Vellus facial hair: why expanding the treatment area is a poor idea

"As we are treating the chin, we may as well do the cheeks" can sound considerate and efficient. In reality, it changes the treatment area, hair type, consent and risk assessment. Fine facial vellus hair often contains little pigment, is a poor candidate for a predictable laser response and sits in a region where paradoxical growth has been reported more often than on the body. A conservative boundary is not incomplete work. It is a way to avoid creating a problem in an area that did not concern the client in the first place.

Distinguish terminal hair from vellus hair

Terminal hairs are generally thicker, longer and darker. Vellus hairs are finer, shorter and lightly pigmented. Side lighting can make vellus hair look much more prominent in a photograph than it does in everyday life, so one enlarged image should not determine treatment.

Map the chin, upper lip, jawline and cheeks separately. The boundary should follow the actual hair type and the client's aesthetic goal, not a convenient sweep of the handpiece.

Discuss paradoxical growth without causing alarm

Paradoxical hair growth after laser and light-based procedures is a recognised adverse event, although reported rates vary. A meta-analysis found a stronger association with the face and neck, while estimates differed between studies.

Do not promise that a particular device, higher energy or an additional course will remove this risk. Explain the uncertainty and document baseline density before consent is given.

Do not expand consent automatically

Consent for the chin does not include the cheeks. A new area requires its own assessment of the skin, hair, sun exposure, medication and boundaries. A request made at the end of the visit does not remove those steps.

If the client is unsure, retain the original boundary and arrange a separate consultation. Pressure based on "while you are here" prevents a considered decision and an honest refusal.

Recognise when medical assessment is appropriate

A rapid new increase in facial hair accompanied by changes in the menstrual cycle, acne, thinning scalp hair, weight change or other symptoms warrants medical assessment. The practitioner records the observation but does not diagnose a hormonal cause.

Laser treatment should not conceal that pattern through endless expansion of the area. After an appropriate medical assessment, the plan can be reconsidered in light of the client's goal and the suitability of the target.

• Map terminal and vellus areas separately.
• Show the client the boundary before treatment.
• Discuss the uncertainty associated with the face and neck.
• Obtain fresh consent for every new area.
• Refer unusual new growth for medical assessment.