by Fayne Frey, M.D. Board Certified Dermatologist

My patients complain often about body hairs sprouting in places they don’t want them. Dark hairs on their chins seem to cause particular distress, but excessive hair growth above their lips and on their cheeks also upsets them. If you are a post menopausal woman age 50 or above, you can probably relate. Women in our phase of life have less estrogen and more testosterone than when younger – and that can lead to undesirable facial hair growth. 

“Dr. Frey, what’s the best way to remove my unwanted hair?”

This question is one I hear almost daily, and not just from older women. The truth is, people of all ages, both male and female, frequently obsess about unwanted hair on various parts of their bodies. In addition to chins and faces, I hear frequently about hair on bikini lines, lower abdomen, under arms, and even on feet and toes.

I wish I had one simple response for everyone, but the answer varies depending on the situation. The location and quantity of the hair in question are important factors. I also consider the amount of time and money an individual wants to commit to the hair removal process.

Rule out Hirsutism before starting hair removal.

Excessive hair growth, also known Hirsutism, may be caused by a hormonal imbalance, medication or genetics, among other things. Most of the time, the undesirable hairs otherwise healthy individuals bring to my attention does not indicate a severe medical issue. However, it’s important to determine if an underlying and possibly treatable problem exists prior to starting a hair removal process. 

For example, a hormonal imbalance seen in women with polycystic ovarian syndrome can cause Hirsutism. Side effects from certain medications like steroids or hormones may also cause this condition. Before I agree to take action to remove unwanted hair, I therefore generally recommend a medical professional evaluate individuals with excessive hair growth to rule out this diagnosis.

Hair removal processes

The removal of undesirable body hair is a thriving industry. In 2018, the hair removal product industry equaled approximately $2.2 Billion in the U.S. This means Americans spend generous portions of their paychecks to eliminate unwanted hair. 

We categorize hair removal techniques as either permanent or non- permanent, neither of which is perfect. Wouldn’t it be nice if one treatment removed 100% of all unwanted hair?  Unfortunately, none of the available options offer a complete and lasting solution.

PERMANENT HAIR REMOVAL TECHNIQUES

Laser Hair Removal:

This medical procedure involves a concentrated beam of light, or laser, that removes hair. This method effectively results in a permanent reduction in hair growth after 3-6 sessions.
Advantages: When performed by a reputable expert with a quality laser, laser hair removal treats large surface areas in a short period of time, and provides long lasting results after multiple treatments
Disadvantages: This process is best for those with dark hair and light skin, though newer laser technology are in development for lighter hair colors. Laser equipment is costly, and therefore this type of treatment may be expensive.

Electrolysis:

With electrolysis, a technician inserts a very fine probe directly into individual hair follicles, and destroys them in the process. This technique uses either a chemical or heat energy process.  Either way, electrolysis requires a lot of time and patience.
Advantages: This technique can remove hair effectively on any part of the body and potentially provide permanent reduction of hair.
Disadvantages: Technicians complete this process one hair at a time.  It requires one or more sessions weekly for long periods of time (months to years) and is therefore not the best option to remove large areas of unwanted hair. 

NON-PERMANENT HAIR REMOVAL TECHNIQUES

Shaving is used the most common technique used to remove facial hair for men and leg hair for women. It removes hair to just below the skin’s surface. Some people believe shaving causes hair to regrow faster or thicker, but this belief is a popular misconception.

Instructions for a close shave with minimal irritation:
1.    Shave on warm skin to avoid skin irritation.
2.    Lubricate your skin with shaving cream, non-soap cleanser or other preferred lubricant.
3.    A shaving brush loosens ingrown hairs before shaving, which might be helpful for curly haired people. 
4.   Use a sharp blade and shave in the direction of hair growth.
5.    Rinse the shaved area with cool water to reduce inflammation.
Advantages: This technique is inexpensive and removes hair easily from large areas. 
Disadvantages: Hair grows back continually, so a smooth and hairless surface requires daily shaving. Also, it may cause ingrown hairs, irritation, the spread of viral warts and bacterial infections.

Plucking:

Tweezers grasp individual hairs one hair at a time to pull them out by the root. Plucked hairs take 6-8 weeks to regrow.
Advantages: This method is safe and inexpensive. It removes the entire hair down to the follicle and the hair does not grow back for several weeks. 
Disadvantages: Plucking is a tedious process and not ideal for large areas. In addition, it may cause irritation of the skin at the tweezed site. 

Depilation:

Depilatory creams dissolve the hair shaft with chemicals and allow you to wipe away the hair with the cream. Hair removal creams are painless and fast-acting. They are most effective after a bath or shower. 
Advantages: These creams are painless, fast acting, and work well on large surface areas of unwanted hair. They are also relatively inexpensive.
Disadvantages:  Regrowth typically occurs in about 2 weeks. In addition, they should not be used on small cuts or sunburned skin. Depilatory creams may also cause superficial chemical burns and/or allergic reactions. I recommend you apply the cream on a small test area before using on larger areas of your body.

Hot waxing:

You can apply a hot wax treatment yourself at home or go to a spa. Either way, a layer of hot wax applied to the fuzzy area traps the hairs. Once cooled, and you pull the wax off the skin, the area is smooth and hair-free. 
Advantages: Effective waxing removes the entire hair down to the follicle and generally takes several weeks to grow back.  Many use this process on their  eyebrows, upper lip area, bikini line, upper back and legs.
Disadvantages: Hair removal with wax can be messy and painful.  And because the wax needs to trap the hair, you need to grow it to at least ¼ inch long for an effective removal process. This process can also cause irritation, infections and superficial burns if the wax is too hot.
WARNING: Do not use this process on skin recently treated with retinoid creams as the wax may remove the skin along with the hair.

Threading:

Threading is an old Asian tradition of hair removal that uses twisted strings. Increasingly popular in Western Countries, this method is a common hair removal technique for eyebrows where skilled aestheticians exercise precise control to shape eyebrows. Threading removes hair at the follicular level in short rows.
Advantages: This technique is gentler on your skin compared to waxing or tweezing when done by a skilled technician.
Disadvantages: Threading can be painful and works well only on small areas.

Medications:

No medication completely removes unwanted hair. That being said, medications that minimize hair growth include:

Spiranolactone: This prescription medication reduces excessive hair growth by both blocking the effects of testosterone and decreasing testosterone production.

Vaniqa (eflornithine 13.9%): This FDA approved cream does not remove facial hair, but may slow its growth when applied twice daily.

The Bottom Line

The anxiety my patients suffer about their unwanted facial or body hair is real. Excess hair is rarely a serious medical problem, but I understand their distress from a cosmetic perspective. 

I get it. Our society values youth and perfection. People feel shame when they think they look “different” or “abnormal”, even though body hair growth is normal and common. Fortunately, we live in a time and place with options available. Before you take action, educate yourself about the pros and cons of each method, and the costs, which vary widely. 

Fayne Frey, M.D., is a board-certified clinical and surgical dermatologist practicing in West Nyack, New York, where she specializes in the diagnosis and treatment of skin cancer. She is a nationally recognized expert in the effectiveness and formulation of over-the-counter skincare products, and, as a speaker, has captivated audiences with her wry observations regarding the skincare industry. She has consulted for numerous media outlets, including NBC, USA Today, and, the Huffington Post, and has shared her expertise on both cable and major TV outlets. Dr. Frey is the Founder of FryFace.com, an educational skincare information and product selection service website that clarifies and simplifies the overwhelming choice of effective, safe and affordable products encountered in the skincare aisles. Dr. Frey is a fellow of both the American Academy of Dermatology and the American Society for Dermatologic Surgery.