Hypertrichosis refers to excessive hair; either exceeding what is normally expected considering the patient's sex and genetic background, or occurring in body regions which normally do not have hair. It can appear at a single site, such as a congenital hairy melanocytic nevus, or involve the entire body, with the exception of the palms and soles. Some medications may also trigger hypertrichosis as a side effect. Minoxidil is an anti-hypertensive medication, but so often causes excessive hair growth that it is also used in a 2% or 5% solution topically on the scalp to treat androgenetic alopecia (common, hormone-mediated patterned baldness) in both men and women! Hypertrichosis must be distinguished from hirsutism; here the excessive hair growth is triggered by hormonal disturbances and favor the sites of secondary sexual characteristics - axillary hair, pubic hair, facial hair. A gynecologic-endocrine evaluation is mandatory to search for underlying hormonal problems. All patterns of hair growth that are obvious and deviate from the „norm“ are a cause of distress in social interactions. Someone with excessive body hair or hair in unusual locations requires a great deal of courage to appear on the beach in a bikini or swim briefs!


People today have much less hair than did our ancestors in the distant past who depended on their hairy coat for protection against wind and weather. Many woman today who have completely normal patterns of hair growth still feel uncomfortable when their body is exposed, such as on the beach or when wearing more revealing summer clothes, There is also a trend in the same direction among men. A smooth, soft skin looks and feels better.


The daily struggle with a razor or regularly using wax or an epilating device on the legs, axillae, and bikini zone is no longer necessary. In these and almost all other body regions, including the face, permanent hair removal can be achieved with a special laser, the diode laser, or with an intense pulsed light (IPL) device.


The ideal conditions for good results with permanent epilation treatments are darkly pigmented hairs and ideally quite pale skin! The energy from the laser or IPL is directed at the target structure: melanin, the pigment which gives us dark skin or hairs. The more energy that reaches only the pigment-laden follicle cells of the hair root, the more effective is the destruction and thus the better are the results. Dark or well-tanned skin captures some of the energy before it can reach the follicle, reducing the effectiveness and increasing the risk of a burn.


This has three major consequences. First, individuals who have dark complexions or are tanned cannot be treated! Second, blond and white hairs cannot be permanently removed! Third, the hairs cannot be mechanically removed (plucking or mechanical epilation) before epilation treatment but only shaved; otherwise the hair follicle is damaged and the laser or IPL energy has no appropriate target, so the treatment is ineffective!


Each body region has a hair growth cycle of a different length. Thus it is critical that the laser or IPL epilation be carried out at exactly defined time intervals. Hair follicles in the anagen or growth phase are most sensitive to the administered heat energy and thus most responsive to treatment. Typically 6-8 treatments in time intervals of 4 weeks to 3 months are required to remove 98% of the hairs. It is wise to start the treatment during the winter months when the skin is not tanned. Regular sun protection after (and even before) the laser or IPL therapy is extremely important in order to keep the skin pale to optimize treatment and to avoid post-treatment increases in pigment triggered by sunlight.


The therapy is variably painful depending on which part of the body is treated. Anesthesia is usually not required. Redness and swelling may appear after the procedure but generally have disappeared by the next day. Small remnants of hair shafts (1-2 mm long) are sometimes discharged in the days after the procedure. To avoid skin irritation, it is best to let these fall out naturally and not pluck them.


A final comment: very fine blond facial hair in women, often on the chin or cheeks, usually is not cosmetically disturbing, but can be treated with eflornithine cream, which when used regularly slows the hair growth and further minimizes the problem.



In a personalized consultation, I will be happy to discuss with you which approaches are best for your excessive hair.

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