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Procedure and surgery of hair transplantation

fueOne to Two Weeks Prior to Your Procedure 

  • Do not take Aspirin or any other anti-inflammatory medications for two weeks prior to your hair transplant as these may increase bleeding. Also avoid taking B or E vitamins for one week before your procedure (including multi-vitamins) as these may also increase bleeding.
  • Smoking constricts blood vessels and decreases blood flow to the scalp, predominantly due to its nicotine content. The carbon monoxide in smoke decreases the oxygen carrying capacity of the blood. These factors may contribute to poor healing after a hair transplantation procedure. You should abstain from smoking at least one week prior to surgery to two weeks after the procedure.
  • Do not drink alcohol for at least three days prior to your procedure as this may increase bleeding.
  • It is important to let us know in advance what medications you are taking on a regular basis. This will be indicated on the form you fill out during your consultation and will be updated by our staff prior to your hair restoration surgery. If you are taking medications, such as blood pressure medicine, you should continue to take it as prescribed right up to and including the day of your hair transplant surgery.
  • For those having Follicular Unit Hair Transplantation, it is best not to cut your hair for at least two weeks prior to the procedure.
  • Please do not dye your hair within one week of your procedure as this may make graft placement more difficult.

The Morning of Your Procedure

  • Shower the morning of your procedure and wash your hair very thoroughly using your regular shampoo. Do not apply sprays, gels, or any other styling products to your hair. If you wear a hair system, please remove it prior to shampooing and do not wear again until after your surgery.
  • Wear loose, comfortable clothing which do not need to be pulled on over your head - this will prevent dislodging your grafts immediately after the hair transplant.
  • Eat breakfast the morning of your procedure. We will provide lunch and snacks. Let us know if you have special dietary needs
  • Do not drink coffee or any caffeinated beverages on the day of your hair transplantation procedure.
  • Although the hair restoration is performed under local anesthesia, you may be receiving medications during the procedure that can make you drowsy. Because of this, you cannot drive yourself home following your procedure.

The Surgery

Your Permanent Hair Transplant Procedure

When you arrive for your hair transplant, the staff begins by going over the activities for the day. The surgical consent form that had been sent to you is reviewed and other paperwork is completed.  The physician will then take high quality photographs that become part of your permanent medical record.

Sedatives, generally oral valium, are given to relax you before the start of the hair restoration procedure, but you can remain fully alert if you like. You will be offered a movie selection and cable T.V. Most patients choose to listen to music, see a movie (or two), or just chat with the doctor and staff.

The length of your permanent hair transplant procedure will depend upon how may follicular unit grafts are transplanted We do our very technical job in a friendly, relaxed atmosphere, so that your experience is pleasant and so that the time goes by quickly

Local Anesthesia

After sedatives are given orally, we use a combination of the local anesthetic Lidocaine (Xylocaine), and a longer acting one called Bupivicaine (Marcaine). High frequency vibration is applied to the skin as the anesthetic is given to decrease the sensation of the injections (this is referred to as vibratory anesthesia). The anesthetic is administered only around the perimeter of the scalp (called a ring block) to make the entire scalp numb. Once the scalp is numb, the remainder of the hair restoration surgery is painless. If more anesthesia is required, usually around 5-6 hours into the procedure, it will be given before the initial medication wears off.

Donor Tissue

In Follicular Unit Transplantation (FUT), to maximize yield and minimize scarring, the donor tissue is removed from the scalp in a single thin strip (Single-strip harvesting). The location of the donor area is carefully chosen to be a region of the scalp with maximum hair density and the best long-term stability. The hair in the area to be removed is clipped short, to a length of approximately 1-mm, so that the uncut hair can completely cover the donor area when the patient leaves the office. In Follicular Unit Extraction (FUE), the units are removed from the scalp by a combination of sharp and blunt dissection (Three-step technique).

Once the donor tissue is removed from the scalp, it is immediately placed into a holding solution consisting of chilled Ringer's lactate. This closely mimics the body's own fluids - it is the medium that is used in organ transplantation. This maximizes the survival of the grafts while they are being held outside the body.

In Follicular Unit Transplantation, the donor area is closed with either absorbable sutures (that don't need to be removed) or staples, depending upon the person's needs. In Follicular Unit Extraction, the donor area is just covered with antibiotic ointment and a dressing.

Stereo-Microscopic Dissection

In Follicular Unit Transplantation, the individual follicular units (each containing from 1 to 4 hairs) are meticulously dissected from the donor strip in their naturally occurring groups under strict stereo-microscopic control. The grafts are trimmed of extra tissue and the intervening skin between the units is discarded. The follicular unit grafts are then sorted into groups containing either 1-, 2-, 3- or 4-hairs and stored. In Follicular Unit Extraction, the extracted grafts are placed under a microscope to assess their integrity and to sort them according the number of hairs they contain.

Creating the Recipient Sites

The creation of the recipient sites determines much of the aesthetic look of the transplant - it sets the angle at which the new hair grows and determines the distribution and density of the grafts. Recipient site creation is a critical aspect of hair restoration surgery that requires considerable experience and surgical skill and a keen aesthetic sense.

Graft Insertion

Once all of the recipient sites are made, the surgical team begins to place the follicular unit grafts into these pre-made sites. One-hair follicular units are used in the frontal hair line to give a soft, natural appearance and 3- and 4-hair grafts are used in the central forelock area to achieve maximum fullness. Placing is the most time-consuming part of the permanent hair transplant procedure. Graft placement is an exacting process and during this period you will be asked to keep your head relatively still. Watching movies, TV or sleeping, will make the time go by quickly and, of course, you make take breaks as needed to go to the restroom, stretch or eat.

At the End of the Procedure

When placing is complete, the position of all of the grafts will be double-checked. The post-op instructions will be explained and a printed copy will be given to you to take home. This will include the doctor's cell phone number.

What To Do After Your Hair Restoration Surgery

The night of your hair transplant, and for the next few nights afterwards, you are encouraged to sleep with your head elevated on pillows. Medication is given for sleep and pain (if needed). Antibiotics are generally not required. The morning after your hair transplant surgery, you will remove the headband and shower and shampoo your scalp every four hours - just for the first day. We'll call you the next day to make sure that everything is OK. You won't need to come into the office at this time, but are welcome to do so.

You should avoid alcohol for three days following your hair replacement procedure and abstain from smoking for two weeks. When in strong sunlight, you should wear a hat. After two weeks you may use a sunscreen with a SPF of 30+.

Generally patients can resume normal daily routine almost immediately. Limited exercise can be started in the first week. You should avoid strenuous exercise for several weeks following hair restoration surgery, depending upon the type of donor incision and the laxity of your scalp. We ask you to return to the office for a one week follow-up visit, but for those who live at a distance from our facilities, this can generally be handled by phone.

What To Expect After Your Hair Transplant Surgery


If the post-operative instructions are followed carefully, in most patients, the transplant is minimally detectable after a few days and almost undetectable after the first week to ten days. Patients are given medication for swelling at the time of surgery, but some still experience swelling of the forehead that settles across the bridge of the nose and around the eyes. If this occurs, it is almost always gone by the end of the first week.

The newly transplanted hair begins to grow at around 10 weeks. It is long enough to be groomed in about 6 months and, in most cases, will be fully grown in at one year.

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