The Hair Transplant Process

Surgical hair replacement techniques have come a long way. In 1955, Dr. Norman Orentreich performed the first hair transplant in the U. S. At that time, he used a small round punch to remove the donor hair from the back of the scalp. While early transplants looked “pluggy”, the process worked. In the early 90’s, we realized that scalp hair grew from groups of follicles containing 1 to 4 hairs, which were labeled “FOLLICULAR UNITS”. When these units were transplanted, they grew hair in a way so natural that you could not see any difference between transplanted and original hairs.

The removal of follicular units from the back of the scalp (donor area) can be done by cutting out a strip of scalp and removing the follicular units under a microscope (Follicular Unit Transplant or FUT) or by removing the follicular units directly with a tiny punch (Follicular Unit Extraction or FUE). This extraction process is known as “HARVESTING”.

The second part of this surgical hair replacement procedure is called the “PLACEMENT”. Tiny incisions are made in the bald “recipient” areas and the follicular grafts are inserted manually.

Manual FUE Science

If hair follicles are removed from the scalp and placed anywhere on the same person’s body, whether it’s the bald scalp or the top of one’s hand, the follicles will thrive and produce hair. Unfortunately, this doesn’t work if someone else is the donor, even if it’s a family member.

In a surgical hair replacement transplant, the follicles removed from the back of the scalp have the ability to grow hair for a lifetime. Because they cannot be rejected, they can be placed in the bald scalp where they will survive and thrive.

Manual FUE

A manual handheld FUE hair transplant is a procedure that is done by a physician using a handheld device to extract the individual hair follicles. Much of the success of this form of procedure is entirely as a result of the efficiency and experience of the Physician, to ensure that harvesting happens at a natural distance apart and that the hair follicle does not get transected during harvesting.

ARTAS® Robotic FUE

In comparison, the ARTAS® FUE hair transplant procedure is a physician-guided robotic FUE hair transplant device. This simply states that the physician will be in control of the robot during the procedure by selecting the density amount desired for harvesting as well as mapping out the desired donor area. The physician does not actually harvest the donor grafts. The harvesting step is all completed by the ARTAS® robot with unparalleled precision and accuracy.

Hair Transplant Surgery FAQs

The first night after the transplant there may be some discomfort that is usually controlled by a pain medication like Tylenol or a mild narcotic. By the next day, most patients feel fine.
Infection and bleeding is rare, but post-op swelling in the forehead may occur in 2 to 3 days and is gone within another 2 to 3 days.
The transplanted hairs fall out over the first few weeks (“transplant shock” like the leaves falling off a transplanted tree). They start to regrow after several months and usually by the eighth or tenth month most of the hairs have come back.

These are three of the most common questions asked by a prospective patient.
In my practice, transplant times average between 4 to 8 hours, with a Robotic procedure taking about 2 hours longer than the traditional strip transplant.
I do not put patients to sleep, but I will use an oral tranquilizer if requested. Local anesthesia is adequate for this type of surgical procedure and certainly much safer than putting a patient out.
Anyone living a reasonable distance from the transplant office can drive home after surgery. If, however, a tranquilizer (usually Valium) is used, then driving oneself is not advisable.

The Follicular Unit Extraction (FUE) method eliminates the linear scar and substitutes very fine dots after the individual grafts are removed, and unless the head is completely shaved, they will never be noticed. Most people who have had both types of transplants prefer the FUE method because the post-op healing seems to be easier.
Another factor for some choosing FUE is its appeal as a more “futuristic” kind of surgical approach, especially when the ARTAS® Robot is available.
Both these transplant methods simply are two different approaches of “harvesting” donor grafts. The second part of the transplant procedure is called the “placement” and it is the same for both.

Not everyone who is losing his or her hair is necessarily a hair transplant candidate.
Age is an important consideration when evaluating a potential patient. As a general rule, age 22 is considered a minimum for transplanting because, in most individuals, by that age, it’s easier to predict the degree of future balding. This, however, can vary with different people and an experienced physician can often predict future balding in a younger individual and get a head start by filling in thinning to balding areas.
Where, exactly, are you losing hair? If your hairline is receding slightly, it might just be the normal change that occurs when a low “juvenile” hairline moves up and indents slightly and becomes a so-called “adult” hairline. Lowering a normal adult hairline is unnecessary and unwise.
How large an area of thinning or balding is present, and how large and full is your donor area? If too large and area needs coverage and there isn’t enough donor hair to adequately fill it in, it’s often wise to settle for transplanting a smaller area with good coverage rather than spreading out your limited supply of donor grafts and achieving coverage with very poor density.
If you’re young and thinning slightly, you may be better served by trying a medical approach using topical minoxidil and/or oral finasteride. While there is no medical cure for common baldness, these medications may slow down the balding process.

Depending upon the area to be covered and continued hair loss, future sessions may be required to increase density and fill in newer bald areas.

Hair grows at different rates, but most people have reasonable growth and coverage in six to ten months.

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