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 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.
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 single
follicular unit (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 (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.
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.
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. 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.
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
Please note
that slits are made by hand. Therefore, it is impossible to insert
them exactly the same distance to each other. NHT has calculated the
graft per cm2 and estimated the distance between two grafts by using
the following formulas:
Grafts per cm2 = number of graft
transplanted / area of transplant
Distance of grafts per mm = length /
number of grafts
The length and width of the hair transplant recipient area are
measured. The number of grafts are counted and inserted into the
slits in the transplant area.
Here is
an
example:
NHT’s calculation shows that this eyebrow transplant has 92 grafts
per cm2 (555grafts in 6 cm2) and an approximately 0.8 mm between
each graft (110 mm for 125 grafts in one row.