FAQ – Procedure

Since hair transplantation is a surgery, all candidates have to be in good health. He or she should perform some laboratory tests including: complete blood count, coagulation study, HIV Antibody, HCV Antibody and HBS Antibody & Antigen. You need to discontinue blood-thinning agents before surgery to normalize bleeding time. Patients must stop taking aspirin, aspirin-containing products and Nonsteroidal anti-inflammatory medications (eg, Advil, Motrin, Aleve) 5 days before surgery. Alcoholic beverages increase bleeding tendency and should be stopped 7 days before surgery. Patients are advised to discontinue vitamin E supplements a minimum of 1 week before surgery. To lower the possibility of infection, patients must shampoo their hair the morning before surgery and abstain from using hair products (eg, gel, mousse, hair spray).

The procedure can take several hours. At first, you'll generally be given a relaxation medicine, and the process will begin. Many of our patients sleep for 20 to 40 minutes and miss the start of the procedure. They don't feel a thing. We have an extensive video library, so you can choose to watch one or more movies during the course of the day. If you would rather listen to music, you can bring your own CDs and we will play them for you. We make every effort to keep you comfortable, amused and happy. The doctor will closely examine the back of the head, or the donor area, and may estimate hair density, sometimes with a magnifying instrument. Based on the number of the grafts to be planted, he will decide how big an area needs to be removed. The donor site is cleaned with Betadine. The patient is placed in a prone position when harvesting donor strip. Hair at the donor site most often is trimmed using shaver. Next, the area is numbed, and the donor hair is removed. You may feel a little pressure during this process, but little or no pain. This donor site heals with a scar that is usually only visible to your hairdresser, unless you razor cut your hair extremely short. Rarely, patients may get spread or thickened scars in the back.

Most patients watch a movie or take a nap while we work. Afterwards, thanks to modern anesthetic agents they tell us that during the procedure they felt no pain. Several methods are used to provide anesthesia to the operation sites. The best is using 2% lidocaine with 1:100,000 epinephrine to infiltrate the donor site. Other options include a mixture of lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine. Any discomfort they feel afterwards is usually very temporary and nearly always minimal and easily relieved with simple pain tablets taken for 1 - 2 days after the procedure. One third of our patients do not take any pain tablets.

It is well known that some hair follicles (usually found in the inferoposterior scalp and inferior parietal scalp) are not lost during androgenic alopecia. It is essential that only these follicles be transplanted to ensure maximal survivability.The donor site is excised as an long strip of skin with great care when excising not to damage hair follicles. The resultant defect is closed using suture or skin staples, and the scar is minimal.

Once the first part of HTS is completed, the patient sleeps or watches television. Then, the technicians divide donor tissue carefully into tiny segments, sometimes as small as a quarter of a grain of rice by using a special dissecting microscope, magnifying loupes and other devices.These are the grafts, and they will be prepared to “plant” into tiny openings on the head. There are usually from one to four hairs in each graft but the smallest ones contain only one hair.

While the technicians are working, the doctor numbs the scalp and makes tiny openings where the grafts are to be inserted. The openings are made at the proper angle so that the hair grows correctly. In the front of the head the hair grows forward and somewhat to the sides, and in the back of the head it grows backward. Sometimes the doctor will even reproduce the irregular pattern or “whorl” that occurs in the crown.Sophisticated techniques are used for creating and preparing recipient sites (where grafts are to be placed). Using a very fine scalpel multiple minute slits are made in the scalp in which the grafts are placed. By using jeweler's forceps or similar small nontoothed forceps we gently insert grafts. We sometimes use a needle to insert and tease grafts gently into place. It's a lot like transplanting seedlings in a garden. The grafts fit snugly into the openings, and the skin simply seals together. There is usually no significant discomfort during the procedure (the local anesthetic is in place). You can be awake and chatting with the doctor and technicians, or possibly a little sleepy from the relaxation medicine.

Hair transplantation is an office procedure that takes approximately 4-6 hours depending on the extent of the planned procedure. A proper modern hair transplant is a labor-intensive process, and implanting so many tiny grafts into over a thousand points on the scalp takes time.

Follicular Unit Transplantation is the transplantation of very small, individual, naturally occurring groups of hair called follicular units. Follicular units are comprised of one, two, three and sometimes four hairs each. These units are placed in thinning/balding areas following carefully studied natural hair growth patterns. The results are incredibly natural in appearance.

Follicular Unit Extraction involves the removal of individual follicular units from the donor area, one by one, without a standard surgical incision. The FOX test is performed to determine which patients are good candidates for this procedure.