CIVASHAIRTRANSPLANT

• Shower the morning of your procedure and wash your hair very thoroughly using your regular shampoo. Do not apply sprays, gels, or any other styling products to your hair. If you wear a hair system, please remove it prior to shampooing and do not wear again until after your surgery. 
• Wear loose, comfortable clothing which do not need to be pulled on over your head - this will prevent dislodging your grafts immediately after the hair transplant. 
• Eat breakfast the morning of your procedure. We will provide lunch and snacks. Let us know if you have special dietary needs 
• Do not drink coffee or any caffeinated beverages on the day of your hair transplantation procedure. 
• Although the hair restoration is performed under local anesthesia, you may be receiving medications during the procedure that can make you drowsy. Because of this, you cannot drive yourself home following your procedure.  

The Surgery

Your Permanent Hair Transplant Procedure 

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 will then take high quality photographs that become part of your permanent medical record.
Sedatives, generally oral valium, 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 length of your permanent hair transplant procedure will depend upon how may follicular unit grafts are transplanted 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

Local Anesthesia

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.

Donor Tissue

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. In Follicular Unit Extraction (FUE), the units are removed from the scalp by a combination of sharp and blunt dissection (Three-step technique). 

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 - it is the medium that is used in organ transplantation. This 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 person's needs. In Follicular Unit Extraction, the donor area is just covered with antibiotic ointment and a dressing.

Stereo-Microscopic Dissection

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. In Follicular Unit Extraction, the extracted grafts are placed under a microscope to assess their integrity and to sort them according the number of hairs they contain.

Creating 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.

Graft Insertion

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 permanent hair transplant procedure. 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.