electrolysis

Insurance and medically necessary electrolysis

by

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

by

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.

 

Genital surgery preparation for trans people

by

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.

Pain management

by

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

by

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

by

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.

Smooth for summer

by

It is not too early to start thinking about getting your hair cleaned up for summer. Nobody wants to deal with the hassle of continuing to shave or wax to remove their unwanted hair during the season to show their skin.

Typically, it takes about six months to see every hair leave their dormant stage least once, so now is the time to start thinking where you want to be for June. Electrolysis is the only method proven to safely remove any hair anywhere on the body, whether it is a few stray hairs under the chin, a trail on the belly, dense areas like your underarms, your bikini line or even broader areas like your arms or legs.

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.

Why you should stick to a schedule

by

Due to the way the hair growth cycle works and, how each individual follicle is on its own timeline, hair is constantly shedding from one follicle and starting in another. This is the reason why, even a few days after waxing, you can already start to notice new hair growing in. The only hairs that can safely be targeted by any method of removal are the ones that are growing, not the ones that are currently dormant and could activate tomorrow.

As the hair enters the anagen growth phase, it is at a fragile stage, with the papilla and bulge close together, making treatment more efficient and effective. It is an ideal time to kill the hair in a single treatment while keeping the visible growth to a minimum versus treating a hair in the middle/late anagen phase when the hair is more robust and the inner follicle more spread out.

For a heavy growth area that needs a lot of treatment, typically, we would recommend that the person comes in every week until the hair gets into a manageable state. From that point on, the frequency of the appointments will gradually decrease, going from weekly, to every other week, once a month, etc and/or the duration of the appointments will lesson. The same is true for less dense areas as well. At some point, the person will enter a bit of a maintenance state, where it isn’t really required to schedule an appointment ahead of time, but works better to call and make an appointment once they start seeing hair growing in. Typically, at this point, it becomes a matter of months between appointments, eventually tapering off to all of the hair being completely removed.

If people do not stick to a schedule, there is a high likelihood of hair that could have been treated going into the telogen state and becoming dormant, meaning it could be six months before there is a chance to treat the hair again. Along with that, there is a likelihood of hair that could have been well treated in the early anagen phase passing into the mid-anagen phase, becoming harder to destroy in a single treatment.

At Emancipated Electrolysis LLC, we want to help you permanently remove your hair as fast as possible. 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.

Hair growth cycles

by

Hair grows in cycles, with each follicle being on its own cycle. There are three stages of growth, anagen, catagen and telogen, as well as a period of time where a follicle can stay dormant.

The anagen phase is the primary growth period of the hair as it exits the dormant stage. The follicle deepens, the hair matrix begins to form the bulb, and over a period of several weeks, the hair emerges threw the skin. In the early anagen phase, the papilla – the organ which nourishes the hair, and the bulge – which contains stem cells that can completely regenerate the follicle, are close together, making this an excellent time to be able to kill the hair in a single treatment. As the anagen phase continues, the hair becomes thicker and more robust. The duration of the anagen phase is what ultimately determines our maximum hair length. Some short hairs are in anagen for as little as six weeks, like with our eyebrows, while others can continue for a period of two to three years, like the hair on our scalp. Despite the fairy tales we are told when we are young, most people can only grow hair to their mid-back (two year cycle) or butt (three year) and it will never get longer than that because the hair cycles to the next phases and ultimately goes dormant again. During this phase, the bulb of the hair will look juicy and full.

During catagen, the follicle slowly begins to shrivel up as the hair prepares for shedding after the anagen growth phase. Typically, the catagen phase lasts for two weeks and the hairs in this phase are notable for being drier with smaller bulbs.

The third phase is the telogen phase, at this point, the follicle has shriveled up in preparation of going back into dormancy. The papilla and bulge are nearby again, making it an ideal time to permanently treat the hair. The hair begins to dry out and the bulb is virtually missing. With the hair no longer firmly pressing along the wall of the follicle, it will simply fall out as the friction that once held it in place is absent. From here, it will go dormant.

While the hair is dormant, it can no longer be treated by electrolysis or laser. In the case of electrolysis, we can no longer see the follicle so it is impossible to place a probe into it to treat it, while with laser, with no melanin present, there is nothing to absorb the light energy to create the heat necessary to coagulate the organs of the follicle. Typically hair can remain in this phase for 6 months, sometimes longer, and hair susceptible to DHT (dihydrotestosterone), the hormone that causes male pattern baldness, may never leave the dormant phase again.

There are hundreds to thousands of follicles per square inch of skin that are dormant and will never grow a hair and this is perfectly normal. How many hairs on our body actually ever reach a growth phase depends on a variety of factors, including our genetic ancestry, hormone levels, and how we treat our skin. Of those that do grow, they individually somewhat randomly cycle on and off, entering and exiting the growth and dormant stages, leaving us with a consistent appearance in our hair at all times if left untouched, barring some systemic event which causes a mass disruption to their normal cycling, such as chemotherapy or alopecia. Understanding these phases and cycles is important to understanding why permanent hair removal is a process and why, even temporary methods like waxing can leave us feeling or seeing new hair growing just days later.

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.

How long and how much?

by

These are the two questions that, as electrologists, we hear the most.

The simple truth is, it is nearly impossible to give a specific estimate as to how long it will take to completely remove your hair since there are just too many factors. These factors include your individual pain tolerance, how dense your hair is, how large the area is, whether or not you stick to the treatment schedule, how long your sessions are, fluctuations in your hormones, whether you have treated the hair below the surface in other ways (waxing, threading, plucking, laser/IPL), etc.

What we can say, is typically, you should see a significant reduction within 6 months if you stay on your treatment schedule and that, in 12-18 months, your hair should mostly be gone, with only maybe one or two touchups per year if there is some new, previously untreated hair growing in that you are concerned about. Why does it take so long? Quite simply because you have more hair than what you currently see growing. Hairs will cycle through a dormant resting phase, typically lasting about 6 months, only to re-emerge again later and each hair is on its own, individual timer.

Hair that isn’t there cannot be treated until it starts growing.

If you pluck/wax/thread a hair out, if it remains in the growth phase, it will typically take about 6 weeks to emerge again. If you have done laser or IPL treatment, your hair that wasn’t destroyed may go dormant for as long as two years before it emerges again. These hairs cannot be treated until they are available for your electrologist to remove and the situation was not caused by the electrologist. Unfortunately, the ability of laser to permanently reduce hair is over-promised in advertising and consultations. The FDA declares “permanent” as a year of no regrowth and, again, let me reemphasize that laser is about reduction, not removal, despite the slick marketing.

Ok, so let’s talk numbers. These are not guarantees, but typical lengths of treatment.
Arms/legs: 20 hours
Underams: 10 hours
Bikini: 10 hours
Eyebrows: 3 hours

At Emancipated Electrolysis LLC, we offer reasonably priced sessions as short as 15 minutes long up to 8 hours long, with discounts for longer sessions. 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.