Electrolysis and Pre-existing Scar Tissue?

Hi there,

I’ve been lurking on the HairTell forums awhile, trying to educate myself about the process of electrolysis as much as possible and overall just getting familiar with the community. There is of course no shortage of literature out there regarding the risk of permanent scarring as a CONSEQUENCE of electrolysis, but what I’m actually interested in is the effectiveness of treating skin with pre-existing scars.

A bit of background: I suffer from trichotillomania (compulsive hair-pulling) that is directed exclusively at my facial hair. It started about five years ago. My behavior is extremely aggressive to the point of poking around and digging with a needle and tweezers to extract the hairs. “Distorted” does not begin to describe the state of my follicles. Ingrown hairs, once an exception and byproduct of my own warped perception, have now become the rule due to my “remediation” attempts. It’s a never-ending cycle and daily battle. I’ve got scars on top of scars, with hairs growing sideways under the skin and unable to surface through the tough exterior.

I’ve been in and out of therapy over the years, and suffice to say, it doesn’t work. It is exorbitantly expensive without enough bang for the buck. More importantly, it cannot address the very legitimate (albeit exacerbated by my behavior) physical/cosmetic issue that ISN’T a subjective “thinking problem.” Without addressing the matter of the hair itself, I feel I’ll never be free from this disorder.

Ideally, I’d like to be a person who is OK with my facial hair growing however it grows. But I liken it to an alcoholic waking up every morning to a drink sitting on his nightstand. Having to constantly, directly engage with the temptation is a recipe for disaster. I’m at the point where I’m done with it. My facial hair, all of it. I want it gone. Even the areas I don’t fuss with. I just want my life back.

Talking about and owning up to this is not easy. Trich is an embarrassing, poorly understood, highly visible and stigmatizing disorder. But it is what it is. In some ways, I’m “lucky” in that I only pull from my face. It makes the nuclear option of getting rid of the hair more tolerable than those who pull from their head. Permanently removing my head hair would be pretty impractical and unappealing; total non-starter. But facial hair? Again, not my preferred solution, but eh, whatever. I can live with(out) it. It’s certainly a better quality of life than my current standard of looking like a Batman villain.

I actually had seven rounds of laser over my entire face and neck earlier this year. Having mostly coarse, dark hair, I was said to be an ideal candidate. Surprise, it was a bust. The hair would shed, I’d get about a week or two of relief, and the next wave would come in. Then later I noticed what was pretty obvious regrowth from previous treatments. Not to mention the laser being totally ineffective on lighter hair, regardless of texture. I realized I could literally be at it forever playing whack-a-mole with laser. Today, it looks as if I had no treatment whatsoever. Pretty classic story for male facial hair, but y’know… confirmation bias and all.

I am now seriously considering electrolysis, though I have a lot of trepidation. One is lack of recommended practitioners in my area (Richmond, VA). I really, really am hesitant to start treatment with someone only to learn three months in that they are undertreating (such being the nature of electrolysis). Not to mention that I present a rather atypical case (I think).

I don’t even really care about the further damage that could be caused by electrolysis. My jawline and much of the left side of my face are already a disaster and my neck is headed down that path. I feel like scar revision is probably in my future anyway, but there’s no point to that unless the hair problem is eradicated first. My sideburns and chin/mustache area would likely be the easiest to treat, ironically, as I’m not really bothered by the hair in those areas. They exhibit normal growth. Nevertheless, better safe than sorry. It’s all gotta go.

Now, I understand that electrolysis works for all skin types and hairs at any stage of growth. I imagine this technically would hold true for heavily scarred skin as well, provided the follicle is at least accessible. In practice, however, I can see this inviting a lot of complications and slow, tedious work for the practitioner. I’m just wondering if it would even be worth pursuing. To the professionals out there, how do you feel about treating already-damaged skin and loads of severely distorted follicles? Have you worked on patients with circumstances similar to mine, and if so, what was your experience? ASSUMING (and this is the real gut check) I am able to leave everything alone between treatments so that hair is present to treat, is there any hope?

Sorry for the long post. This condition has utterly consumed me, inside and out, and I’m at the end of my rope. Thanks in advance for any replies.

Unfortunately my reply was lost. So a short version: doing electrolysis on an area with large hair density is very similar to the procedures dermatologists apply when the do scar treatment with a fractional laser or a dermaroller. In all cases a healing process which will lead to collagen formation will be triggered.

That means that electrolysis (without leaving healing gaps) does indeed have some skin rejuvenating effect. Doing intense electrolysis on Your face will not only remove the cause of the irritation - the ingrowing hairs - but also improve Your skin ageing. If You are lucky, massively - but there can’t be any guarantee for the latter.

So You need to find an electrolysis with experience in that heavy stuff (full clearance of a beard IS heavy) and who knows how not to overtreat You despite of that heavy hitting.

One of my clients visited me with the same problem as You have. His skin actually improved but as always as with severe folliculitis the hairs keep growing in as long as there any growing… So we needed to do clearances every one to 3 weeks in order to keep the face hair free.

So, have you been diagnosed with trichotillomania? I hear that behavioral intervention / habit reversal strategies do better than medication.

So, Beate did a great job answering your question about working on scarred skin and I, too , say yes, you can work on skin like you describe and see benefit. Another electrologist expert, Mike Bono, would say we can work through scar tissue and electrolysis actually would make the scars better because it get the macrophages revved up and the old scars get re-modeled. You should see at least a 50% improvement on the scars. Throw in some "Kenalog’ injections … and you may see even greater outcome.

Interview several electrologists and get some short treatments with them before you decide where to invest your time and money. If you have a large amount of hair it would be highly desirable to find someone that is will move this along. If they can work on you for more than hour at a time and remove enough hair, the size of you palm in about an hour or so, that would be helpful. Get a plan and go forward. That is better than any pill a doctor may prescribe in regard to any depression you feel about your situation.

Indeed. But the folliculitis going hand in hand with trich (regardless which causes which) requires intervention, too. You probably cannot solve one problem without the other. And psychological treatment against any form of self injury is difficult.

These ingrowns are really deep, and the inflammations are really ugly and painful. On my client i tried just to clear the cheeks and leave a normal male beard shape around the mouth intact. But the folliculitis started to extend in the untreated areas (or he started pulling hairs, i cannot judge…).

Well I know it should break up the fibrous tissue formation and trigger a healthier collagen buildup. there is some recent technology available which is dubbed “Radio Frequency Microneedling”. How it works is that they have a device that looks exactly like a dermastamp and the needles on it are inserted into the skin and a heat blast is delivered through the needles into the damaged tissue. It causes the collagen in the scarred tissue to denature and new/healthy collagen takes its place instead. I guess they got their inspiration from electrolysis on this one.
However, what I am also reading up related to this procedure (radio frequency) is that it is a very risky process with nasty and permanent side effects. There are many reports that people ended up with permanent burn scars and/or hyperpigmented lesions.

Just wanted to share this bit of info here.

Do you have any links you can share about RF micro-needling?

Sounds like Radio Frequency Micro-Needling and electrolysis could be cousins to each other in as much that they stimulate new tissue to form collagen.

Well this is the device… You can see how the device is operated by watching this video… It is also know as Infini micro needling since I guess the makers of the technology go by this name. You can find more videos on youtube if you search for radio frequency or infini micro needling.

The device the operator is holding has needles on the tip which are placed apart from one another. Resembles a dermastamp, really. When she pushes down the device in her hand the needles go into the skin like a dermastamp would and then she delivers a heat charge. The needles open up micro channels inside the skin and the heat delivered through them stimulates things on a cellular level.

In theory this should work the best when it comes to scar revision and alike and I hear good things about it, but when complications happen, they ruin lives, and there are a lot of negative reports floating online.

Also on this site there are some positive and some negative reviews of radio frequency micro needling if you are seeking for user opinions.

You can also try looking up user reviews or diaries on acne.org as well. Here is one:
http://www.acne.org/messageboard/topic/322562-my-infini-treatment-for-my-acne-scarring/

Personally, for the scarring I have, I will stay as far away from these devices as possible and will stick to regular micro needling. Can’t take any more risks. However, the device can be considered as proof that the damage caused by electrolysis stimulates new collagen growth since in both cases needles are pushed into the skin and a heat charge is delivered through them.

Your information is much appreciated. I will carefully this peruse later today. Thank you!

One more comment regarding your case: There are many electrologists that could handle your situation just fine. We see complicated cases all the time - you are not as atypical as you think, I would bet. Experience does matter for the most part. Interview and choose. Undertreating hairs is not a problem. you should not feel tugging or any traction as they lift the hair out. Some of the newer technology today offers modalities that were designed for quick removal of stubborn, twisted hairs. If you choose someone that expertly performs Multiple Needle Galvanic (slow, but highly effective), or a beautiful frothy Blend (faster than MNG) or Synchro thermolysis (very fast and as effective as MNG), you will get permanent hair removal.

There are many paths to disabling hair follicles, so don’t let anyone tell you that their way is the only way. Go get treatment from different practitioners and decide for yourself.

Lastly, you seem to think that electrolysis will pile on more scars than you already have. Not true. This is false information that grows strong on the internet all the time. The professional electrologists, who do this everyday and have thousands of hours of experience under their belt, do not scar people. The person that does DIY on themself or a friend are more likely to scar. Keep that in mind. There is a better day ahead for you. If you private message me, I can refer you someone I highly trust in your geographic region.

I want to marry this reply. Thank you. It is absolutely the case that my condition started as an exaggerated response to a legitimate, albeit minor problem (occasional ingrown hairs). It has since exploded into an even more exaggerated response to a rather more severe, legitimate problem (constant ingrown hairs, distorted growth, and ribbons of scarring). This is largely of my own making, but permanent hair removal seems the only way out of the vicious cycle. Body-focused repetitive behaviors (BFRBs) like trich are indeed notoriously difficult to treat psychologically - probably because they tend to come with several comorbidities or “borrow” elements from OCD, body dysmorphic disorder, or other impulse-control disorders. Addressing the physical component at least pulls one ingredient from the mix of perversely intermingled and otherwise inseparable issues.

So very true! Speaking from experience, the behavior definitely tends to migrate, especially when you aren’t able to pull from your usual “go-to” trouble spots. This happened with laser. When my cheeks and jawline were effectively bereft of hair, I found myself drawn to my chin and lower neck (which were not as responsive to the laser). I had NEVER pulled from these areas before! This is why I have the attitude that it’s all gotta go. With no other options, I’m sure I would start in on some new area that hasn’t been a problem in the past if I leave any hairs intact.

If you don’t mind me asking, how was your patient’s outcome, once all was said and done?

Thanks! Even as I was writing it, I found myself questioning how atypical my case really was. Atypical compared to the general population, but perhaps not for what electrologists are accustomed to seeing. Believe me, I am definitely not of the mind that electrolysis = bad/scarring. I was just concerned that my existing scars would impede progress and wanted to express that I was indifferent to the (LOW) risk that it could be made a tiny bit worse. On the contrary, I am encouraged by the replies here suggesting that electrolysis could actually be beneficial in this regard!

I guess it makes sense. The controlled, precise destruction of tissue stimulating new collagen development is not altogether different from what dermarolling/dermastamping seeks to accomplish (which I’ve admittedly never tried). Whatever the case, I am confident that electrolysis would leave me no worse off than my own unchecked behavior for the next however many years. As far as I’m concerned, putting a stop to that would be 95% of the battle. I will absolutely PM you for a referral.

He has given up because some dermatologist acted against electrolysis. His cheeks are almost hair free, but the remaining few hairs are sufficient to cause trouble (which seems pretty common with ingrowing hairs). He did not address the psychological aspect, however.

Yep, professionally diagnosed a couple years ago. I’ve seen two different therapists (plus a psychiatrist) and the second one leaned more towards dermatillomania or compulsive skin picking (CSP), which is actually a separate thing. He felt that the aggressive nature of my hair-pulling and its motivations were more consistent with CSP (i.e. a need to “fix” something). However, the focus has ALWAYS been on hair. The only time I’ve achieved anything close to remission was during my temporary success with laser. No hair meant nothing to pull or otherwise mess with, no matter how much I scanned.

I suppose I may straddle the line between CSP and trich, but I’ve not found therapy (for one, the other, or both) to be particularly effective. CBT, mindfulness, replacement behaviors, hypnosis, you name it. Medication generally comes in the form of antidepressants - SSRI or combination of drugs from different classes. I think I’ve forgotten more of the pills I’ve tried than I can remember at this point.

I don’t mean to bag on the mental health profession, but my experience has been enormously frustrating and expensive. This is one area they really, really haven’t figured out. Not even a little bit. Maybe given another 100 years, they’ll have found a real breakthrough, but I can’t afford to wait that long. Hence, not enough bang for the buck.

I can’t say I’ve exhausted all my options yet since there’s still electrolysis to try. My knee jerk reaction to electrolysis a couple years ago would’ve been, “it’s weird and scary.” Having learned a lot since then, I’m now wishing it was the FIRST thing I’d pursued instead of the last!

Too bad, but not terribly surprising. It only takes a few scant hairs to result in significant damage. My biggest hurdle would probably be discipline: I’d have to leave everything alone to ensure there is actually hair present to treat and maximize effectiveness. Which means being OK with things possibly getting worse before they get better. Progress is the best motivator, though, so as long as I felt like I was getting somewhere, I think I could push through it. (Laser kind of taught me that, until the diminishing returns set in.)

Discipline was the reason why i gave him Sessions as close as possible, quite often in addition to normal working days.

That makes total sense based on the way this disorder manifests. I can stand in front of the mirror for an hour and “clear” my face to my own satisfaction. But the next day, it’s the same story, as dormant follicles activate and previously plucked hairs return. Without permanent removal of the hair, there’s no end to it. Based on the cyclical nature of the hair growth cycle itself, you don’t even get so much as a day of relief. It sounds like you were totally cognizant of that reality for your client and very generous in availing yourself to better accommodate his challenges. So rare to find someone who “gets it!”

I’ve heard reports of people having one area cleared to prevent this, and the patient switches to a different area. Do you think this a possibility in your case?

Seana

That’s what he told us.

Hi Seana,

I can’t say it isn’t a concern. That happened a bit with laser. I would Find myself plucking hairs from lower and lower on my neck, where they had never bothered me before. With dramatically less hair, I think what was present tended to stand out more. Overall, however, the brief windows of clearance via laser afforded me a MASSIVE quality of life improvement. I am hoping electrolysis can make that permanent.

At the end of the day, I know electrolysis is limited to destroying distorted follicles, not distorted thinking. That’s something I’m going to have to work on myself. It’s easier to avoid starting a new habit in the first place than stopping one when you’re in the thick of it. If electrolysis can at least remove the direct target of my current behavior - resolving the physical/cosmetic problems and thus breaking the cycle - I’m OK with the rest of the battle falling on me.