Understanding modern hair transplantation is straight forward: hair roots that exist in abundance in the back of the head (the donor area) are removed and placed into the thin and balding areas on the front and top of the head (the recipient area). This hair takes “root” and actually grows. There are two ways modern hair transplants are performed: The first is where the hair roots are removed from the back and sides of the scalp in a thin STRIP. This is also known as Follicular Unit Transplantation, or FUT. The second is where the hair roots are removed from the back and sides of the scalp individually or in small groupings. This is also known as Follicular Unit Extraction, or FUE, and Modified FUE, or “mFUE.”
A more detailed description of the procedure
To begin, the patient meets with the surgeon for a consultation. At that time the hair loss is evaluated, the risks and benefits are reviewed, and a plan is discussed. The patient then makes an appointment for hair transplant surgery and leaves a non-refundable first payment. On the day of the hair transplant surgery the patient comes to our New York office dressed in comfortable clothing such as jeans and a t-shirt. The plan is reviewed and photographs are taken. Lines will then be drawn to demark the area that will receive the hair. More pictures are taken. The risks and benefits of the procedure are discussed in detail again and the patient is given a consent form to review and sign. The patient is then brought into the procedure room and is offered a mild sedative. At this point the hair and scalp are cleansed and disinfected. The hair in the back of the head will be gently combed upward and taped out of the way an electric razor will be used to shave away just a small band of hair in the back. After the skin is exposed, Dr. Feller and Dr. Bloxham will numb the area with a local anesthetic and a strip of hair-bearing skin is removed. This is why it is called the “strip method.” This strip of skin will be taken into a dissecting room where the staff will carefully remove and separate the hair roots for implantation.
(If the patient is having an FUE he will not have a strip removed or sutures (staples). Instead tiny holes will be made in the donor area less than 1.0 mm. If the patient is having an mFUE, small, millimeter-sized “groupings” of grafts will be removed and separated into hair roots under microscopes for implantation; this patient will not have a strip removed either.)
The strip, FUE, or mFUE grafts will be placed under a microscope by a trained team of full time technicians and be refined into Follicular Units – the gold standard of modern hair transplantation.
Next, the patient is reclined back into the chair and local anesthetic is applied to the bald or thinning area. After a few minutes the skin is numb at which time the hair transplant doctor painlessly creates hundreds or thousands of tiny sized slits in the area. All slits made by the doctor are under 1.0 mm in length and are made at the proper depth and angle to maximize results.
The hair transplant patient feels nothing and is usually watching TV or using their smart-phone at this point while the grafts are placed one by one into the skin under magnification. At the end of the day it looks as if the patient has small bumps on his head which represent the scabs of the new hair follicles. After 4 days the scabs usually fall away leaving the grafts safely under the skin to continue healing. In most cases few would ever guess that a transplant had just been performed, probably not even the family doctor.
After about a week the patient returns to the Doctors’ New York office and the sutures/staples are removed leaving a thin scar — usually about the thickness of the edge of a few playing cards. This fine line scar is easily concealed by surrounding hair. The transplanted hair on the top should grow for another few weeks and then go into a sleeping phase.
By the fourth month in most patients, the hair will begin to sprout and grow. By the sixth or seventh month the patient will visit the office for follow-up pictures. This hair will usually continue to grow naturally throughout the life of the patient and it can be treated just like the original hair. Cut it or pull it out (we don’t recommend pulling hair out!), it will just grow back naturally.