Should I get laser hair removal before electrolysis?
No.
I know this stance puts me at odds with most of the transfeminine community. After all, it is common knowledge that, in order to remove a beard, you start with laser. After laser kills off all of the dark hairs, you then turn to electrolysis. So entrenched is this belief that, despite me telling you all the reasons why you shouldn’t get lasered right here on this very page, I know that you’re going to get some sessions of laser before you come to see me. You’re going to claim that I don’t have an M.D., or you’re going to claim that I clearly have a bias as an electrologist. Just don’t claim that I didn’t warn you.
I am not afraid that the book will be controversial, I’m afraid it will not be controversial.
Flannery O’Connor
How do medical lasers work?
Lasers can target many different structures in the skin, not just hair. For example, a vascular legion, such as a port-wine stain birthmark, can be treated with a laser that targets hemoglobin, a compound found in blood. General remodeling of the dermis can be achieved with a laser that targets water, which is found everywhere. Hair-removal lasers target melanin, a broad group of pigments responsible for the coloration of both skin and hair. These targets are known collectively as “chromophores”.1
What do I mean when I say that a laser “targets” a chromophore such as melanin?
Chromophores absorb light, then release the absorbed energy as heat. As shown in the figure above, different wavelengths of light are not absorbed equally. Lasers used for hair removal fall within the pink band labeled “optical window”, where melanin absorbs far more strongly than both water and hemoglobin. The original ruby lasers produce light at a wavelength of 694 nm; alexandrite, 755 nm; diode lasers, 800 nm; and Nd:YAG, 1064 nm. Because the vast majority of the laser light is absorbed by melanin (and not water or hemoglobin), the subsequently released heat is localized to regions surrounding the dark melanin-containing hair bulb. In theory, this heat should damage the follicular structures responsible for growth, resulting in permanent hair removal.
Why should I not get laser hair removal prior to electrolysis?
As mentioned in the previous question, in theory, heat from laser energy should damage the structures responsible for hair growth, resulting in permanent hair removal. In practice, one of several results can occur. The following excerpts are taken from an article on photoepilation (Sadick et al., 2000).2
Four clinical responses may ensue after the light exposure. First, heat-induced destruction of the hair shaft without germinative damage may lead to hair “drop-out”, i.e., the hair shaft falls out and then regrows at the next scheduled anlagen cycle as a nonaffected, terminal hair.
In other words, nothing happens. Your hair falls out, then regrows as normal.
Second, besides the hair shaft, there may be partial injury to the germinative (amplification) zone of the hair follicle, resulting in trichoregulatory dysfunction, telogen-shock response, prolonged telogen dropout, and eventual regrowth of normal hair once the anagen phase has been reinstituted.
Similarly, your hair falls out and will regrow as normal, albeit much later as your hair’s natural growth cycle has been disrupted. In my experience, the re-establishment of the cycle occurs between one and two years later, when clients finally resort to electrolysis.
Third, partial germinative zone injury may lead to the development of dystrophic hairs (thinner and finer in texture, with variable hypopigmentation).
This is the most common result, particularly on the upper lip and chin. Hair grows back finer, although they still feel bristly like a terminal androgenic hair. In many cases, the absolute number of hairs hasn’t changed. Speaking from professional experience, I find that these hairs are often—for lack of a better phrase—fucked up. They tend to snap when manually manipulated with the tweezers, resulting in incomplete removals. I’ve heard it claimed that the follicles seem “spot-welded” in place. While I think that that particular metaphor is a bit strained, I do find that laser-treated hairs do not release easily and typically require more current than I would otherwise use. Hairs that were once brown or black grow back blonde or gray. There are many claims in online communities such as Reddit that this phenomenon is due to laser killing all of the dark hairs, leaving behind the gray ones, which are now plainly visible. Not in my experience.
All of these phenomena result in hair that is much more difficult and time-intensive to treat. Smaller, distorted follicles make for tricky needle insertions. Thin, blonde hairs are difficult to see, and I often must resort to cross-shadowing techniques with several lamps or manually hunting them down with my fingers. Abnormally tenacious hairs require more current, and therefore more time (or more pain—your choice) to treat.
Finally, long-term photoepilation may ensue, defined as a reduction in the number of hairs over an interval longer than the normal hair cycle (usually 1-3 months depending on the particular given anatomic region). Long-term (or potentially permanent) photoepilation is most likely a consequence of light-induced interactions with the primary “bulge” and secondary matrix germinative regions of the pilosebaceous unit. To induce permanent hair removal, “pan-tricho” destruction of the entire germinative areas of the hair follicle (bulge/trichoepithelium/matrix) must occur. Permanent, nonscarring hair loss has been described following a single treatment with high-fluence ruby-laser pulses, similar to that seen with flashlamp devices. Miniaturization of the terminal hair follicles seems to account for this response.
The ideal case. Most dermatologists will admit that this is difficult to achieve on the face, hence why journal articles touting the efficacy of laser hair removal typically show before-and-after pictures of chests or backs.
Can laser stimulate hair growth instead?
Laser, rather than killing hair, can encourage fine peach-fuzz to mature into thick terminal hair. This phenomenon is called “paradoxical hair stimulation” or “paradoxical laser-induced hypertrichosis (PLIH)”. Here’s a great Refinery29 article about one woman’s experience with PLIH.
Some sources claim that PLIH is extremely rare, occurring in as low as 0.3% of clients undergoing laser hair removal. Others are more pessimistic, claiming PLIH to occur in about 10% of patients. It seems that this phenomenon is most common in clients with dark hair and comparatively light skin3, particularly if there’s a fair amount of downy peach fuzz. Note that these are the same people who are “perfect candidates” for laser hair removal. The cause of PLIH is still not known, although it is suspected that the skin reacts to mild thermal trauma by inducing growth as a reparative measure. I used to think that this phenomenon would be rare among trans women, as it seems to affect superficially rooted hair rather than dense beards. Personal observation has proven me incorrect. I will also note that about one-third of my classmates at the American Institute of Education, the electrolysis school I trained at, were inspired to become electrologists because they had personally experienced PLIH.
The asvak paper
While conducting research for this website, I kept coming across references to a journal article from the ASVAK Laser Center in Turkey claiming that laser hair removal is “60 times faster and less painful than electrolysis” (Görgü et al., 2000). Wikipedia cites the article:
A study conducted in 2000 at the ASVAK Laser Center in Ankara, Turkey comparing alexandrite laser and electrolysis for hair removal on 12 patients concluded that laser hair removal was 60 times faster, less painful and more reliable than electrolysis. It is important to note that the type of electrolysis performed in the study was galvanic electrolysis, rather than thermolysis or a blend of the two. Galvanic current requires 30 seconds to more than a minute to release each hair whereas thermolysis or a blend can require much less. This study thus did not test the capability of all forms of modern electrolysis.
Laser hair removal. (2020, December 20). In Wikipedia.
I was curious to see what settings were used, so I purchased the article. Here’s the first half of the Materials and Methods section.
The study was performed on 24 axillar regions of 12 patients. The right axillar area of the patients was treated with electrolytic epilation four times at 3-week intervals and the left axillar area was treated with laser epilation three times at 4-week intervals. Electrolysis intensity was set at 4-8 mA. Laser energy was set at 30-50 J/cm2 and pulse duration was 3 msec. Gas spray epidermal cooling was used for laser hair removal.
I’m skeptical that either the unnamed electrologist or the writers at ASVAK know what they’re talking about with regards to electrolysis. Knowing the current intensity is meaningless without knowing the duration. Furthermore, 4.0 mA is ludicrously high. The highest I’ve ever worked at is 0.7 mA, and my machine doesn’t even go above 2.0 mA.
Here’s the second half:
The same specialist who had been working for 15 years in this area performed all electrolytic epilation sessions, and all laser epilation sessions were performed by the same plastic surgeon. Before each session, hairs in a 2 cm by 2 cm area centered in the axilla were counted. The final evaluations were done 6 months after the first session. Time expended for each session was counted by chronometer. Pain was evaluated subjectively; patients scored the pain as + (feel), ++ (tolerated), +++ (painful), ++++ (unbearable). The costs of the procedures also were evaluated. Finally, patients were asked which of the two techniques they preferred.
Electrologists can only treat hair that they can see. Except for the case of ingrown hairs (which can be manually lifted), this means that an electrologist can only treat a hair once it has emerged through the skin surface. Laser can treat hairs under the skin, before they’ve broken through. The cause of disparity between laser and electrolysis is obvious. In essence, ASVAK was treating “future” hairs, before they emerged, where as the electrologist could only treat presently emerging hairs. The rules of engagement appear to favor neither side, but they are heavily slanted towards laser. Also note that there was no follow-up. We do not know what happened to these test subjects a year in the future.
If a six-month timeframe seems long to you, bear in mind that the duration of anagen phase in axillar hair is between three and six months. The duration of telogen phase is also between three and six months. The percentage of underarm hair that is in telogen at any given time is estimated to be between 31% and 79%. As I stress multiple times on this website, complete treatment takes over a year. A shorter timeframe is an anatomical impossibility. Twelve weeks of treatment will barely put in a dent in the overall number of hairs.
The paper concludes with an interesting comment that seems to get buried in online discussion.
The disadvantages of laser hair removal are that is it not permanent, the long-term results and complications are not known, and there may be pigmentation problems.
1I’m being a little sloppy with terminology. Technically, a chromophore absorbs visible light and confers color onto a material. This distinction isn’t relevant here.
2This article in particular is about IPL (flash lamp) treatments. I reference it with regard to laser hair removal because (1) the purported physical cause of hair removal, thermal damage, is the same, (2) the results reported agree with my general observations on laser, (3) the paper is eager to draw comparisons between IPL and ruby laser, and (4) the exact language in this article has found its way into several textbooks on laser.
3That is to say, skin types dermatologists would classify as Fitzpatrick III/IV: Mediterranean, Armenian, Persian, etc.