First-rate Tools, Good Technique and Expert Practical Skills

DURING THE LAST few years - judging by the many published articles on the blend method and random remarks from uninformed electrologists - I think thermolysis epilation (AC, shortwave, radio wave, high frequency) has, if you'll forgive the pun, been sold short.

I'm from California, and although blend epilation is prolific in the state today, it wasn't when I began my career in electrolysis in 1959. My mother, who was an electrologist, used thermolysis successfully, so I followed her example.

Over the 37 years I have been using thermolysis I have had to adjust and add considerably to the technique that I was taught. In electrology school you really only learn the basics, and you're limited to the knowledge of your instructor. When you get out into the real world, you have to test the theories you've learned and develop your own skills and techniques based on experience and observation.

In order to kill the hair follicle successfully with thermolysis you must have a variety of techniques that are specific to this modality. And the most important skill necessary to performing thermolysis well, is good insertions. There is less margin for error with this modality, and more emphasis is given to pin-pointing the target area.

To accomplish accurate insertions, it is very important that the electrologist has adequate light and excellent magnification, so it can easily be seen where the hair exits the skin. (And letıs not forget how small that entrance to the hair follicle really is.) The higher the magnification and illumination, the easier it is to see, of course, but this better vision comes at a higher price and many electrologists are hesitant to lay out the extra money for quality equipment. I am absolutely convinced, however, that it pays off in the long run. For magnification, my own preference is for surgical telescopes with 3.5x magnification.

First-class illumination is another secret to good insertions. Years ago, when patients kept telling me that they wished I could see their hair as they see it in the bathroom mirror or their car vanity mirror, I realized I would have to search for a work-light that would give me (as near as humanly possible) a light with the brightness of sunlight ‹ without creating an uncomfortable heat for the patient. The answer was a quartz halogen lamp. With halogen light I found I could see so much more. The fine blond hairs on the face that didnıt show up under fluorescent light were suddenly revealed, and by shading (blocking the light) and moving the fixture I could easily determine the exact point at which the hairs exit the skin.

Thermolysis is not necessarily done quickly. In the past, speed was encouraged and a rhythm (like that in knitting) was highly commended. However, after I had been in practice for a few years I realized this didnıt make any sense. To get a good insertion, the electrologist must slide the probe alongside the hair and into the follicle ‹ not jab it into the skin and make a new opening. Like typing or playing the piano, making a good insertion is a skill, and rushing the process makes for many mistakes and a poor result.

One of the reasons I believe the word ³probe² is an appropriate name for an electrolysis needle is that it is (or should be) used as a probe to ³feel² the follicle opening. When there is further difficulty entering the follicle, a good tip is to grasp the hair with the forceps and gently move it around. This not only helps oneıs eyes to focus on the opening, it loosens any scaly debris that may be blocking the entrance.

Another advantage to having accurate insertions is the lessening of trauma to the skin. It has been my observation that the follicle seems to act as an insulator and keeps the action of the electrical current contained. The depth of the insertion may be responsible for pain to the patient and for damage of the epidermis, especially on the upper lip, where the hair is usually fine and the depth of the follicle is very shallow. Too frequently electrologists force the needle further than is prudent, or necessary.

Patients who have extremely dry skin can be encouraged to use lots of moisturizer on their skin (right before their appointment) on the day of their appointment. Since high frequency electrical current reacts with liquid in the skin, the extra moisturizing helps facilitate the epilation process and makes the insertion easier.

PERT, or ³Double Dipping²

Observation, and paying attention (as opposed to talking) helps electrologists evaluate the accuracy of their insertions. When the electrical current has been applied to the follicle and the hair is being removed with the forceps, the electrologist must note exactly where the hair came out, how deep it was, and the precise angle. Sometimes that hair, as it is sliding out, will leave a small amount of debris to mark the spot. If it appears that the insertion has been ³less than perfect,² it may be necessary to employ the procedure known as PERT ‹ the Post-Epilation Reentry Technique (an old procedure that was researched more recently by James E. Schuster, M.D.).

PERT sounds a lot more complicated than it really is, and it gives the electrologist a wonderful advantage when attacking very deep, coarse, anagen hairs. Itıs even better than progressive epilation with the blend method, because it gives the practitioner a chance to adjust any slight insertion error. The essentials of the method are as follows:

1. The needle is inserted in the follicle in the usual way.
2. The current is applied.
3. The needle is removed from the follicle.
4. The hair is removed from follicle.
5. Needle is re-inserted into the empty follicle. 6. A second dose of current is applied. 7. The needle is removed from the follicle. PERT should be used if; (1) an easy release cannot be accomplished without over-treatment, or; (2) if the original insertion is slightly off target. In both cases the needle is re-inserted easily (exact location and papilla depth have already been established) into the naked, vulnerable, follicle which now has no hair blocking the destructive current. Another factor that influences permanency in thermolysis is an easy release. In order to ³feel² a good release, you must take your time. The majority of comments that I get from patients that have had poor results with straight thermolysis is, ³I canıt feel you pulling the hair out.² My answer, of course, is that they are not supposed to feel the hair being pulled: That only prolongs the treatment. The only time that I allow myself to tug on a hair is during the initial first clearing of very thick, deep rooted hair. At that point, with the reinsertion technique, I know that I have done damage to the hair follicle. Tugging, by the way, is different than pulling. It should feel like the hair is tight in the follicle, but not connected. Once the heavy hair has been removed, any reappearing hair should be noticeably finer and slide out easily with no need to tug. I also use PERT if the skin reacts violently to the current the first time and Iım concerned about over treatment. My first priority is to have the skin heal well. I had a case recently of a woman of Italian and Armenian heritage who had the treatments or taken any longer to achieve. The same needles are especially good for the toes and fingers, that are so difficult to insert. Some practitioners find the small, two-piece needles rather wobbly at first and have trouble making a smooth entry into the follicle ‹ because it cannot be forced in ‹ but practice eventually helps the electrologist get a feel for better insertions. If the needle is small enough and the current is well controlled, there should be no scabs or pigmentation on the upper lip, even on Iranian or Indian women. To get good healing in thermolysis, we have to understand what we are doing to the skin. We are heating it up, so it follows that the best after-treatment is ice, applied immediately after the treatment for at least 10 to 15 minutes. This improves the healing, and cuts down on any adverse reaction. (I give my patients an ice pack at the office, for them to use on the way home.) It is important (and interesting) for the electrologist to track treatment patterns. The public is always asking for estimates, but most electrologists give very vague answers. I decided some years back that I needed to know this information, and began paying close attention to the pattern of progress on my patients. I can now give pretty accurate estimates. Generally, most of the time and expense for an electrolysis patient is in the first four to six months. At the end of that time, their appointments start to space out and the time per appointment is cut down. We have to keep good records, but it is fun and challenging to see the patterns, and document how long it takes to treat various cases. For instance, when I get a telephone inquiry for an upper lip that has only been bleached, I estimate that between six to ten 15-minute visits will be required, or 1Ŝ to 2Ŝ hours. If, after seeing the patient, I see that itıs a particularly thick growth, I expand it to five hours. Total familiarity with the type of current that is being used, and having the ability to visualize what that current is doing below the skinıs surface, are two of the most important commands an electrologist can possess. For the thermolysis epilator there is also a helpful light bulb device ‹ available through the manufacturer ‹ that allows us to see what current output we are getting. When we use a longer timing, we should know by instinct how long it will take for the current to rise to the surface, given certain timing and intensity settings. If the electrologist has a proper understanding of thermolysis and can control it, use an appropriate technique, and make accurate insertions, it is a very effective tool to permanently destroy unwanted hair ‹ be it fine or strong, curly or deep. The electrolysis profession has come a long way and seen a lot of changes during the years I have been practicing, but as I often explain to my patients, there is nothing magic about electrologistsı epilators or the different modalities. Someone has to plug them in, decide what settings are needed for certain skin and hair types, and make the proper judgments on insertions and release. It is the quality of the tools, in the hands of a knowledgeable and skillful electrologist that ensures permanent follicle destruction, not which modality is used.