Prior to undergoing hair transplant surgery, the patient will first be examined by the physician to determine the number of details. First and foremost, the doctor will need to isolate the cause of the hair loss and ensure that it is the result of androgenetic alopecia and not a medical condition or a form of temporary hair loss which could be treated by other measures.
The doctor will determine the root of the hair loss by examining the patient’s scalp, and questioning them about their lifestyle, eating habits, and family history. If there are any signs that the hair loss could be resulting from a medical condition, x-rays and blood work may then be ordered. However, should it be determined that the hair loss is the result of androgenetic alopecia, the next step will be for the physician to take a look at the pattern of the hair loss. This is important because not everyone loses their hair in the same manner.
In most cases, men lose their hair beginning with a receding hairline whereas women lose hair in the same amounts over the entire scalp. One method the doctor may use to examine the pattern of hair loss and examine the hair follicle is a pull test.
A pull test is performed just the way it sounds. The doctor gently pulls on several strands of hair at the same time. Those hairs that are in the telogen phase will come out easily, while those that are actively growing will remain in place.
The doctor will examine the sample of hair and skin, usually under a microscope, to look for indications of infection or anything else that could be causing the loss of hair.
The physician may also compare the appearance of the patient’s scalp and hair loss to standardized charts that have been developed for the purpose of classifying hair loss patterns.
The patient should anticipate the fact that the surgeon will most likely take several photographs, from different angles, during the pre-operative consultation. These photographs serve multiple purposes. The most important purpose is to aid both the patient and the surgeon in understanding how much progress has been made at a later date when comparing before and after views of the patient’s scalp area.
Prior to the surgery, the physician will provide the patient with information on what they should and should not do the night before the surgery. This generally involves discontinuing the use of alcoholic beverages, etc. Many surgeons may also advise their patients to cleanse their hair and scalp with a special shampoo that will act as an antiseptic and reduce the risk of infection and contamination during the surgery. The patient will also be advised not to use any hair styling products on the morning of the surgery.
Most hair transplant surgeries are performed in the office of the surgeon on an outpatient basis. Quite a number of hair transplant surgeons have installed state-of-the-art outpatient surgical facilities right in their offices to facilitate the procedure for the patient. These surgical centers are fully equipped with all the same safety measures and necessary equipment one would expect to find in a standard operating room.
On the day of the surgery, the physician will make notations on the patient’s scalp using a marker specially designed for surgical procedures. This will allow the surgeon to see exactly where the donor grafts are to be removed and which areas will receive them.
The patient should be aware that their hair will be trimmed very closely, using scissors, making it easier for the surgeon to remove hairs from the donor site. Following this, an anesthetic will be applied to both the donor and transplant areas. Depending on the surgeon’s preference, the patient may either be instructed to lie down or sit up. Sometimes, the positioning of the patient may depend upon where the donor sites are located on the patient’s scalp.
Almost all surgeons use at least local anesthesia to reduce the level of discomfort for the patient during the surgery. Depending on the circumstances, the physician may also use a mild sedative along with the anesthesia. Any patients who have had a bad reaction to anesthesia in the past should inform their surgeon of this information prior to the surgery. In addition, anyone who has any drug or latex allergies should let their doctor know this as well so that alternate arrangements can be made.
Although a local anesthetic will be used, the patient should be aware that while they may not feel any pain during the surgery they will be aware of what is going on around them and may hear noises as the donor grafts are excised and then later placed in the recipient areas. Since anesthesia has been applied, the patient won’t actually feel anything but the sounds can be a bit unnerving, if not prepared for this ahead of time.
The first step that will occur during a hair transplant procedure is the removal of grafts or plugs from the donor site of the patient’s head. This is commonly the sides and back of the scalp because these areas are not usually as affected by the balding process.
The surgeon may use a variety of instruments in order to achieve the desired results; however, a scalpel and other specialty tools are quite common. One of the tools that may be used is a small hand tool that is pressed against the scalp. The tool contains an interior engine that allows it to spin against the scalp and extract the donor plugs. This technique is known as punch harvesting.
Depending on the procedures the surgeon determines are needed in order to produce the best results, an excision method may also be used. This involves the utilization of a scalpel. Strip harvesting may also be necessary, using a scalpel mounted with multiple blades in order to excise strips.
Regardless of whether a single method or a combination of methods are used in order to obtain the donor tissue, the samples will commonly be further dissected before transplantation to the recipient site occurs.
Once the donor’s hairs are removed, it may be necessary for the surgeon to close the donor site area with stitches or staples. The patient should be aware that this commonly results in a scar, however, it is usually not noticeable since it is covered by new growth hair.
To facilitate the insertion of the donor tissue, the surgeon will need to score the section of the scalp where the transplant is to take place. Again, the surgeon may use a single method or a combination of methods. In the frontal area, it is more common for the doctor to make slits in the scalp using a single scalpel. Another method that is common along the frontal area of the scalp is the dilation method.
The surgeon will use a special tool that will move the skin of the scalp to the side so that the donor tissue can be put into place. Other methods include punch grafting to create a recipient site and laser-assisted grafting. There has been some controversy over the use of punch grafting because some experts feel the utilization of this method may lead to a less natural appearance.
After the recipient site is created, the surgeon will simply place the donor tissue inside the flap or pocket that now exists. Following the procedure, the scalp will be cleaned using an antiseptic solution to defend the area against infection. Like all surgery sites, the scalp will be wrapped in gauze, which will also prevent the area from becoming infected by dirt and bacteria.
The patient may be given pain medication as well as a prescription for antibiotics for a few days following the surgery. Some physicians will cover the transplant area with gauze to aid in healing while others recommend the use of a baseball cap. Within a couple of days following the surgery, most patients will be able to shampoo their heads; although care will need to be exercised when doing so due to the fact that both the donor and recipient areas will likely still be somewhat tender.
Usually, hair transplant patients are able to resume normal activity about this same time as well. For this reason, many patients elect to have their surgeries performed on a Friday so they can rest and recuperate over the weekend.
As with any type of incision or cut, the area where the transplants were placed will crust over within a few days following the surgery. This is perfectly normal and should not cause any alarm. Within a few days, the scabs will fall off.
The patient should also expect that there will be some itching in the days following the surgery. This is most likely to do the incision areas begin to heal and scab over. As tempting as it can be to scratch these areas, it is extremely critical that the patient refrains from the urge. Scratching at these areas can easily result in loosening one or more of the transplanted hairs.
Permanent new hair growth will not begin until some 2 to 3 months after the surgery. Keep in mind all of the healing and phases that the hair and its components must go through in order to begin an active growth phase. This waiting period can be distressing for some individuals who expect to begin growing hair immediately. The ability to grow hair is not an overnight process and should not be viewed as such. Permanent healthy hair takes time to grow.
Instead of focusing on the wait for growth to begin, patients can instead use this time to ensure they are giving their bodies the necessary nutrients and vitamins it needs to sustain the growth process of healthy hair. Remember that all hair, regardless of whether it is original or transplanted, must-have essential vitamins and nutrients to aid the growth process. Now is not the time to go on a crash diet, pick up or continue bad eating habits. Refer back to the information in Chapter One on the essential vitamins needed for healthy hair.
One of the most alarming parts of what occurs after the hair transplant surgery, if the patient does not know what to expect, is the resulting hair loss; sometimes called shock loss. Sometime within about two weeks to a month following the surgery, the patient can expect the original hair from the transplant to begin to shed. Again, this is natural and to be expected.
This hair must fall out in order for new growth to begin. Within about a month or two later, the patient should begin to see a very fine growth of new hair. This growth will continue consistently.
By 6 to 8 months, most patients can expect to see some significant results in the hair growth process. Full results will not be achieved until approximately 9 to 12 months following the surgery.
Patients should be aware that there may be some post-operative bleeding following the surgery. This should be minimal, however. Should more substantial bleeding arise, the patient should contact their physician immediately.
Prior to the actual surgery, the hair transplant surgeon will meet with the patient is at least one pre-operative consultation. The purpose of this visit will be to determine 1. Whether the patient is a suitable candidate for hair transplant surgery based on a number of factors, 2. Determine the cause of the hair loss and whether it is temporary or permanent, 3. Discuss options with the patient, including long-term planning should the patient decide to have the surgery, 4. Explain the procedure and tell the patient what they can expect and not expect from the surgery.
Almost all hair transplant surgeries are performed on an outpatient basis in the surgical center of the surgeons’ office. A local anesthetic is usually applied to make the procedure more comfortable for the patient. The surgeon will begin by making marks on the patients’ scalp using a surgical marker. The hair on the patient’s head will be trimmed very closely. The procedure will begin by removing the donor hairs and sections. Once this has been accomplished, they will be transplanted to the recipient area. The surgeon uses a variety of tools to accomplish both tasks, including a scalpel. The donor area will be sutured using either stitches or staples. Depending on the surgeon, the patient may either leave wearing a gauze dressing or a baseball cap to protect the area from infection.
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