Ross Medical Hair Restoration, Inc
"Where physicians go for their hair restoration needs!"
1-(858)-546-0060
This page is intended to be a pictoral guide of the step-by-step process we use to perform our hair transplant surgery at RMHRI. These pictures have been taken on a real patient during an actual hair transplantation. This tour is intended to be purely educational and it may not be reproduced. If you are squeamish, it is advised that you do not scroll further on this page, as some of these hair transplant surgery pictures may be considered disturbing to some people. This patient's name is Alon. He has had 2 procedures of 1,716 grafts and 1,785 grafts, for a total of 3,501 transplanted follicles. The before and after photos in figure 1 clearly illustrates the amazing transformation which has taken place after his 2nd hair transplant surgery. Alon has a new hairline, he looks younger, and he has a much better overall appearance.
The first step in the RMHRI hair restoration process is the complimentary consultation. These usually take 30-45 minutes and include an explanation of the procedure, a scalp analysis to determine what options you have available, a review of other patient success stories, and a Q&A period. It should be noted that the following pictures have been taken during Alon's 2nd hair transplant surgery, which explains why he already has some hair in these photographs.
When you arrive at our office on the day of your surgery, you will review and sign our surgical consent form which indicates your understanding and willingness to have the hair transplant When you arrive at our office on the day of your hair transplant surgery, you will review and sign our surgical consent form which indicates your understanding and willingness to have the hair transplant operation. You will also be offered a menu for your complimentary lunch, as well as an extensive list of movies you may watch during your procedure. You will then be escorted to our operating room #1. In this room, Dr. Ross will again review the details of your imminent surgery and answer any questions you still may have. As shown in Figure 2, the doctor will proceed to outline the boundaries of the hairline and other pertinent areas with a wax pencil. You will have a mirror to evaluate and discuss the location of the hairline such that Dr. Ross is comfortable knowing that the location will provide you with a natural and realistic look in the future, and you are comfortable with the extent your hairline is to be altered.
Figure 3 shows the hairline we have settled on just prior to the hair transplant. Alon has elected to stay on the conservative side by keeping the hairline at a relatively high location. Symmetry is maintained and he has hairline curvatures appropriate for an adult male. It is noteworthy to mention that there is an infinite combination of variables at play when deciding the location of your hairline. No two people have exactly the same facial features and pattern of hair loss. Therefore, each hairline must be uniquely designed to address the needs of each individual patient to maximize our end results.
After all the boundaries have been outlined, Dr. Ross will make you more comfortable by giving you a valium and possibly a small amount of another sedative called versed. These medications have multiple benefits before we begin. Since 100% of patients feel nervous anticipation at least to some extent, the light sedation helps you to relax. In fact, many people fall asleep shortly after we begin hair transplant surgery. The sedative medication also serves as a muscle relaxant to help avoid muscle strain as the procedure moves along. At this point, you also may be given an injection of an anti-inflammatory medication to reduce the chance of any post-operation swelling. Every attempt is made to perform this portion of the hair transplant surgery in such a way that the back of your head will be inconspicuous starting on post-operative day #1. This is not always possible, however, due to certain pre-operative hair characteristics (most notably when the patient"s hair in this region is less than ¼" in length).
Figure 4 shows Alon's donor region after it has been isolated. The scar from his first procedure is visible at this point and it will be entirely removed as part of the new donor strip during his 2nd operation. Dr. Ross always spends the extra time involved during this step to ensure that his patients have only one scar on the back of their heads. The extra 20-30 minutes spent here is well worth a lifetime of having one scar, rather than multiple scars on the back of the head.
The next step is to outline the area which will be removed with a surgical marker. This is illustrated in FIG 5. Measurements will be taken and calculations will be made to ensure that the donor area will be large enough to provide us with the targeted number of grafts. Any additional follicles removed during this stage will be placed free of charge. The length of the incision will depend on the inherent characteristics of your hair. A scalp with a very thick/dense and scar-free donor area will require less scalp tissue to be used than a donor region with scars and/or more diffuse hair. Therefore, the area of scalp to be used will be smaller and the length of the incision will be shorter.
The patient is then escorted into the OR #2, where he/she will be seated in a comfortable massage chair. This position ensures the doctor will have maximum visualization and maneuverability during this portion of the hair transplant surgery. This enhanced visibility affords Dr. Ross the ability to maximize the survival of the follicles and minimize the scar in this area. Harvesting the donor tissue in this manner allows the doctor to minimize the follicle transaction as he makes his incisions, as opposed to harvesting at the awkward angle resulting from the upright situated patient.
Alon is shown sitting in this fashion in Figure 6. He has also had a sterile field draped around his donor region. The wire visible in the picture is part of the electrocautery device used to minimize any operative bleeding which may occur.
After all the prep work has been finished, Dr. Ross will proceed to numb the donor area with a local anesthetic. He generally uses a combination of the short-acting lidocaine plus the longer-acting marcaine. The ensuing 1-2 minutes is generally considered the worst part of your day (tied with the 1-2 minutes required to numb the top of the head). Dr. Ross will place a series of injections in a line just below the donor area. Since the nerves in this area usually travel upwards, this is usually the only place that he needs to numb. The local anesthesia used in this step is similar or identical to the anesthetic used when the dentist numbs the mouth. The injections can be described as the feeling one would have receiving a series of quick ant bites or bee stings.
Once the area has been numbed, Dr. Ross will begin making the incisions along the marked lines in order to remove the donor tissue for grafting. This stage should be completely pain free and many patients fall asleep at this point. Once the doctor has removed this section, the tissue is immediately put into a chilled sterile solution and transferred to the cutting room for dissection by the medical assistants. Figure 7 shows Alon's donor tissue immediately after it has been removed. Again, note that his previous scar can be visualized in the new donor strip.
Dr. Ross proceeds to carefully suture the incision closed. Again, he takes his time with his closure, as this step is very important to ensure minimal scarring. Figure 8 shows Alon's incision immediately after the incision has been closed. The suture line is visible only if the hair above the area is moved out of the way. Figure 9 shows the same area, only with the hair covering the incision.
Once we have finished closing the donor incision, we are all done with the back. You will have a pressure bandage placed over the area, and then be escorted to the 3rd and final OR. This room is where you will spend the bulk of the day. The room is large and comfortable, with a large reclining chair and a big screen TV with surround sound. You will be provided with a list of over 300 DVDs to choose from for your entertainment while we work. Figures 10 and 11 show Alon situated in this room.
The next step, unfortunately, is the other 1-2 minutes when you will experience discomfort. Similar to earlier, the doctor must now perform a series of injections of the local anesthesia. This time the anesthesia will be placed just below where the hairline has been placed. This series of injections will usually numb the entire top of the head, as the nerves come directly from the front in most people. For the next few hours of the hair transplant surgery, Dr. Ross will proceed to make all the tiny "recipient sites" where the grafts will be placed. Each graft will require its own tiny incision for it to grow. Dr. Ross takes his time while making the sites, as this step is critical to the final outcome. The grafts must be made at the proper depth, angle and location for the hairs to look natural. This is one of the parts of the procedure that distinguishes Dr. Ross from many other hair transplant physicians. Again, it must be done correctly for the results to be good.
Figure 12 shows Dr. Ross as he is making recipient sites for Alon's hairline. The instrument the doctor uses to make the slits is called a NoKor needle, and it resembles a very tiny scalpel on the tip of a needle. Figure 13 shows a picture of a NoKor needle to illustrate its relative size.
After Dr. Ross has finished making all of the recipient graft sites, you will enjoy a short lunch break. After lunch, you will have 2-3 medical assistants placing the follicles into their sites. This step will also likely take several hours. Figures 14-16 show Alon's scalp after the doctor has made all of the recipient sites. Once the grafts have all been placed into their corresponding sites, the hair transplant surgery procedure is completed. You will come back approximately 10 days later to have your stitches removed, and then the tough part is all finished. From this point forward, all you have to do is be patient as your hair grows in.
The sooner you decide to undergo hair transplant surgery, the sooner you will see and benefit from the results! Contact Ross Medical Hair Restoration in La Jolla, San Diego today.