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

In Central London, Bernice Krochmal, who works at the Skin Health Spa in Wigmore St. has a good understanding of the needs of MtF patients, and uses a laser, which is good for dark hair. Appointments may be made on 020 7935 3366. You should ask for Bernice by name.