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Dr Serkan AYGIN

Hair transplantation is generally performed under local anesthesia. Naturally, the first questions that come to one’s mind are: Is painless hair transplantation possible and is it a very painful operation?

Ultimately, in hair transplantation, the process of both extracting and grafting of hair follicles will require surgical interventions. Still more confounding questions will also come to one’s mind as: What are the levels of invasiveness of these interventions? Do these interventions exceed the human pain threshold? Before giving the answers to all these questions, it is necessary to talk about the stages of hair transplantation in detail.

Stages of Hair Transplantation

Hair transplantation basically consists of four stages. Below, the stages that constitute the essence of the operation on the day of operation are listed.

These are:

1. Administration of local anesthesia (The most important stage of hair transplantation where you will feel pain)

2. Graft extraction from the donor site

3. Recipient site creation (in DHI method, this stage is combined with the next stage)

4. Placement of the grafts (local anesthesia is administered before the transplantation process).

First Stage: Local Anesthesia in Hair Transplantation

Local Anesthesia in Hair Transplantation

This constitutes the basis for pain-free hair transplantation. In order to extract hair follicles from the scalp, they must be separated from the surrounding dermis with the aid of a micromotor. Performing this stage will naturally require anesthesia.

A local anesthetic agent will be administered to provide loss of sensation in the area to be treated, which will prevent the patient from feeling pain. From this aspect, hair transplantation can be considered as a pain-free procedure. Only minor pain of needle sticks will be felt during the injection of anesthetic solution. Pain-free hair transplantatio, indicates that the process of administration of local anesthetics is pain free. Two basic approaches can be applied to eliminate the pain of local injection. These are:

Needle-free local anesthesian and Local anesthesia with sedation. In the procedure of needle-free local anesthesia, local anesthetic agents are delivered under the skin with the aid of a mechanical pressure device. As the process eliminates the insertion of fine needles into the skin, local anesthesia is applied without causing any pain. Another pain-free hair transplantation method is the application of local anesthesia under sedation. This method is applied if the pain threshold of the patient to be treated is really low. Prior to the operation a soothing drug is given to the patient through venous route so as to relax him/her. Afterwards, local anesthesia can be applied with or without using needles. From this perspective, pain-free hair transplantation is associated with the pain-free application of local anesthesia.

Second Stage: Graft Extraction from the Donor Site

Follicular units are collected by extracting them from the skin with cylindrical incisions with the aid of a micromotor. Here, the diameter of the terminal end of micromotor is at least 0.6 mm, which depends on the individual's hair thickness and the extraction of single or multiple grafts. Grafts can be harvested with cylindrical needles called punches having calibers of 0.7 mm, 0.8 mm or 1.00 mm.

Third Stage: Recipient Site Creation

The recipient sites where the harvested follicular units will be placed in, are opened with metal slits and more sophisticated sapphire blades.

Sapphire blades are smoother and cause less damage to the skin.

The recipient site creation process is the most important phase of the operation which determines the overall success of procedure.

Angles and directions of hair growth should be determined very carefully when creating the sites where the grafts will be placed in. In this way, transplanted hair grafts may yield a natural-looking hair pattern.

With the implanter used in the DHI method, the grafts can be placed with the needles that also plant the hair roots without opening the channels.

Fourth Stage: Placement of the Grafts

Grafts are placed in the previously created sites. As a critically important issue, the sites should be created in the right direction. If the sites are not created in the proper direction, then the transplanted grafts cannot have a natural appearance. Additionally, the hair follicles are placed in the sites at an angle in parallel with the angle of the constructed recipient sites.

Another critical point at this stage is to determine the sites where single or multiple grafts will be transplanted. The basic principle here is to transplant single grafts in the front rows. With this precision, the natural look may be achieved more easily.

Generally hair transplantation is performed in these four basic stages.

Painless Hair Transplantation

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