Hair Removal For Phalloplasty Surgery | What Works?

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If you plan to undergo phalloplasty with urethral lengthening (construction of a neourethra), permanent hair removal is a must!

Whether your doctor chooses to harvest skin from the forearm radial artery (RAP) or the anterolateral thigh (ALT), hair removal is a requirement.

Why? Because you want to avoid hair related complications. In which case, the skin-flap area that will be used to construct neourethra must be rendered free of hair-growth.

Some of the potential complications of hair growth within the neourethra may cause:

  • Urinary retention within the urethra.

  • Post-void dribbling.

  • Build-up of stones and waxy deposits on the hairs: which obstruct urine flow and predispose to urinary infections.

As one can see, hair removal prior to genital surgery is a necessary step you can’t miss! Not to mention, a requirement from your surgeon.

But which method is best? Laser? Electrolysis? Having your surgeon “scrape” it off? Most importantly, which method is the most reliable to ensure zero regrowth?

Think your surgeon knows best method? Most likely not. In fact, there is lack of consensus in the medical community with regard to most permanent hair removal methods for genital surgery. If you consult with two doctors, chances are you will get two different suggestions.

This is primarily due to the lack of medical research. Especially lack of follow-up studies on post-operative patients to document which hair removal method works best. Additionally, the literature on hair removal prior to genital surgery is limited.

The lack of research and consensus in the medical community makes it difficult to decide which method is best.

To help you decide, let’s consider each method in detail.

ELECTROLYSIS HAIR REMOVAL aka EHR

Approved by the FDA in 1875, electrolysis is the oldest process for permanent hair removal. It involves use of an electric current with a very fine needle-shaped probe to destroy the root of individual hair follicles.

There are three types of electrolysis: galvanic (direct electrical current produces a chemical reaction), thermolysis (diathermy: short-wave which produces heat) and blend (combination of galvanic and thermolysis).

One of the biggest pros of EHR is its ability to be used on all hair colors and skin types. Additionally, EHR has been commonly used for gender affirming surgery as it had been the sole solution for long term hair removal before the LHR.

Treatments are typically weekly and lasting up to one hour. Targeting individual hairs may be time consuming and costly. A common negative factor for many. However, EHR is very effective at permanent hair removal, especially when used to treat hair that has nor or will not respond to LHR.

LASER HAIR REMOVAL or LHR

For starters, let me note that LHR is FDA-approved for permanent hair reduction rather than permanent hair removal.

The word reduction is often misleading. The distinction is mechanistic. LHR does not reduce the number of hair follicles, as electrolysis does. Rather it reduces the number of hairs by damaging the follicular bulb. The follicle however, remains intact.

LHR works by the use of light to selectively target dark, coarse hairs. The pigment in dark hairs absorbs the light. This in turn creates heat that is transmitted down the shaft to destroy the follicle.

The pros of LHR include the ability to treat larger surface areas. As well as being less time consuming than electrolysis. Treatments are typically every 4-8 weeks. Depending on the treatment area.

EHR vs LHR

So which method is best? The truth is we don’t know for certain. What we do know is that EHR is the oldest permanent hair removal method and has a long track record. Of course that doesn’t mean it is 100% effective!

One has to be careful not to fall prey to approaches that may have become dogmatic in trans care. Let’s not forget that evidence-based medical research is absent for both EHR and LHR when it comes to gender affirming surgery.

Both of these procedures are very burdensome for individuals. Both are very expensive and rarely are covered by insurance. And both just may be as effective and equally ineffective.

Additionally, many individuals report regrowth of white hairs following LHR. Which can be an issue given potential complications of hair regrowth in neourethra mentioned above.

What I have personally observed is effectiveness of EHR for gender affirming surgery. Most importantly, waiting between 6 months to a year after treatment to ensure no regrowth on the harvested site.

In fact, waiting at least a year to ensure no regrowth seems to be the most reliable way regardless of using either LHR or EHR methods.

That’s why it is so important to start on the hair removal process prior to gender affirming surgery. And in this case, time is on your side given a year period on HRT is a requirement prior to genital surgery.

If you are planning on undergoing phalloplasty, consider the pros and cons of each method. Most importantly, start early to ensure zero regrowth!

References & Sources

Pickens, J.E., and Zakhierh, M. (2004). Permanent Removal of Unwanted Hair. Aesthetic Surgery Journal. 24:442-5.

Reeves, C., Deutsch, M., and Stark, J. (2016). Hair Removal. Transcare UCSF.

Zhang, W. R., Garrett, G. L., Arron, S. T., and Garcia, M. M. (2016). Laser Hair Removal for Genital Gender Affirming Surgery. Translational Andrology and Urology. 5(3):381-387

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