Surgery Basics

How is a Hair Transplant Performed?

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How Is Hair Transplant Performed

A hair transplant can only be done when you “boil it down”. A hair transplant’s real purpose is to move healthy hair follicles from an area of the scalp that is rich in them – the “donor region” – to another area where they have diminished or disappeared completely – the recipient area. Although it may seem simple, hair transplant surgery requires a skilled team and a lot of patience. This process must be done in a series of steps to ensure success. These steps can be broken into:

  1. Surgical design and planning
  2. Donor preparation and graft removal
  3. Microscopic graft preparation
  4. Recipient site preparation and creation
  5. Graft placement (implantation)

Surgical Design and Planning

The surgical design and planning phase of hair transplantation begins. The surgical design and planning phase involves the doctor evaluating the patient’s hair, level of hair loss and facial features. The next step is to discuss the goals and limitations. Finally, lines are drawn on the scalp that will indicate where the new hair will go. Although it may seem simple, the planning and design of the surgery is crucial. This is especially true when frontal hairline surgery is required. The doctor will evaluate the donor area – the location where donor follicles are to be removed – and then formulate a harvesting strategy.

Donor preparation and Graft Removal

Once the surgical plan has been completed, the patient is taken into the procedural suite (operating area), where the patient’s scalp is cleaned and the donor areas on the sides and back are trimmed. The doctor will evaluate the donor area and decide where the follicles should be removed. The safe donor area is a defined, small area at the back and sides of the scalp that contains hair follicles that are immune to hair loss. To ensure that the transplanted hair follicles last for a long time, the doctor must carefully assess and remove any follicles within this safe zone. The area surrounding the donor is then anesthetized with “local anesthesia”, which is the same medication that the dentist uses to numb your mouth. Finally, the tissue is removed. There are two ways to remove the follicles:

  1. Follicular Unit Transplant (FUT or “strip” technique)
    During FUT, a narrow strip of hair-bearing skin is removed via a single linear incision and then closed using stitches or staples.
  2. Follicular Unit Excision (FUE – previously known as Follicular Unit Extraction)
    During FUE, small punch tools are used to remove follicles individually (“one-by-one”). The empty holes created by follicle removal are then left open to heal into circular scars.

Microscopic Graft Preparation

The hair transplant technicians will examine the grafts under powerful microscopes to prepare them for implantation. FUT procedures require that the technicians carefully cut the strip into “follicular unit” sections. Follicles naturally grow in groups of one to four hair “folliculars units” on the scalp. These natural units must be removed in order to ensure proper transplantation. These follicular units can be prepared with surgical precision under microscopes to create the best quality grafts. The FUE procedure does not require the use of microscopes to dissect the grafts. The microscopes can still be used for trimming, examining, and categorizing FUE grafts.

Recipient Site Preparation and Creation

The doctor will then prepare the “recipient area” in which the new grafts are to be placed. This is the first step. The doctor will then use small tools (typically custom-cut blades or needles) to incision thousands of scalps. These incisions, or “sites”, are made in precise directions to create a natural look. To make incisions at the new hairline, the doctor uses smaller tools. Because only small, single-hair follicular units are allowed to create a natural, soft frontal hairline, this is possible.

Graft Placement

Once all the grafts have been prepared, and the incisions for the recipient sites have been made, the team must now place the follicular unit (“implantation”) into the locations. Technicians traditionally use fine-tipped forceps (“tweezers”) to grasp each graft, then gently slide them into the incision sites. It is easy to see how much focus and dedication a hair transplant technician must put into placing each graft correctly. The case is completed when all the grafts have been placed.

Following surgery, the patient receives post-operative instructions as well as a short course antibiotics and pain medication. The patient is then allowed to go home to rest and recuperate. The FUT procedure will see the patient’s stitches and staples removed from the donor area within 10 days.