The Hair Transplantation Process
Most hair transplantation processes and work flows are similar but everyone has their own unique flare to the process that makes it theirs. I have developed my process from a few different hair surgeons and am constantly revising it to make it more efficient and enjoyable for my patients. Here is what to expect in a typical FUE hair surgery with Dr. Crose.
Preparing for Surgery
The patient arrives at 7:00 AM. The patient and I will sit down and go over consent forms and I will take vital signs and perform a small preoperative exam. Then preoperative pictures are taken for appropriate documentation of the transformation process. After the photos, I carefully draw and measure the hairline and double and triple check with the patient to make sure they are satisfied with the shape, location, and dimension of the hair line. I also explain that HAIRLINES are not LINES! Yes, a line is not natural and is merely a guideline as I will place hair grafts behind and in front of this line randomly to provide a natural variation to reproduce the new hairline.
After the hairline drawing has been completed, the patient is directed to my surgical suite. The hair is trimmed to 1.2-1.5 mm in length in the back donor area where we will extract the hair. If the patient agrees to have Robotic site making or Robotic hair implantation then the top of the scalp will also be shaved to 1.5-2.0 mm in length, otherwise, it can be left longer for manual site making per patient wishes. Regardless, the majority of patients will ultimately need to shave and/or trim much of their hair to aid the transplantation process and to appropriately visualize all of the existing hairs and follicles. This allows us to avoid damaging your hairs on the top of the head when we make new hair follicle sites.
Next, blood is drawn for PRP and sedation is offered to the patient (ie. valium, ativan, xanax). This helps the patient relax and make the day go by faster.
Starting the Surgery
Depending on the size of the case and quality and quantity of donor hair that the patient has, I will make a decision to start with harvesting the hair follicles or making the new hair follicle sites first. If we are uncertain as to the ability to safely get all the hair needed to cover the desired areas of the patient, then I will start with hair follicle harvesting first. If the patient has plenty of donor hairs with good quality, then I will start with site making first. Regardless, the area that is to be worked on first will be numbed up with local anesthesia. I provide ProNox gas if desired to the patients as it helps reduce pain while we inject the lidocaine and marcaine.
After the patient has received an area nerve block to prevent any pain, the FUE extraction process can begin. We position the patient in the surgical chair and commence hair extraction with the ARTAS iX Robot. It carefully triangulates the position, angle, and depth of each hair using a complex algorithm calculated from the physical measurements of each hair above the skin using its 3 microscopic cameras and artificial intelligence software. I coordinate the extraction of each hair myself as the operator of the ARTAS iX. Some physicians may leave the room or not perform this step, but I feel it is my obligation as a Hair Surgeon to be present and run the surgical process myself. Throughout the hair follicle harvesting process, the patient may take breaks and stretch or use the restroom if desired but it will lengthen the day. Upon completion of Robotic follicle harvesting, I use my handheld WAW FUE mechanical harvester to complete the process by feathering in harvested follicles on the edges of the square grids used by the Robot. This provides a more natural and aesthetically pleasing transition to the more densely harvested areas in the back (I can explain this better in person).
After harvesting, the patient takes a lunch break provided by Capitis Medical & Aesthetics as part of the entire experience. This is usually no more than 30-40 minutes before we bring the patient back into the surgical suite and perform an area nerve block on the next region.
Site making is a critical part of the process and I usually combine Robotic and Manual site making to maximize the efficiency based on each case. The hairline, temples, and crown/vertex are always performed manually as these areas require a careful eye for pattern creation and randomization to create natural and artistically appealing hair design. I reserve mid-scalp and sometimes forelock site making for the ARTAS iX robot where it can use its 3 microscopic cameras to carefully and rapidly create sites without damaging existing follicles.
After the hairs have been extracted from the scalp and been cleaned up by my technicians under a microscope and all of the hair sites created, my technicians carefully place the grafts into their new homes. Just prior to the placement of the grafts, I inject the PRP into the scalp to assist with graft healing and to provide additional hair growth to the existing follicles. I then assist with placement and coordinate the exact areas that certain types of hair follicles should be placed to maximize the coverage and provide the most natural looking hair.
The patient is comfortably reclined and watching TV during this step which is a nice way to complete the day as many times this step can take 1-3 hours as a part of an 8-12 hour day. Up to 3 people will be placing the hair grafts into the scalp at a time to expedite the process but this depends on the size of the case. I am present and reinforcing anesthesia but will come and go from the Surgical Suite at this point in the day.
When the last graft is placed, we carefully bandage your head and start providing you with detailed instructions about aftercare and what to expect. I proved a second copy of post-operative instructions and some medicines that help with recovery. I also send you home with a spray bottle of lipolized ATP that helps feed your newly transplanted hair as they try to reestablish a new vascular supply. This promotes survival and recovery and reduces shock effect to the new hair follicles. Finally, the patient is released and a follow up appointment is scheduled within the first 4 days.
Schedule A Consultation
If you are interested in ARTAS Robotic Hair Restoration and would like to learn if you are a candidate for the procedure, schedule a consultation by calling 916.886.5027 or filling out the contact form below.