Tuesday, January 23rd, 2018

Hair Restoration

A typical well-done modern hair transplant can not be detected as a surgical transplant even when closely examined by anybody who is not a hair transplant surgeon or a hair transplant technician and this includes your barber.

Hair transplantation is now done with follicular units. It will probably surprise you to learn that the hair on your head does not grow as separate hairs, rather like bushes in groups called follicular units each containing 2 or 3 hairs or 4 or 5 hairs. I will remove a strip of hair from the donor region which consists of the back and the sides as far as the ear. This strip will then be cut under a surgical microscope into the naturally occurring follicular units. The first stage of this dissection is called slivering where the strip is carefully cut into small “slivers” one follicular unit thick without damaging any of the follicles. These slivers are then cut into the individual follicular units. I will then make the recipient sites usually using a needle which I might use to give a shot in the arm. This controls the location and direction of the hairs. If you get a shot in the arm, the mark usually disappears in a day or two. Since we put a follicular unit into the needle hole the site usually takes about 30 days to disappear. It takes 90 days for the hair to begin to grow. At that time it will grow just like it grew before in the back which on the average is ½ an inch a month. Thus six months after surgery the average patient has hair 1 ½ inches long and it will continue to grow just as it would in the back of your head.

The average patient experiences no pain! When you are in our office the only thing which could hurt is the injection of the local anesthetic. When this is complete I always ask did it hurt. Every patient answers no. An occasional patient says they didn’t know that I was doing anything. How is it possible to put 20 shots in a patients head and not have him feel it? I have a very fine needle and I just put a drop under the skin. Now I can go through this drop to the right and to the left into the fatty tissue and the feeling is only a feeling of pressure. Then I wait until the local anesthetic has drifted up and the surface becomes numb and I can continue to advance further to the right and to the left. Thus I am only putting the needle in areas where it is already numb. I have something to help me—nitrous oxide also known as laughing gas. Most people love it. An occasional patient will say they don’t want to breathe it because it makes them dizzy. This is not a problem but if they breathe it I can get the anesthesia done sooner.

For the past 2 ½ years almost all patients have experienced no pain after they go home.
This is because I have been injecting the donor site with Marcaine before the local anesthesia wears off. This is not the same anesthesia that I use to do the surgery but keeps the donor site from hurting the first night after surgery. Almost all pain originates in the donor region and this is blocked. I always ask patients when I remove the bandage the next morning if they used any of the pain pills that I gave them. Occasionally a patient will say that they took one or two. I then ask did it hurt and they answer no but I took them just in case it might.

For about 2 ½ years I have been closing most of my patients with a trichophytic closure.
With this, in a patient who has had no previous surgery, 95% of the patients have no scar at the donor site to be found. Careful examination with a comb will not allow the observer, who is not a hair transplant surgeon or technician, to find the donor site. With further procedures the percentage of totally scar-less procedures gets less but it still is very high.

Dr. Straub has invented a special pair of scissors to make the trichophytic cut much easier and they are now being manufactured and sold as part of a kit containing a CD teaching surgeons how to do the trichophytic closure, a scissor sharpener, and four tension clamps.

Most doctors do not like to do the trichophytic closure because it takes longer. The results are excellent but I often spend 2 to 2 ½ hours doing it. Some doctors staple the donor site which they can do in 30 seconds but they get a scar. I feel it is worth the time.

Since the onset of follicular unit transplants, trichophytic closures, nitrous oxide inhalant anesthesia and Marcaine injections the satisfaction rate is extremely high approaching 100%. I have had people from all over the world come to my office to get hair and I have many fathers who I did years ago send their sons to me to get a good head of hair. I also have many men who tell me they got married and have children and their wives and children do not know they had a transplant. Just a short time ago a patient told me that after 15 years of marriage he finally told his wife he had a hair transplant.

Other things that we can transplant:

facelift scars
scars from trauma or burns