Removal of unwanted facial hair

Unwanted facial hair is a common condition that often goes untreated. Women most often seek treatment, but men may also have concerns about this problem. (1) In most cases, a severe underlying medical condition is not the cause of unwanted facial hair. Its presence, however, causes significant psychologic stress and may lead patients to resort to uncomfortable and often expensive means of removal.
Hair Growth Cycle
The growth of human hair is cyclic, involving phases of active growth (anagen) and quiescence (telogen). In addition, an intermediate stage of transition, known as catagen, occurs between active growth and cessation of growth. Between 85 and 90 percent of hairs are in the anagen phase at any one time, with the remainder in telogen. (2-4)
During the anagen phase, mitotic activity in the hair bulb and dermal papilla resumes and forms the new hair shaft, pushing out the old inactive hair, or club hair, as the new hair advances. The matrix cells, which form the new hair, multiply rapidly and ascend into the follicular canal, dehydrate, and form the growing shaft. The visible hair shaft is composed of an outer cuticle, the cortex and, sometimes, a core of compact, keratinized cells, all of which are made of protein. (2-5)
Hairs that are in the anagen phase during removal are more sensitive to the various treatment modalities than hairs in the telogen phase. Alteration of matrix cell activity during anagen, by whatever method chosen, increases the amount of time from removal to regrowth. As a result, one of three alterations can occur: early cessation of anagen causing telogen to occur, transition into a dystrophic stage of anagen, or degeneration of the matrix. (5-8)
Depending on the site of the hair, the time spent in each phase differs considerably, from an anagen phase of two to six years for scalp hair to one to two months for thigh hair. The telogen phase also varies, ranging from one and one half months for mustache hairs to three to six months for leg hairs. (5) During telogen, growth stops, and the entire structure rests for a variable period of time, depending on the site. Once anagen begins, the remaining club hair is ejected, and the growth cycle continues.
Patterns of hair growth vary greatly depending on whether the patient is male or female. In addition, ethnicity may also determine normal growth patterns that can be interpreted as abnormal by physicians outside of a patient's native culture. Growth of androgen-sensitive hairs at various regions of the body (beard, axillae, pubis, chest, and shoulders, for example) can arouse suspicion of an underlying organic cause. (2,3) Overproduction of testosterone and other androgens in female patients may cause abnormal growth patterns that can be clinically evident as hirsutism. (2,3) All such patients should be evaluated for an underlying cause of the hair growth, whether the unwanted facial hair is to be treated or not.
Methods of Hair Removal
Several methods of hair removal are available, each with varying degrees of cost, efficacy, and side effects. Methods of hair removal are summarized in Table 1.
SHAVING
Shaving does not change the thickness or growth rate of human hair. (5,9) Rather, the rough-textured, beveled edge that shaving produces (compared with the softer, tapered tip of uncut hair) may give the appearance of thickening. (5,6) Although shaving is a useful and safe method of facial hair removal (and the chief method chosen by men), it is not popular among women.
Side effects of shaving are generally minimal. Irritation, often caused by components of the shaving lubricant, and minor cuts can occur. Pseudofolliculitis barbae, caused by the ingrowth of curly hair, is also a fairly common side effect in some ethnic groups. (5)
EPILATION/DEPILATION
Epilation, or plucking, is often the first method chosen by patients. The entire hair shaft and bulb are removed, with results lasting six to eight weeks. (5,10) While this method is probably the least expensive, it is not practical for use over larger areas. Unless the hair is plucked in anagen, the method generally does not change the growth rate of hair. (11,12) Plucking during anagen may shorten the duration of time spent in this phase and, if repetitive, may permanently damage the matrix. (5,6 )
Numerous methods are used for epilation, from tweezers to devices that pluck several hairs at once. Hot or cold waxing is also a form of epilation. Mixed with the wax is a resin that hardens around the hair shaft and aids in pulling out the hair when the wax has dried. Side effects, which are more common when more than one hair is removed at a time, include burns (from hot wax products), folliculitis, pseudofolliculitis, postinflammatory hyperpigmentation, and scarring. (5,13)
Depilation is the use of a chemical that dissolves the hair shaft, with results lasting up to two weeks. (5,14) Composed of thioglycolates and mercaptans, and mixed with an alkali compound (calcium hydroxide or sodium hydroxide), depilatories do not affect the hair bulb. (5,14) The thioglycolates disrupt disulfide bonds between the cystine molecules found in hair, helping to dissolve the hair shaft. (5,14) The addition of an alkali compound increases the pH level and can improve the efficacy of the depilatory.

Take it off! The best hair-removal options for a fuzz-free you

Close shave: Easy and cost-effective
Best for: Underarms and legs. How it works: "Start with a sharp blade, and do your best to shave in the direction the hair is growing," says Danielle Malka, creator of e-Shave, a line of shaving tools and products based in New York (eshave.com). "It's a good idea to shave at the end of a shower. Heat and water open pores and soften hair, so you'll get a closer shave." Use oils, foams or creams that lather as buffers and softeners. Hair conditioner is actually a great softener, Malka adds. Costs: $5-$50 for shaver and supplies.
Sugaring: An alternative to waxing
Best for: Sensitive-skin types. How it works: "This ancient practice uses sugar, lemon and water to create a gel that, like waxing, removes hair with the use of cotton strips," says Shobha Tummala of Shobha, a threading, sugaring and waxing studio in New York (shobhathreading.com). "Because sugar doesn't stick to skin as tightly as wax, it can be much less irritating than waxing. Many say it's a lot less painful." A plus: If your hair is coarse, you can go over an area more than once to remove stubborn hairs, which is a no-no with waxing. Costs: $10-$80, depending on area being treated.
Waxing: Quick and inexpensive
Best for: Just about any body part. How it works: "No matter where you choose to wax, you'll get the best results if you have at least a quarter inch of hair--a bit more if your hair is coarse," says master waxer Cindy Barshop, owner of Completely Bare Hair Removal Spas in New York (completelybare.com). "People love waxing because it's fast, lasts longer than shaving, and is relatively cheap compared with most other professional treatments." If you wax at home, stick to the legs only, Barshop adds. "You need a certain vantage point to effectively wax underarms, the bikini area, the brows and the upper lip," she explains. Your skin can be more sensitive the week before your period, so skip waxing during this time. Sensitive-skin types should avoid exfoliation just before waxing; that bit of dead skin can actually be a buffer against irritation. Costs: $5-$100.
TIP
If you suffer from ingrown hairs between waxing and shaving sessions, try a daily exfoliator to lessen the chances of getting them. We like: Bliss Ingrown Hair Eliminating Peeling Pads.
When you choose invasive professional treatments like electrolysis, IPL or lasers, select practitioners who have had ample experience with people of color.
Lasers: A ray of light for us
Best for: Any part of the face or body. How it works; Laser hair removal is not permanent, but the results can last for months. Which lasers are right for us? "Lasers that use longer wavelengths to focus on the hair follicle without damaging the skin," answers Jeanine Downie, M.D., a dermatologist in Montclair, New Jersey. When hair returns after laser removal, it is also more likely to be much thinner, according to Robert Guida, M.D., a plastic surgeon at New York Presbyterian Hospital-Cornell Medical Center, who has had tremendous results treating severe razor bumps (pseudofolliculitis barbae) with his Lyra laser: "You'll need a few sessions with lasers, but not as many as with electrolysis." Costs: $250 and up.
Threading: Easier on skin than waxing
Best for: The face or those with ultra-fine hairs or with skin too sensitive for waxing. How it works: "The threader quickly winds a taut strand of thread around the individual hairs, twisting and pulling them out of their follicles by the root," says Tummala of Shobha. "It's a very precise method of brow removal." It's also a terrific option for those on skin-thinning medications like Retin A or Accutane, hence dermatologists often recommend threading as an alternative to waxing. Costs: $5-$50.
Intense pulsed light (IPL): The next wave
Best for: Any part of the face or body. How it works: "Intense Pulsed Light treatment uses bursts of light, as opposed to a single coherent beam, like lasers, to remove hair," says Downie. "It isn't permanent, but many say hair growth is significantly reduced after repeated treatments." Dana Elise of Laser Solutions Skincare Medical Clinic in Beverly Hills, California (lasersolutions90210.com) adds, "IPL is not safe for people of color unless it's used with what is known as a 755 filter. This filter allows for a greater cooling time between the light pulses. Without the cooling time, IPL could be damaging to Black skin." Costs: $125 and up.
Tweezing: For quick cleanups
Best for: Brows and stray facial hairs. How it works: "Even threading is not as precise as tweezing," says Ramy Gafni of Ramyspa in New York (ramyspa.com), who shares this advice about at-home tweezing: Before you begin, clean the brow area with witch hazel. Brush brows upward and trim excess hair with small grooming scissors. Pluck in the direction of hair growth. If necessary, remove a row of hairs from directly underneath the arch to open it up. Then clean the hairs between your brows. Costs: $6-$50 for tweezers and supplies.

Body hair removal: the 'mundane' production of normative femininity

Women's body hair (5) removal is strongly normative across numerous cultural contexts today. Survey research indicates that the practice is currently prevalent in North America (Basow, 1991) and Australia (Tiggemann & Kenyon, 1998). However, accounts of women's hair removal from such diverse regions as Ancient Egypt, Greece, and Rome; the Tobriand Islands; Uganda; South America; and Turkey (Cooper, 1971) show it to be neither a modern nor a purely Western invention. Taken together, the long history and the current, documented prevalence of women's body depilation suggest it to be of social significance. Moreover, there is strong evidence of a widespread symbolic association between body hair--or its absence--and ideal gender: to have a hairy body is a sign of masculinity; to have a hairless one, a sign of femininity (6) (Basow, 1991; Basow & Braman, 1998; Cooper, 1971; Ferrante, 1988; Firth, 1973; Greer, 1970; Hope, 1982; Simpson, 1986; Synnott, 1993; Tiggemann & Kenyon, 1998; Toerien & Wilkinson, 2003, 2004). Indeed, the depiction of the female body as depilated, with "smooth unwrinkled ... skin" (Tiggemann & Kenyon, 1998, p. 873), is part of the current, dominant, mass media image of ideal femininity (Whelehan, 2000).
Yet hairlessness is not the inevitable state of the female body; to be hairless typically requires work (Synnott, 1993). Thus, women's practices of depilation--the work required to produce themselves as hairless--may be understood as one means of transforming the body such that it more closely resembles the feminine ideal. As such, hair removal may act as a "structuring device ... reflect[ing] larger cultural conceptions of masculinity and femininity, of sex roles, and of changes in social-sexual status" (Ferrante, 1988, p. 220). This article, in which we highlight the normative status of hair removal in a cultural context not researched before--the UK--presents the results of an investigation of the work of hair removal; we argue that this is a significant facet of the production of a socially acceptable femininity.
Few social scientific studies have concerned the practices of women's routine hair removal (Basow, 1991; Tiggemann & Kenyon, 1998). Somewhat more common are psychological investigations into the impact on women of so-called 'excess' hair growth (e.g., Barth, Catalan, Cherry, & Day, 1993; Kitzinger & Willmott, 2002; Rabinowitz, Cohen, & Le Roith, 1983). However, Basow and Braman (1998) have demonstrated that negative evaluations of women's body hair are not confined to 'excess' growth. In their study, participants, who were randomly assigned to watch a video-recording of the same bikiniclad woman either with or without visible body hair, judged the woman as less attractive, intelligent, sociable, happy, and positive when hairy than when hairless. The presence of hair on a woman's body, then, may be symbolically--and, importantly, socially--problematic irrespective of whether or not it may be defined as a medical concern. As Ferrante (1988) concluded: "Perhaps it is because the division between masculine and feminine hair growth is physiologically arbitrary yet socially and psychologically rigid that any amount deviating from hairlessness is threatening. A woman never knows when she may have crossed the boundary" (p. 231).
Coupled with socio-cultural emphases on feminine 'beauty' (see Wolf, 1991), the above findings suggest that most women within cultures that view body hair as masculine will remove at least some of their hair. The only two published social psychological surveys on women's hair removal strongly support this hypothesis: Basow (1991) found that 81% of the professional North American women in her sample reported removing their leg and/or underarm hair; and Tiggemann and Kenyon (1998) found that 91.5% of their Australian university student sample removed their leg hair, and 93% removed their underarm hair. Tiggemann and Kenyon also surveyed a group of Australian high school students, and found similar results: 92% reported removing their leg hair, and 91.2% their underarm hair. Industry reports provide similarly high statistics (Hope, 1982); for example, Chapkis (1986) cited the "Epilator 2700" estimate that between 85 and 90% of women have body hair that they would prefer to be rid of. Hair removal, then, may well be "[s]tatistically ... one of the most frequent ways women alter their bodies to achieve the ideal of youthfulness and attractiveness" (Tiggemann & Kenyon, 1998, p. 874). As such, women's depilatory practices not only contribute substantially to the cosmetic industry, but reinforce the view that underpins all the body-changing procedures, from make-up application to cosmetic surgery: that a woman's body is unacceptable if left unaltered (see Basow, 1991; Chapkis, 1986; Tiggemann & Kenyon, 1998).
This study, together with two previous surveys (Basow, 1991; Tiggemann & Kenyon, 1998), provides baseline data on women's everyday hair removal practices. We expected that a majority of participants would report removing at least some body hair, thus providing empirical support for an understanding of women's hair removal as a powerful social norm within the UK. Because norms are seldom monolithic, we also expected some participants to report never having removed any body hair. Thus, we investigated one possible explanation for women's non-removal that has not yet been explored: age. Basow (1991) reported being surprised by the number of women (around 20%) in her sample who did not remove their hair. And, indeed, Tiggemann and Kenyon (1998) found a higher rate of removal in their study. Both Basow and Tiggemann and Kenyon suggested that the discrepancy may be because the former study specifically maximised the number of feminist and lesbian participants. An additional reason might be that Basow's study included participants from a much wider age range (20-81) than did Tiggemann and Kenyon's, which focused on undergraduates (mean age of 22.3 years) and school-goers (mean age of 14.3 years). If the norm has become, as may be inferred from Hope's (1982) analysis, increasingly powerful over the past 90 years or so, then we might expect that younger women would be more likely than their older counterparts to have grown up with an understanding of hair removal as virtually de rigueur. Thus, we investigated whether older participants were more likely than younger participants to report never having removed their body hair.

Male body depilation: prevalence and associated features of body hair removal

During ancient times Egyptian and Greek cultures placed a premium on the appearance of a hairless male body, and ancient Egyptian men often shaved their body hair with pumice and razors (Luciano, 2001). In the modern era however, body depilation (i.e., body hair reduction or removal below the neck) has typically been culturally sanctioned only for women (Basow & Braman, 1998; Hope, 1982; Tiggemann & Kenyon, 1998) and is strongly normative within contemporary Western culture (Toerien & Wilkinson, 2003, 2004). With few exceptions, men have not engaged in body depilation because the presence of body hair has traditionally been symbolic of masculinity and therefore associated with men's attractiveness and virility (Basow, 1991; Basow & Braman, 1998; Lewis, 1987; Tiggemann & Kenyon, 1998). It appears, however, that the hairless male body ideal has come back into vogue (Luciano, 2001). According to popular press accounts, this shifting ideal has influenced many men both to remove and reduce their body hair (Gomes, 2001; Smith, 2000; Stuever, 2000). In fact, Boroughs and Thompson (2002) found that appearance concerns motivate some men to shave or trim many parts of their bodies, including most notably: abdomen, chest, groin, and legs. Consequently, the aim of the current study was to investigate the prevalence and characteristics of body depilation, as well as its related social and affective features. This information will provide a greater understanding of male body depilation and also inform our understanding of the rapidly developing field of men's body image.
Although a few researchers have examined the idealization of body hair on the male body, data have not indicated that less body hair is necessarily considered ideal (Dixon, Halliwell, East, Wignarajah, & Anderson, 2003; Lewis, 1987). Results from previous studies, however, may have been due to a number of methodological limitations. For instance, Dixon et al. (2003) found that women rated male silhouette figures as more attractive if they had hair on the chest and abdomen. One shortcoming of the study conducted by Dixon et al. (2003) is that it only investigated women's attitudes toward the presence of body hair on men and did not examine men's attitudes toward hair on their own bodies. Another shortcoming of the study is that the location and amount of body hair were not examined as variables (i.e., excessive body hair and/or hair on certain parts of the body where it may not be considered appealing). Generally, the findings from previous research do not preclude the possibility that men remove body hair to approximate a hairless ideal of attractiveness. Given that anecdotal reports support an emerging hairless ideal (e.g., Luciano, 2001) and data that indicate that men are removing hair in order to increase their attractiveness (Boroughs & Thompson, 2002), there is sufficient reason to suspect that body image concerns are a critical underlying factor that influences body depil
Clearly, there is a need to confirm the numerous anecdotal accounts and preliminary data that suggest that body hair removal is indeed a new and potentially important component of body image for men. Therefore, the current study had several objectives: (1) to estimate the prevalence of body depilation in a sample of men, (2) to assess the characteristics of body depilation by examining the various body sites where hair reduction and removal take place, (3) to determine the reasons for body depilation and the methods used to reduce and remove body hair, and (4) to assess the social and affective variables related to body depilation.
METHOD
Participants
One hundred eighteen men completed questionnaires to investigate body depilation. Sixty-nine (58.5%) of the participants were European American, 17 (14.4%) were Latinos, 18 (15.3%) were African American, eight (6.8%) were Asian American, five (4.2%) were Native American, and one participant did not report his ethnicity. One hundred and seven (91.7%) of the participants indicated attraction only to the other sex, two (1.5%) identified as having exclusive same-sex attraction, and the remaining nine (6.8%) reported some level of attraction to both sexes. Participants were recruited from a university research pool and volunteered for this study; they received extra course credit for their participation. All participants were recruited from one large research university in the southeastern United States. The only inclusion criterion was being a male over the age of 18. Age of the sample ranged from 18 through 55 years (M = 22.04, SD = 4.75).
Measures
Body Depilation Questionnaire (BoDeQ)
This new instrument was created based on the results of previously conducted structured interviews (Boroughs & Thompson, 2002). The interviews yielded qualitative and quantitative information concerning the locus of depilation, removal strategies, associated emotional and behavioral components (i.e., anxiety or avoidance), as well as descriptive information about men who remove or reduce body hair via shaving, trimming, or both. In developing items for this questionnaire, the results from the prior study were considered in addition to the sparse literature in this area and the diagnostic criteria for Body Dismorphic Disorder (BDD) in the DSM-IV-Text Revision (American Psychiatric Association, 2000). The final draft instrument contained 18 questions (see appendix).

The lowdown on laser hair removal

Q I'm tired of shaving every single day. Has laser hair removal improved at all over the past couple of years, and is it right for me?
A Today's lasers are more advanced and do effectively reduce hair growth. They also cost less than they did when they first hit the market; you'll now pay anywhere from $250 for the upper lip to $750 for the legs. But it's important to note that even with all these advances, there's no guarantee that everyone will get the same results, says Kathleen Gilmore, M.D., a physician who specializes in laser hair removal in Farmington Hills, Michigan. Keep the following points in mind before you decide to get zapped:
* Lasers work best on dark hair and light skin. The low-energy light targets pigment in the hair follicle, damaging it enough to slow down future growth. "The light is attracted to color like a magnet," Gilmore explains. "Since blonde hair doesn't have much pigment, the laser won't gravitate toward it as well as it would dark-colored hair." And if your skin is naturally dark or tanned (even from self-tanners), the laser won't detect dark hair against it.
* You won't get instant results. Hair cycles through one growth phase and two dormant phases, usually within two to four months total. So as more hair grows in, you'll need additional treatments, about four weeks apart.
* It's not pain-free. It feels like rubber bands snapping against the skin. To take the edge off, pop acetaminophen beforehand, or ask your doctor to prescribe a numbing cream (apply 30 minutes ahead of time). Slight redness and swelling afterward is normal.
Q I'm using a new antiaging cream. When will I see results?
A It depends on your goal, says Neil Sadick, M.D., a New York dermatologist. Here's what to expect:
* Tone and texture should improve first. Rough skin, uneven pigmentation, and dullness are the early signs of premature aging, but they can also be improved the quickest because they occur in the skin's outermost layer. "Use a cream with a chemical exfoliant like glycolic acid," suggests Sadick. "It will gently slough away these imperfections in about a month."
* Fine lines and wrinkles take longer to fade (up to six weeks) because they develop deep in the middle layer of skin. (Deeper wrinkles can take up to a year.) Deep-penetrating ingredients like vitamin C and retinol jump-start cell activity by encouraging collagen production. (A breakdown of collagen is the primary cause of wrinkles.)
To speed results, use antiagers both day and night. In the a.m., apply a cream that also protects against the sun's rays, one cause of premature aging. Try L'Oreal Paris Advanced Revitalift Complete SPF 15 lotion ($16.60; at drugstores); before bedtime, try Neutrogena Visibly Even Night Concentrate ($11.75; at drugstores).
QUESTIONS? Send your beauty questions to Shape, Beauty Q&A, 1 Park Ave., 10th floor, New York, NY 10016, or e-mail us at beautyq&a@shape.com.