A TYPICAL HAIR TRANSPLANT PROCEDURE – A WALK THROUGH TOUR
About three weeks before the scheduled session in our Los Angeles hair transplant office, 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 a motel or travel arrangements.
The day of the hair transplant procedure, the patient needs to get a ride to their appointment and a ride for when it is over. We do not allow our patient’s to drive themselves home after the procedure. The hair transplant patient is encouraged to take a shower and shampoo their hair the night before and morning of the procedure. The patient is also encouraged to eat a generous breakfast the morning of the procedure. 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 Hair Transplant Patient
After taking the time to review, discuss and sign consent forms, the hair transplant 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 5 different views, which can be looked at later on to measure the progress from the transplant sessions. The patient is then escorted into the procedure room for his or her day’s adventure.
Entering the Hair Transplant Procedure
The patient enters our spacious and comfortable hair transplant procedure room in Century City, Los Angeles and changes into a comfortable gown while background music plays. 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 they agrees with the plan. One final photo is then taken of the plan drawn on the patient’s scalp.
The patient is then turned over onto the stomach in the “prone” position. With the patient in this position, Dr. Dauer then shaves a very narrow horizontal strip of hair down to about 1mm 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, around the bump known as the “nuchal ridge” in the back of the head.
The donor area is then anesthetized with a series of small local injections and the pain is minimized by a special vibrating device that Dr. Dauer uses. There is no general anesthesia used in this procedure. The donor region 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 strip of donor hair is meticulously taken out by Dr. Dauer with a specialized scalpel technique. Dr. Dauer is careful to limit the depth of the incision to 3-4mm in order to minimize any damage to the surrounding or underlying tissue. The strips are then carefully removed and placed in chilled saline.
Dr. Dauer uses a very fine suture to close the donor region which results in a very fine donor scar and is much more comfortable to sleep on than the staples that other doctors commonly use. Dr. Dauer also performs a trichophytic closure on the donor region, which allows hairs to grow through the donor scar, making it even more undetectable.
Once the donor harvest is completed, the patient then turns onto their back, and the angle of the surgical chair is adjusted to create maximum comfort for the patient. A goal of ours for people undergoing hair transplant in our Los Angeles / Century City practice is to create a soothing atmosphere to maximise their comfort during their procedure.
Next Dr. Dauer “tumesces” the scalp in the recipient area. This means he injects saline into the area so that the skin is expanded and elevated. This serves to “widen the playing field” thus allowing Dr. Dauer to place the grafts even closer together. As well, this elevates the skin away from the underlying blood vessels and protects the vasculature in the scalp. This allows for more rapid recovery and greater growth of the transplanted follicles.
Dr. Dauer also has a machine that allows him to create custom cut blades for his receptor sites. The blades he uses range in size from .5mm to 1mm in increments of .05mm. This allows Dr. Dauer to use the smallest possible blade that works with the character of the patients hair, so that the greatest amount of density can be created with the least amount of scalp injury. Not all hair follicles are created the same and therefore it is imperative that the proper recipient blade is suited to the patient’s hair type. Dr. Dauer also has a specific blade handle which limits the depth of the blade so that it only goes as deep as the length of the patient’s hair follicle. This is also to protect the scalp from unnecessary injury in the course of the creation of the recipient sites.
All of these innovations allow Dr. Dauer to create the maximum amount of density in any particular area of the scalp, while minimizing the damage to the scalp.
In the next phase of the procedure Dr. Dauer meticulously creates all of the recipient sites for the transplanted hair follicles, into which the hair grafts will be placed. These are created following the pattern which Dr. Dauer drew at the beginning of the procedure, with special care taken that the direction of the hair is completely natural.
While Dr.Dauer is making these tiny incision sites for the recipient grafts, the assistants are busy dissecting the harvested donor hair into hundreds or 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 recipient sites that are made, matches the number of grafts that are cut. Oftentimes, Dr. Dauer will make only a few recipient sites for a certain type of graft and then do a “test placement”, to insure that the grafts and the sites match perfectly.
The final step in the hair transplant process is the placing of the grafts into the scalp recipient sites. It is up to the patient whether they woul like to have light-hearted back-and-forth conversations while the assistants carry out the all-important task of placing the grafts, or the patient can watch tv or take a nap. When we are finished, Dr. Dauer carefully inspects the patient to be certain that the position and placement of the grafts are perfect.
Depending on the number of grafts the patient is going to receive, the procedure usually takes anywhere from 6-8 hours to complete. The patient is given a small bag of medications and a brand new baseball hat. The post procedure instructions are carefully explained and reviewed.
Approximately 12-14 days after the procedure, the patient returns to see Dr. Dauer to have their sutures removed. If the patient is from out of town, arrangements can be made for the patient to have the suture taken out by a physician close to their home.
The hair transplant procedure is minimally invasive and while there may be some minor discomfort, there is rarely serious pain involved. Dr. Dauer provides every patient with pain medication for the post procedure period. Some patients do not feel the need for pain medication and it is rarely needed after 24-48 hours.
How Will I Look After a Transplant Procedure?
The first day after the procedure there are tiny scabs around each transplanted follicle that look like little grains of sand. If the patient has native hair in the region they can usually cover up the work with a creative hair style. Within a week most of the scabs are gone and the patient is left with the transplanted tiny hair follicles.
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 12-14 days to avoid accidentally damaging the grafts or stretching out the donor region. FUE patients are able to resume normal activities after 1 week. Feight days following the procedure, patients need to gently wash their hair by pouring water over the scalp. The grafts are not touched during this time. After 8 days the patient may resume normal shampooing of the hair. There is usually a little redness of the scalp in the transplanted regions that dissipates over a period of weeks after the procedure.
Activities After Hair Transplants
You may return to work the day following the procedure as long as your work does not require strenuous activities. Light exercise such as walking is permitted after 3 days, but it is best to wait 12-14 days before participating in strenuous activities, workouts, or sports.
For a period of 3-4 months after the procedure, Dr. Dauer recommends that you wear a hat for prolonged periods in the sun to protect your scalp from sunburn,
If you have any questions or concerns about anything at all please do not hesitate to call Dr. Dauer at 310.748.2224.