Hair Removal: Technology or Tradition
MSBTh. Cristianos Laser Clinic, GENDYS
RGN, Laser Clinician
This is the fourth time I have addressed conference and when preparing my presentation to you I couldn't help but think how my life has changed and how the lives of delegates must have changed dramatically over these past six years. It made me consider the work of conference in bringing guidance, help and support to people who are undoubtedly going through radical periods of adjustment and change. The ability to meet like minded individuals, sheer opinions, the willingness of professionals to give their time to make the journey less fraught with misinformation and lets not forget the organisers time and commitment in making this all possible.
Many transgendered individuals both male and female have past through my clinic over these six years, all of who have lived to tell the tale I'm glad to say. Much experience has been gained because don't forget removal of hair for a transman or woman is a very different application form that of a genetic client. Issues such as the effect hormones and any photosensitive reactions they may cause, the effect of stopping hormones prior to surgery. The need for hair removal from the genitalia prior to surgery is it needed? If so from what areas, when and how? All issues specific to the treatment of trans clients.
When I first addressed conference in 1998 I believed desperately in the benefit of laser treatment for hair removal and wanted equally as desperately to bring these benefits to the trans community in an atmosphere of trust and understanding.
During my presentation today I intend to talk about electrolysis and laser, how each works, their advantages and disadvantages and getting the best from your treatment plan. Whilst the theory of how these techniques work is long established by greater minds than mine, the practical experience I have gained is to be accredited to all of my clients and my thanks go to them. The passing on of such experience is vital if we are to continually improve and perfect our treatments. I await the day when there will be a model of clinical excellence applied to hair removal for trans clients.
Before we look at how treatment works we need a basic understanding of how hair grows.
There are two long term methods of hair removal:
Lets look at electrolysis first.
There are three methods of electrolysis. The first method is called galvanic electrolysis where a direct current is applied to the hair follicle and sodium hydroxide is produced at the base of the follicle causing its destruction. The chemical reaction takes 12 seconds per hair follicle, making the process very time consuming and reducing the number of follicles, which can be treated in any given session. The advantage to this method is that where hair follicles may be distorted the sodium hydroxide is able to trickle into the base of the follicle.
The second method is thermolysis, which is also known as short-wave diathermy. This method is simply the application of high frequency current, resulting in the heating and therefore the destruction of the follicle. This method has the advantage of only taking two seconds per hair follicle therefore allowing more follicles to be treated per session. However the disadvantage is that distorted hair follicles will not be successfully treated using this thermolysis.
The third method is a combination of the two previous methods. The heat from the thermolysis is used to speed the chemical reaction of the galvanic approach. This method, known as blend takes 6 seconds per hair follicle and brings together the advantages of both methods.
Now lets take a look at laser
Laser works on the principle of selective photothermolysis. The laser light is selectively absorbed in the melanin in the hair shaft, whilst passing harmlessly through the surrounding tissue. This results in selective heating and destruction of the hair follicle. This method relies upon the presence of dark melanin in the hair and an absence of melanin in the skin; therefore only pale skin and dark hair are suitable for treatment.
It is important to remember that laser is a different methodology than intense pulsed light.
Now that we know how both treatments work and when they should be applied, lets look at planning treatment.
Treatment plans for the face and donor site tissue for surgery need to be looked at separately.
Facial Hair Removal.
In my opinion the speed of result and lack of need to grow the hair for treatment makes laser the first choice every time.
Where the hair and skin are suited to laser then I would suggest monthly sessions of laser to remove the dark hair growth. 10 full-face sessions should see the majority of the cheeks and neck clear leaving only stubborn areas usually the upper lip and either side of the chin.
Once the vast majority of the dark hair has been removed the need to leave the hair for several days in order to have electrolysis does not present as daunting a prospect, as the remaining white hairs are far less visible.
From here on in electrolysis can be carried out on the hairs which are unsuitable for laser for three week out of the month, the fourth week laser treatment can be carried out on the remaining dark hairs.
The information gathered over the past 6 years has lead us to believe that in the majority of cases there is very little benefit from having more than 15 laser sessions. Any remaining dark hairs are thought not to contain enough pigment or are too deeply seated to be destroyed by laser. Either way I would advise in most cases laser should be discontinued after treatment fifteen. Any remaining hairs should be treated with electrolysis.
Obviously the proportion of hairs, which are amenable to laser, will depend on the individual but this methodology results in speedy results and ability to manage the hair growth and live successfully in a female role during the course of treatment.
Our audit results show after treatment 85% of clients report improved self-confidence, 77% report improved self-esteem and 92% report improved appearance.
Treatment of the genitalia prior to surgery.
It is my personal opinion that electrolysis should not be used in the treatment of scrotal tissue prior to GRS.
If we re examine the methodology for electrolysis you will remember that the skin tissue needs to be pulled taut in order to insert the needle at the correct angle. The scrotal tissue simply does not lend itself to this process.
The effect of incorrect needle insertion is destruction of the dermal tissue and disruption of the blood supply. This damage to the dermal layers of the skin can ultimately lead to problems for the surgeon.
The nature of the scrotal tissue means that even the most experienced and skilled electrologyst would, in my opinion, experience difficulties with this treatment.
I consider that the risks simply outweigh the benefits.
The use of laser does not present the same risk therefore where the hair and skin are suitable then laser should be considered.
The treatment must be pre planned, it's no good turning up two months before surgery. The treatment should be scheduled well in advance leaving time for six treatment sessions at monthly intervals. The perfect scenario would be to also have several months grace in case of any regrowth. Remember after surgery we cannot perform treatment inside the new vagina.
Its also important that the person performing the treatment knows exactly which areas to treat, as certain areas will need to remain hair bearing for a completely natural appearance.
It is important that your therapist will take the instructions from your surgeon.
Again where phalloplasty is concerned even though the nature of the donor tissue is more suited to electrolysis than the scrotal tissue I would advise laser only prior to surgery and where the skin and hair are not suited to laser the hair should be removed by electrolysis a least six months after surgery and only after agreement with your surgeon.
1 Laser hair removal is suited to dark, coarse hair and pale skin. Has the advantage of speedy results, monthly treatments and not having to grow the hair prior to treatment.
2 Electrolysis is suited to all skin and hair types, but takes a long time to produce results, involves weekly treatments and needs several days' hair growth.
Most clients will have a proportion of dark hair and white therefore a combination of both treatments will lead to the optimum results.
We suggest, as a guide:
Ten monthly laser sessions followed by
Three weeks electrolysis and one week laser for five months
Any remainder to be treated with electrolysis.
The treatment of donor site tissue prior to GRS should be:
Laser only, make sure therapist is familiar with the nature of the surgery and will take instructions from your surgeon if needed, remember the importance of planning.
Laser prior to phalloplasty, where not suited to laser electrolysis six months after surgery with surgeon's permission.
To finish: a word of guidance on finding a good clinic.
All users of laser or IPL systems are required by Law to register with The Healthcare Commission under the Care Standards Act 2000. I am saddened to say that industry estimates say that 90% of users of such equipment are not registered
The Healthcare Commission was set up to protect you the service users and ensure quality assured treatment and care.
The Healthcare Commission inspects all registered premises at least once per year and formulates a report. This report is a public document; it is your right to see the report produced by the Commission with regard to any clinic or salon. The report should be on display at the premises or can be obtained directly from the Commission.
The report will give you an insight into the running of the clinic and whether the clinic is meeting the required standards.
Any clinic, salon or individual who is not registered is operating illegally.
Cristianos laser clinic has been established for over 10 years with clinics in Manchester, London, Leeds and Lancashire specialising in all types of laser hair removal inc dark skin and light hair along with skin treatments for the trans community inc active acne, thread veins and Rosacea. Free consultations and test patches. For more information see cristianos.co.uk or contact firstname.lastname@example.org
Citation: Hart, C., Fillingham, S., (2004),Hair Removal: Technology or Tradition, GENDYS 2004, The Eighth International Gender Dysphoria Conference, Manchester England.
Web page copyright GENDYS Network. Text copyright of the author. Last amended 27.03.06