About three 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 may assist 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.
Reviewing Consent with the Patient
After taking about 10 minutes to review, discuss and
sign consent forms, 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. The patient is then escorted into the operating
room for his or her day's adventure.
Entering the Procedure
The patient next enters our spacious and comfortable
procedure room, with background stereo music playing
and changes into a comfortable gown. Dr. Dauer 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.
The patient is turned over on his
stomach in the "prone" position, on the
belly. With the patient in this position, Dr. Dauer,
seated at the head of the patient with one of his
assistants, then shaves a very narrow horizontal strip
of hair down to about 1cm in length in the area where
the donor hair will be harvested. This strip is located
about 1/3rd of the way up from the bottom fringe border.
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, and Lidocaine (anesthetic) to
numb the region. Then, a single or double strip of
donor hair is cut out by Dr. Dauer with a free-hand
scalpel technique. Dr. Dauer then carefully cuts underneath
the strip, 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.
The first part of the procedure is
now over. The patient then lies down on his back,
and the angle of the surgical table is adjusted to
be very comfortable for the patient’s back and
neck.
During the next 40-60 minutes Dr.
Dauer 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. Dauer
"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.Dauer is making these small
inicision sites, the 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. There is ample
communication between Dr. Dauer and the cutters, to
insure that the exact number of holes that are made
matches the number of grafts that are cut. Oftentimes,
Dr. Dauer 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.
The final step in the transplant process
is the placing of the grafts into the scalp recipient
sites. At 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. Dauer 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.
The procedure, which usually takes
anywhere from 4-8 hours to complete (depending on
the number of grafts the patient is to receive), is
now over. A small bag of medications and instructions
are then given to the patient and carefully explained
and reviewed.
The patient the returns to see Dr.
Dauer approximately 10 days after the procedure to
have their sutures removed. If the patient is from
out of town, arrangements are made for the patient
to have the suture taken out by a physician close
to their home.
The relocation process is minimally
invasive and is a minor surgical procedure not much
different than having a filling or crown at the dentist.
While there may be some discomfort, there is rarely
serious pain involved. Patients are awake and alert
during the entire procedure and they can have a friend
or spouse present, watch a movie and even have lunch
during the procedure.
How Will I Look After a Procedure?
Some people are concerned about how they will look
after the procedure. Since hair restoration is a minor
form of surgery, directly following the procedure
it may be possible to return to normal activities
such as work. Some have visions of your entire head
being bandaged and so on. We do however recommend
rest during the day of the procedure.
During the days following the procedure, the patient
can return to work and recreational activities. We
recommend refraining from strenuous activities such
as weight lifting, racquet ball or tennis for a week
or two to avoid accidentally damaging the grafts.
The hair can and should be washed gently with the
fingers and a very mild shampoo.
After a few days, the redness will subside at the
top of the head and the grafts will blend in with
the existing hair.
Activities Afterwards
It is reasonable to expect some discomfort, but there
shouldn't be much pain involved. Most people also
return to work the day following surgery and this
is quite acceptable. While you may engage in recreational
activities, try to refrain from strenuous activities
or those where your grafts may be damaged, such as
weight lifting, tennis or racquetball.
While the hair transplant procedure is minor surgery
we strongly recommend that you take off from work
on the day of the procedure. Normally patients can
drive themselves home after the procedure.
If you have any questions or
in doubt about anything at all please do not hesitate
to call Dr. Dauer immediately.
TO SCHEDULE YOUR NO OBLIGATION,
FREE CONSULTATION, CALL 310.748.2224.
