is approved as a prescription cream to reduce unwanted facial hair in women. In some patients, the cream can cause acne, folliculitis, stinging or burning of the skin, redness or skin irritation.

Women who are pregnant or breastfeeding should consult with their doctor before using.

Eflornithine is applied twice daily, at least eight hours apart. Results may be seen in four to eight weeks.

Oral
Spironolactone is a diuretic (water pill) that can be used to lower blood pressure. In dermatology, it is used in certain situations to block androgen (male hormone) activity, which is normally produced in all women in low levels. Higher androgen levels in women can cause acne and unwanted facial or chest hair.

Spironolactone is taken daily. Your doctor may do bloodwork to check on your kidney function and potassium levels while taking this medication, or ask you to check your blood pressure periodically.

Women should avoid getting pregnant during the duration of use of the medication as it can affect the development of an unborn baby. It is not used in pregnant or in breastfeeding women.

Hair Removal & Reduction - Canadian Dermatology Association (2024)
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