A: You may have heard that the
process is very painful. But with the proper technique in
the application of anesthesia, it does not have to be a painful
process at all. It all depends on how the surgeon applies
the anesthesia, and our office uses the least painful process
available for the comfort of our patients.
For a hair transplantation process, every surgeon uses either
a nerve blocking process or a local anesthesia (general anesthesia
is never used in this case).
Any pain at all during our procedure would be during the initial
needle injection. Our office uses NHT
Anesthesia Method to reduce even this small pain. The
anesthetic is warmed to reduce reaction time, the skin is
pre-numbed before each localized shot and the finest gauge
needle (30 gauge) is used to minimize this pain. Initially,
the patient is given a sedative through an IV medication.
This sedative puts the patient into a relaxed, "twilight zone"
state to minimize any pain there might be from the subsequent
injections. The tumescent technique is used for prolonging
the anesthesia time.
Most patients have informed us that the process was less painful
than a routine trip to the dentist. In addition, the day after
the hair transplant process, 50% of our patients do not require
any pain relievers at all, and the other 50% will take pain
reliever for only one or two days until the discomfort is
gone.
We feel that our procedures are much less painful in comparison
to many other clinics. The only disadvantage to this "twilight
zone" anesthesia is that the patient will not be able to drive
on the day of the surgery. However, should the patient forego
the "twilight zone" anesthesia and opt instead for a local
anesthesia, he will be able to drive on that day.
A: The preparation of hair grafts
is identical in both conventional and laser hair transplantation.
The difference is that laser hair transplantation uses a machine
that shoots a beam of high energy light burning slits or holes
in the scalp, while cold steel is used to make slits conventionally.
The hair grafts are then transplanted into the slits manually.
The laser beam cannot be used in removing or cutting the patient's
own permanent hairs with roots from the "donor" areas. It
burns permanent hairs and vaporizes tissues.
Laser Hair Transplantation Experiences in Germany:
Laser hair transplantation has been performed widely in Germany.
Several research reports have indicated that there are no
advantages of laser hair transplantation over the conventional
cold steel technique and more and more stories are surfacing
in the German media about unsuccessful laser treatments, casting
a bad light on the whole hair transplant industry. The only
advantage of laser hair transplantation is in marketing.
Disadvantages of laser hair transplantation:
The laser beam burns tissues, damages existing hairs
and seals blood vessels around the transplant areas.
The yield of growing hairs on the laser hair transplanted
side is visibly lower.
Longer post-op crusting time.
Delay in hair growth.
For laser hair transplantation, there are two concerns:
High energy laser beams may damage hairs existing near
the implant site. Laser applications are used for permanent
hair removal! Unlike electrolysis which removes hair one
by one, laser removes hair in a certain area all at once.
Some doctors claim that there are special laser torches
specifically designed for hair transplant and that no
thermal damage is caused. But as a prospective client,
you should demand to see the results of the laser hair
transplant for yourself.
A laser seals blood vessels. This is helpful in other
types of cosmetic surgery, where wounds need to be closed
up and cauterized. But for hair transplantation, continuous
blood flow is important for hair growth (blood brings
necessary nutrients and oxygen to the implanted hairs).
The heat of the laser stops this blood flow, resulting
in a lower growth rate and less successful transplant.
* Claudia Preawetx-Moser and Karl Moser: Laser Adventures
in Germany, Hair Transplant Forum International, Volume 5,
Number 2, March-April 1995; P.6
The area for transplantation is confirmed and the new
hairline design is drawn onto the scalp.
Photo documentation.
The patient enters the operating room and changes into
surgery clothes.
The patient sits, relaxes, and listens to music while
the heart rate, blood pressure and oxygen saturation are
carefully monitored.
It will take our surgical team about four to five hours
to perform a 1000-graft session, six to eight hours for
a-2000 graft session. Each patient receives the full attention
of our staff.
The patient is given local anesthesia with or without
a mild sedative intravenously.
Hair is taped up in the back to allow access to the
selected area of hair-bearing donor scalp. A thin strip
of the permanent hair along the lower back of the scalp
is used. Afterwards, this thin scar will be easy hidden
underneath the surrounding permanent hair.
Using a very fine 30 gauge needle, the scalp is anesthetized.
Once the scalp is numbed, the surgery is virtually painless
as the nerves are blocked.
After the fine strips of hair are removed from the back
of the scalp, the technicians divide them into the predetermined
sizes of grafts using a video visualizer or a stereoscope.
The back of the scalp is sutured by the surgeon. This
scar will be barely detectable in a few months and will
be completely hidden by hair growth.
The grafts are now ready to be transplanted into the
"recipient" area. Mini-slits are made for the
modified follicular grafts (2 to 4 hairs) while 19 gauge
needle holes are made for the micro grafts (1 to 2 hairs.)
We are able to accomplish several thousand hair grafts
in one session.
The patient is then served lunch and is offered a selection
of movies to watch after the slits are made according
to the design.
After lunch, two to four surgical technicians begin
implanting the grafts. This part of the procedure can
last between 2 to 4 hours.
After all grafts have been completed and checked, the
donor and recipient areas are cleaned and the donor area
only is bandaged. The patient is given a list of post-operative
instructions and medications. If I.V. sedation is used,
the patient must not drive home himself. It will be necessary
to arrange for transportation home prior to arrival at
the clinic.
Maintain an adequate length of hair on the back of your
head. Your donor grafts will be removed from here and
you should expect coverage following your procedure.
Two weeks before surgery
No Rogaine or Minoxidil.
No Aspirin (acetylsalicylic acid - A.S.A.) or anti-inflammatory
medications that contain Aspirin.
One week before surgery
No Vitamin E.
No Ginkgo Biloba, Ginseng or other herbal supplements.
One day before surgery
No Alcohol.
Make arrangements for someone to take you to and
from the clinic if you want to have I.V. sedation
in addition to local anesthesia.
Confirm your appointment.
On surgery day
Wash your hair in the morning using your regular
shampoo.
Have a light meal one hour prior to your procedure.
Wear a button-down shirt and comfortable, easily
laundered pants. You should also bring an adjustable
baseball cap or scarf along with you.
No tight hats or caps.
Do not wear anything that will have to be pulled
tightly over your head.
Eat a light meal just before coming to the clinic.
A: For the first twenty-four fours,
there will be a strip of bandage around the head. After that,
you will be able to remove the bandage and shampoo your hair.
If you have the surgery done on the hairline, the small scabs
will remain for seven to ten days. Some patients may want
to cover the area with a cap or even a hairpiece at work if
they desire. If you have partial hair, it is much easier to
cover up the area, or you can use a camouflage product.
When the small scabs fall off after seven to ten days, the
freshly implanted grafts will be pink, slightly shiny skin
which is usually a similar color to the surrounding normal
skin and is minimally obvious at first. After approximately
six weeks, the areas where the grafts were transplanted are
barely visible.
Pre-existing hair around or adjacent to the transplanted
grafts may shed, giving a thinner look, but will begin to
grow back within a few months. This temporary thinning
of pre-existing hair is called Telogen Effluvia. Unfortunately
there is a time lag between this increased thinning of pre-existing
hair and re-growth of transplanted hair, so do not be alarmed
if this happens.
A: If you have a completely bald
area, it may take two to three surgeries to cover. If you
have an area partially covered with hair, it may take only
one surgery to fill in the area. Our goal is to restore about
twenty-five percent to thirty-five percent of the donor's
original density in each surgery. After two surgeries, the
density is at about fifty to sixty percent which is often
adequate coverage to satisfy the patient. The time between
each session is usually four to six months in order to see
how the hair is growing out and to provide more equal distribution.
A: Usually it takes three to six
months for the hair to grow out, and after that it will grow
about half and inch per month which is the same rate as the
donor hair. Initial hair quality is usually very thin, softer
in texture like baby hair and then it becomes coarser over
time. Sometimes the initial hair is curlier, then straightens
in about one year. The color of the initial hair may also
be darker. It may be lightened by the sun later.
A: Typically male pattern baldness
affects the frontal or vertex area of the scalp, while not
affecting the sides and the back of the scalp. The hairs on
the back of the head are genetically programmed to be life
permanent. The transplanted hair comes from the hair on the
back of the head, and will retain all of the characteristics
as those hairs, including being practically life long lasting.
Therefore, it is reasonably safe to say that the results of
hair transplantation will continue to grow for the rest of
your life.
A: Hair roots are very tough and
can tolerate surgery or any irritation to the scalp. We know
this because we can see how difficult it is for people to
remove unwanted hair. A hair can be plucked out hundreds of
times and just keeps growing back. The actual physical trauma
of cutting the scalp, when inserting the donor grafts, can
cut the shafts and/or damage some hair follicles. But more
significant is the interruption to the pre-existing hair's
blood supply which is enough to cause the shedding of this
pre-existing hair.
It is temporary as most lost hair will grow back after
a few months.
A: To estimate the number of grafts
is not an easy job. Here is the approach that we are using
in our facility:
We first have to calculate the total area of coverage. Based
from the total area of coverage then we can decide the size
of donor area that should be harvested. From the size of donor
area then we can find out number of grafts depends on the
size of graft. The sequence is very important.
Measure the Area of Coverage
Please keep in mind that the scalp is in 3 dimensions so it
is very difficult to calculate 100% accuracy, but we only
need an approximation.
Discuss with the patient to find out his desired coverage
area; and draw the area directly on his scalp with a “China
Marker” (or a black eyebrow pencil).
Apply the transparent sheet (plastic food wrap) over
the scalp.
Trace the coverage area on transparent sheet.
Place the transparent sheet over the specially
designed graphic paper* to count the number of small
squares. (Each small square =1 cm2, big square
= 4 cm2). In this way, you can estimate the
approximate coverage area in centimeter square easily.
Take a digital photo of the scalp with the mark; keep
it on file for future reference.
Photocopy the transparent sheet and keep it in patient’s
chart. (When the patient comes back for surgery, compare
the coverage area to make sure it is exactly the same
as measured during consultation.)
Decide the Size of Donor Area
From my experience, 90% of our patients are satisfied with
a 50% donor site density. Of Course, depends on the patient’s
hair color/texture, skin color, contrast between skin and
hair color and patient’s age, we have to do some adjustment.
For an average person, we assume 50% donor site density gives
adequate coverage.
If the patient has lost his hair completely at the time of
surgery, we usually suggest for two surgeries at 25% density
each session. If the bald area is 100cm2, to achieve
25% density we will need to harvest 25 cm2 of donor
area in each session.
Calculate the Number of Grafts
Now that we have harvested 25 cm2 of donor strip.
Depends on the size of the grafts, we can figure out the number
of grafts without difficulty.
For example, each follicular unit is about 1 x 1 mm2, 1cm2
will produce about 100 grafts; therefore, 25 cm2
will give 2500 grafts.
Temporary Thinning of Pre-Existing Hair
After the surgery, it is normal for some pre-existing hair
to thin. The pre-existing hair will return to normal in full
condition within a few months after the surgery.
Bleeding
Some bleeding is normal and will stop with simple pressure.
Persistent bleeding occurs in about one in a few hundred cases.
Additional stitching is rarely required.
Pain
Pain is usually fairly minimal and lasts only a few days.
50% of our patients do not require any pain relievers, and
the others take Tylenol for a few days.
Numbness
Some transient numbness is inevitable, and usually lasts from
three to eighteen weeks. It is rarely bothersome or long-lasting.
Hiccups
Hiccups may occur after surgery. The cause is not well known,
but hiccups seem to occur more frequently after hair transplantation
than scalp reduction. The incidence of this complication is
about 5%. It usually lasts several hours to several days.
If left untreated, the hiccups may interfere when you eat
and sleep, but there is a medication that the doctor can prescribe
to ease the hiccups.
Itching
Some itching commonly occurs but is rarely troublesome and
lasts only a few days. Shampooing the hair daily will help
the discomfort.
Swelling
There is some swelling in nearly all cases. It affects the
forehead and the area around the eyes and lasts two to five
days, being maximal on the fourth day. In about one in fifty
cases, a “black eye” develops. With particular patients, swelling
can be considerable and temporarily disfiguring, especially
after the first session. However, it does little harm and
lasts no more than a week. We can prescribe you some medication
to reduce the swelling.
Infection
This happens in one in several thousand cases and is easily
cured with antibiotics. We will provide you antibiotics prior
and after the procedure to prevent it from happening.
Scarring
Keloid scarring occurs only in pre-disposed individuals, and
even more rarely (1/1000 cases) has this keloid scarring been
hypertrophy to the point of “ridging.”
Cysts
One or more cysts may occur in the recipient area when many
mini-grafts have been inserted. They usually disappear by
themselves after a few weeks or immediately with various simple
treatments. They are not usually more than 2 or 3 mm in diameter,
i.e., the size of small pimples.
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2003 Natural Hair Transplant Medical Center. All rights reserved. Privacy Statement
