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:

 

1. 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.
   
    
2. 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

 

A:

1. The patient signs a consent form for surgery.
2. Antibiotics are given to prepare for surgery.
3. The area for transplantation is confirmed and the new hairline design is drawn onto the scalp.
4. Photo documentation.
5. The patient enters the operating room and changes into surgery clothes.
6. The patient sits, relaxes, and listens to music while the heart rate, blood pressure and oxygen saturation are carefully monitored.
7. It will take our surgical team about four hours to perform a 20cm2 donor size surgery, five to six hours for a 35 cm2 session. Each patient receives the full attention of our staff.
8. The patient is given local anesthesia with or without a mild sedative intravenously.
9. 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.
10. 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.
11. 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.
12. 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.
13. 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 single follicular unit (1 to 2 hairs.) We are able to accomplish several thousand hair grafts in one session.
14. The patient is then served lunch and is offered a selection of movies to watch after the slits are made according to the design.
15. After lunch, two to four surgical technicians begin implanting the grafts. This part of the procedure can last between 2 to 4 hours.
16. 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.

 

A: Pre-Operation Instruction

 

• Maintain an adequate length of hair (about one inch) 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 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 hours, 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. You may want to cover the area with a cap. 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 implanted area will be pink, slightly shiny skin which is usually a similar color to the surrounding normal skin. After approximately four to 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 or 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 should 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:

We first have to measure 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. 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.

 

1. 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).
   
    
2. Apply the transparent sheet (plastic food wrap) over the scalp.
   
    
3. Trace the coverage area on transparent sheet.
   
    
4. 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.
   
    
5. Take a digital photo of the scalp with the mark; keep it on file for future reference.
   
    
6. 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. For example, if the bald area is 100cm², to achieve 25% density we will need to harvest 25 cm² of donor area in each session.

 

A: There are some minor, temporary complications:

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 pimple