Most of the candidates do not know how the procedure is made technically. The briefest explanation is – it is the hair grafts transplantation from donor area (back of the head, between ears) to hairless area. This procedure has two methods: the FUT and the FUE. On this page you will find details on these techniques.
The hair transplant procedure can be divided into three main stages:
- a) Before the hair transplant period. Sleep well on the eve. Have a light breakfast on the operation day (if the procedure is made in sedation, you should not eat anything).
- b) Operation.
- c) After the hair transplant period.
How is the Hair Transplant Made? What are the Stages?
Before moving to procedure details, let us study the stages of the hair transplant operation. This is the operation phase from the moment you enter the hair transplantation center until the end of the surgery. Some procedures can take a few days depending on the number of grafts. On this page, we will describe a one-day hair transplant operation. The same process repeats when the procedure lasts a few days.
- Arrival in the Hair Transplant Clinic
- Preparation for the Hair Transplant
- Design on the Frontal Hairline
- The Hair Transplant (Operation)
- Procedure Finish and Leave
Let us take a look at each phase
Arrival in Hair Transplant Clinic
Here starts the exciting part of your journey. This day you will face a new procedure in your life. If you come from far away, you can have pre-surgery manipulations: tests here like anamnesis, questionnaire, grafts planning, etc. If you do not plan to do the operation in sedation, you need to have a light breakfast. If you have any hesitation, you need to share them with your doctor.
Preparations For the Operation
Some paramedical preparations may need to be done before the hair transplant. Let us look at them in sequence:
1. Hair Transplant Information Sheet
All medical interventions that would be applied to you needed to be presented in written form. This is already a legal requirement. In the attachment you will also find special procedures that are applied personally to you. If you put a signature at the end of the document, this means that you accept all written manipulations and conditions. You can ask for a copy of the document for yourself.
2. Blood Pressure and Heartbeat Check
Being excited before the operation is normal. Your blood pressure and heartbeat will be checked. If there is something abnormal, then your doctor will take necessary measures.
3. Dressing in Surgery Ipron
You need the surgery ipron to avoid stains on your clothes. Take on comfortably and easy undressable clothes for the surgery. Do not dress in a crew neck sweater. You can damage the implanted hair when dressing or undressing. Give the priority to wide collars or buttons.
4. Photo Shooting Before Shaving
The pictures are needed to see the contrast between before and after. If possible, get wet and dry hair photos. These photos are also helpful for the doctor during the operation.
5. Hair Shaving
You will be zero shaved (1mm long). If you agreed for an unshaven hair transplant, you will do a different planning.
6. Photo Shooting After Shaving
It is better to compare the results of the hair transplant when the hair is short. Pictures should be taken under bright light and by professional cameras with high resolution. This is very important to see the results. The clinic may use pictures with a hidden face or not only upon your permission.
7. Hair Wash
Hair is washed with an antiseptic solution before the procedure. It is good in terms of hygiene and also cleans oily hair.
8. Vascular Access Establishment
The establishment of vascular access is a routine procedure in all surgeries. It helps to react immediately in case of an emergency. For example, you may get allergy or rapid blood pressure. The person is monitored this way during the operation.
Frontal Hairline Design
The hairline is one of the most important issues of hair transplants. To design a nice frontal hairline according to face shapes of a person, the doctor needs to have a vision. The naturally-looking hairline is very important. Improper hairline causes disappointment for the patient. We described the hairline design and all its details on the due page. The design must be made before the shaving, after shaving, or before grafts extraction. We prefer to do the planning before or after shaving. Each doctor has his own way. In this picture, you can see the design process of the hairline after shaving.
The Hair Transplant Stages
Once the operation preparations and hairline phases are done, we can move on to the procedure. You are at the excitement peak. Operation phases can be classified as follows. In brief, the answer to the question of how the hair transplant is made is the grafts extraction and their implant.
1) Grafts collection from the donor area
- Marking the Donor Area With a Simple Pen
- Local Anesthesia of the Donor Area
- Extraction of the Hair Follicles (FUT, FUE methods, or hair from the body)
2) Lunch Break. It is advised to have a light meal. The break must last 15-20 minutes because extracted grafts should not be left outside for a long time.
3) Hair Transplant Phase is based on:
- Local Anesthesia of Recipient Area
- Opening the Channels
- Implant of the Grafts Into Channels
Let us have a look at these phases in detail. Since we do not operate with the FUT technique, we will explain the process based on the FUE.
a) Marking the Donor Area With a Regular Pen
First of all, the donor area from where grafts are collected should be marked. Especially, the doctor must be careful with the area above the ears. Marking should not be outside of the so-called safe zone. It is worth remembering that the number of available grafts depends on donor area capacity. Grafts number determination must be made in advance. Usually, the hair on the nape is used as grafts. If the capacity of that area is poor, then hair follicles from the beard, chest, and other body parts can be used.
b) Local Anesthesia of the Donor Area
Local anesthesia is applied in the hair transplant. Some physicians, who transplant from body hair (rare procedure), identify in the literature that they take root from the body under general anesthesia. We do not prefer this approach. For those people who wonder about the operation, the scariest part is anesthesia. Local anesthesia blocks the sensitivity of the nerves in the donor and recipient areas. Such drugs as Jetocain, Marcain, and Citanest are usually used. Resistance to pain is different in every person. It is called the pain threshold.
Pain threshold is divided into three groups.
- High. There is almost no reaction to the injection. Anesthesia is applied easily.
- Middle. There is some reaction to the needle.
- Low. Some people have a very low threshold. They feel straight pain once the needle is injected.
Those people who have a low pain threshold need so-called sedation, the short sleep. The sedation must be made by an anesthesia technician. Unfortunately, it has some complications. We will describe them all in our anesthesia part. Besides, anesthesia pumps, which have become popular recently, also help us in numbing the purchase and planting region. Anesthesia application into the donor area usually lasts 2-5 minutes.
c) Grafts Extraction
The donor area is marked, anesthetized, now the turn is in grafts extraction. There are two fundamental techniques: FUE and FUT. We will explain the procedure based on the FUE. Some doctors prefer collection of the grafts in the patient’s sitting position.
Before explaining the extraction, we would like to define the grafts.
- ● Donor Quality (bad, good, middle)
- ● Grafts Size (short, middle, long)
- ● Grafts Structure (thin, regular, thick). This classification particularly belongs to us. It helps us very much to select the proper punches, their length, and diameter.
Grafts extraction from the area between the ears, chest, or other body parts one by one is called FUE. We dedicated a whole page to the FUE on this website. The most preferred method for the hair transplant operation is FUE. It has two ways of grafts extraction, these are:
- Manuel FUE Hair is extracted one by one by manual punches with a hand. This was very popular at the beginning. Manual punches can be fish-mouthed, round, and U shaped. They extract 1 mm grafts from the skin entering it in certain depth, their rotation can also be easily adjusted.
- Micro-motor. This tool was invented based on the dentist tool model. It gained demand and popularity in the last couple of years. The micro motor lets the punch enter the skin at a certain speed, extract the roots, and let them free.
You can get more information about the above tools on our other due page.
Things to Pay Attention in Grafts Extraction
In both approaches, the manual or automatic there are some points from a surgical perspective to be paid attention to. Let us check these principles:
- Whenever possible, it is better to use the thinnest punches. Punches are selected due to the thickness of the hair follicles, their growth angle. The experienced doctor can easily find an appropriate tool in a few tries.
- If the extraction is made by a micro motor, the lowest speed must be used. If the speed is high, then the grafts may be damaged.
- Collection must be made only within a safe donor area. Especially the area above the ear should be operated carefully. Planning the number of the total grafts has to be made based on the patient’s capacity. Around 25-30% of the hair from every square centimeter is suitable for transplant.
- The extraction must be homogeneous. Moth-like look appears if the collection is not done properly.
- Less grafts must be taken out from the lines marked with a pen. This is to create a very slight transition from donor to regular hair area.
The Hair Transplant Phase
We already divided this phase into three stages, which are recipient area anesthesia, channel opening, and grafts implant. This is the most critical part of the surgery. How the procedure is done remains the most popular question within candidates. Grafts extracted by FUT, FUE, or body hair are stored in Petri dishes.
a-Local Anesthesia (Recipient Area)
Theoretically anesthesia on donor and recipient areas is the same. Moreover, the hair transplant operation may be done in the meantime. In other words, once grafts are collected from the donor area, they can be implanted immediately. We dedicated a page to local anesthesia on this website.
Here we will explain the classic FUE procedure. First of all, channels are opened in the hairless area for implants. These channels are made in the skin with special cutting tools such as a slit or sapphire tip. Some clinics use bladers instead of slits, we do not recommend this. Scalpel tips used to be practiced for opening the channels in the past. Fortunately, they are not used anymore because they result in scarring. Depending on the diameter of the grafts, channels between 0.7 mm and 1.2 mm can be opened. The little diameter is very important to create a dense look. The channel method of hair transplant is no more actual nowadays.
Bleeding is a usual sequence of the channel opening in this method. Some clinics use adrenaline to decrease this bleeding. Adrenaline is one of the major drugs that is used as an emergency medicine in vital situations. It has an astringent-narrowing effect. Therefore, it reduces the bleeding. However, since it narrows the capillaries, it decreases the blood flow, so it may cause malnutrition in the implanted grafts and a condition called tissue necrosis may occur. It also has effects such as increased blood pressure, heart rhythm disorders.
After anesthesia microchannels are opened according to the number of the grafts. The hair follicles are placed into these channels. There are different tools that doctors use to open the channels. The channels are opened with sharp and pointed tips such as a slit or hypodermic needle. Channel opening has two important features.
- Channel depth. The depth control must be made before the operation starts. This is the depth based on the hair roots length. If the roots are implanted too deep, then the risk of the hair not to grow is high, moreover, there may be scars on the skin or hair grows weak and curly. The deeper a channel is opened, the higher is the risk of folliculitis (inflammation) and acne.
- The width of the opened channels (diameter). The very wide channels result in rare looks or skin scars. On the opposite, very narrow channels cause damage to the grafts. This is the disadvantage of the FUE technique. To decrease all risks, channels must be opened according to roots (single, double, triple, etc.).
- The angle of the channels. This is one of the most important criteria in the creation of a natural look. The channels can be opened in two ways as lateral and coronal slits.
Lateral Slit Technique: the angle is lateral. It is easy to find the right angle. It creates a better look than a coronal slit. Lateral channels are opened parallelly.
Coronal Slit: the channels are opened straight. It is hard to create natural-looking hair. However, the root implant is easy. Those doctors, who choose the easiest way, apply to this method. We perform the hair transplant by lateral slits to achieve excellent results.
The slit and its size proportion according to the grafts is illustrated on the picture above.
c- Implants of the Hair Grafts into Opened Channels
Chanel opening time depends on the total number of the grafts. Usually, it lasts for 1 hour. To extend a distance between channels, sometimes, an isotonic solution is injected into the recipient area. This is one of the reasons for swelling after the hair transplant.
1-3 technicians take the hair follicles from Petri dishes and place them into the opened channels one by one with the help of forceps. Single rooted grafts must be placed in the frontal hairline. This is very important for a final natural-looking result. Generally, grafts placed on gauze are held on the back of the hand. Putting too many grafts on the back of the hand can cause the roots to dry out. Forceps must not hold the hair follicle’s root because this damages its structure.
How Does the Hair Transplant Made With the Pen Implanter and DHI?
We are using the most modern hair transplant method. We can confidently state that the best hair transplant method is pen implanter (pen technique). This method is called DHI in our country which is false. There is no such approach as the DHI. It is the name of one clinic Direct Hair Implanter which performs surgeries by the pen implanter. We shared all information about the DHI hair transplant on the due page.
Needle Method (Stick and Place)
This method is very successful in terms of the procedure results. Once a channel is opened with the nozzle tip, a hair graft is placed in this channel at the same time. The doctor operates alone. Dense hair transplant is easily achievable, in the meantime, the cost is pretty low. There is no collective channel opening. As for disadvantages, the maximum number of grafts that can be transplanted in one session is between 1.000 and 1.500. There is also more bleeding than in the pen implanter operation. The doctor does not need many assistants. Stick and place can be considered as the developed version of the pen implanter technique.
End of the Operation and Leaving the Clinic
You went through a difficult period. You must be tired. Once the transplant is done, your hair will be washed with sterile isotonic spray, that cleans the clot residues. Do not get up from the chair right away. Your blood pressure may decrease immediately as a reflex. You can have something, like juice to drink, which refills lost liquid. By the end of the operation, you may feel some pain. Your doctor will cope with it easily. He will apply the bandage to your nape to make some pressure. Do not take it off till the first washing.
You will pay the cost of the surgery that you agreed in advance. In our opinion, payment must be made after the hair transplant. Some clinics require payment before the operation. This is also acceptable. Every hair transplant clinic has its principles.
You will be provided with instructions after the hair transplant. We hand our patients the free of charge kit. Some places charge for it additionally.
What is inside of this kit?
- Mattress cover: take it on before using your bed. It will keep your pillow and sheets clean.
- Travel pillow: You will sleep more relaxed with it.
- Antibiotics: It is not a must in all cases. For example, patients with diabetes may need them.
- Pain Killers: The simplest pain killers are more than enough.
- Medicine against swelling: In general, prednisolone type tablets are very effective for swelling after hair transplantation
- Shampoo: We usually advise to use baby shampoo for 1 month after the operation.
- Washing Lotion: It softens the scabs before washing.
This is the end of the hair transplant operation phase. You can return to your hotel for rest. We recommend you to not go outside, if possible, after the procedure before the very first washing. You can also check.
How is the Choi Hair Transplant Performed?
Dhi Hair transplant – pen implanter technique is also known as Choi method. In short, it is a stick and place procedure without touching the hair roots. It is known as the best hair transplant method. Moreover, it makes unshaven hair transplant very easy.
How is the Best Hair Transplant Done?
With 17 years experience we can state that it is definitely pen implanter. It is the best method for unshaven, natural-looking, and dense hair transplant
How is Natural Hair Transplant Result Achieved?
The most important criteria is natural looking hair. Other people should not recognize that you went through the hair transplant operation. Hair direction determination is very important in creating the natural look. Pen implanter is a great benefit here.
Which One Should I Select the Micro Motor or Manuel FUE?
We think that the tool is not important. More important is who and how he uses this equipment. This question does not bring you to the right results, try to focus on the doctor and his skills.
- Hair Transplantation: Current Concepts and Techniques Walter P.Unger https://doi.org/10.1111/j.1087-0024.2005.10111.x https://www.sciencedirect.com/science/article/pii/S2352587817300372
- Controversies in Hair Transplantation J Cutan Aesthet Surg. 2018 Oct-Dec; 11(4): 173–181. http://www.jcasonline.com/article.asp?issn=0974-2077;year=2018;volume=11;issue=4;spage=173;epage=181;aulast=Kumaresan