The FUE Hair Transplant Procedure

When you arrive for your hair transplant, the staff begins by going over the activities for the day. The surgical consent form that had been sent to you is reviewed and other paperwork is completed. Your doctor reviews the goals that have been established and answers any questions that you still might have. He will carefully re-draw the hairline that was marked and photographed during your consultation and will add other markings to further delineate the extent of the procedure. You will have a chance to examine and discuss them before proceeding. The physician will then take high quality photographs that become part of your permanent medical record.

Sedatives are given to relax you before the start of the hair restoration procedure, but you can remain fully alert if you like. You will be offered a movie selection and cable T.V. Most patients choose to listen to music, watch a movie, chat, or just relax.

The length of your hair transplant procedure will depend upon how may follicular unit grafts are transplanted. Smaller sessions generally take one day. Larger FUE sessions will be performed on consecutive days.

We do this very technical job in a friendly, relaxed atmosphere, so that your experience is pleasant and so that the time goes by quickly. You will be able to take a series of breaks, to the restroom, to eat, or to just move around and stretch. Many of our patients tell us that all the attention they received throughout the hair loss surgery made the experience truly enjoyable.

We take great precautions to protect both our patients and ourselves from blood-born agents during the hair restoration procedure. Our patients and staff are routinely tested for HIV and hepatitis for everyone’s safety and protection. Instruments are either sterilized in an autoclave or are disposable.

Local Anesthesia

After sedatives are given orally and intra-muscularly, we use a combination of the local anesthetic Lidocaine (Xylocaine), and a longer acting one called Bupivicaine (Marcaine). High frequency vibration is applied to the skin as the anesthetic is given to decrease the sensation of the injections (this is referred to as vibratory anesthesia). The anesthetic is administered only around the perimeter of the scalp (called a ring block) to make the entire scalp numb. Once the scalp is numb, the remainder of the hair restoration surgery is painless. If more anesthesia is required, usually around 5-6 hours into the procedure, it will be given before the initial medication wears off.

Since the scalp is very vascular, there is a commonly held belief that a permanent hair transplant is a bloody procedure. In our hands, this is not the case. We have developed techniques that both minimize bleeding and minimize the amount of medications that are needed (see Limiting Epinephrine) while at the same time making the hair surgery a more comfortable one for you.

Donor Tissue

In Follicular Unit Extraction (FUE), the donor tissue is removed from a broad area of the back and sides of the scalp. The location of the donor area is chosen to have long-term stability. The hair in the area to be removed is clipped short, to a length of approximately 1-mm. This will include the entire back and sides of the scalp in large sessions and a long, thin band in smaller procedures.

In robotic FUE, the patient sits leaning forward, with his/her forehead on a special headrest. As the robot moves around the donor area, scanning select follicles, one-by-one, it begins to separate the follicular units from the surrounding tissue. Once the all the selected follicular units are removed in a specified area, the medical staff gently removes the follicular unit grafts from the scalp. The grafts are immediately placed into a holding solution consisting of chilled Ringer’s lactate. This closely mimics the body’s own fluids. This maximizes the survival of the grafts while they are being held outside the body.

Once the grafts are extracted, the donor area is covered with antibiotic ointment and a dressing that will be removed the following morning.

Stereo-Microscopic Dissection

In Follicular Unit Extraction, the extracted grafts are placed under a microscope to assess their integrity and to sort them according the number of hairs they contain. In cases where a particular size follicular unit is needed, such as for the frontal hairline, larger units may be microscopically dissected into smaller 1-hair grafts (if the number of naturally occurring groups are not sufficient). In eyebrow restoration, for example, where all single-hair grafts are needed, this is particularly important.

Creating the Recipient Sites

Recipient sites are made by the hair transplant surgeon using a fine instrument the size of 21- and 19- gauge hypodermic needles. For most procedures, we use lateral (perpendicular slits) for the recipient sites. The creation of the recipient sites determines much of the aesthetic look of the transplant – it sets the angle at which the new hair grows and determines the distribution and density of the grafts. Recipient site creation is a critical aspect of hair restoration surgery that requires considerable experience and surgical skill and a keen aesthetic sense.

When making sites, Dr. Bernstein is able to work in and around your existing hair so that it does not need to be cut. This is particularly helpful so that you can use your hair to camouflage the transplanted area during the immediate post-op period.

Graft Insertion

Once all of the recipient sites are made, the surgical team begins to place the follicular unit grafts into these pre-made sites. One-hair follicular units are used in the frontal hair line to give a soft, natural appearance and 3- and 4-hair grafts are used in the central forelock area to achieve maximum fullness. Placing is the most time-consuming part of the hair loss surgery. Graft placement is an exacting process and during this period you will be asked to keep your head relatively still. Watching movies, TV or sleeping, will make the time go by quickly and, of course, you make take breaks as needed to go to the restroom, stretch or eat.

At the End of the Procedure

When placing is complete, the position of all of the grafts will be double-checked. The post-op instructions will be explained and a printed copy will be given to you to take home. This will include the doctor’s cell phone number. A tennis bandage is placed around the head to cover the donor area and a baseball cap or bandana is worn home. No bandages or dressings are required on the transplanted area and all dressings can be removed the following morning.