Overview

With today’s modern methods, using follicular units ( or micrografting ) there is no visible plugginess or "Barbie doll" look and transplants always look natural. Hairlines are created in an irregular fashion, never appearing abrupt or straight lined but always soft and natural. Transplanted hairs grow in gradually so change is very subtle. The grafts begin to grow at approximately three months after the transplant session and full growth is seen at one year post operativley.

Grafts follow the direction of existing or lost hairs, allowing patients flexibility in future hairstyling. Today's techniques of micrografting are excellent, not only for bald areas but for thinning hair as well. The small size of the grafts allows for graft insertion between existing hair follicles. Even with minimal donor resources, natural coverage of strategic areas can be achieved.

The Actual Procedure

Prior to surgery, patients recieve preoperative instructions and a prescription for a prophylactic antibiotic

Surgeries are scheduled to start in the morning.

	The plan is reviewed again, the area to be transplanted is drawn in and photos are taken. For confidentiallity, all photos are taken from the eyebrows up.
	Patients are also given pre-operative anti-inflammatory medications and a mild tranquilizer (valium), orally and/or intravenously. This relaxes patients, reduces discomfort and decreases side effects that may be caused by the local anesthetic.
	Hair in the donor area, which will be excised, is clipped short. If the remaining hair in the donor area is approximately 1 to 1 1/2 inches long, it will completely conceal the sutures immediately after the surgery.
	Both the donor and the recipient areas are anesthetized by injecting local anesthetic. Small gauge needles, buffering the PH of the anesthetic, and our careful techniques, minimizes any stinging.

Dr. Marla Rosenberg and her team will ensure your comfort during the entire procedure. Most patients are pleasantly surprised by the very minimal discomfort that this causes and often say that the procedure is more comfortable than going to the dentist.

The Donor Area

After the donor area is “frozen”, the donor strip is excised and the two edges of the wound are sewn together. If a subsequent session is planned, then the fine scar from the preceding session is nearly always excised as part of the new donor strip. This means that patients will only ever have one scar no matter how many surgeries they undergo. Sutures are removed 7 to 10 days after surgery.

Because of careful surgical techniques and post operative care, the resulting scar is usually narrow and difficult to find in the donor rim. It is on average 1mm wide, barely visible, and sometimes undetectable.

The recipient area (area to be grafted), is anesthetized using the same method as in the donor area, using local anesthetic.

• Sites are created for the hair grafts in the recipient area.
• The majority of transplants are done with micrografts or follicular units.
• Natural hair patterns are recreated.
• We pay careful attention to hair angle and direction.
• Areas of hair loss and potential future areas of loss are treated at the same time. This minimizes the need to chase an evoloving balding pattern.

The donor tissue is then divided under a magnification microscope into follicular units.Follicular units vary in the number of hairs per unit and are divided in the way they naturally occur The majority are two and three haired units with approximately 15% existing as single haired grafts.This requires the expertise of a very experienced team of transplant RN’s and technicians. Because we are dealing with large numbers of grafts, many staff members are required to carefully prepare and handle the grafts

Finer follicular units are used in the front portion of the hair line zone. The larger units are used in areas where one is creating higher density. .

Our experienced team’s role in graft preparation, handling and placement is key to a successful transplant.

	Donor strip preparation

Types of Grafts

Micrografts (Follicular Unit Grafting)

• Most surgeries are done with this technique.
• very small individual follicular units, contain 1-4 hairs
• placed in tiny holes made with a hypodermic needle
• Recipients sites for the micrografts are angled and directed for maximum natural appearance.
• can be used between existing hairs in areas where hair is still present,the advantage here is being able to treat patients at early stages of thining,
• always looks natural, never any pluggy appearance
• can do area only once and it will always look natural
• Further sessions are done to treat additional areas or to increase the density of already treated zones. This depends on goals, donor availabity and long term prognosis fo hair loss.
• In rare instances double or triple follicular units are used. These can provide added density in appropriate candidates.

After the Surgery

A bandage is recommended for the first postoperative night. Patients return the day following surgery for bandage removal, hair washing and careful inspection. At this time postoperative care instructions are reviewed. Postoperative medications for discomofort, sleep and swelling are provided with detailed instructions.

Sites are virtually undetectable within a few days to one week. Grafts will shed their hair in two to six weeks time and new hair growth begins three months postoperative with full growth seen at one year. The donor areas are concealed immediately by one’s own hair.

Postoperative

The most common postoperative problems are listed below. I want to emphasize that they are generally mild and short in duration, given the longevity of the permanent hair resulting from this surgery.

1) Swelling

• To be expected when the frontal area is transplanted
• Usually involves the forehead
• 2% may experience exess swelling
• Can last 7-10 days, usually gone within 4 days
• Medication to reduce swelling are given before, during and after surgery

2) Temporary Scalp Numbness

• Results in temporary decrease in scalp sensitivity
• Sensory nerves regenerate in 3-18 months

3) Temporary Hair Loss

• a temporary hair loss can occur when grafting into hair bearing areas
• hair will always grow back
• 25-50% in female patients vs. 10% in male patients
• effects can be reduced and sometimes even prevented with topical Minoxidil.

4) Infection

• very RARE and easily treated if it occurs.
• perioperative antibiotics are administered.
• Strict OR protocol will further minimize the risk of infection.

5) Sutures

• Suture in the donor area are removed in the office 7 to 10 days after surgery
• Alternative arrangements can be made for out of town patients.

All postoperative events (should they occur) are temporary and are managed with medications and careful advice.

Textbook photographs courtesy of: "Hair Transplantation 4th Edition",

Marcel Dekker, Inc. 2004

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