emancipatedelectrolysis

Insurance and medically necessary electrolysis

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Our office sees a lot of clients that require electrolysis for medical conditions. Generally speaking, insurance companies specifically exclude all electrolysis from coverage. However, there is one area where insurance companies are increasingly allowing coverage – hair removal prior to vaginoplasty and/or phalloplasty. If you have a medical need for another reason, read on.

We’ve had trans clients get approved by several insurance companies in Western New York, including Excellus, Bluecross/Blueshield, MVP, Aetna, and private underwriters through companies that provide benefits directly, like StarBucks.

Our office does not take insurance directly and, to our knowledge, the only office in the state that does, is at Mt. Sinai, but we can still help you get reimbursed if you choose to do your electrolysis here. To the insurance companies, we’re simply an out of network provider, which means that you’ll pay us, we’ll give you an invoice to submit to the insurance company, and then the insurance company will reimburse you.

Prior to having electrolysis, you’ll need to contact your insurance company’s customer service department and tell them that you’re having surgery and that you have a medical need to get the hair removed prior to surgery. The insurance company will want the same documents that you need to qualify for surgery – ie, the two letters required by WPATH guidelines, as well as a “letter of medical necessity” from your surgeon, stating that it is required. Your surgeon knows what this letter is and how to write it. We have also occasionally been asked to submit one from our side of things in addition to your surgeon’s letter, and, thus already have one prepared.

After you submit this information to your insurance company, they should give you a letter stating that you have prior authorization to get the work done. You may need to argue with your insurer some, since you do have a need which conflicts with their exclusion policies, and, at least one insurer has been steadfast in their refusal to cover pretty much anything trans related.

Once you’ve received your prior authorization, you can start coming in to get work done. Again, you pay us, we give you an invoice, and then you submit that invoice to the insurance company for reimbursement, after which, they send you a check. You need to be timely with submission of your invoices, however, or the insurance company may deny reimbursement even with prior authorization.

For people seeking medically necessary hair removal for other reasons. You have an uphill fight with your insurance company, but it’s possible that you may get similar reimbursement coverage if you are persistent enough.

Plan for Re-Opening after COVID-19

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While we are awaiting New York to allow businesses to resume operations in the wake of the Coronavirus outbreak, also known as COVID-19 or Sars-CoV-2, we have been developing a plan with additional steps in how we will operate going forward. The following plan is subject to change as our knowledge of the Coronavirus expands.

I. Precautionary steps in place prior to Sars-CoV-2

A. While rare, because of the potential exposure to blood, we follow universal precautions, including hand washing before and after each client utilizing a sink present in each treatment room, nitrile gloves during sessions, skin cleansing and preparation of areas to be treated and post-treatment aftercare.

B. All surfaces people contact undergo disinfection with an appropriate agent.

C. Most of the supplies are single use and are disposed of after each client.

D. The few tools that we re-use are properly cleaned and sterilized in a FDA listed sterilizer, and that sterilizer undergoes weekly spore testing through an independent lab to ensure it is functioning properly.

E. Masks are worn if either a technician or client was having any symptoms of a cold, but the symptoms weren’t severe enough to warrant cancellation. Signs are posted in the office asking our clients to cancel if they are sick.

F. Technicians use loupes with shields available, protecting their eyes from pathogens.

G. We schedule a 15 minute gap between clients to give technicians an appropriate amount of time to ensure thorough cleaning can be accomplished and to maintain privacy for our clients by reducing the likelihood of sitting in our waiting area with other clients.

H. All services are by appointment only and each technician has her own separate room for privacy.

I. Payments are made with a card terminal that allows contactless payment and has a chip reader so that clients may pay by themselves.

II. Additional steps to be taken after re-opening

A. Clients and technicians will be asked to certify a screening that they are not ill and have not had any symptoms or positive diagnoses in their household in the previous 14 days.

B. To enforce social distancing, the waiting room has been rearranged to make sure chairs are separated by an appropriate distance and/or barriers.

C. We are asking clients to not bring unnecessary visitors with them – minors may have a support person present, all other non-necessary persons should wait in their car or at the picnic area outside. Additional seating is available in the hallway outside the office.

D. Hand sanitizer will be available in the waiting area.

E. In addition to technicians washing their hands before and after appointments, clients will be asked to wash their hands as well.

F. Facial coverings for technicians are now mandatory during appointments and clients will maintain facial coverings when possible.

G. Disinfection of surfaces will now include door handles and credit card terminals in addition to the previous surfaces that were disinfected after each client.

H. Additional signage will be posted in the waiting area to inform clients of the symptoms and risks of COVID-19 with additional instructions on our guidelines.

Ultimately, our goal is not only to make you feel safe, we want you to be safe. And, that was our goal from the very first day we opened. I’ve shared the story of losing my father to a MRSA infection that he acquired when he was in the hospital, and, with that in mind, the business was set up to minimize the spread of infectious disease from the start. After all, we don’t just want to make sure you don’t get sick, we don’t want to get sick either.

 

Mandatory closure of all personal service salons

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Emancipated Electrolysis LLC will be temporarily closed after our last appointment March 21st.

In anticipation of being able to re-open, we are currently booking again for the week of April 6th, though we may need to reschedule those appointments as we get closer if we aren’t able to open yet.

In the event of a longer closure, we’ll still be here once we’re allowed to open. In the meantime, we can keep in touch and keep people rolling on the schedule since, when we do open, we’ll probably be pretty busy getting everyone caught up.

In the meantime, remember, shaving and trimming are great ways to deal with your hair that won’t make anything worse. Avoid plucking, waxing, and threading, since that will end up making the process take longer. The hair that we’ve already killed is dead and you won’t lose your progress.

If you have questions or concerns, wish to schedule an appointment, or want to buy gift certificates, you can reach us at:

Keri (owner) hairinfo@emancipatedelectrolysis.com

https://www.EmancipatedElectrolysis.com
https://www.facebook.com/EmancipatedElectrolysis
585-270-5230

Email will get the quickest response, since we can reply from home.

Thank you and we’ll miss you all,
Keri

 

March 18 Corona update

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This morning, Monroe County Executive Adam Bello asked for all non-essential businesses to send their employees home and remain closed for the time being.

Given the potential severity of the Coronavirus and the recommendations of public health officials, in the interest of the health and safety of our clients and families, we’re announcing a two week temporary closure beginning at the end of this week, lasting until April 6. We will continue to see clients whom are already booked for this week.

Tomorrow, we’ll begin calling clients booked for next week to reschedule them. People receiving electrolysis treatments out of medical necessity for surgery in 2020 will have first priority, so that we can keep you on track for your planned surgery date and we may make special arrangements for you if needed.

Natalie and I live for this job. We enjoy having all of you come in, sharing your personal journey, and allowing us to become a part of it. Over the years, many of you have given us cards, gifts, and words of appreciation for helping to change your life. All of you mean the world to us.

As hard as this has been for me to write, I know this is just a temporary blip. We are a small business, however, and this is typically the time of year that most new people get started – the people that will keep our business going during the slower months. We’ll need your support once we re-open.

If you have questions, concerns, wish to schedule an appointment, or want to buy gift certificates, you can reach us at:
Keri (owner) hairinfo@emancipatedelectrolysis.com

www.EmancipatedElectrolysis.com
www.facebook.com/EmancipatedElectrolysis
585-270-5230 (business landline, I will try to return phone calls as frequently as possible given our closure)

Thank you and see you soon,
Keri and Natalie

 

COVID19 Update

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The subject of infectious disease is something very important to us. In 1998, my father acquired nosocomial (hospital transmitted) VRE (vancomycin-resistant eterococcus) infection while in the hospital and, later, in 2013, died of a MRSA (methicillin-resistant staphylococcus aureus) infection that he acquired during a different hospitalization. These infections are both caused by bacteria that can live for extended periods of time on surfaces, rather than viruses, which tend to die quickly on surfaces in comparison. These two bacteria fall into the classification of “super bugs” which can often be hard to kill with antibiotics and can become deadly.

Given the experience I that had from the infections my father acquired, we have always gone above and beyond the requirements for sanitizing and sterilization in our office.

We use the same disinfectant that hospitals use, Cavicide, on all of our surfaces between clients. Cavicide kills MRSA, VRE, HIV, tuberculosis, hepatitis, herpes, influenza, etc. There’s a reason it has been a gold standard for years.

Our tools are run through a sterilizer after each use, and, although we aren’t required to, we run a weekly spore test that we send to an independent lab to verify that our sterilizer and sterilization protocols are working as intended.

Finally, our probes come from the factory in individual, sterilized packs, and are thrown out after each client.

In a typical day, somewhere between 8-16 people come through our office and we each have a 15 minute buffer between clients to handle payment, rescheduling, and chatting, so it is uncommon for people to spend a lot of shared time together in our waiting room and we work one on one in our treatment rooms.

The risk of transmitting or acquiring the Corona virus, or any other infectious disease, in our office was already very low by design.

Because of the protocols we have always had in place, we are currently, and intend to continue to be open.

However, because of the ease of transmission, we do ask that people whom are feeling ill, especially if they have a fever, cough, and breathing difficulty, to please contact your doctor and reschedule your appointment(s) with us. Likewise, if you suspect that you have had contact with an infected person, please reschedule your appointment to a day at least 14 days after you had the suspected contact to ensure you are healthy.

There is no need to panic, much less devolve into hysteria, but we all should take the potential risks of this infection seriously, and, we ask for your cooperation in doing so.

 

Again, we are currently, and plan to continue to be, open for business.

Thank you,
Keri

 

Genital surgery preparation for trans people

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Since the inclusion of coverage for SRS/GRS/GCS genital surgery for trans people, the number of people seeking surgery has increased immensely.

In a recent discussion between an international group of professional electrologists, including our own Keri and Natalie, we have become concerned that many surgeons are telling their patients NOT to bother with hair removal or that they only need three months worth of removal before surgery, because we’re seeing an uptick in post-operative clients seeking hair removal. Particularly for trans women seeking vaginoplasty using the penile inversion technique, postoperative hair can be quite challenging for the electrologist and very distressing for the client, since the hair is now inside of the body and pointed at an angle away from the surface.

Hair concerns for trans women after genital surgery:

Imagine someone laying on a bed as we look down from an overhead view, imagining being able to see through the pubis and into the neo-vagina:

Anterior view of neo-vagina with hair growing inside after genital surgery
Anterior view of neo-vagina with hair growing inside after genital surgery

What we see here, is the skin that was used to make the vagina now has hair growing, pointing inward. This hair can cause pain during vaginal penetration (including dilation), bleeding, infections, etc. Sometimes, depending on the angle and length of the hair, it can also grow to hang out of the vaginal opening, increasing dysphoria. Because the hair is now inside the vagina, removal requires the use of a speculum to spread open the vagina, specially angled lighting just to try to see the hair, probes bent back upon themselves to try to insert at a proper angle, and a lot of patience on the part of the electrologist and client as they attempt to treat the hair. Because of the difficulty involved, most electrologists are not capable of doing the work and most surgeons will tell their patients that it is simply unfortunate and that nothing can be done about it.

Why does this happen? For starters, while surgeons may be quite knowledgeable and skilled in the practice of surgery, most don’t really understand the process of hair removal that well. A mechanic may know how to rebuild your engine, but that doesn’t mean they will do a good job painting your car. Even if a surgeon DOES fully understand the process, many of them fail to effectively communicate with their patients, giving misleading or ambiguous preoperative instructions (advice on how many sessions, how early to start, illustrations of what areas to cover, etc are often poor). Because of their failure to convey good information, many MTF surgeons see poor outcomes with patients that had some removal, so some surgeons now instruct their clients not to bother with any hair removal at all before surgery, promising they’ll either scrape or cauterize all of the hair during surgery. The reality, is that nobody is 100% perfect and there is only so much time available during surgery to remove hair, and often hair ends up being left behind to grow.

Here’s the bottom line: to ensure that no hairs are left dormant and untreated, it takes approximately 10-14 months for all of the hair in the genital area to go through a full dormancy cycle. This means that, at a minimum, you should give your electrologist at least a year, preferably two years, to remove all of your hair prior to your surgical date. Yes, we understand that you want surgery as soon as possible and some surgeon you’ve contacted can get you in six months from now… but you really should wait, so that your hair can be properly removed, if you want to be sure that you don’t end up with postoperative internal hair. Also, laser is NOT approved for permanent REMOVAL of hair, only for “permanent REDUCTION” of hair. We frequently see hair that grows back after laser, sometimes years later. Five or ten years from now, laser can put you in the same situation as if you did no hair removal at all.

If you want to be absolutely certain that you will not have hair in your vagina, it is imperative that you start electrolysis, and only electrolysis, at least a year before your intended surgery date.

 

Hair concerns for trans men after genital surgery:

Phalloplasty usually involves taking skin and tissue from the forearm or thigh and then using it to make a penis. Often, it is not possible to extend the urethra through the penis without also making an urethra from the skin as well. Hair on the penis can generally be worked on after healing, since the skin is still at the surface, however, the skin being used for the urethra should be perfectly hairless before surgery. Like in the case of trans women above, once it is inside the body, it is tremendously difficult to work on internal hair and it can cause very similar problems – discomfort, bleeding, infection, stricture, etc. To our knowledge, nobody is even attempting to removal hair from the urethra after surgery, but fortunately, FTM surgeons seem to be much better in understanding, illustrating, and communicating pre-surgical needs.

Thus, the best plan of action is to come in at least one year, preferably two years, before your intended surgical date.

Beginner hair styling class

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Need to learn how to style your hair? Need tips on curling or braiding? Afraid to ask for help?

Natalie at Emancipated Electrolysis, LLC will be hosting a beginner class on how to style, curl, straighten and braid your hair. Get tips on a hair style for the holidays.

One person will be chosen as Natalie’s model for the night while everyone else will get to practice on each other or on a mannequin head.

This event is trans affirming but open to anyone interested. There’s a $10 cover charge which will be deducted off of your first hair styling service with Natalie (and waived if you are an existing hair client). Snacks will be provided.

Friday, December 8, 2017 at 6pm at Emancipated Electrolysis, LLC.

Space is limited, so RSVP soon!

For those intimidated by group events, one on one education is always available by appointment.

 

Pain management

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Pain sensitivity varies greatly between people, with the pain experienced during electrolysis generally diminishing with age, as the amount of moisture in the skin declines. Pain tolerance also varies on a number of other factors, including hormonal fluctuations, changes in the weather, how much sleep the client had the night before, stress, medication, etc. Some people barely even notice any pain during the procedure.

Before we get into ways to help with pain management, first, we’ll examine what causes the pain.

During galvanic electrolysis, the application of direct current to the follicle, mixed with the salt and water already present in the follicle, causes a chemical reaction that creates sodium hydroxide, better known as lye, which is a base, that chemically eats away the cells inside the follicle, much like how acid can eat away metal. Typically, this process lasts for anywhere from 30 seconds to several minutes depending on how it is performed.

During thermolysis, the application of radio waves excites the water molecules inside the follicle generating heat, much like what happens in a microwave, which damages the cells inside the follicle. The heat creating during thermolysis dissipates quickly, usually within a fraction of a second for a single hair, but when working in a dense area, the tissue around the follicle continually warms, making a residual amount of heat for up to an hour or two after completion.

Blend is a combination of both at the same time.

Again, most people find that they can go through up to an hour of electrolysis with no need to manage the pain. However, for the people that do need some help, here in the office, we offer a fast acting topical anesthetic (20% benzocaine), as well as a longer acting topical anesthetic (4% lidocaine), another type of topical anesthetic for mucous membrane areas (20% benzocaine gel in mint or cherry for the upper lip), ice packs, as well as a selection of insulated probes (used during thermolysis to reduce the amount of heat radiated into the skin) from Ballet and Laurier. These methods can be combined together to create an amplified effect (such as using lidocaine with insulated probes). We then follow up the treatment with an application of chilled pure aloe or witch hazel gel.

Those are not the only tools available, however. Some people take oral over the counter medicines, such as acetaminophen or ibuprofen an hour or so before coming in (just be sure to let us know, as some of these can cause the blood to thin, resulting in minor bleeding during treatment). Another option is prescription EMLA cream (2.5% lidocaine, 2.5% prilocaine), acquired from their doctor prior to treatment, which is then applied about an hour before your session and covered in plastic wrap to keep it fresh (the wrap is peeled back and removed as we work through an area). For people getting work done around the mouth, your dentist can give an injection to numb the area prior to coming in (we also have a dentist we can recommend if your own dentist isn’t comfortable doing this), and for areas not around the mouth, you can get another doctor to give you lidocaine injections prior to coming in.

Along with these ideas, one other tip to note, is that many people experience a histamine response when working on the upper lip near the nose. This area will frequently cause watering eyes, runny nose, itching and/or sneezing. Some people prefer to take an antihistamine before their treatment to reduce the effect, although most people manage fine without it.

To sum up, there are options available for people that need help managing the pain of having their hair removed, however, most people don’t need to take any of these steps to receive an effective experience. For more information about pain management during electrolysis, permanent hair removal or electrolysis in general or to book an appointment, contact us at hairinfo@EmancipatedElectrolysis.com or call us at 585-270-5230 and finally be free of unwanted hair.

Modality Wars: Thermolysis vs Galvanic vs Blend

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One of the most frequent topics of debate in electrolysis, is which modality is the best, thermolysis, galvanic or blend.

The answer is very simple – ALL three are effective at permanently removing hair. It is primarily the skill of your electrologist that determines whether or not any one of those methods are effective for them and much of that comes down to the region you live in.

Galvanic was the original way of doing electrolysis and it works by chemically dissolving the inside of the follicle to destroy it. It absolutely works to remove hair, but the problem is, it takes as long as 30 seconds per follicle to kill a hair. To combat this, the manufacturers of galvanic epilators created “multiple needle galvanic” (MNG) machines, which treat as many as 16 hairs at a time. Few schools specialize in MNG electrolysis, so it’s more of an art form shared between practictioners whom enjoy this modality. Don’t let the word needle scare you, they are using the same dull, rounded tip probes that other electrolysis modalities use. One of the downsides of galvanic, and as a consequence, blend, is that it passes a DC current through the body, which can be dangerous for certain medical conditions, requiring a doctor’s permission to treat a person with them.

Thermolysis is a newer method, which uses localized heat, almost like a miniature microwave oven inside the follicle, to destroy the structures in the follicle. It is EXTREMELY fast, typically only taking a few hundredths or tenths of a second to work, but it requires very precise placement of the probe because the heat only targets a very small area. Because of this, it is also important to stretch the skin so that the tip of the probe can reach the terminus of the follicle, where the papilla that grows the hair is, making it harder to treat curly or distorted hair follicles.

Blend is a combination of both galvanic and thermolysis, giving it the advantages of both, although it is slower than thermolysis.

Thermolysis tends to be more popular on the east coast of the US, blend more popular on the west coast. The simple reason for this, is because the schools on the east coast focus on thermolysis, while the ones on the west coast focus on blend, largely because the inventor of the blend method was located in California, where he manufactured the units and had an electrolysis school.

So, which method is best? Again, it comes down to how skilled your electrologist is with that particular modality. Blend is easier to do, particularly on curled/distorted follicles, but thermolysis works just as well if the electrologist can stretch the skin. Blend is a little slower, but perhaps slightly more thorough, meaning that both thermolysis and blend are likely to get your removal completed in roughly the same amount of time.

A particularly skilled electrologist will be very familiar with at least two modalities and can use the one they feel is most appropriate for your personal needs. In order to maximize our effectiveness for our clients, at Emancipated Electrolysis, LLC, we primarily deal with both thermolysis and blend, and frequently use both depending on the individual case, although we can also do single probe galvanic if necessary. For more information about permanent hair removal, electrolysis or to book an appointment, contact us at hairinfo@EmancipatedElectrolysis.com or call us at 585-270-5230 and finally be freed from unwanted hair.

Electrolysis probe selection

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Electrolysis probes are the hair sized pieces of metal that electrologists insert into follicles to destroy the hair. Sometimes, the word “needle” is used, but it is inaccurate, as the probes do not have a sharpened tip, but a duller tip to reduce the likelihood of penetrating the walls of the follicle, which would cause a poor treatment. Also, probes are not like the needles you would find on a syringe, as they are solid and not hollow.

Depending on the manufacturer of the probe, some are machined out of a single solid piece of steel (and then coated with an insulating material if they will become an insulated probe), while others have a separate shaft which is inserted into a shank (which is designed to fit the probe holder of the machine) and then crimped into place. One piece probes are stiffer, while two piece probes are more flexible and require a higher level of skill to insert properly.

There are three primary types of probes available for electrolysis – stainless steel, gold and insulated. Stainless steel probes are good for general purpose use, gold probes help increase conductivity while minimizing allergic reaction, and insulated probes help protect the skin from excessive heat during thermolysis, which is most important when doing work on young people or for removing shallow, vellus hair.

The size of the probe should match the size of the hair to be treated, erring on the side of using a slightly larger probe rather than a smaller one. The larger the probe, the less resistance there will be during treatment, allowing the electrologist to use a lesser amount of power (which helps protect the skin) while still destroying the follicle. The difficulty with using a larger probe, is that they can be harder to insert since the size of the hair directly corresponds to the size of the follicle and forcing a larger probe into the follicle requires significantly more stretching.

Ultimately, it is up to the electrologist to select the probe that they feel the most comfortable with using for your treatment. Some electrologists use only one type of probe from one particular manufacturer with a limited selection of sizes. Since we understand that every job is different, at Emancipated Electrolysis, LLC, we carry a variety of brands, materials and a wide range of sizes, often exceeding the typical stock of many electrologists, to ensure that we can select the probe most appropriate for your personal needs.

For more information about permanent hair removal or to book an appointment, contact us at hairinfo@EmancipatedElectrolysis.com or call us at 585-270-5230 and finally be freed from unwanted hair.