General Considerations

See 3d simulation of the procedure.

Currently, hair restoration surgery can achieve a high degree of natural result. The American Society of Aesthetic Plastic Surgery considered this procedure "the surgery of the decade", as it showed the most progress in the 1990's. It is one of the most frequently performed operations of an aesthetic nature in the U.S.A., and is gaining great popularity in Brazil. People are becoming aware that they no longer have to fear an artificial result, with the corn-row / doll's hair appearance.

Surgical technique for hair transplantation should take into account the fact that follicles are very delicate, and therefore should be perfectly prepared and transplanted, so as to guarantee survival and, consequently, hair growth. This is known as the follicular unit technique, or FUT. No longer are mechanical devices acceptable (the hand-engine) for preparation of hair plugs, and lasers have been totally abandoned because of the damage caused to the recipient sites.

The dermatological and plastic surgery societies do NOT recommend the use of the hand-engine technique!

Surgical technique

Surgery

Here is a step-by-step description of the procedure

1. Consultation

Choosing to undergo surgery is a very personal decision. The surgeon should present clear and honest information, explain his surgical strategy, answer all questions openly, and show many different cases that exemplify his own results. Photographs must be high-quality, with close-ups so that the patient may see the frontal hairline, assuring that no plugs are used. See previous section

2. The day of surgery

Técnica cirúrgica

Exams are usually checked before, and patients are asked to arrive by 7:00 a.m., so that surgery can be finished in the early afternoon. By 5 or 6 p.m. patients are discharged from the clinic. Fasting is begun the night before, because an empty stomach is a requirement. The anesthesiologist will meet with you in your room, and will want to ask specific questions. Photographs are taken and, when all is set, the patient takes a "sleeping pill", which causes a relaxed and comfortable feeling.


3. Anesthesia

Técnica cirúrgica

In the surgical suite, an endovenous sedation is begun. This is the safest and most controllable type of sedation, because the experienced anesthesiologist will know exactly what amount of medication to administer, to assure a light but safe sleep.


4. The operation

Técnica cirúrgica - Etapa 4 - Preparando Técnica cirúrgica - Etapa 4 - Implantando Técnica cirúrgica - Etapa 4 - Restaurando

Here is a short explanation of the surgical procedure. Under local anesthesia, the surgeon removes a strip of hair-bearing tissue from the back of the head (this is the donor area). Sutures are applied so as to leave a single, thin scar, which will always be hidden inside the hair. These stitches are taken off after one week. Tricophitic closure is almost always done.

The next step is perhaps the most important, which is the correct preparation of the grafts. The team of technicians, with the use of magnifying lenses and microscopes, separates the follicles into units containing one to four hairs per graft. Meanwhile, the surgeon is preparing the recipient area, where tiny orifices will be made so as to insert the individual grafts.

This is a very dynamic procedure, requiring a large and well trained team. In this manner, it is possible to transplant over 1,500 grafts in a single session.


5. Post-op. recovery

Duration of surgery is variable, but a large session takes no less than 4 hours. As surgery winds down, the sedation wears off, and the patient becomes awake, talking with the team. There is no pain, and no recollection of anything that happens in the surgical suite!

We do not apply any dressing, so that the patient's head is not wrapped up in bandages. He or she will remain in the recovery room, a light lunch is offered, and 2 or 3 hours later patient is discharged. Ideally, there is someone to accompany him or her home.

6. The first 10 days

The patient returns to Pilos the next day, when the nurse will wash the head. Some swelling may occur on the 4th - 5th day; this is simply the saline solution that was used for local infiltration of anesthesia coming down the forehead.

There is usually no post-operative pain. Patients must realize that an incision is placed in the back of the head, so some discomfort is to be expected. The sutures are removed after one week.

Permanent hair begins to grow after 3 - 6 months, and the patient will be able to appreciate the final result by one year post-operatively.