Hair removal before GRS
There is a lot of debate about hair removal and GRS. The Thai
surgeons, and most American surgeons, describe hair removal during GRS.
This can clearly be effective, although most admit that not all follicles
are removed, and that hair continues to grow, although in very much smaller
quantities. The downside to intra-operative depilation is that, to depilate
the skin, all the fat has to be removed from the scrotal flap, and the
blood vessels are removed with it. This effectively makes it a free graft,
without any blood supply. In the best conditions, 25% of such grafts will
not survive, and I see a number of patients each year where the vagina has
gradually atrophied as a result of graft failure. It is therefore my
practice to recommend preoperative hair removal by electroysis or laser. So
long as this has been completed at least two weeks before surgery, it has
no effect on the viability of the skin. Because of the cycle of hair
growth, a minimum of 4 months is needed to ensure that all follicles are
removed before surgery. (This probably explains hair growth after
intra-operative depilation) If a penile invesion technique is to be used,
hair removal is not usually needed; the vault of the vagina is formed from
hairless skin, and any hairs which might remain are at the introitus, and
can be removed postoperatively; I am not aware of any patient in whom this
has been needed.
The photograph below shows the area of the scrotum which is used for a
scrotal flap; if you wish to undergo hair removal prior to surgery, this
area should be treated.
In addition, the small area at the base of the penis in the pubic area
is inverted to make a clitoral hood. If hair removal is being carried out,
this area should also be treated. A semicircle about 2cm in diameter from
the penis would normally be sufficient. This is the only area I recommend
for patients having a penile inversion operation.
There are a number of practitioners who are available for this
service. In West London, I know and recommend Sara Thomas, who now has a
regular session in the Charing Cross GIC, and whose website contains useful
information and links; Sara Thomas' website
London, Bernice Krochmal, who works at Skin Oasis in George St, has a good
understanding of the needs of MtF patients, and uses a laser, which is good
for dark hair.
Their website is www.skin-oasis.co.uk and
Bernice’s email there is Bernice@skin-oasis.co.uk