How is hair transplantation performed?

We perform all procedures in an operating room fully equipped with monitoring equipment, emergency supplies, and sterile instruments. Prior to the procedure, photographs will be taken and the surgeon will carefully trace your hairline with your approval. Then, once an IV line has been started, you will be given relaxing and pain medications, usually by mouth.

The essence of extensive micrografting: a small strip from the donor area is dissected and cross dissected into micrografts containing 1-4 hairs each

How are the grafts taken and inserted?

Once you are completely numb, a small strip (usually approximately 3/8" wide) containing healthy donor hair will be taken from the back or side of your scalp. This area, after closure with stitches or staples, and later resulting in a linear scar, will be hidden by your downward combed hair in back

This strip is then meticulously dissected, under magnification, into groups of micrografts and follicular units containing 1, 2, 3, and 4 hairs each. In some cases, the top (epithelium) of each graft may be removed, although it usually is left intact.

Simultaneously, the physician first divides the scalp into "zones" to receive the various sizes and types of grafts. He then creates the hundreds of tiny needle-holes or slits in exacting fashion in your recipient (balding) region. Care is taken to orient the transplanted hairs in the same angle and direction as that possessed by your original hair. The needle holes are smaller and more closely spaced along your hairline, and are situated between your existing scalp hair on the front and crown of your scalp.

The various sizes of micrografts are carefully matched to dilators (if used) and special needles; These micrografts are then inserted into "zones" of single-hair micrografts (in front) followed by 2-hair and 3-hair micrografts, with 4-hair micrografts placed into the crown for density.

In patients who are quite bald, or who desire repair/camouflage of older plugs, small "microholes" of bald scalp or scar tissue may be removed prior to graft insertion.

The hair is then patiently inserted under magnification with a jeweler's forceps, by the staff, until your scalp recipient area has been blanketed with micrografts. All grafts are carefully inspected and readjusted, if necessary, at the conclusion of the operation. No stitches are necessary in this recipient area - the body's own "glue" from the clotting process keeps the grafts in place.

After application of a sterile dressing, you will be discharged from the operating room. You generally will receive a phone call that afternoon and that evening, and you will be seen the next day for a dressing change and examination of your transplant.

This second dressing can be removed on the second day (48 hours), followed by a light shampoo. On the third postoperative day, following shampooing and hair styling, many patients can return to work. The stitches in the donor area are usually removed in 10-12 days. Tiny pinpoint crusts are generally present for 2 weeks; small red dots may delineate the graft sites for a month or so. Occasionally, a small "pore" may be present at the site of the graft insertion.

Immediately after the operation, the grafts usually go into the "resting state". The transplanted hair then starts to appear in approximately 2-4 months, growing at a rate of approximately 1/2 inch per month after that. Thus, it will take a number of months to see the growth from any one session.

33 year-old white male with deeply receding temples

Same patient, after two sessions of 1-hair, 2-hair and 3-hair micrografts displaying a beautiful, natural result

Risks and complications

If the surgeon could anticipate untoward effects, he would, of course, never perform the surgery. However, with hair restoration surgery, most of the adverse events are of a cosmetic, or aesthetic, nature. The patient must bear in mind the fact that cosmetic surgery of any type is never perfect. The patient should hope for improvement, of course, but cannot expect to recreate the perfect hairline and full head of dense hair that he or she possessed at age 16. As previously mentioned, even the best series of micrograft procedures produces a "naturally thin" appearance. One session will add noticeable, though sparse, coverage.

Other relative risks or side effects include post operative swelling, discomfort and nausea; these can be treated with special medications. The postoperative appearance of the recipient area, though temporary, may cause a problem for those in the public eye; this can be covered by hair styling, hair additions, or camouflage cosmetics. The donor scars can be covered by downward combing of the hair. Tiny pores or pits may occasionally result from micrografts where the hair exits the skin. Patients with dark hair and light skin pose a more difficult challenge, as well, since there is a strong contrast between skin and hair color. Rarely, a defective donor area may lead to poor growth of, or future loss of, grafts. Other risks can be discussed during the consultation and are covered in detail in the consent form.