Hair Transplant Surgery : Walk Through Tour

Additional Topics:

-	Limited role of scalp reductions
-	Use of Propecia/Rogaine
-	Transition from a hairpiece to hair transplants
-	Temple area transplantation
-	Trans-gender Transplantation
-	About Donor Scars

Links

60 Railroad Place Suite 102 Saratoga Springs, NY 12866
Phone: 518-581-1872 Toll Free: 1-800-281-9198
e-mail: saratogahair@spa.net

A Typical Hair Transplant Procedure
(a "walk through" tour)

About four weeks before the scheduled session, the patient is sent a list of "pre-op instructions", and also a map and a brief description of what to expect during the first week after surgery. Our nurse-receptionist, Betsy, also assists the patient with any other arrangements they need help with, such as motel or travel arrangements.

The day of the procedure, the patient shows up either alone or with a driver. The patient is encouraged to take a shower with shampoo that morning and to eat a normal breakfast. When the patient arrives, he is greeted by our staff and is handed a consent form and "medical history questionnaire" to fill out.

review consent with patient
Carla reviews consent form with patient in waiting room prior to surgery

After taking about 10 minutes to do this, the patient usually makes one last trip to the bathroom and then is ready to get started. We first stop briefly in our small, in-office "photo studio" to take an initial series of photos from 7 different views, which can be looked at later on to measure the progress from the transplant sessions.

Patient escorted into operating room for his day's adventure

The patient next enters our spacious and comfortable procedure room, with background stereo music playing (classical in the am, easy-listening in the pm - or whatever the patient prefers; sorry, no rap or hard rock!!) and changes into a comfortable gown. Dr. Beehner then reviews the plan with the patient and draws the proposed hairline on the scalp, along with the zones behind it which will be filled in with the appropriate size grafts. The patient is given one last look at it with mirrors, to make sure he agrees with the plan. One final photo is then taken of the plan drawn on the patient’s scalp.

drawing hairline outline Dr. Beehner draws the hairline outline for today's transplant session

The patient then lies back on our comfortably padded surgery table, and a small intravenous "butterfly" is placed into a vein on the back of the hand, through which the mild sedative and narcotic are given. This makes the patient quite "mellow" and comfortable throughout the procedure and removes any anxiety that might be present.

The IV sedative and pain reliever is administered into the IV
"butterfly" by Dr. Beehner prior to the procedure

Some patients chat back and forth with us throughout the procedure, while others "snooze" off at times and hardly say a word. Throughout the procedure the patient is periodically monitored for blood pressure, and the pulse rate and oxygen concentration are constantly monitored by a small sensor placed over the finger tip.

We then begin the "numbing" of the scalp. We first place a tiny ice cube just above the eyebrow on each side, and after 30-40 seconds – when the skin is cold and becomes relatively numb – a tiny "Novocaine" injection is given which blocks the supra-orbital and supra-trochlear nerves, which supply sensation to the entire front half of the scalp. This injection is usually accomplished with virtually no pain felt by the patient.

The hair in back is taped back and out of the way

Next, the patient is turned over on his stomach in the "prone" position, with the forehead comfortably placed on a special cushion, which has a large central space through which the patient can easily breathe. With the patient in this position, Dr. Beehner, seated at the head of the patient with one of his assistants, then shaves a very narrow horizontal strip of hair down to about 1/8th of an inch in length in the area where the donor hair will be harvested. This strip usually starts over one ear and extends toward the back wall of the scalp, and, in larger cases all the way around to the other ear. This strip is located about 1/3rd of the way up from the bottom fringe border. A Dermojet device is then used to numb the entire back of the scalp. This is a needleless injector device, which blows the Novocaine (actually Lidocaine) into the skin. No needles are used in this initial part of the procedure, so the patient feels nothing sharp. The donor area is then “tumesced” (filled by injection) with a saline solution which also has a weak concentration of adrenaline in it to control bleeding. Then, a single or double strip of donor hair is cut out by Dr. Beehner, either with a free-hand scalpel technique or with a fixed-width multi-blade holder that cuts the two wide strips at one time. Dr. Beehner then carefully cuts underneath the strip(s), leaving just enough fat to protect the follicular bulbs at the bottom of the grafts. The strips are then carefully removed and placed in iced saline. An Infrared Coagulator device is then used to cauterize any small bleeders, and then the donor area is sutured in two layers, so as to create the thinnest possible donor scar.

Carol cutting FU grafts under the microscope

The first part of the procedure is now over. The patient sits up and usually drinks a small container of a fruit drink of his choice. He next lies down, and the angle of the surgical table is adjusted to be very comfortable for the patient’s back and neck. A soft, white washcloth is then folded up and placed gently over the patient’s eyes, so that the bright lights don’t bother him during the procedure. A second dose of sedative and narcotic, this time much smaller, is then injected through the previously placed Butterfly IV port on the back of the hand, to insure that the patient remains relaxed and doesn’t get "antsy" during the last part of the procedure.

Since the suprorbital block performed at the start of surgery numbed 90% of the front half of the scalp, all that remains now is to add a little Novocaine at the outer aspect of the hairline near the temples. During the next 40-60 minutes Dr. Beehner carefully makes all of the hundreds of small recipient holes, into which the hair grafts will be placed. These are made, following the pattern of the zones which he drew at the beginning of the procedure, with special care taken that the direction of the hair is natural and the spacing of the grafts is random. If the "crown" area is to be transplanted, then a few hundred narrow needle holes are made back here also, carefully following a natural "whorl" pattern. During this part of the procedure, just as in the donor area, Dr. Beehner "tumesces" the skin in the recipient area, so that the holes will be limited in their depth and not cut the blood vessels which reside deep in the subcutaneous layer of the scalp. Because of this new advanced technique, the small holes can be spaced much closer together than a few years ago. While Dr. Beehner is making these small inicision sites, the four assistants are busy cutting the harvested donor hair into hundreds (sometimes thousands) of small grafts. This process is done entirely under microscopic vision, which results in far superior grafts and better preservation of hair than was possible before microscopes were used. There is ample communication between Dr. Beehner and the cutters, to insure that the exact number of holes that are made matches the number of grafts that are cut. Oftentimes, Dr. Beehner will make only a few recipient holes for a certain type of graft and then do a "test placement", to insure that the grafts and the holes match perfectly. Also, in some special cases which require greater density in a more localized area, Dr. Beehner will use the “stick and place” method, whereby he inserts each FU graft immediately after making the hole with the small needle. Usually 80-160 FIU's are placed in this manner in a targeted area such as the fronto-temporal recession in front. By placing the graft right away, the hole doesn't have time to contract and become smaller, and thus a two to three-hair FU graft can be placed in each tiny hole, and the holes can be placed much closer to one another, with less damage to the scalp's blood supply.

A happy patient gives a 'thunbs up' as his grafts are being placed

The final step in the transplant process is the placing of the grafts into the scalp recipient sites. Dr. Beehner usually puts in the first 100-150 or so grafts, while the assistants finish dissecting the last of the grafts and take a brief well-deserved coffee break. He then lets them take over placing the rest of the grafts.

By this time, the patient is quite alert and usually a lot of light-hearted back-and-forth conversation takes place while the assistants carry out the all-important task of placing the grafts. When they are finished, Dr. Beehner then puts on his magnifying glasses and gloves, and carefully inspects each graft to be certain that the position and placement of the grafts are perfect. He usually will lift a few, push a few further down, and rotate a few others – so that the hair comes out of the skin looking absolutely natural.

Dr. Beehner carefully makes a final check of all the grafts

By this time the patient is usually fully awake. The washcloth is removed from the eyes, fruit juice or coke is offered to the patient again, and he sits up to have a light dressing applied along with a stylish bandana covering all.

Becky applies bandana to cover the day's work

The procedure, which usually takes about 4-5 hours to complete, is now over. A small bag of medications, gift shampoos, and instructions are then given to the patient and carefully explained. If the patient chooses to come in the next day for a shampoo and cleaning by our assistants (about 50% of our patients opt for this) or, if they are going to return to have their donor stitches removed by us, these arrangements are then made at this time. Around half of our patients elect to use the Graftcyte kit after surgery, and the first Graftcyte gauze layer is placed on the grafts at this time, and then covered with the usual light dressing.

Becky reviews post-op
instructions with patient

The instructions for using the Graftcyte spray, dressings, and shampoo are carefully explained by the assistant. If the patient lives a little further away and someone at home is going to remove the sutures (which are very easy to take out), then we place a stitch-removal kit and a drawing of how-to-do-it in the bag also.

Dr. Beehner always asks the patient afterwards if they remember having any "pain", and about 95% of our patients say they felt "none whatsoever." Most patients also remark that the 4-6 hours went by like 20 minutes.

Patient and staff are all glad to have the day's transplant work completed!

A Typical Hair Transplant Procedure (a "walk through" tour)

A Typical Hair Transplant Procedure
(a "walk through" tour)