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What To Expect With A Transplant Surgical Procedure

Preoperative Steps

When you arrive at our office on the day of your surgery, you will review and sign our surgical consent forms which indicate your understanding and willingness to have the hair transplant surgery. You will also be offered a menu for your complimentary lunch, as well as an extensive list of movies you may watch during your procedure.

You will then be escorted to pre-operative room. In this room, you will be gowned as well as answer medical history questions, and have your vital signs taken. At this time we will take several digital photographs from various angles so that we have a record of your hair loss prior to hair restoration. These will be used for comparison purposes when you come in for your follow up visits. Your best donor area will be determined and shaved. The hair directly above this area will be clipped up in such a way that it will later drop back down and cover the area where we worked. Next your donor area will be examined and counted under a video microscope to determine your follicular density. This examination will determine the amount of donor tissue that needs to be removed in order to receive the estimated number of follicular units to be transplanted. Then the donor area will be measure marked with a surgical marker. Any additional follicles removed will be placed free of charge.

Picture of donor area under video microscope
Picture of donor area under video microscope
Donor area has been shaved & marked
Donor area has been shaved & marked

We will again review the details of your imminent surgery and answer any questions you still may have. Then we will proceed to outline the boundaries of the hairline and other pertinent areas with a wax pencil. You will have a mirror to evaluate and discuss the location of the hairline such that we are comfortable knowing that the location will provide you with a natural and realistic look in the future, and you are comfortable with the extent your hairline is to be altered. The boundaries of hairline curvatures are appropriate of an adult male. Hairlines are not symmetrical, and are quite irregular, although the balance of the amount hairs on each side of the hairline is essential. It is noteworthy to mention that there is an infinite combination of variables at play when deciding the location of your hairline. No two people have exactly the same facial features and pattern of hair loss. Therefore, each hairline must be uniquely designed to address the needs of each individual patient to maximize our end results.

Initial hairline drawn in
Initial hairline drawn in

 

Jaggedness added to hairline to give a more natural appearance
Jaggedness added to hairline to give a more natural appearance

After this preparatory phase, we will make you more comfortable by giving you a valium and a small amount of another sedative called versed. These medications have multiple benefits before we begin. Since 100% of patients feel nervous anticipation at least to some extent, the light sedation helps you to relax. In fact, many people fall asleep shortly after we begin hair transplant surgery. The sedative medication also serves as a muscle relaxant to help avoid muscle strain as the procedure moves along. At this point, you also will be given an injection of an anti-inflammatory medication to reduce the chance of post-operation swelling.

Intra-Op

You will then be escorted into the procedure room, and be positioned on a comfortable massage type table. Where you will be prepped for hair transplantation surgery. This position ensures the doctor will have maximum visualization and maneuverability during this portion of the hair transplant surgery. This enhanced visibility affords the surgeon the ability to maximize the survival of the follicles and minimize the scar in this area. Harvesting the donor tissue in this manner allows the doctor to minimize the follicle transaction as he makes his incisions, as opposed to harvesting at the awkward angle resulting from the upright situated patient.

Next you will receive a series of small injections of a local anesthetic across the lower aspect of the donor area. The anesthesia step usually is considered being the worst part of the day; very similar to the injections received at the dentist’s office (some people relate it to a bee sting). The doctor will then remove the donor area as a single piece of tissue. Once the donor tissue has been excised, it is immediately placed into a chilled sterile saline solution and is transferred to the cutting room for dissection into Follicular Unit Grafts.

Donor Area

Follicular Unit Grafts

Once the incision is closed, the donor area will be cleaned up and bandaged. Here, you will enjoy a short break before your movie begins showing on the large screen television (with surround sound).

Completed Donor Area

Completed Donor Area

Creating Follicular Unites Grafts

All of the dissection takes place under a stereo microscope with a LED light source. The importance of the LED light is that it gives off the minimal heat; other light sources give off 70% more heat than a LED. Excessive heat to the tissue causes cellular damage and in turn results in poor growth. From the elliptical piece of excised tissue, the assistants begin to dissect the tissue into 1 follicular unit wide slivers. This process is the most important in creating ideal FUs; the assistant must take their time to ensure no transection occurs or damage to the sebaceous gland. Perfect slivers warrant excellent FU grafts. All grafts are kept chilled and moist. The assistants count and separate the one hair fu’s from 2, and 3 or more hair FUs.

Follicular Unit Grafts

FU grafts

Completed FUs in piles of a hundred

Jaggedness added to hairline to give a more natural appearance

Recipient Sites

As you watch your movie or fall asleep, the surgeon will numb the frontal area of your scalp with more local anesthesia, and then proceed to make the recipient sites where the grafts are to be transplanted. Many patients fall asleep at some point during this process, as the recipient site formation should be pain free. The Recipient sites are very small slits, made with the tip of a needle. The size of the recipient needle is determined by the pt.’s own follicle size and recipient area laxity, to safeguard the handling of the tissue. Each graft will require its own tiny incision for it to grow. The surgeon takes his time while making the sites, as this step is critical to the final outcome. The grafts must be made at the proper depth, angle and location for the hairs to look natural. This is one of the parts of the procedure that distinguishes us from many other hair transplant clinics.

The recipient sites are very small slits, made with the tip of a needle
Hair Transplant Needles
Recipient site – side view
Recipient site - side view
Recipient site – front view
Recipient site - front view

After the all the sites are completed, you will enjoy a short lunch break.

Placing the Follicular Units

With the sites and grafts complete, the placing process begins. Each assistant wears magnification to accurately see each site and differentiate the FUs. Each graft is placed one by one into the corresponding sites. One hair Fus are placed in the hair line and approximately .5cm behind the hairline. A one haired FU must contain one hair and one hair only (no transected parts of another hair), to keep the as natural as possible. A transected hair could still possibly have the ability to grow a regular hair. This is a meticulous process, which could take several hours.

During surgery
Recipient site - front view
Once the placing finished, you will be cleaned up and bandaged.
Post-op recipient site – side view
Post-op recipient site - side view
Post-op recipient site – front view
Post-op recipient site - front view

Post-Operative

You will be given medications to take home and detailed instructions on to take care of your newly transplanted area. This will conclude your surgery day and you will return in 7 days to have your sutures removed.

Sutures prior to being removed
Sutures prior to being removed
Sutures after being removed
Sutures after being removed
Grafted area 1 week post-op
Grafted area 1 week post-op

Get in Touch

To schedule a NO COST hair loss consultation, please contact Powell Medical Hair Restoration in Cardiff, San Diego today!

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