Long term hair removal is open to debate. Most surgeons recommend shaving during healing and for a few months after but very few patients are able to maintain such a regimen long term and there have been studies showing long term shaving results in increased reocurrence risk. However, keeping the midline free of hair certainly helps reduce future risk, which means you should consider laser hair removal if you can get your insurer to cover it. In the study referenced below, laser hair removal significantly reduce recurrence rate.
Laser Hair Removal
Laser hair removal has shown promise at reducing recurrence of PIlonidal Disease post-surgery. Typically, health insurers consider laser hair removal to be a strictly cosmetic elective procedure. You and your doctor are going to have make a solid argument that is it medically necessary to prevent further recurrences of Pilonidal Disease. Dr. Paul Harper has reported success in laser hair removal as an aftertreatment to Pilonidal surgery but has noted that getting insurers to pay has been challenging.
Laser Hair Removal as Adjunct to Surgery for Pilonidal Sinus: Our Initial Experience
Journal of Cutaneous and Aesthetic Surgery: Sept-Dec 2011 pp192-195
Wagih Mommtaz Ghnnam1 and Dhafer Mohmmed Hafez
BACKGROUND: This prospective randomized study compared permanent laser hair removal following the excision of pilonidal disease with conventional methods for hair removal.This prospective randomized study compared permanent laser hair removal following the excision of pilonidal disease with conventional methods for hair removal.
METHODS: Patients undergoing surgery for pilonidal disease were randomized to two groups: those using laser hair removal methods following completed healing of wounds (group I) or regular post-healing conventional methods for hair removal, mainly razor and depilatory creams, for at least 6 months (group II). Group I patients received regular, monthly laser hair treatment sessions using Alexandrite laser for four sessions at monthly intervals . The Alexandrite laser has a wavelength of 755 nm, and was used at a fluence of 14–16 J/cm2 and fixed pulse duration of 3 ms, with spot size of 15 mm. The light (pulses) was delivered at 1 pulse/s, allowing large areas to be treated rapidly (we call it frequency)
RESULTS: After a mean follow up of 2 years, Group I (laser hair removal group) had an overall recurrence rate of 2.3%. Group II (razor shaving group) had a recurrence rate of 17.1%.
CONCLUSIONS: In this study, the recurrence rates for surgical intervention were found to be comparable with the results of previous studies, but our results strongly suggest that laser hair removal after surgical interventions in pilonidal sinus disease decreases the risk of recurrence in the long term. Laser epilation is simple and quick, without any complications. We recommend laser epilation to every patient with pilonidal sinus disease as an adjunct treatment after the surgical intervention to prevent further surgery.
Read the full study at PubMed, US National Library of Medicine
A study in 2009 concluded that shaving was associated with increased chance of reocurrence – we post the abstract from this study:
Long-Term Effects of Postoperative Razor Epilation in Pilonidal Sinus Disease
Diseases of the Colon & Rectum: January 2009-Volume 52-Issue 1-pp131-134
Petersen, Sven M.D., Ph.D.
PURPOSE: To study potential benefits of postoperative epilation after pilonidal sinus surgery, the long-term effect of hair removal on pilonidal recurrence was investigated.
METHODS: A total of 1,960 patients with pilonidal sinus treated surgically from 1980 to 1996 in three hospitals of the Deutsche Bundeswehr were eligible for the study. Regular hair removal with a razor was recommended for all patients after surgery. A randomly selected sample of 504 patients was contacted for a follow-up telephone interview.
RESULTS: The mean follow-up time was 11.3 (standard deviation, 6.4) years. Overall, pilonidal sinus disease recurred in 111 (22 percent) of the 504 patients. A total of 113 patients followed the recommendation to perform epilation (mean duration, 7.5 months), and 391 patients did not. Recurrence was observed in 30.1 percent (34/113) of patients who performed postoperative epilation and in 19.7 percent (77/391) of patients who did not perform postoperative epilation (P = 0.01).
CONCLUSIONS: Razor hair removal increases the rate of long-term recurrence after surgery for pilonidal sinus disease and therefore should not be recommended. However, the rationale for hair removal in pilonidal sinus disease is compelling. Other epilation techniques such as laser hair removal should be investigated in appropriate studies
With the above research in mind, it is our suggestion that shaving is not a good idea in most circumstances. Patients who have significant body hair in the buttock region would be advised to consider laser hair removal.
One Woman’s Tour of Hair Removal Hell
Just in case you do decide to proceed with hair removal, here is a tour of the options:
- Shaving, blade – blade shaving is the most traditional form of shaving, but also is the hardest on tender skin. The natal cleft is about as easy to shave with a standard razor as the bikini area is — which is to say that it ain’t easy. The only sane way is if you have someone else to do it for you, since the usual results of self shaving are nicks, cuts and razor burn.
- Shaving, electric – electric shavers have become the method of choice for many of us. True, the shave is not as close, but electric shavers do the least amount of damage to tender skin areas. The absolute, hands-down winner in the category of electric shavers are the “groomers”. These small shavers are unsuitable for legs or larger body areas, but perfect for the natal cleft. Most are about the size of pen and range in cost from $15 to $20. Order online or pick up at most major drug chains. Look in the men’s shaving area for best options. These electric groomers are typically marketed for men to touch up under beard and neck areas, they are nimble enough for use in the buttock cleft.
- Waxing – waxing tends to last longer than shaving, up to 3 weeks. It is not horribly painful (at least this part of the body). Waxing can be done at home if you have help (like shaving, it’s tough to do this body area solo) or in a salon. Before you freak out at the salon idea, remember that professional waxers do bikini areas all day long and the also do “Brazilian bikini waxes” which is, basically, waxing everything below the navel. Waxing pro’s have seen worse things than anything you’ve got to show, so don’t sweat it. If you are considering this method, keep in mind the above warning about traumatizing the skin. Waxing is pretty brutal on hair follicles and areas treated can stay inflamed for several hours. Check with your surgeon first and make sure you are using No Bump RX afterward to avoid ingrown hairs and relieve the inflammation. Do not attempt waxing if you have any kind of an open wound.
- Depilatories – many doctors recommend this to their patients, but few people stick with the method over time. Unless you are already fan of these products, you probably won’t be enthused. Depilatories are smelly and don’t always do a good job. DO NOT USE ANYWHERE NEAR AN OPEN WOUND. Many people report rashes or inflamed skin resulting from depilatories, so use with caution.
- Electrolysis – expensive and painful, but effective. I’ve had my eyebrows done and am thrilled with the results. Electrolysis remains the only guaranteed form of permanent hair removal. For anyone considering this method, the same caveats apply as with waxing. Electrolysis cauterizes that hair follicle, which does result in inflammation. But, if the follicle is now dead, how much danger remains? There are no answers, but the worry scares off most people who have seriously considered electrolysis for Pilonidal related hair removal. We have no reports yet at this website of anyone actually attempting electrolysis of the natal cleft.
- Vaniqa / Eflora – I have NOT tried these products. These are FDA approved creams that claim to retard facial hair growth. From what we’ve read so far, they showed results in 58% of those tested, 42% experienced no results. These are products designed to reduce facial hair growth in women (and some men who are so inclined). They don’t get rid of the hair, just make it grow slower and finer. Vaniqa is a prescription only but it appears you can buy Eflora over the counter (same ingredients, just generic). I’ve seen lots of positive reviews of both products but not on any sites that I trust to have impartial, real users.
This page last updated: January 5, 2019