Hair-free heals better: how to support your wound care
Welcome to our information page on hair removal! After an Pilonidal Sinus operation, careful hair removal in the area of the gluteal fold (rima ani) plays a decisive role in ensuring undisturbed wound healing and preventing recurrences. Here you will find an overview of the various methods of hair removal, their advantages and disadvantages, and how they can specifically help to prevent recurrence.
When the hair is removed, the fistula will heal.
Where do the hairs come from that you find in the cave of a Pilonidal Sinus ?
- The hair mainly comes from hair roots in the area of the gluteal fold.
- New studies show that hair from the head can also be found in the fistula ducts, hair from the back only rarely. Short, freshly cut hair from the neck seems to penetrate the skin most easily.
- Hard to believe: hair from partners, family members or pets is rarely found in coccyx fistulas!
In our own experience and according to recognized clinical studies, a hair-free gluteal fold can help to reduce the risk of healing disorders and recurrences after surgery. Many recurrences are actually poorly healed surgical scars(type IV fistulas). Consistent hair removal after surgery can usually prevent these recurrences. The penetration of loose hair from other parts of the body can best be prevented by covering it with a closed bandage.
Depilation: hair removal of the visible part of the hair
Procedures that only remove the visible part of the hair, the hair shaft, such as shaving and depilatory cream, are called depilation. These methods last for about two weeks and do not affect the hair root in depth or the risk of a real recurrence. Contrary to popular belief, depilation does not change the growth rate. Shaved hair does not grow back faster or thicker.
Shaving - Useful, indifferent or harmful?
The WHO recommendation from 2016 states: "Shaving is strongly discouraged at all times, whether preoperatively or in the operating room." We see it differently in 2 situations:
- To assess the fistula before surgery: In patients with dense hair growth, the true extent of the Pilonidal Sinus and the number and localization of the pits can only be assessed when shaved.
- In the healing phase after surgery: Regardless of whether laser epilation has been performed or is planned, it is crucial to control hair growth during the healing phase. The hair must not reach the edge of the wound.
What you need for the perfect shave
The alcohol-free disinfectant Octenisept® is ideal for cleaning and disinfecting. Thanks to its viscous consistency, it allows the razor to glide smoothly and prevents shaved hair from getting into the wound. Hospital razors (e.g. from Wilkinson®) have proved particularly effective. Special razors for the bikini line, clippers or beard trimmers, such as those offered by Braun or Philips, can be useful for hard-to-reach areas.
This is the best way to proceed
When shaving, we recommend shaving directly from the edge of the wound on both sides and at least 2 cm below (footward) the wound. In the case of dense hair growth, it is advisable to use a new razor for each side and to use it only lightly to avoid injury.
A weekly shave is usually sufficient. Ask a relative for help, as it can be difficult to see the area well yourself.
Make sure you have good lighting and use a magnifying glass if necessary. After shaving, take a photo with your cell phone and enlarge it to make sure no stubble has been missed. Send us the picture by e-mail or Messenger so that we can assess the shave.
Continue this care, even if the wound is already closed, until the color of the scar changes from purple to skin-colored.
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Hair removal cream
Depilation with depilatory creams is a widespread and painless method of temporary hair removal that leaves less unpleasant stubble than shaving. It is based on the splitting of disulphide bridges in and on the hair by thioglycolates. This loosens the hair shafts up to approx. 1-2 mm under the skin. Sharp stubble as with shaving is avoided.
The preparations available on the market differ mainly in terms of the concentration of active ingredients and carrier substances, care substances, fragrances and preservatives.
The cream is applied and left on for about 10-15 minutes until it is washed off again or scraped off with a scraper.
Pros:
- The treatment is generally painless and well tolerated.
- The entire procedure is simple, can be performed by the patient and takes less than 15 minutes.
- All the necessary utensils are included in the product packaging.
- Hair removal cream is available in special formulations for sensitive skin. (Just search for "intimate hair removal" or "bikini line hair removal").
- Even babies have been successfully treated with it in special medical situations.
- We are of the opinion that hair removal with a cream is definitely better than no hair removal at all.
Disadvantages:
- Short-term results: Hair removal usually only lasts about one to two weeks.
- The chemical ingredients can very rarely cause pronounced skin irritation or allergic reactions. We therefore strongly recommend a tolerance test on a less sensitive area before treating the buttock crease.
- Combined use with shaving or waxing should be avoided at all costs.
- Unpleasant odor: Some hair removal creams have a strong, unpleasant odor.
- Studies show a mild inflammatory reaction that could possibly slow down wound healing.
Epilation: hair removal with the root
Waxing
Waxing involves applying warm or cold wax to the skin and then quickly pulling it off to remove the hair along with the roots. There are different techniques, including strip wax and hard wax.
Pros:
- Long-lasting results: As the hair is removed at the roots, the skin remains smooth for up to four weeks.
- Finer regrowth: After repeated waxing, the hair can grow back finer and thinner.
- Suitable for large areas of skin: Waxing can quickly treat large areas of skin such as legs or back.
Disadvantages:
- Painful: Removing the wax can be painful, especially in sensitive areas.
- Skin irritation and ingrown hairs: Waxing can cause skin irritation and increase the risk of ingrown hairs.
- Hair length: The hair must have a minimum length of about 5 mm to be waxed effectively.
Sugaring
Sugaring is similar to waxing, but uses a paste made from sugar, water and lemon juice. This paste is applied to the skin and removed in the direction of hair growth.
Pros:
- Less painful: Sugaring is often perceived as less painful than waxing.
- Natural ingredients: The paste consists of natural ingredients, which reduces the risk of skin irritation.
- Finer regrowth: After repeated sugaring, the hair can grow back finer and thinner.
Disadvantages:
- Painful: Although less painful than waxing, sugaring can still be unpleasant.
- Hair length: The hair must have a minimum length of about 3 mm to be effectively removed.
- Time consuming: The procedure can be time consuming, especially for large areas of skin.
Epilating with an electric epilator
With this technique, the hair is pulled out with a rotating tweezer system (e.g. Braun Silk-épil, Philips SatinPerfect).
- Rotating tweezer system: Electric epilators are equipped with a rotating roller that contains several small tweezers. These tweezers open and close as the roller rotates.
- Grasping the hairs: When the epilator is moved over the skin, the closing tweezers grip the hairs on the surface.
- Pulling out the hair: The tweezers pull the hair out of the skin through the rotational movement of the roller. The pull is quick and continuous, pulling the hair out at the root or just above the root of the hair
- Hair removal: The treated skin area remains hair-free for several weeks. This distinguishes epilation from shaving.
- Regrowing hair: The hair grows back after a few weeks as the hair roots and growth zones remain intact. The hairs that grow back may appear thinner and softer as they go through a new growth phase.
Pros:
- Longer lasting results: As the hair is removed at the roots, the skin remains smooth for up to four weeks.
- Finer regrowth: After repeated epilation, the hairs can grow back finer and thinner.
- No chemical substances: Epilating does not require any chemical substances and is therefore suitable for sensitive skin.
Disadvantages:
- Painful: Plucking out the hair can be very painful.
- Skin irritation and ingrown hairs: Epilating can cause skin irritation and increase the risk of ingrown hairs.
Laser epilation - permanent hair reduction by laser (IPL, diode laser, alexandrite laser)
Laserand IPL (Intense Pulsed Light) systems for hair removal use different technologies to generate light pulses of a suitable wavelength.
The light energy is absorbed by melanin, the hair's pigment. The germinative zone of the hair follicle, which is responsible for hair growth and regeneration, is irreversibly destroyed when exposed to the resulting temperatures of around 60°C to 70°C (selective photothermolysis).
The most common device types are
- Alexandrite laser (755 nm) - ideal for lighter skin types
- Diode laser (810 nm - 950 nm) - versatile in use
- Nd:YAG laser (1064 nm) - perfect for darker skin types as it can penetrate deeper into the skin and absorbs less melanin in the superficial layer of the epidermis
- The IPL method (Intense Pulsed Light) uses a flash lamp that emits intense, non-coherent, broadband light with wavelengths between 400 and 1200 nm. Filters are used to block potentially harmful wavelengths and only allow those that are effectively absorbed by the melanin pigments in the hair to pass through. IPL is flexible to use, but somewhat less precise.
Pros:
- Long-term effectiveness: Repeated lasering can achieve a permanent hair reduction of up to 90%
- Less painful: Most patients find laser treatment less painful than waxing or epilating. Nevertheless, we use local anesthesia in the very sensitive regions of the gluteal fold to ensure effective treatment.
- Reduced risk of ingrown hairs
Disadvantages:
- The cost per session is between €80 and €200 depending on the technology and provider, several sessions are required and statutory health insurance companies may not cover the costs.
- Requires several sessions: Usually 6-8 sessions are required for optimal results.
- Not suitable for all skin and hair types: The treatment is most effective on dark hair and light skin.
Preventive laser treatment?
In order to prevent Pilonidal Sinus , action should be taken at an early stage, as the first "pits" often appear at the onset of puberty. Permanent laser hair removal of the buttock crease could have a preventative effect, but it is difficult to estimate who will really benefit from this. As the treatment is not covered by statutory health insurance and several sessions are required, prophylactic laser epilation only appears to make sense in the case of heavy hair growth or a family history of hair growth.
Electric hair removal (electro-epilation, electrolysis)
- In needle epilation, a fine wire is inserted into the hair follicle parallel to the hair shaft and the hair root at the bottom of the follicle is destroyed with an electric current. The loosened hair is plucked out with tweezers.
- In medical electrolysis treatment, the hair root is sclerosed by a short-wave pulse, which is also applied via an inserted probe.
These methods are considered by the American FDA (Food and Drug Administration) to be the only technique of truly permanent hair removal with so-called 510(k) approval. The risks include infection of the hair follicle. As with laser epilation, repeated treatments are required.
This treatment requires in-depth training and experience and is offered by beauticians. Theoretically, electroepilation would be covered by statutory health insurance (EBM code 10340). This would require the treatment to be carried out by a licensed panel doctor. However, there are no panel doctors available who are proficient in this method.
On the website of the professional association you can check if a therapist in your region offers this technique. It has advantages especially for very light and/or delicate hair that does not respond optimally to laser treatment.
Pros:
- Permanent hair removal
- Suitable for all hair and skin types
- Precise method: Ideal for small areas such as the face or bikini line.
Disadvantages:
- Very time-consuming: Each hair root must be treated individually
- The costs can be high, especially for large treatment areas
- The procedure can be painful, depending on the patient's sensitivity to pain.
Most of the information on this issue comes from the treatment of abnormally increased hair growth (hirsuitism) and treatment after gender reassignment treatment for transsexuals. Hormonal or hormone receptor-blocking treatments can be considered to reduce excessive hair growth, particularly in the case of hormonally induced hair growth. Antiandrogenic drugs such as cyproterone acetate or spironolactone inhibit the effect of male hormones (androgens) and can reduce hair growth. Such therapies are often used for hormone-related conditions such as hirsutism, but are also an option for increased hair growth, which can lead to complications such as coccyx fistulas. As hormonal treatments can have side effects, they should only be used under medical supervision and after careful consideration of the risks.
Hair removal literature
Alster, T., Bryan, H., & Williams, C. (2001). Long-Pulsed Nd:YAG Laser-Assisted Hair Removal in Pigmented Skin. JAMA Dermatology, 137(7), 885-889
Barolet, D. (2012). Low fluence-high repetition rate diode laser hair removal 12-month evaluation: Reducing pain and risks while keeping clinical efficacy. Lasers in Surgery and Medicine, 44(4), 277-281.
Boss, W., Usal, H., Thompson, R., & Fiorillo, M. (1999). A Comparison of the Long-Pulse and Short-Pulse Alexandrite Laser Hair Removal Systems. Annals of Plastic Surgery, 42(4), 381-384-381-384.
Galadari, I. (2003). Comparative evaluation of different hair removal lasers in skin types IV, V, and VI. International Journal of Dermatology, 42(1) Garcia, C., Alamoudi, H., Nakib, M., & Zimmo, S. (2000). Alexandrite Laser Hair Removal is Safe for Fitzpatrick Skin Types IV-VI. Dermatologic Surgery, 26(2)
Giltay, E., & Gooren, L. (2000). Effects of Sex Steroid Deprivation/Administration on Hair Growth and Skin Sebum Production in Transsexual Males and Females. Journal of Clinical Endocrinology and Metabolism, 85(8), 2913-2921
He, X., Jia, L., & Zhang, X. (2022). The Effect of Different Preoperative Depilation Ways on the Healing of Wounded Skin in Mice. Animals, 12(5)
Hendricks, K., Nxumalo, C., Makgobole, M., Ghuman, S., Jacobs, D., & Mpofana, N. (2023). Evaluating the effectiveness of laser hair reduction using a home use laser in comparison to a Diode laser. PLoS ONE, 18(5)
Karanfil, E., & Görgü, M. (2024). Efficacy and Pain Tolerance of Alexandrite Laser Hair Removal at Different Stages of the Menstrual Cycle. Aesthetic Surgery Journal, 44(8), NP558-NP566.
Kiene, J., Maiman, R., & DeKlotz, C. (2020). Severe irritant reaction following sequential waxing and use of a chemical depilatory cream in an adolescent. Pediatric Dermatology, 37(1), 190-191.
Le Coz, C. (2002). Contact nummular (discoid) eczema from depilating cream. Contact Dermatitis, 46(2)
Liew, S. (2012). Laser hair removal. American Journal of Clinical Dermatology, 3(2), 107-115.
McDaniel, D., Lord, J., Ash, K., Newman, J., & Zukowski, M. (1999). Laser Hair Removal. Dermatologic Surgery, 25(6)
Nisar, M., Lloyd, J., & Khan, T. (2013). Laser Hair Removal Put in the Wrong Hands. Dermatologic Surgery, 39(3pt1), 480-482
Ommer, A., Iesalnieks, I. & Doll, D. S3 guideline: Pilonidal sinus. 2nd revised version 2020. coloproctology 43 (Suppl 1), 25-73 (2021)
Oram, Y., Kahraman, F., Karincaoglu, Y., & Koyuncu, E. (2010). Evaluation of 60 Patients with Pilonidal Sinus Treated with Laser Epilation after Surgery. Dermatologic Surgery, 36(1)
Pronk, A., Eppink, L., Smakman, N., & Furnee, E. (2017). The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature. Techniques in Coloproctology, 22(1), 7-14
Rogachefsky, A., Silapunt, S., & Goldberg, D. (2002). Evaluation of a New Super-Long-Pulsed 810 nm Diode Laser for the Removal of Unwanted Hair: The Concept of Thermal Damage Time. Dermatologic Surgery, 28(5)
Tanzi, E., & Alster, T. (2004). Long-Pulsed 1064-nm Nd:YAG Laser-Assisted Hair Removal in All Skin Types. Dermatologic Surgery, 30(1)
Wendelin, D., Mallory, G., & Mallory, S. (1999). Depilation in a 6-Month-Old with Hypertrichosis: A Case Report. Pediatric Dermatology, 16(4)
