The technique that we employ is referred to as follicular unit transplantation. This technique provides extraordinary naturalness. It allows the patient to have only one session and still have a natural appearance. With follicular unit grafting we isolate the naturally occurring hair groupings (hairs grow in groups of 1, 2, 3 or 4 hairs). The donor area is taken from the back of the head using magnification to avoid follicle damage. The procedure takes several hours depending on the number of grafts being transplanted. For a 2000 graft case the average time is about 6 hours.
Patients are given local anesthesia (like a dentist uses) and an oral sedative and rest or watch movies/TV/Blackberry/ iPhone/iPad. Anesthetizing the areas is the only painful part of the session and the above technique usually causes less discomfort than a visit to the dentist. Nevertheless, to maximize patient comfort nitrous oxide or “laughing gas”, can be used to diminish any discomfort associated with the local anesthesia. Bandages are avoided altogether.
The following day the patient returns to have the areas checked and shampooed. After the procedure patients have crusting and mild redness in the recipient area that can last 7-10 days, and it is normal for the transplanted hairs to “fall out” in the first few weeks. The hairs then recycle and begin growing in about three to four months. The results are often not visible for six months or somewhat longer with final results evident at 12 months. The results are permanent.
Our goal is to achieve the most natural appearance possible and create density as well. We are particularly interested in providing the most natural hairline possible and have written and lectured extensively regarding ways to achieve this. We believe that we have the skills and aesthetic knowledge to consistently obtain natural results. Generally, the front half of a balding area will require one session to produce satisfactory and natural-looking coverage. The back half or crown area can also be completed in one session. “Fill in” sessions can be done subsequently depending on the patient’s density objectives. The number of grafts which should be transplanted at one session and the number and frequency of transplant sessions depend on the characteristics of each individual case; this will be planned out in advance for each patient. For example, coarse hair provides twice the coverage as compared to fine hair. The number of follicles that can be transplanted in one procedure depend on your individual donor characteristics such as scalp elasticity and follicle density.
There are two methods to obtain the donor follicles.
Strip Donor Procedure
Hair in the donor area is clipped to about 2-10 mm length. The hair above the donor site can generally camouflage immediately after the procedure. For such coverage, it is recommended that the hair in this area be left at least 1-1 ½ inches long for the procedure.
After anesthetizing the donor area, a specially designed scalpel is used to remove a “strip” of hair bearing scalp from the donor area. This area is usually closed with the “LEDGE” trichophytic closure developed by Dr. Rose, also utilized by all our surgeons, allows hairs to grow through the scar to minimize its appearance. In 90% or more of cases, strip scar lines are 2mm wide or less and are only visible if you pass a comb upward through the donor area and look carefully. The “strip” is then divided under microscopes into small follicular units containing 1-4 hairs. Small slits which are no larger than those that would be created by an injection needle are made in the recipient area and the grafts are placed into these small openings. It is recommended that pain medication is taken the first night.
Follicular Unit Extraction / ARTAS
Unlike for a strip, the entire back and sides of the scalp need to be shaved for this type of donor harvesting. Follicular unit extraction (FUE) is a technique for removing follicular units from the donor area in a different way. It utilizes a small (0.8-1mm diameter) circular needle called a “punch” to remove the units in a non-invasive scattered array from the donor area and produces many tiny “dot like” scars instead of the line scar that is produced by strip removal. The advantage of FUE is that you will be able to wear your hair shorter in the donor area without evidence that a procedure has been done but the FUE “dots” may be visible if you completely shave your head.
We utilize the ARTAS physician-guided robotic system for FUE which the most technologically advanced method is worldwide. With the ARTAS procedure, advanced digital technology and laser guided, precision robotics harvest permanent hair from the back of the head to be transplanted into balding or thinning areas where they will grow permanently and with a completely natural appearance.
The advantages of this technique include maintaining the donor area without any linear scars, in fact, the donor area heals faster than with traditional methods and there is almost no postoperative pain. The patient can then wear his hair quite short (but not completely shaven) without any evidence that a procedure has been done. In addition, patients who have been extensively harvested by the strip technique and do not have further donor that can be obtained by further strip harvesting can have donor follicles obtained by the ARTAS technique.
What does the ARTAS technology mean to you as a hair transplant patient?
- Greater precision, consistency and accuracy to remove donor hair.
- Minimally invasive procedure.
- No linear scarring.
- Hair follicles can be inserted into existing line scars from strip procedures.
- Quick recovery with less pain.
Patients often ask about the difference between strip harvesting and FUE/FIT. Here is some information that may help clarify these approaches. Please note that we offer both techniques.
- Able to harvest a larger number of grafts in a shorter time.
- No need to completely shave the donor area.
- Multiple sessions can often be performed using the same scar.
- Results in a linear scar. With the “ledge closure” the scar may be extremely difficult to see however you are limited as to how short you can wear your hair.
- No Linear scar.
- The patient will be able to wear his hair much shorter than with a strip harvest.
- The donor area of the head must be completely shaved for the procedure.
- Thinning of the donor area can occur if multiple sessions are required.
- Scars that appear as “tiny dots” may be visible if the hair is completely shaved.
Platelet Rich Plasma (PRP)
PRP is prepared by drawing the patient’s own blood at the time of the transplant procedure. It concentrates platelets which have growth and healing factors. These factors will enhance healing and may aid growth of the transplanted follicles. Studies have shown that PRP decreases redness and crusting following transplantation and improves the percentage of growth of transplanted follicles. We recommend PRP for all procedures but particularly for patients who have had previous transplants.
Reese, R. A single-blinded, randomized controlled study of the use of autologous platelet rich plasma (PRP) as a medium to reduce scalp hair transplant adverse effects. Hair Transplant Forum International, March/April 2008, 51-52
Statistically significant differences in scalp crusting and erythema
At POD 5 and 10 for the PRP group vs. control
Uebel, C. A new advance in baldness surgery using platelet-derived growth factor. Hair Transplant Forum International, May/June 2005, Improvement in number of hair follicles in a PRP treated area compared to a non-treated area improved between 3 and 52% (avg 15%).
To reduce your discomfort after strip donor surgery, EXPAREL can be injected into your donor area at the end of the procedure.
- EXPAREL is a local analgesic that contains the local anesthetic bupivacaine. Local anesthetics provide pain relief by numbing the tissue around the surgical site.
- EXPAREL is specifically designed to release medication over time and can control pain for up to 48 hours.
- In addition to EXPAREL, your surgeon will provide other medications to control your pain.
- Each patient is different and depending on how you respond to EXPAREL, you may require less additional pain medication during your recovery.