All procedures performed at Bernstein Medical – Center for Hair Restoration are based on Dr. Bernstein’s pioneering Follicular Unit Transplantation (FUT) techniques. The essence of these procedures is that the hair is transplanted into the balding area as individual follicular units (naturally occurring groups of 1-4 hairs), so that it will look totally natural and be undetectable as a hair transplant.
Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) differ in the way the hair is harvested (removed) from the donor area in the back of the scalp. In FUT Follicular Unit Transplantation a thin strip of hair is taken from the back and/or sides of the scalp and the area where the strip was taken from is sewn closed. The hair from above the incision covers the area so that it is not visible. The donor strip is placed under a series of special dissecting microscopes where the individual follicular units, of one to four hairs each, are carefully dissected into tiny grafts. These grafts are stored in a special holding solution and refrigerated while awaiting placement.
The recipient sites (tiny incisions) are made in the bald or thinning areas of the scalp using a fine-needle size instrument. Once the recipient sites are made, the follicular unit grafts are carefully inserted into the scalp. The 1-hair grafts are placed at the hairline, the 2’s immediately behind them and the larger 3- and 4-hair units are placed in the central, forelock area. The recipient site sizes are matched to the different size follicular unit grafts to facilitate healing and maximize the growth of the transplanted follicles., the hair is removed in a single, thin strip and then dissected into in individual follicular units using microscopes.
In Follicular Unit Extraction (FUE) a relatively large area in the back and sides of the scalp is shaved to approximately 1-mm in length. Instead of removing a single strip, as in FUT, a tiny circular incision is made around each follicular unit. The follicular units are then extracted, one-by-one, directly from the scalp. These grafts are stored in a special holding solution and refrigerated while awaiting placement in the bald or thinning scalp (the recipient area). The tiny wounds are left open to heal on their own.
As in FUT, recipient sites (tiny incisions) are made in the bald or thinning areas of the scalp using a fine-needle size instrument. The follicular unit grafts are then placed into these sites. The follicular units are removed directly from the back and sides of the scalp using a robotic device (see Robotic FUE).
All of our hair restoration procedures are performed under local anesthesia. Hair transplant sessions that use thousands of follicular unit grafts may take a whole day; however, the time goes by quickly. During the procedure, patients rest comfortably and can watch TV or a movie, take a nap, or chat with the staff.
The misconception that most people have of hair transplantation is associated with the out-dated “plug” techniques in which patients leave the office with their head wrapped in bandages and enduring significant bleeding and pain. In modern follicular unit hair transplants, patients leave the office with only a hat and headband and are able to shower and shampoo their hair the day after the hair restoration surgery.
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. The doctor 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 then takes high quality photographs that will 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, 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 hair surgery 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. 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 their hair loss surgery made the experience truly enjoyable. Our full-time staff has years of experience assisting Dr. Bernstein with these procedures. In addition to expertise in performing the procedures, the staff is adept at ensuring the comfort of our patients.
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.
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. However, at Bernstein Medical, this is not the case, as 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.
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.
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 and 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 particular situation.
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.
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.
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. Throughout the procedure and afterwards, Dr. Bernstein and our highly-trained staff will answer your questions and take care to help you feel comfortable.