Excerpt from Laser Hair Removal

Laser Hair Removal by Samer Alaiti, MD

Although loss of hair is usually perceived as emotionally devastating, excessive hair growth can be equally problematic. Many women and even men strive to achieve a hairless state in certain body regions as dictated by society.

Hair removal market in the United States is flourishing and currently exceeds 1 billion dollars annually, most of which is spent on electrolysis. None of the hair removal methods available today permit complete or permanent hair removal. This goal will be obtained as researchers learn more about hair anatomy, physiology, growth cycle, and laser-tissue interactions, and as more sophisticated technologies emerge.

History of the Procedure: Over the years, many methods for hair removal have been employed; all of the following methods are successful in temporarily removing hair.

Manual plucking, tweezing

This method offers an easy and practical method for removing single hairs, although it usually stimulates new hair growth by inducing the anagen state. Additionally, it can create postinflammatory hyperpigmentation, true or pseudofolliculitis, and scarring (rarely).

Shaving

This method can be employed for a rather large surface area such as upper or lower extremities.

Disadvantages and risks include skin erosion, potential pyoderma, folliculitis, ingrown hairs, postinflammatory hyperpigmentation, and stimulation of rapid regrowth of darker, thicker hair.

Waxing (hot or cold)

For most women, this is probably the preferred method for hair removal of an extensive area (legs, arms, lower abdomen, bikini area, eyebrows, facial hair).

Hair regrowth is slow, although new hairs usually are darker and coarser.

Waxing is mildly-to-moderately painful (depending on individual and body site).

It can create significant irritant dermatitis (either from the physical nature of this procedure or the chemicals used), pigmentary alteration, true or pseudofolliculitis, and possibly scarring.

Chemical depilatories

Thioglycolates and strontium sulfide are the most common ingredients in chemical depilatories and offer a popular method of hair removal for both men and women. They dissolve the hair above the surface of the skin, offering only a brief hair-free period.

Disadvantages include potential for irritation or allergic contact dermatitis.

Chemical bleaching: Rather than physical or chemical hair removal, bleaching with hydrogen peroxide is an alternative for patients with dark but fine facial hair who do not wish to physically remove hair.

Electrosurgery

Electrolysis can achieve permanent hair follicle destruction in 15-80% of patients. It employs a weak direct current that passes through a negative electrode (anode) inserted in the hair follicle and a positive electrode (cathode) in the form of a wet pad in the patient’s hand. Follicular destruction is achieved via the formation of toxic sodium hydroxide (a free radical).

Electrothermolysis uses an alternating current that causes direct thermal destruction of the hair follicle.

These two methods are extremely laborious, slow, mildly-to-moderately painful, and carry a low but real risk of scarring and pigmentary alteration.
Etiology: Excessive hair growth is classified into hirsutism and hypertrichosis.

Hirsutism

Hirsutism implies the presence (in women) of excessive hair growth in androgen-dependent areas (where males grow hair at or after puberty). It is related to excessive androgen production (adrenal, ovarian, or exogenous androgen source), and/or skin hypersensitivity to normal or mildly elevated levels of androgens in predisposed individuals. The latter accounts for approximately 95% of all cases of hirsutism.

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