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Notes -
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.
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