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PaperclipPerfector  2d ago (text post)   2170 thread views

Small-Scale Question Sunday for October 27, 2024

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I desperately need any tips for reducing pain with laser facial hair removal that might not be easy to find on Google.

I'm 2 sessions in so far, and this is so painful that I cannot find words to express it; I end each session with tears dripping down the side of my head, and I get flashbacks to the session for a few days afterwards that are so intense as to be distracting. I do not have any kind of anxiety disorder, but entering the second session I felt panicked at the pain that was coming (and it did not seem that “the anticipation was worse than the event”.)

I believe the technician is not actually mechanically fucking up and burning me, because I am experiencing absolutely zero redness, blisters, or lasting pain; but this is still such an unpleasant experience that I'm considering aborting the sequence even if they won't give me a prorated refund for the unused sessions.

First session:

  • Didn't take any special precautions
    • the clinic's website said “Most patients describe the laser hair removal process as uncomfortable or mildly painful”;
    • I am a pretty optimal candidate as I have rather light skin and medium/medium-dark facial hair;
  • Did standard recommended prep such as shaving 24h beforehand, avoiding vitamin A the week beforehand (applies to all sessions);
  • attempted dissociation / wandering mind during the session (applies to all sessions);
  • applied a cooling aloe gel provided by the clinic at the end of the session (applies to all sessions).

Second session, after asking the technician for tips and doing a bit of basic research (I'm not sure how much any of this actually helped):

  • 3000mg acetaminophen 30mins before;
  • smearing on a thin layer of lidocaine gel 30mins before, washed off at the clinic immediately before the appointment;
    • this was the technician's recommendation, though I just got whatever was to hand at the local store, which happened to be a 4% gel;
  • requested a stress ball to squeeze during the session.

Current plans for the 3rd session, coming up in around 3 weeks — asking for stuff to add/remove/change here:

  • avoid coffee the morning of;
  • drink water the morning of;
  • 4000mg acetaminophen 1h before, so it has time to properly kick in;
  • 100mg diphenhydramine 30min before;
  • smearing on a 1mm layer of 10% lidocaine cream advertised for tattoo artist use and applying saran wrap on top of it 30mins before, washed off at the clinic immediately before the appointment;
  • bringing a small plush toy of my own as a comfort item to squeeze instead of the clinic's stress ball.

I do not know what laser type this clinic is using; I suspect it's diode (810nm), but I sent them an e-mail this weekend asking so I should hear back within a day or 2. I have read that alexandrite (755nm) might be better and less painful for my skin type. I'm currently e-mailing other clinics in the area to see what laser types they have.

https://cambridgelaserclinic.com/laser-treatments/hair-removal/lasers-explained/ (edit: their great diagram doesn't seem to want to embed as an image)

https://pubmed.ncbi.nlm.nih.gov/10886276/#:~:text=The%20800%20nm%20diode%20laser%20causes%20greater%20discomfort%20than%20the%20755%20nm%20alexandrite%20laser.

https://www.health.harvard.edu/pain/acetaminophen-safety-be-cautious-but-not-afraid

https://www.fda.gov/news-events/press-announcements/fda-warns-consumers-avoid-certain-topical-pain-relief-products-due-potential-dangerous-health

I don't have great connections to trans women spaces, but that seems pretty on the higher side of the typical range of pain most I've talked to have reported. It's probably worth emphasizing exactly how painful you find it to the technician; in other contexts I've definitely seen doctors overlook pretty clear pain from a patient because they didn't want to highlight it (even as a necessary step to bring up options) until the patient did, and this does seem like some matter where people have wildly varying responses.

From the literature, 'spot size' is adjustable, and smaller spot sizes seem consistently less painful than larger ones regardless of laser type. Still some tradeoff in effectiveness, and since I think this involves swapping the heads it may not be something that this particular office is set up to do. Some people I've talked to found alexandrite much less painful than diode, but it's not clear how much of that difference reflects the swap also coming at the same time that they went from debulking to fine cleanup work.

You can get 10% lidocaine cream, and I'd consider that. The FDA doesn't like it and I definitely wouldn't use them regularly or outside of this procedure, but the bigger concern about higher OTC concentrations are less likely to be relevant for well-spaced intervals with entirely topical uses on unbroken skin. You may be able to get a script from the tech, though it's also just the sort of 'illegal' that's on Amazon.

I'd reiterate the concerns about general anesthetics: acetaminophen is a helluva drug, and not really good for skin pain regardless of dose, and doesn't mix well.

Fw: exchange with the technician (all bold emphasis added):

Technician: You sent in a message asking about the type of laser we use and how painful the treatment is.
First of all, I am sorry you're having that experience. Our laser is the Rohrer Epilaze. You are being treated with the 810 Diode attachment currently.
Use a lidocaine cream about an hour prior to our appointment and ibuprofen or tylenol at that time as well. When you come in I will have you remove it completely so we can have a more effective treatment. As far as the pain goes, those are the only options for pain relief.
I do want to reiterate that this is not supposed to be a pain free experience unfortunately. There is a hot laser going into coarse hair follicles to try to kill the follicle so hair doesn't grow back. The first treatments are usually the worst because you have the most hair. It should eventually get easier, but the face is always going to be a very tender area.
Do you want to continue treatment?

Me: Is there a reason the 755nm alexandrite isn't being used in my case? I've read that it's less painful for sensitive areas, and I thought that my facial hair is dark enough & skin light enough to support its use.
I'm currently trying to get my hands on a stronger lidocaine solution; the 4% gel and tylenol I used before our previous session didn't seem to help much. I'll also try adding ibuprofen in.
I'd like to proceed at least through our next appointment[.]

Technician: Everyone [fitzpatrick] 1-3 I debulk with 810 diode due to its debulking power. I have found in my experience with 755, I only pull it out once we have gotten to the point in the laser process where the hair is very fine and sparse. That is when 755 is most effective. If you’d like I can use 755 at your next appointment, but your results are going to take longer.

Me: Do you mean that it would take more overall sessions, or that each session would just take a bit longer?
I’m perfectly OK to be in the chair getting zapped for a few more minutes if the pain could be a bit less intense; but I absolutely don’t want to risk making the overall treatment slower or less effective. If using the 810 is the best way to ensure that the debulking gets done well in as few sessions as possible, then let’s stay with that for now.

Technician: Using the 755 would take more sessions! We will continue with 810, and if you ever want to swap before necessary let me know!

I wonder how much of that is “genuinely true” vs. just a consequence of clinic-wide policy meant to keep these $67 sessions as short as possible for maximum patient throughput...

DO NOT fuck around with pain killers, also don't drink acetaminophen, at all, ever. For any reason.

I'm following the range posted on both the label and on https://www.fda.gov/consumers/consumer-updates/dont-overuse-acetaminophen

If you would like to recommend a different source advocating lower doses, please do. I've seen a lot of people chiming in with comments to this effect but I can't validate any of them.

Are you saying don't drink acetaminophen based on the risk of overdose, or for another reason?

I ask as I often give my toddler liquid acetaminophen for teething.

Liquid acetaminophen is safe as long as you mind the doses, and IIRC, paediatric suspensions are usually intentionally made in sizes and concentrations where even consumption of large amounts or the whole bottle won't be lethal.

He may have accidentally dropped some words and meant "don't drink [alcohol with] acetaminophen, at all, ever."

4000mg acetaminophen 1h before, so it has time to properly kick in;

Unless you have a relevant advanced degree and significant domain specific knowledge DO NOT DO THIS.

Tylenol overdose is one of the worst ways to do imaginable.

So why are you doing this yourself?

Aesthetically, I hate the presence of stubble between shaves. That said:

this is still such an unpleasant experience that I'm considering aborting the sequence even if they won't give me a prorated refund for the unused sessions

I also don't like the hassle of shaving, but obviously “hassle” pales in comparison to the goddamn torment nexus that this — I want to emphasize — was advertised not to be:

the clinic's website said “Most patients describe the laser hair removal process as uncomfortable or mildly painful”

Wait, you want a permanent babyface?

Being clean shaven is not babyface. I only really hear this from guys with beards, the same way I hear people with tattoos describe perfectly fine skin as a "blank canvas."

If you can pull it off, having no facial hair just looks better. Male movie stars generally don't have beards. I can't think of a single romcom where the male love interest had a beard. Male models usually don't have beards. Sure, in many ways these examples all appeal primarily to women, but even very male movies generally have clean-shaven stars.

If you can pull it off, having no facial hair just looks better.

Taste is subjective and all, but wow I disagree with this. If you can pull it off, facial hair looks way better than being clean shaven.

I think the majority of people would disagree, which is why I brought up movie stars.

I grow a nice beard. IME most people mildly preferred the beard but the minority that didn’t like it really didn’t like it.

There's a difference between a clean-shaven face (that has a visible shadow) and a babyface.

Aesthetically, I hate the presence of stubble between shaves.

A shocking response. I thought for sure you were a transwoman. I work with a few and can guess at the physical difficulties they go through.

I kinda sorta technically am, according to maybe 90% of peoples’ definitions; but I don't crossdress either publicly or privately (that is, I don’t dress as a woman; I do dress as a man.)

The question, “why would you undertake a painful process in order to remove facial hair?” contains its own answer; @Southkraut gave me no seed of direction on which to build a high-effort or interesting answer, so I figured giving a true and precise literal answer to his content-free expression of shock as-stated was appropriate.

I do enjoy trying to reconcile massively disparate philosophies of gender identity, trying to make a stance for my own when the counterparty is actually up for it; but that didn't seem to be the case here; I only had something tantamount to “can you believe this guy disagrees with my own opinion on what the consensus on the attractiveness of male facial hair is?”

That's a bit strawmanny, but then again now that I know you're a transsexual (I previously assumed you were a woman or simply a metrosexual) this behavior matches what others of your kind have displayed in the past; the rapidly escalated assumptions of hostility when faced with anything other than affirmation. And instead of asking simple questions and getting worthwhile answers to better understand each other, we can instead pattern-match the other to our preferred ideological enemy group.

@Southkraut I edited the toplevel to note that it looks like alexandrite was found to be less painful than diode when used on thin skin; I am pursuing the “switch to a provider that uses alexandrite” option in parallel with the “reduce the pain by whatever means” option, with the latter being my main request for advice.

Not to be smug, but...that's advertisement.

The steelman I've heard is that it's much less painful in the case of legs (which could make up a large portion of their treatments), where the skin is thick enough that the overpenetration of the 810nm beam doesn't matter.

This is probably the reason. I’d imagine most laser hair removal is actual natal women getting their legs depilated for beauty reasons.

3000 milligrams of acetaminophen in one dose is dangerous to your liver. That’s one third higher than the recommended maximum dose for a entire day. 4000 would be double the maximum allowed daily dose. Especially if you regularly drink any alcohol at all. Can you ask your doctor to put some lidocaine on your face before he starts? Or use an injected numbing agent?

[3000mg is] one third higher than the recommended maximum dose for a entire day. 4000 would be double the maximum allowed daily dose

The source I linked in the toplevel says that 3000mg would be the “Safest maximum daily dose for most adults” and that 4000 is the maximum allowable 24h dose. Where are you getting your numbers from?

I do not take pain relievers for any other purpose; I had to buy a bottle of acetaminophen specifically for this use.

Especially if you regularly drink any alcohol at all.

I have 2 drinks per week for good health superstition, but will obviously refrain for the week surrounding that dose.

Can you ask your doctor to put some lidocaine on your face before he starts?

At the technician's recommendation, I already did try lidocaine, but I'm not sure how much it helped, so I'm going to be using a higher dose next time. (This clinic doesn't seem to include it with service, in any case.)

A few years ago 4000 was the maximum daily dose but the FDA has recently revised the recommendation down to 2000 mg because of evidence that acetaminophen is more hepatotoxic that previously realized. And to reduce the risks of accidental overdose from multiple medications, and because of the synergistic damaging effects with alcohol.

I've got to ask again where you are getting those numbers from.

I googled fda.gov acetaminophen safety and the first result, explicitly labeled “current as of” February of this year, has the same number as the Harvard article I cited in the toplevel comment:

The current maximum recommended adult dose of acetaminophen is 4,000 milligrams per day

https://www.fda.gov/consumers/consumer-updates/dont-overuse-acetaminophen

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