9.2 Abnormal Hair Growth, Tweezing, and Eyebrow Design

Abnormal hair growth on the exam

The NIC outline lists "abnormal hair growth (e.g., hirsutism, hypertrichosis)" under Scientific Concepts. Clients often come to an esthetician first about hair growth that bothers them, so you need to recognize the patterns, offer appropriate temporary removal, and know when the growth itself calls for a medical evaluation.

Hirsutism versus hypertrichosis

Esthetics textbooks sometimes use the two terms loosely, so read each exam question for the pattern it describes. "Male-pattern hair in a woman" points to hirsutism, while "excess hair in areas not tied to hormones" points to hypertrichosis.

Other hair-growth situations

• Hormonal life stages: puberty, pregnancy, and menopause all change hair growth. Increased facial hair after menopause is common.
• Medication effects: topical or oral steroids and some other drugs can increase hair. Intake forms should list medications.
• Ingrown hairs (pseudofolliculitis): hair curls back into the skin, causing red bumps, more often with curly hair and after shaving. Gentle exfoliation between waxing appointments helps. Infected bumps are referred.
• Myth to recognize: shaving does not make hair grow back thicker or darker. The blunt cut end just feels coarser.

When to refer

Recommend a physician visit, without diagnosing, when a client reports sudden or rapidly increasing hair growth, hair growth with irregular periods, acne, scalp hair thinning, or deepening voice, or growth that began with a new medication. Then you can still offer temporary removal for comfort.

Hair-removal options and the Class E scope

Eyebrow design

Mapping the brow

Before removing a single hair, map the brow so you shape it to the client's face:

1. Start (inner end): hold a straight edge, such as an orange stick or brow pencil, from the side of the nose (outer edge of the nostril) straight up past the inner corner of the eye. Hairs between the brows, inside this line, are removed.
2. Arch (highest point): angle the straight edge from the outer nostril through the outer edge of the iris while the client looks straight ahead.
3. End (tail): angle it from the outer nostril past the outer corner of the eye. The tail ends on this line, and stray hairs beyond it are removed.

Mark the points lightly with a pencil, show the client in a mirror, and agree on the shape. Remove hairs mainly from beneath the arch and between the brows. Take hairs from above the brow line only sparingly, because over-tweezing the top flattens the shape and some hairs may not regrow well.

Professional tweezing technique

1. Consult and check for contraindications: recent retinoid or isotretinoin use, sunburn, irritation, moles or skin tags in the area, and eye infections.
2. Prepare: wash your hands and put on gloves. Cleanse the area, apply an antiseptic or pre-epilation product, and optionally use a warm compress to soften the follicles.
3. Brace: rest the side of your hand or a finger on the client's face for stability whenever you work around the eye. The NIC practical expects bracing near the eyes and mouth.
4. Hold the skin taut with the fingers of your other hand.
5. Grip each hair close to the skin with disinfected slant-tip tweezers and pull quickly in the direction of hair growth.
6. Work methodically, a few hairs from one brow and then the other, checking symmetry often.
7. Finish with a soothing antiseptic or post-epilation product. Discard disposables in a covered receptacle and clean and disinfect the tweezers as Missouri's implement rule requires.

Tweezing in the NIC practical

In the Hair Removal of the Eyebrow section, the examiner asks you to apply and remove simulated soft wax along the entire length of one eyebrow, then to tweeze three hairs from the same eyebrow and conclude the service. You are graded on clean implements, the tweezing procedure, keeping the drape in place, and disposing of items into the correct containers. Chapter 10 walks through the full section.

Scenario: the client with new chin hair

A 32-year-old client asks for regular chin waxing. She says the coarse dark hairs appeared over the last six months, along with more acne and irregular periods. The pattern (terminal hair in a male-pattern area of a woman) and the timing suggest hirsutism linked to androgens. The esthetician can wax the chin for comfort after a normal consultation. She should also tactfully recommend that the client see a physician about the recent changes, without naming a cause, and note the referral on the client record.