I often get asked this question in clinic. And the short answer is – there are multiple reasons why some women suffer with excess facial hair, for example above the upper lip, on the sides of the cheeks, or in the chin area.
To start with, not all cases of more ‘generous’ facial hair have a pathological reason – some do, some don’t. And that’s because there can be significant differences in the amount of facial hair between different women, depending on individual genetic, familial and ethnic factors. Sometimes it simply runs in families or certain ethnic backgrounds. Women of Mediterranean, South Asian, and Middle Eastern heritage for example are more likely to have more facial hair.
So, if it for example runs in your family and you have always had it, it may just be ‘one of those thing’s and whether or not you would like to reduce it with treatment, is of course completely up to you, as preferences differ from person to person. Don’t let anybody tell you what you should and shouldn’t do. Just listen to yourself and decide whether it bothers you or not. If it does, I will tell you more about the different treatment options below.
However, there are other cases, where excess facial hair is a sign of an underlying pathology in the body, such as an imbalance of hormones, which should be looked at by a doctor.
We frequently see patients with excess facial hair at Eudelo, as it can be connected to acne breakouts, spots and pimples, which is of course one of our specialties. The triage of excess facial hair (also known as hirsutism), diffuse hair loss on the scalp (often worse in the crown area) and acne breakouts often appear together, because they have the same underlying hormonal cause, namely a relative excess of male hormones (androgens such as testosterone). You see, both men and women have male and female hormones (it’s the ratio that naturally differs between men and women). However, if in women the delicate balance between female and male hormones becomes disturbed, a consequence can be excess facial hair (often in combination with hair loss on the scalp and breakouts, as mentioned). This also happens as part of PCOS (polycystic ovary syndrome, where it often is connected with irregular menstruation, too).
Apart from individual differences and hormonal imbalances, excessive facial hair growth can also result from taking certain medications such as Minoxidil or Cyclosporine, as well as taking anabolic steroids.
Another not very common reason for excess facial hair may be Cushing’s disease (where there is an excess of cortisol) and other adrenal gland disorders.
So, best to see a doctor, ideally a dermatologist (dermatologists are experts not only in skin, but also hair and nails, which actually belong to our organ skin!), who will examine you and may arrange some tests such as blood hormone levels, to look into the reasons for your excess facial hair. They may also arrange an ultrasound scan of your ovaries to check for cysts.
There are various treatment options for excess facial hair. For coarse dark hair (also known as ‘terminal hair’), there are of course several mechanical removal methods including shaving, waxing, plucking, dermaplanning and threading. Some of these mechanical methods also work for vellus hair (‘peach fuzz’). Alternatively, bleaching of darker hair to make it less obvious, may work for some women.
Your doctor may also prescribe a cream called Vaniqa (containing eflornithine), which slows down facial hair growth after a couple of months.
All of the above methods have to be performed on a regular basis. A longer-lasting method is laser or IPL hair removal. Laser or IPL hair removal works by targeting the melanin pigment in the hair. The IPL or laser light travels down the hair to the follicle (the hair root) and essentially heats it up to put it into a resting phase, or occasionally ‘kill’ it off for good.
Generally, the higher the contrast between the hair pigment and the skin pigment (ie dark hair on fair skin), the better the outcome of laser and IPL hair removal. Due to the low levels of melanin in light-blonde, white/grey and red hair, IPL and laser hair removal treatments are generally not as effective on these hair colours. Laser and IPL treatment may also not be as suitable for women with naturally dark skin tones, as there is a higher risk the light may react with the melanin in your skin, ie causing burns and/or pigmentation in the skin.
Laser/IPL hair removal can be done in clinics for near-permanent results (all of them will need occasional repeat treatments after a certain amount of time though, as they are not 100% permanent) or alternatively with gentler devices such as the Philips Lumea Prestige at home. The latter is a great alternative to in-clinic treatments and I have one myself at home.
At-home IPL hair removal devices use a lower intensity of light than professional, in-clinic treatments. The benefit of using at-home devices is that it gives you the flexibility of carrying out the treatment in the comfort and privacy of your own home, when it suits you best. However, as at-home products have a lower energy intensity (to make them safe to use at home), you have to conduct treatments more frequently and results can take a longer.
Very occasionally it can happen that there is more hair growth observed after laser or IPL hair removal. This is called ‘laser/IPL-induced paradox hair growth’. Thankfully it’s not very common and can be treated. If there is a history of this, we will prescribe the above mentioned Vaniqa cream alongside the laser/IPL course, which almost always prevents paradox hair growth.
Electrolysis is another permanent hair removal method. It uses an electric current to essentially damage the hair follicle. The method treats each hair follicle individually, one by one, so only works for smaller number of hairs. However, the advantage is that it can be done for grey and red hair also.
My strong advice is to not suffer in silence in any case. Seek help from a doctor, ideally a dermatologist, and get diagnosed properly as well as treated.