Bare No Hair

Summer Hardy (00:01):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Summer Hardy, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is Bare No Hair. On a previous episode, we've talked about growing thinning hair and hair transplantation. Today we're going to talk about removing unwanted hair. What should I know to start with Dr. Bass?

Dr. Lawrence Bass (00:35):
Well, the first thing to understand is the biology of hair. We think of hair being on our heads, but we know hairs fall out. Then there's something going on there. So hairs go through a growth cycle, and there are different stages of that growth cycle. So there's a growth phase called antigen when the hair follicle wakes up, starts to become active and starts to produce a hair shaft. Then there's catagen when the hair is present there and then the hair is shed and the hair goes into a resting phase called telogen. Actually, most of the hair follicles are in telogen or resting even on top of our head. As we go onto other areas of our body, the amount of time that hairs are in telogen is longer and the percentage of hairs that are in telogen is greater. So on top of our head, as I said, most of the hairs are probably resting most of the time and they rest for about four months and then they perk up and start growing in a young adult person. So that affects what happens when we try to start treating hair that we don't want to see anymore.

Summer Hardy (02:07):
Okay. Now that I'm up to speed on hair biology, what are some of the treatment methods?

Dr. Lawrence Bass (02:12):
So we all know the traditional methods that are basically not medical methods. There of course, is shaving and men, if they're clean, shave and shave typically every day of their adult lives or every day that they want to look clean and groomed. And shaving works very well, but it's very temporary. And then there are things like waxing, sugaring and threading. So these are all mechanical hair removal or hair reduction methods. So shaving cuts the outside visible portion of the hair away, so you can't see it. There's still a hair shaft in the hair follicle under the skin, but it's not on the outside. You can see it so you don't care that much. And things like waxing sugaring and threading latch onto the hair and yank it out of the hair follicle. So the hair follicle is temporarily empty and it will take a period of time depending on what part of the body and how fast the hair is growing, but period of a couple of weeks to maybe a month for hair to show up again. So that's again, a temporary but very commonly used approach that's doesn't require a visit to the doctor's office.

Summer Hardy (03:40):
Got it. So I have to ask, does shaving make the hair grow faster or thicker? Is that a myth or is it reality?

Dr. Lawrence Bass (03:48):
So shaving does not actually make a bigger, fatter or faster growing hair, but what it does do is cut the hair sharply and leave the blunt, thick part of the hair visible when the hair next grows. So the hair that's not shaved, that sits outside the body over time, that hair gets worn down and it thins and softens, and the edge of that hair is tapered instead of being blunt and sharp when the hair has been shaved. So that makes the hair appear finer and a little bit less visible compared to a shaved hair. So you're not actually changing what the hair follicle is doing, but you change a little bit the external appearance of the hair.

Summer Hardy (04:46):
Thanks for explaining. Now, back to hair removal and reduction methods. What else is there?

Dr. Lawrence Bass (04:51):
So the gold standard is electrolysis. Electrolysis is a technique where the tiny needle is introduced down the hair follicle itself. You follow down from the opening in the skin where the hair shaft comes out down into the hair follicle and then apply an electric current slowly until the hair follicle is killed.

Summer Hardy (05:20):
That sounds great. Doesn't that mean the problem is solved or are there disadvantages?

Dr. Lawrence Bass (05:27):
So the advantage of electrolysis is it's the most reliable and the most permanent hair method that we have. Occasionally a hair regrows a little bit in a few years, a little finer and thinner, but mostly the hairs are permanently removed, permanent, the way you and I think of permanent because the way FDA thinks of permanent when they talk about permanent hair removal with lasers or energy devices, they mean longer than the growth cycle of the hair, which is not really what you and I think of as permanent, it just means long term. Or in another definition they sometimes use is six months, which again, since we're going to live decades, is not really permanent the way we think about it. So long-term is a better way to look at that. But getting back to electrolysis, the big disadvantage is it's a single hair at a time.

(06:28):
So if you have three hairs growing on your chin and you don't want to look at them, electrolysis is a really good way to get rid of them. But if you have a full male beard, like some ladies have so much hair growing on their face, it's like a man's beard, or if you're a man trying to get rid of your hairy back or your hairy belly, there's just no way electrolysis would be a lifetime project. So it's too slow to deal with large areas. Sometimes you get scarring if a little too much energy is applied and it's very slow and very painful typically has to be done in multiple sessions doing only so many hairs at a time. So it's not practical for big areas, even though it's very effective if you only have a few.

Summer Hardy (07:20):
That makes sense. So are there more alternatives, Dr. Bass?

Dr. Lawrence Bass (07:25):
So there are a variety of other things that are done, and one thing is pharmacologic. Basically a topically applied skin lotion that contains a medication called Vaniqa. And Vaniqa is a medication that's used in ladies that slows down the growth of the hair. So it doesn't take the hair out and it doesn't eliminate the hair from growing, but it slows it down dramatically. So if you were shaving twice a week or every other day because of hair on your face and you're a lady and you want that hair to slow down, you go on Vaniqa and you might only have to shave every two or three weeks a single time to keep the hair controlled. So that is the right fit for some people for some areas on their body, principally the face. The other big thing that you used nowadays since the 1990s are lasers and other light sources that can be used to zap the hairs and create hair reduction that way.

Summer Hardy (08:41):
Lasers sound very cool, but will they work? I know there have got to be advantages and disadvantages. So lay it out for me.

Dr. Lawrence Bass (08:49):
So you're exactly right. Any technology is going to have advantages and disadvantages, really important to understand what they are, so if it's a good fit for you or not. So the first thing to understand when we turn to the light-based devices is to understand a little bit about how they work. So hairs contain melanin pigment and the way all of these devices work, they're wavelengths or colors of light that are heavily absorbed by melanin. So the melanin in the hair shaft itself absorbs the hair, the hair shaft heats up. That heat is conducted into the adjacent cells of the hair follicle that grow hair, damaging those cells. And if the follicle can't grow hair anymore, the hair grows out a little more and then falls out. So that's the mechanism by which light-based devices help reduce hair. The issue is, remember I said many, many of the hair follicles are in telogen resting face, so they have no hair shaft. So the telogen follicles or resting hair follicles are not treated in any given treatment. So that means there's always a series of treatments because even if you succeed at treating a hundred percent of the actively growing hairs that contain a hair shaft, you're not going to treat any of the resting hair follicles.

Summer Hardy (10:37):
All of that makes sense to me. But isn't there melanin in my skin? Also, how does my skin color and hair color affect the treatments?

Dr. Lawrence Bass (10:46):
So that's the million dollar question, Summer. Skin is the other main item that contains melanin. And so your skin is also targeted by these light or laser-based sources along with the melanin and the hair shaft. And so it's a competition between the melanin in the hair shaft and the melanin in your skin. What's going to absorb the energy and what's going to get potentially affected by the laser light. We want a lot of light and energy in the hair follicle to get a lot of heating there in the hair shaft and the hair follicle. We don't want a lot of light or energy in the skin. And melanin in the skin is at the base of the epidermal layer. So it's relatively superficial where hair follicles are a little bit deeper. So the trick of laser treatments for hair is to get the light deep into the hair follicle with a very mild effect, ideally no effect on the skin.

(12:00):
And this is done a couple of different ways. At the same time, how much your skin absorbs is going to be affected by your skin pigmentation, how much your hair absorbs is going to be affected by how dark the hair is. So the fatter the hair and the darker the hair, the better it gets zapped and the lighter the hair or the thinner the hair, the less it absorbs, the less it gets zapped. And the lighter your skin is, the less your skin will potentially be affected by the laser treatment. So the ideal patient has a big, thick, dark hair, black hair or dark brown and very fair skin.

Summer Hardy (12:47):
Okay, that's really interesting. Could I get my hair lasered if I have white or gray hair? And if not, couldn't it just be dyed to absorb the laser then?

Dr. Lawrence Bass (12:57):
Well, the problem with dyeing hairs is it's too superficial. So when you dye your hair, it's the hair outside your body that's absorbing the dye, and we need dye in the hair shaft that's inside your skin, still inside the hair follicle, and it's really sealed in there. And at the very dawn of laser hair removal, they tried to zap hairs by putting on a carbon paste and getting it down into the follicle. But studies eventually revealed that you could not get the carbon particles successfully down deep enough into the hair follicle to effectively target the carbon pigment instead of the hair pigment. And there was other research trying to use nanoparticles of gold thinking that the very tiny particles would succeed in getting down there, but it still didn't really work out to be a usable hair removal system. So what that means is if you have white hair or gray hair, that's not going to work well for laser hair removal and we have to look at other strategies.

Summer Hardy (14:23):
Gotcha. And then what about any peach fuzz?

Dr. Lawrence Bass (14:27):
So that's another important question because a lot of people have little fuzzy hairs on their upper lip or in front of their ears and their sideburn area, and those hairs are so fine and they're often very light that they don't get enough melanin absorption to be treated by light-based devices. So those are hairs you're going to have to chase with waxing or threading or sugaring or you go on the medication Vaniqa that I described before and try to slow down the growth of those hairs.

Summer Hardy (15:05):
Okay. So let's turn to more practical considerations. What areas are people treating?

Dr. Lawrence Bass (15:12):
So that's an important consideration. So the main light-based treatment areas are areas that are also commonly treated with waxing and things like that, areas like mustache areas, chin, neck and jawline areas and sideburn areas. For ladies, they don't want to see a lot of hair in those areas. And as I said, some ladies have so much hair, it's like a man's beard and they're shaving every day or every other day, and the hair is still a little bit visible. They really want to try to get rid of that hair. And light-based devices are a good way to chase that. There are a lot of body areas, the tummy area, the bikini area, instead of waxing, you can treat that area currently with laser treatments and get the hair gone from those areas. And armpit areas are also very common to either eliminate the hair so you don't have to shave or just reduce it tremendously so that shaving becomes a very infrequent event. And another common area are our arms and legs. So ladies love to treat legs so they don't have to shave their legs. If they choose to be bare and hairless, they can get the laser, get the hair off and not have to go through the recurrent process of shaving the legs.

Summer Hardy (16:47):
That makes sense. Is this mostly for women?

Dr. Lawrence Bass (16:50):
Well, it's really for everyone. And men also chase a lot of areas. So men that are very hairy and body areas that have a hairy back or chest or abdomen, which they or the person they're with does not find attractive, may look to reduce the amount of hair or sometimes eliminate hair in those areas. If they have hairy years, which some men have, particularly as they age, this can be another application area, although not all laser devices have a delivery system or applicator that can target a small and curvy area like that. They tend to do better on big flat open areas. And then there are other small niche areas like hairy knuckles and hairy toes that often men and women find unattractive and they chase with lasers.

Summer Hardy (17:49):
Okay, Dr. Bass, thanks for explaining. So time to share your takeaways with our listeners.

Dr. Lawrence Bass (17:55):
So the main thing is to plan enough sessions and start early enough to be ready for summertime or whenever you're planning to show your skin. That's going to depend on the area you're treating, how much hair is there, and how dark and thick the hairs are, and how dark your skin is. So all skin types can be treated, but if you have darker skin, we have to use a little bit lower energies. We have to use different wavelengths typically on dark skin, but we have figured out how to treat even very dark skin patients. Typically you do a treatment once a month for three months and then you do another treatment a few months later and another treatment a few months after that to catch any straggler hairs as they wake up from the resting phase. But even with that, there may be some touchups required long-term with these lasers.

(19:00):
So you may come back in six months, a year or two years and do another treatment just if a few hairs that got missed or skipped or were resting are now showing themselves. Even when hair grows back though, it tends to be thinner, finer, and slower growing. There are a lot of systems out there for hair reduction, but the medical office systems tend to be more powerful and they also have more sophisticated cooling options. So some use contact cooling, some use cryogen cooling where a little, the laser pulse fires and five to 20 milliseconds later a little pulse of cryogen fires to cool the skin. Or you can pre-cool the skin with a little cryogen. You have a lot of control over timing the cooling compared to the laser, so the skin is not damaged, but the hair can be targeted effectively. For any area with a lot of hair, this is probably a good candidate area for treatment with laser and light-based devices.

Summer Hardy (20:18):
Thank you Dr. Bass for sharing the ins and outs of hair removal technologies. Definitely good to have these technologies available if you want to go bare. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that is coming your way. If you want to contact us with comments or questions, we'd love to hear from you, send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.