Enhance your intimate hair removal expertise

Dr Samantha Hills, Dr Godfrey Town, Dr Ross Martin, Anita Clarkson-Dalton look at proven techniques to enhance gender-affirming surgery

Managing unwanted hair in intimate areas is a concern for many patients and requires specialised attention. Traditional remedies like waxing, shaving, and depilatory creams offer fleeting respite but leave clients dealing with unwanted side effects such as itching and irritation, ingrown hairs, and folliculitis. In contrast, energy-based techniques like electrolysis, and the popular light-based treatments such as intense pulsed light (IPL) and laser, offer a more permanent solution to this age-old dilemma.

Light-based hair removal treatments make use of photothermal energy to generate heat within the hair follicle, disrupting and destroying the cells responsible for hair regrowth. This process relies on the absorption of light by the melanin in the hair shaft, making the dark, coarse hair regularly found in intimate areas ideal for this application, so that light-based hair removal is an effective choice for intimate areas for people of all genders.

Given the intimate nature of these procedures, practitioners utilising light-based treatments such as IPL and laser must establish meticulous protocols to uphold client privacy, dignity, and safety. It is also essential for practitioners to base their approach on evidence-based research like that of Town, Martin et al.,¹ which provided detailed clinical guidelines on the treatment of intimate hair. Prior to treatment, clients should undergo a comprehensive consultation covering their health history and provide written informed consent, ensuring a safe and tailored approach to their hair removal journey.

Light-based hair reduction is a versatile and effective solution suitable for all clients seeking hair removal across the body. While the procedure offers comprehensive coverage, a reduction in energy settings may be necessary for regions with heightened pigmentation or sensitivity like the groin.

Female intimate body areas include:

• Upper bikini line – the area above the femoral triangle (also known as Scarpa’s triangle), and directly below the groin line of the bikini or underwear

• Extended bikini line – this area covers treatment over the mons pubis, labia majora and perineum for female clients

• G-string – this area is the gluteal cleft around, but not over, the anus

• The nipple or areola.

Similarly, male clients seeking hair removal in intimate areas may target regions such as the scrotum and base of the penis. The trend of male hair removal in these areas is on the rise, driven by both aesthetic preferences and hygiene considerations. It’s noteworthy to recognise the significance of hair removal for trans women undergoing gender-affirming surgery, underscoring the diverse motivations behind such procedures.

Before starting treatment, thorough consultation is key to determining the precise areas for hair removal, and effective communication with clients is needed to understand their preferences and desired treatment zones, recognising potential variations in terminology and definitions. For instance, in many clinics and salons the term ‘Brazilian’ may include the perineum and perianal areas, so clarification is required to ensure alignment with client expectations.

COMMON TREATMENT TERMS INCLUDE

1. Standard bikini line
This treatment addresses hair along the bikini or underwear line, with visibility extending down the thigh for some. Treatments typically involve a 1-2 finger width inward from the groin crease and 3-4 finger widths outward. Wider coverage is termed ‘extended bikini line’ treatment, offering clients more comprehensive hair removal options.

2. Brazilian
This usually includes hair removal from the front, back, and between the buttocks. However, some clinics may not include hair removal from the labia and perianal areas as standard. A small patch of hair is left on the mons pubis, often in a strip or other shape chosen by the client, which is agreed upon in advance.

3. Hollywood or ‘integral’
The Hollywood treatment involves complete removal of all pubic hair from the entire bikini area, including the front, back, and between the buttocks, similar to a Brazilian but with total hair removal.

TREATMENT PROCEDURE

1. Ensure areas to be treated with laser/IPL are shaved beforehand, leaving no more than 1mm of stubble.

2. Recognise bikini line areas as moderate to highly sensitive; employ appropriate cooling methods and take extra care.

3. The treatment area should be sectioned with a white makeup pencil due to skin tone variations, necessitating fluence adjustments. ‘Zoning’ assists in ensuring even laser/IPL coverage.

4. Apply additional cooling gel to delicate areas to enhance patient comfort.

5. Begin treatment from less sensitive areas, progressing gradually inwards; adjusting fluence levels as required.

6. Treat the scrotum, penis, and labia majora cautiously, avoiding mucous membranes.

7. Extend post-treatment cooling for delicate areas to alleviate discomfort.

TOP-TIPS

1. Advise patients to wear light underwear or provide disposable white paper briefs. Alternatively, remove clothing from the waist down. It’s important to avoid treating near any dark coloured underwear which could absorb the light.

2. Maintain patient privacy and dignity by covering intimate areas that are not currently being treated.

3. For male or pre-operative trans-female patients, request that the patient moves the penis or stretches the scrotum as required.

4. You may need to patch test different areas of the bikini, especially if they present as different skin shades or hair thicknesses.

5. Positioning of the patient: For the bikini line and groin areas, it can help to have the patient lie on their back with their legs apart and bent as necessary. Placing towels under their buttocks helps reach these areas easily. For the perianal area, placing the patient in the recovery position is best for keeping their dignity and comfort intact.

Inguinal area marking/perianal/perineal area marking in recovery position. Towels or drapes are used to maintain patient privacy and dignity

Before and after treatment with Motus AY, Lynton Lasers. Note the improvement in folliculitis Courtesy of Amy Jayne Aesthetics, Rainham

Six weeks after three sessions with the Initia Diode laser, Lynton Lasers Courtesy of The Hair Removal Clinic, Ilminster

TREATMENT PROCEDURE FOR HAIR REMOVAL PRIOR TO GENDER-AFFIRMING SURGERY

IPL/laser hair removal is commonly used for transgender clients undergoing gender-affirming procedures, and removing hair from the genital area is crucial for comfort and preparation for surgery (especially for male-to-female genital reconstruction). Pre-surgery treatment helps prevent complications like folliculitis and ensures better surgical outcomes.

In neovaginoplasty surgery, hair removal from the penile shaft and scrotum is essential to keep the vaginal canal and urethra free from hair, as this reduces infection risks. Hair inside the neovagina can lead to infections and debris build-up, while hair in the neourethra can cause urine flow issues.

Before surgery, all hair should be permanently removed from the scrotum, penile shaft, and surrounding areas to ensure the best conditions for surgery, including a 2.5cm area around the base of the penis, as in the following example:

Clients should also be made aware that white or grey hair will not respond to light-based treatments, in which case electrolysis may be required. It is advised to wait at least three months after light-based treatments before proceeding with surgery to ensure that no regrowth has occurred.

CONCLUSION

Light-based hair removal treatments are both safe and effective for aesthetic and gender-affirming treatments, offering increased comfort and confidence. From refining the bikini line to facilitating gender-affirming surgeries, its impact transcends mere aesthetics, empowering individuals with newfound freedom and comfort in their own bodies. Through meticulous protocols and technological advancements, practitioners ensure optimal results and client satisfaction. As demand grows for inclusive solutions, light-based therapies stand as a beacon of empowerment, fostering self-expression, acceptance, and wellbeing in diverse communities.

REFERENCES 1. Godfrey Town, Ross Martin, Anita Clarkson-Dalton, Samantha Hills. Guidelines on Photoepilation: Techniques for Intimate Body Areas. J Med Clin Nurs Stud. 2023. 1(1): 1-7. DOI: doi.org/10.61440/JMCNS.2023.v1.33