Hair removal in the Twenty First Century

Chris Hart
MD Cristianos Laser Clinic

Issue 54
Summer 2011

 
Removal of facial hair is without doubt one of the major issues for trans women, conducting one's life and being accepted as a woman is virtually impossible whilst sporting a six o'clock shadow. However the issue goes much further than facial hair with many surgeons now believing genital hair removal is advantageous prior to vaginoplasty. Trans men may also have a problem in this regard as hair bearing tissue may be required for the pseudo phallus, which in some cases can lead to problematic hair balls inside the pseudo urethra post operatively.

Thankfully many PCT's are willing to pay for hair removal as part of the transition process. Technology moves on so what are the options in the Twenty First century?

Chris Hart from Cristianos Laser Clinic is a qualified electrologist and laser therapist who has been specialising in hair removal since 1997 and has spoken at conference on many occasions. Well respected for her work and collaboration with other professionals caring for the needs of Trans men and women we asked Chris to give an overview of hair removal.

"The first thing for everyone to realise is that information is key. Every client has the right to receive accurate information with regard to treatment options, their effects, side effects, benefits, risks, limitations and any costs involved. Only when a client is furnished with this information can an informed decision with regard to treatment be made".

Electrolysis

Until the advent of laser, electrolysis was considered the only permanent method of hair removal. Electrolysis is the destruction of the lower follicle through the application of electrical current. Electrolysis was first reported to the medical profession by Charles E. Michel MD of St. Louis Missouri USA in 1875.

There are three methods of electrolysis. Galvanic electrolysis where a direct current is applied via the needle causing a chemical reaction which produces sodium hydroxide to form within the follicle, which in turn causes the destruction of the hair follicle. This method requires 12 seconds per hair follicle. The second method is short wave diathermy sometimes known as high frequency or thermolysis. An oscillating current of very high frequency and low voltage is applied to the follicle via the needle. In this method the rapid agitation of atoms by the current causes the atoms to vibrate producing heat and ultimately damage to the follicle. This method requires only 2 seconds per follicle. The third method, Blend combines the heat from the thermolysis to speed the chemical reaction of galvanic electrolysis. Although treatment with thermolysis will treat more follicles per hour session than other methods of electrolysis blend may be more suited where the follicles are distorted as the sodium hydroxide can trickle to the base of the follicle which may be inaccessible to a straight needle application.

Effects:

· Long term hair removal

Side effects:

• Skin can be red and raised and may feel tender for up to 24 hours
• Many people find electrolysis painful, although some clinics do offer pain relief.

Benefits:

• Can treat any hair and skin colour
• Can treat hair of any diameter

Risks:

• After care instructions must be followed to avoid the high risk of infection
• Incorrect needle insertion, incorrect needle size, incorrect application of current and over treatment can all cause scarring and pitting of the skin.

Limitations:

• As electrolysis relies on the treatment of individual follicles this restricts the amount of treatment that can be conducted in any session
• Weekly treatments are required
• Electrolysis is progressively permanent and results can be slow
• In order to insert the needle at the correct angle the client must have three days visible hair growth for treatment
• Make up cannot be applied for 24 hours post treatment.

Light Based Technology

Light based technology, Laser, Intense Pulsed Light (IPL) and Variable Pulsed Light (VPL) all use the same principle of selective photothermolysis to bring about long term destruction of the hair follicle. Selective Photothermolysis is the use of light to selectively destroy a target beneath the surface of the skin whilst passing harmlessly through the surrounding skin tissue. Although using the same basic laws of physics Laser, IPL and VPL are different and we will look at them separately.

Laser:

Professor Marc Clement, Dean of Faculty at Swansea Institute, first discovered the effects of ruby laser light on hair growth whilst conducting a scientific experiment. Prof. Clement modified his discovery in order to assist plastic surgeons where donor sites for reconstructive surgery were hirsute. The resulting laser, the Chromos 694 Ruby Laser, works on the principle of selective photothermolysis. In doing this the laser uses one pure band or wavelength of light. Each wavelength has different absorption properties with the skin and its structures. It is the wavelength that dictates the use of any laser. In this case the wavelength 694nm is highly absorbed in the melanin in the skin and hair.

As a result it uses the melanin in the hair shaft to selectively absorb the laser light whilst passing harmlessly through the surrounding skin tissue. Once absorbed the light energy is converted to heat energy. The heat is passed to the follicle by means of conduction, causing thermal damage. The major limitation here is that the skin must be free from melanin making this treatment only suitable for white skin and dark hair. Some hair removal laser systems work on differing wavelengths for example the Alexandrite Laser works on a wavelength of 755nm. Whilst being absorbed in the melanin 755nm is also absorbed in the haemoglobin and although this system can treat skin with a small degree of colour the treatment can be more painful.

Effects:

· Long term hair removal

Side- effects:

• Skin may be red and raised for anything from 15 minutes to 24 hours post treatment and can feel like mild sunburn.
• Sensation similar to being flicked with an elastic band

Benefits:

• Laser can be used to treat individual hairs or extensive amounts of hair.
• Extremely effective on coarse hair growth
• The hair needs to be just visible on the surface of the skin for treatment thus allowing the client to shave and avoiding conspicuous growth before treatment.
• Treatment is scheduled at monthly intervals with results being apparent within two weeks of the first session.
• The total number of sessions needed to produce the desired result is much less than traditional methods of treatment.
• No risk of infection post treatment
• Make up can be applied immediately after treatment
• No risk of scarring*

Risks:

• Exposure of laser light can be dangerous to the eye, specially designed goggles must be worn and safety instructions adhered to.
• 10% chance of mild transitory skin pigmentation change which usually resolve naturally within six months*

Limitations:

• Only hair containing dark pigment will respond ( not suitable for grey, red or blonde hair)
• Only Caucasian skins without suntan can be treated
• Difficult to treat very fine hair.

Intense Pulse Light (IPL):

Some applications of a laser can be successfully carried out by a non-laser system based on an intense pulsed light, and the machines, which are used to do this, are generally known as IPL machines. Whilst IPL systems also work on the principle of selective photothermolysis they use broad spectrum light. This means multiple wavelengths are applied heating the hair and skin. IPL machines work on the principle of the hair holding in heat longer than the skin, therefore although both skin and hair absorb light, as the skin cools the temperature in the hair can be raised by the application of multiple, shorter pulses of light. IPL is suitable for most skin types.

Effects:

· Long term hair removal.

Side effects:

· Very little skin reaction although a small number of clients may experience mild redness which lasts a very short period of time

Benefits:

• IPL can be used to treat individual hairs or extensive amounts of hair. However the large treatment head allows for the fast treatment of large body areas for example the back and reduces the time for treatment of areas such as the face.
• Can treat most skin tones
• The hair needs to be just visible on the surface of the skin for treatment thus allowing the client to shave and avoiding conspicuous growth before treatment.
• Treatment is scheduled at monthly intervals with results being apparent within two weeks of the first session.
• The total number of sessions needed to produce the desired result is much less than traditional methods of treatment.
• No risk of infection post treatment
• Make up can be applied immediately after treatment
• No risk of scarring *

Risks:

• Exposure of intense pulsed light to the eye can be dangerous, specially designed goggles must be worn and safety instructions adhered to.
• Chance of mild transitory skin pigmentation change which usually resolve naturally within six months*

Limitations:

· Only hair containing dark pigment will respond ( not suitable for grey, red or blonde hair)

Variable Pulsed Light (VPL)

Like IPL technology variable pulsed light systems (VPL) deliver broad spectrum light. In any one pulse of light there are packets of energy and periods of rest. These periods of rest allow the heat to dissipate in the skin tissue whilst the heat builds in the hair shaft; this all takes place in milliseconds and is undetectable to the eye. VPL systems allow these packets of energy and periods of rest to be altered in terms of number, length and intensity. For example reducing the number of packets of energy in one pulse will have the effect of delivering the energy in a more intense way, whilst lengthening the off period will help safe guard a darker skin tone, in addition the systems can be adjusted to target coarse or finer hair.

The effects, side effects, benefits, risks and limitations are the same as IPL with the exception that these systems have far more flexibility allowing treatment to be tailored to the needs of the individual client.

(* information given relates to the Chromos 694 Ruby Laser and the Energist Ultra VPL)

Conclusion

A note of caution where light based technology is concerned you must ensure that the systems being used have been clinically proven safe and effective.

For most clients a combination of all of these treatments would be the ideal. For Example reducing the amount of dark facial hair quickly and effectively by means of light based technology where the hair growth needs to be kept as short as possible prior to treatment. Once this is removed growing any unpigmented hairs for electrolysis treatment will be less visible and easier to deal with. In cases where all of these treatments are not available on one site collaboration between professionals is advantageous to avoid over treatment and risks to the integrity of the skin.

Of course there are contra-indications to all of these treatments. For example certain medications may preclude individuals from laser/IPL treatment or medical conditions prevent to use of electrolysis. Consultation with experienced professionals is essential.