Hair Transplant Surgery, A Typical Procedure, Start to Finish

A Typical Hair Transplant Procedure, Start to Finish

STEP ONE: FORMS The day of your transplant procedure you will be asked to fill out an informed consent form that gives the doctor the right to perform your hair transplant procedure. All the information contained in the consent should have been explained during the consultation, but since these forms are designed by attorneys, they may be confusing. You have the right to have any legal statement explained to your satisfaction. This is completed while the doctor and surgical technicians prepare the room for your surgery. The doctor will also need to know your medical history, and a copy of our Medical History form can be downloaded HERE, and filled-out prior to any appointment.

STEP TWO: VITALS & PRE-OP PHOTOS: Your blood pressure and pulse will be taken and a medical assistant will quiz you to make certain you have carefully followed the pre-operative instructions that were given to you at the time of consultation. Pre-operative photos are taken from several angles so we can trace your progress.

You will next be taken to the surgical room for the actual procedure. The room is designed for the most state of the art arrangement for hair transplants with an eye for comfort during the time you will be seated throughout the surgery.

STEP THREE: REVIEW WITH SURGEON: The hair surgeon will take the time to review your expectations and discuss where the donor hair will be placed. At this point you will have an opportunity to ask any remaining questions you may still have regarding the procedure. The proposed hairline is again drawn with a grease pencil and approved by the patient. We then determine the donor region and clip the hair to approximately 2-3 mm in length. The hair above the clipped hair will be able to camouflage the donor area by being combed over the incision. Using a densitometer which magnifies the hairs, we can count how many grafts we will be able to obtain from one square centimeter. With this information, we can extrapolate how much tissue needs to be removed for the planned number of grafts.

STEP FOUR: MILD SEDATIVE: One of the things we mention in the pre-operative instructions is our recommendation to have someone drive you home following surgery. We cannot give you a sedative such as Valium if we know you are planning to drive yourself home. Valium like most sedatives can take as long as 24 hours before the sedative effects are totally gone. Since we are responsible for giving you the sedative, we also become responsible if you are driving home under the influence of the drug. In our office, 90-95% of the patients have a driver. The sedative takes the ‘edge’ off your nervousness and also makes the anesthetizing procedure more palatable.

STEP FIVE: LOCAL ANESTHESIA & DONOR EXTRACTION: We begin the anesthetizing procedure by carefully and as painlessly as possible injecting a local anesthesia into your donor and recipient areas. We inject the same numbing medicine as your dentist. The medicine works immediately by anesthetizing or putting the nerves to sleep.

When the area planned for extraction is numb, we will remove the donor strip. This takes just under an hour. Your position will be face down and also on your side.

When the strip is removed, we will close the donor site with sutures (stitches) that are designed especially for cosmetic surgery. These sutures will be removed painlessly in 14 days by our medical assistants.

STEP SIX: STEREOSCOPIC DISSECTION OF THE DONOR STRIP: The donor strip after being excised is placed in a bowl filled with normal saline and handed to the lead hair technician. First, the lead tech will sliver the strip into smaller 1-2 follicular unit wide strips with the stereoscopic dissecting microscope. The other hair technicians take these smaller strips and begin the dissection into individual 1-4 hair follicular unit grafts. Keep in mind that the technicians are highly trained, skilled technicians who are very adept with the stereoscopic microscope.

Donor strip ready to be harvested into follicular units.

Hair Transplant Technicians Dividing Donor Strip into Follicular Unit Hair Grafts

Hair technicians carefully divide the hair strip
into follicular units for transplanting in the scalp.

After this initial phase of the procedure, you can get up and go to the bathroom. If you like, you can drink something offered you by one of the technicians. Following the rest period comes the second phase of the transplant procedure.

Custom Made Blades: In this second phase of the procedure, you will return to the reclining chair and you may watch a DVD of your choice or read. While you are relaxing we will begin creating the recipient sites. Recipient site preparation varies tremendously from surgeon to surgeon. Most hair transplant surgeons use standard size blades which come in multiple widths. For the past several years we measure the width of several follicular unit grafts and then cut a custom made blade which duplicates the size. The machine we use is called the Cutting Edge Blade Cutter. With this machine, we can cut blades of any size starting at 0.5mm to as large as 1.25 mm. The cutter has the ability to cut in 0.1mm increments to precisely match the width of the graft.

We custom make our own blades to better create
the recipient sites for your follicular units.

By using custom made blades, we can make the narrowest recipient site needed to accommodate the graft. The more narrow the recipient site, the closer we can place the next graft and therefore the more grafts per square centimeter we can achieve. What does this mean to you the patient? We are able to obtain more hair density per area since we are placing more grafts within that area. We also measure the length of the follicular unit graft and then position the blade in the blade holder to the exact depth of the graft. By restricting the depth to the exact length of the graft we reduce tissue injury and unnecessary trauma to the underlying blood vessels. Since the advent of the Blade Cutter, dense packing has become much easier to achieve.

Diagram showing the process of a typical hair transplant procedure.

STEP SEVEN, GRAFT PLACEMENT: Another relatively new, innovative technique involves the direction the graft is placed in the scalp. The older technique of making the recipient sites parallel to the direction of hair growth causes the grafts to line up to give an unnatural and thinner appearance. The Lateral Slit Technique pioneered by Canadians Victor Hasson, MD and Jerry Wong, MD, changed our thinking dramatically with their revolutionary procedure of making recipient sites perpendicular or lateral to the direction of hair growth.

To quote surgeons Hasson & Wong:

“The lateral slit technique is the only surgical method that is able to duplicate the alignment and distribution of hair as it occurs in nature, maximizing coverage, and eliminating the pluggy results of older hair transplantation methods.

“The angle and direction of hair growth can be precisely controlled, allowing transplantation of areas previously regarded as too difficult or unsuitable for hair transplant surgery. In the donor area, follicular units appear to be lined up alongside one another in a plane perpendicular to the direction of hair growth. Lateral slit technique mimics nature’s arrangement of hair follicles providing the patient with the most natural possible results.”

Typically, once all the recipient sites have been made, you will have time to stretch and go to the bathroom. A lunch is then served while the hair technicians continue cutting the donor strip in follicular units. After finishing lunch we re-anesthetize the recipient region before the skin nerves have a chance to return to normal. If at any time during the surgery you begin to feel anything other than pressure, you must alert the surgeon. If we re-numb before the anesthetic effects are gone, you will not experience any discomfort.

We then begin the last phase of the surgery which is the most time consuming and labor intensive, namely placing the grafts in their new recipient sites.

Careful Placement of Follicular Units

Good Technicians are Crucial: Hair transplantation is not a procedure which is performed solely by the surgeon. Since there are so many complex steps involved in harvesting and planting grafts, more people are involved in the procedure. This is where qualified, well trained hair technicians become as important as the surgeon. These hair technicians are usually originally trained as a medical assistant in a community college or private school.

The post graduate training in the hair transplant office is a very rigorous regimen involving learning scalp anatomy, hair cycle dynamics, cutting tissue under stereoscopic microscopes, and handling and placing follicular unit grafts into the recipient sites. When they are ready to start cutting grafts, they must watch the lead technician cut grafts under the teaching microscope. When the supervising tech feels they are ready to cut tissue, they must cut under the teaching microscope so the lead tech can view every movement and graft. Learning how to insert grafts carefully and precisely requires additional training. It takes a person with exceptional hand eye coordination to be able to complete our hair tech training program.

Rest assured, we would never have anyone other than a professional cutter & placer touching you or your grafts. In our office, 4 hair technicians have a combined 35 years of experience cutting and placing literally tens of thousands of grafts. Throughout the procedure, we will make certain the alignment and distribution imitates the way your natural hair grew or your remaining hair grows. When all the grafts have been placed, the surgeon will check the donor and recipient area one more time to make certain everything is perfect.

STEP EIGHT, POST-OP RECOVERY: When the procedure is completed, a tech will clean the donor and recipient regions as much as possible. Too vigorous cleaning at this time will result in bleeding or oozing of a clear fluid. We have not used a pressure bandage in 10+ years. Prior to your discharge we give you our post-op instruction packet, various medications, including an antibiotic, a pain killer and an anti-inflammatory. You will also be given an appointment for the next day for your shampoo. We find it extremely important that the patient return to the office the next day so we can not only answer any new questions regarding post-op instructions, but clean their scalp so we can get a head start on healing.

Animated Patient Education Video : Hair Transplantation, 8 minutes
Topics Discussed: A visual animation and explanation of follicular units and how state-of-the-art hair transplant surgery is performed.

5 Stars
“Amazing Doctor! – The process was very easy from the consult to post day. Everything was explained to me multiple times to ensure I understood how the process was going to work as well as what I would expect long term. There was little or no pain in the whole procedure as I expected from what was told to me. The medical and nurse staff was amazing and was very helpful.

-J. J.
10/08/2018
Verified Patient

Hair Transplant Surgery, A Typical Procedure, Start to Finish

A Typical Hair Transplant Procedure, Start to Finish

About Dr. Shelly A. Friedman