Your Permanent Hair Transplant Procedure at Bernstein Medical
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. The physician 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, generally oral valium, 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, see a movie (or two), or just chat with the doctor and staff. The graft dissection will be performed in the same room as your procedure so that we can explain what we are doing and answer any questions that you may have.
The length of your permanent hair transplant procedure will depend upon how may follicular unit grafts are transplanted. Small sessions of less than 800 grafts can be finished by noon, but larger sessions, of 2,400 or more, generally take a full day.
We do our 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 and pampering they received throughout the procedure 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. All instruments are either sterilized in an autoclave or are disposable.
Local Anesthesia
After sedatives are given orally, 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 (Limiting Epinephrine - 2000), while at the same time making the procedure a more comfortable one for you.
Donor Tissue
In Follicular Unit Transplantation (FUT), to maximize yield and minimize scarring, the donor tissue is removed from the scalp in a single thin strip (Single-strip harvesting). The location of the donor area is carefully chosen to be a region of the scalp with maximum hair density and the best long-term stability. The hair in the area to be removed is clipped short, to a length of approximately 1-mm, so that the uncut hair can completely cover the donor area when the patient leaves the office. In Follicular Unit Extraction (FUE), the units are removed from the scalp by a combination of sharp and blunt dissection (Three-step technique).
Once the donor tissue is removed from the scalp, it is immediately placed into a holding solution consisting of chilled Ringer’s lactate. This closely mimics the body’s own fluids – it is the medium that is used in organ transplantation. This maximizes the survival of the grafts while they are being held outside the body.
In Follicular Unit Transplantation, the donor area is closed with either absorbable sutures (that don’t need to be removed) or staples, depending upon the person’s needs. In Follicular Unit Extraction, the donor area is just covered with antibiotic ointment and a dressing.
Stereo-Microscopic Dissection
In Follicular Unit Transplantation, the individual follicular units (each containing from 1 to 4 hairs) are meticulously dissected from the donor strip in their naturally occurring groups under strict stereo-microscopic control. The grafts are trimmed of extra tissue and the intervening skin between the units is discarded. The follicular unit grafts are then sorted into groups containing either 1-, 2-, 3- or 4-hairs and stored.
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 a 20- 19- or 18-gauge hypodermic needle. For most procedures, we use lateral (perpendicular slits) for the recipient sites although vertical sites will be used when appropriate in specific situations. 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 permanent hair transplant procedure. 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.
110 East 55th Street, 11th Fl., New York, NY 10022 212-826-2400
Toll Free: 1-866-576-2400 contact@bernsteinmedical.com
Bernstein Medical: Center for Hair Restoration in New York - offering hair transplant surgery
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