Consultation: Evaluation of Hair Growth

Presented to the Kansas Association of Professional Electrologists on April 14, 2019 by Barbara Greathouse, CPE

This presentation provides electrologists a method to evaluate the treatments they provide and gives clients essential information needed to recognize the signs of progress by the electrologist they have selected.   Using information gathered during the consultation for electrolysis treatments the electrologist will have asked the client specific questions about the methods and frequency of their previous hair removal.  Documentation of this information provides a quantitative comparison of hair growth before, during, and after the required series to reach permanent hair removal goals. 

According to a survey presented to three professional electrolysis groups on social media, more than 85% of first appointment consultations for electrolysis are requesting treatment on the face.  Since clients rarely remove body hair with frequent tweezing, the questions are in reference to what has been done on the face, but hair growth on body areas can be documented with all but the Pre-Treatment Tweezing information.  Knowledge of the nature of other methods of hair removal and the physiology of hair growth allows the electrologist to better explain how and why the electrolysis treatment takes time; to reinforce to the client that the hair did not develop overnight and therefore completing electrolysis will take a series of treatment to reach permanent results.    

DOCUMENTING THE CONDITION OF SKIN AND HAIR

Written and photographic documentation will provide the electrologist and client with before, during, and after comparisons thus showing the results of treatment. 

1. In what condition is the skin? (healthy, smooth, rough, oily, dry, irritated, pitted, broken skin, pustules)
2. What type of hair is present?  (diameter and texture of hair – vellus, accelerated vellus, terminal)
3. How much space is between the hairs?  (sparse, intermediate, dense)
4. What methods of hair removal have been used most recently? (tweezing, waxing, threading, shaving, depilatories, laser or other light based, electrolysis)

The old wives tale that shaving makes hair grow in heavier is probably why so many women started tweezing their unsightly facial hair.  The fact is that shaving does nothing to produce more or larger hair is hard for people to get past, however, electrologists report they see many clients with hair diameters larger than average after the client reports they have tweezed for many years.   

PRE-TREATMENT TWEEZING  (PTT)   

Questions about tweezing before beginning electrolysis treatments:

• How often do you tweeze the area?
  1. Every day (raises PTT number)
  2. Once a week 
  3. Once a month (lowers PTT number)
• How much time did you spend tweezing each time?
  1. 1 – 2 minutes (lowers PTT number)
  2. 5-10 minutes
  3. more than 10 minutes (raises PTT number)
• When was the last time you tweezed the area?
  1. Today (reevaluate when they return next)
  2. Yesterday (shows how much hair grows in 24 hours)
  3. Last week (first clearing helps determine how long to schedule for weekly treatments)
  4. Last month (probably very few hairs, see you in a month)

DOCUMENTING PTT 

PTT+1     Occasional tweezing of a few hairs or electrolysis more than 90 days ago

PTT+2     Tweezing in the past 10 to 20 days or electrolysis 30 to 90 days ago

PTT+ 3     Tweezing within the past 10 days; removed 50% of growth or electrolysis about 20 to 30 days ago

PTT+4     Most of the hair tweezed within the last 10 days or electrolysis within the last 20 days

DETERMINING LETTER CODE

The letter code is determined from observing hair diameter.  A fine hair is less apparent than a large diameter hair and a long hair is more obvious than a short hair.  Larger diameter hairs grow faster than smaller diameter hairs.  The electrologist should select a probe size close to the diameter of the hair to allow for the treatment energy to effectively treat all the stem cells in the follicle.  Too small a probe with larger hairs will not reach all of the stem cells, contributing to regrowth of the hair from that follicle.   

Determine the ratio of the various types of hair.  For example:  90% fine hairs with a few large diameter hairs scattered.  OR:  Mostly large diameter hairs with a few fine hairs.

A  is a vellus hair with less than 1 mm depth and a diameter of less than .001 inch

B is a vellus, accelerated vellus, or terminal hair with a depth of 1 mm and a diameter of less than .001 inch

C is a vellus, accelerated vellus, or terminal hair with a depth of 1 to 3 mm and a diameter of less than .003 of an inch

D is a terminal hair with a depth of 3 to 5 mm and a diameter of more than .003 of an inch

DETERMINING DENSITY RATING

Select one or more areas to measure using a one centimeter cut-out to photograph or count the hairs.  

1. Are hairs close together or is there much space between hairs?
2. How many hairs per square centimeter? 
3. Does there appear to be more than one hair growing out of the same follicular unit?

DENSITY RATING

+1 Very sparse; only a few hairs present

+2 Sparse – 2mm to 15mm between hairs

+3 Moderate crowding – 1mm to 3mm between hairs

+4 Very dense growth – 1mm between hairs

+5 Unusually high density; most of the follicles have more than one hair and these follicle units are less than 1mm apart (less than 1% of clients will fall into this category – less than 1mm apart; 2-3 hairs growing in each follicular unit

EVALUATING THE INFORMATION

Clients may give inaccurate information about recent electrolysis or laser treatments.  They may not admit to using self-administered hair removal treatments such as tweezing, waxing or threading.  Learn to recognize the signs of recent tweezing, laser treatments, or faulty electrolysis treatment. 

The following signs will help you recognize regrowth from the various forms of epilation: 

1. Ingrown hairs; with or without active lesions.  Ingrown hairs may need to be carefully lifted from the skin with sterile forceps or a sterile lancet.  Frequent picking by the client can also contribute to acne in the area of the hair growth.  When a client insists they cannot stop tweezing between treatments their first goal will be to stop the tweezing, with the knowledge that continued tweezing will delay completion of the treatments.
2. Hair fragments protruding through the surface of the skin.  This can be from tweezing, poorly executed electrolysis or an indication of recent laser treatment.  
3. Follicles reverting to premature telogen, expelling distorted and/or corkscrew hairs.  Follicles that have been tweezed or under-treated with electrolysis may result in a hair with a clumpy root sheath.  The corkscrew hair (not a naturally curly hair) will often be seen with the whole root so close to the surface of the skin that you can see where the hair is attached to the papilla. Some electrologists believe these hair follicles are essentially dead and can be tweezed out without regrowth or causing more problems, but treating the visible follicle is a good exercise in checking insertions and current application.
4. Dark spots (black dots) embedded in the skin. These will show up as if there is pepper under the skin.  They are a remnant of the hair root. They will expel from the follicle on their own.
5. Hair growing from pitted follicles.  Most pitting is caused by the client picking the skin.  Over-treatment resulting in large diameter and deep scabs or high-frequency blowout may result in some pitting. 

As treatments progress the Density Rating will lower and the Letter Code will change as evidence of permanency. As treatments progress the length of each treatment will become shorter while the time between treatments will become longer. All signs of regrowth will disappear and the skin condition usually improves.  The electrologist can evaluate their work by comparing clients with similar hair problems to see if results are similar.  K. Lasker, the source of this information, recommends evaluating every 15-20 hours of treatment.  While it is not necessary to document progress at every appointment, reviewing hair growth every 2 to 3 months will provide evidence of the decrease in hair growth.  

Collecting and documenting this information provides evidence of the success of the electrology treatments.  Providing a new client with quantitative results gives them confidence in the knowledge and experience of the electrologist and shows measurable proof that electrology works.

Adapted from the Manual for Epilation Charting System, 2nd Edition by K. Lasker, B.S.