Yes and no. Yes, because the procedure requires meticulous precision and intelligence in both short and long-term strategies. No, because the technique remains mild, not very bloody, without operative side effects, and is practiced in an ambulatory under local anesthesia. Since the scalp contains few vital elements (arteries, nerves, etc.), there is little concern over avoiding vital parameters, thus defining this procedure as non-surgical.
In general, the operation takes place under strict local anesthesia, which could even be considered a superfluous luxury. We are personally used to working in collaboration with anesthesiologists whose role is to keep an eye on the patient at the beginning of the operation and to perhaps eventually administer a light sedative to help the patient handle prolonged immobility, not pain.
Time passes quickly while the patient rests and sleeps during the operation. This helps the patient bear a long session of 1,000 micrografts for example. The presence of an anesthesiologist is therefore desirable depending on the case. A complete and rigorous pre-operative consultation will determine the type of intervention suitable to the patient.
Local anesthesia is sufficient in all instances. As discussed earlier, it may be useful to administer a light sleeping agent to enhance the anesthesia's effect, make the time pass faster, and reduce inevitable pre-operative anxiety, which is quite natural during the first session.
But from the second session on, the intervention, being completely painless, takes place according to normal protocol in a calm setting. All anxiety experienced during the first session totally disappears.
A stronger anesthetic may be administered in certain cases, especially if the patient is very sensitive. This decision is made during the first pre-operative consultation. The operation is painless even if the patient does feel the first injections of local anesthesia. It is possible, however, to diminish the pain of these injections by applying anesthetic creams to the injected zone or by using certain machines that make the injections practically painless. The rest of the operation, which entails the removal and transplantation of skin grafts, is strictly painless. We have never had a patient complain of pain, except discomfort related to being badly positioned on the operating table. In general, men, who have a reputation of being overly sensitive, are happily surprised.
While there is no such thing as 0 risk, it is seriously limited by the expertise of an experienced team as well as the use of local anesthesia. Since the patient never falls asleep, he/she is monitored throughout the operation and afterwards in a recovery room. Furthermore, emergency-response material is immediately available during the operation if the slightest problem arises. Micrografting is a very minor procedure, similar to a simple tooth extraction. It is simply longer.
Depending on the case, the grafted hair will be about 1 cm long in two or three months. It will continue to grow without ever falling. This is a specific characteristic of hair originating in the crown area, genetically programmed to live forever. The result is natural looking and aesthetically perfect.
There is no age requirement; it is more a question of warning indications related to the balding prognosis. For all patients under the age of 25, a capillary summary report is compulsory. The procedure is recommended for patients between the age of 25 and 35 and also useful afterwards.
For the most part, hospitalization is useless. The majority of competent practitioners complete micrograft interventions in specialized medical offices equipped with operation tables and recovery rooms. These offices must possess all necessary equipment and emergency-response material in case of possible complications. These include mainly a cardioscope (a machine that monitors cardiac frequency and heart rhythm), an oxygenmeter (a machine that monitors the patient's oxygen levels), and a defibrillator (a machine that responds to any cardiac rhythm complications). It is also expected that the office be equipped with all necessary sterilization materials and be in rigorously aseptic conditions. Dr. Ghalib personally prefers to operate in her clinic, assisted be a fellow plastic surgeon for the graft removal.
The length of an operation varies according to the number of micrografts transplanted during one intervention, the number of assistants who prepare the grafts, and the number of assistants helping the doctor during the operation. The length also depends on the candidate's patience level during the session. This, in turn, depends on the conditions under which the intervention takes place: comfort, information, kindness, etc. Generally speaking, a trained practitioner aided by 2 experienced assistants can complete a transplantation of 300 to 400 micrografts in a matter of 2 hours. When it comes to larger interventions of 500 micrografts or more, it is preferable to have 3 assistants in order to expedite the process. Under such circumstances, it is possible to complete 600/800 micrografts in about 3 ½ hours and 1,000 micrografts in about 4 hours, give or take, depending on the case.
Micrografting and follicular microtransplantation are quite similar. These are the best techniques: implantation of follicular units of hair (1 or 3 hairs per microtransplantation).
What position am I in?
In all cases, but especially long sessions, it is essential to assure the patient's comfort. Patients sit in special chairs for flap removal and capillary microtransplantation. We can remove flaps and graft the patient in the same chair during a normal session (less than 400 micrografts), which makes the operation much more comfortable. For mega sessions, we prefer that the patient lay stomach-down on a table with an opening for the face. This position may be slightly less comfortable, but it allows us to remove flaps from a larger surface area. Furthermore, it allows the patient to loosen up and better relax.
Does the doctor work alone?
The doctor works badly when alone. Current techniques make it impossible for the doctor to work alone; two or three assistants are necessary in order to help cut and prepare the micrografts, a long and meticulous task, which may take 2 to 4 hours. These assistants intern for long periods of time before becoming fully functional alone. Oftentimes, the team consists of two well-trained persons supervising the training of one intern. Thus, the team ensures quality work throughout the session. The doctor must always check the quality of work and continue informing and training his/her team in order to sustain motivation.
What are the different stages of the session?
First, the productive zone is shaved; shaving is essential to the rest of the operation and should be strictly limited to the area from which flaps will be removal. It is sometimes difficult to avoid touching neighboring hair, but if we pull them out and carefully hold on to them during the operation, we can replace them at the end so that they instantly cover the remaining stitches. Then, with the patient seated or laying stomach-down, the removal is completed. Once the stitch is in place, there is a rest period. Afterwards, local anesthesia is injected into the area to be treated. Micro slits are made for the implantation of the grafts, which, in the meantime, have been cut and prepared by the team. During the final part of the operation, the micrografts are implanted one by one. The patient is then placed in a personal recovery room in order to relax; he/she will spend one or two hours under our supervision and receive a light meal. The patient can generally get home alone, but should not operate a moving vehicle after receiving anesthesia. Almost immediately, the patient can take up normal activities.
While it is difficult to predict the future, an exhaustive questionnaire, a trichogram, and a phototrichogram help us establish a Computerized Capillary Summary, which allows us to make a near prognosis.
The scars are perfectly discrete, even invisible a few months after the operation. They may also be concealed by surrounding hair immediately after the intervention, but will remain forever.
Surrounding hair immediately covers the wound; scarring takes place within 1 to 3 months.
Tiny flakes are visible 8 to 15 days after the operation; then they are hidden by your own hair, eventually becoming totally invisible.
This operation should be largely sufficient. However, you should pay attention to the evolution of your hair loss; it may necessary to perform additional sessions. A good doctor tries to make a diagnosis of the evolution of your hair loss in order to propose an operation strategy adapted to your specific situation.
There is no danger. In fact, the major advantage is that results last for life. However, if the operative strategy isn't pre-established, results may be aesthetically deceptive if the productive zone weakens and hair loss grows. Hair restoration surgery isn't intended to fill large holes at a certain period, but rather treats what is known as Coherent Global Units (CGU).
Yes.
Restoration begins 2 to 4 months post-operation. The speed of hair restoration is 1 cm per month. Thus, 6 to 12 months are necessary before results are visibly optimal.
