Microscopic Follicular Unit Hair Restoration, Hair Transplant

Hair loss is a condition that affects, at some point, nearly 100% of the population. While patterns and causes differ, both men and women are at risk for hair loss. Hormones, heredity, scars, and vitamin deficiencies can, together or separately, be at fault.

St. Louis hair replacementEarly hair loss is often manageable with medical therapy with Rogaine (minoxidil), Propecia (finasteride), special shampoos, and low level laser devices. Each of these has proven benefit in arresting hair loss, and some of these treatments have been proven to actually regrow hair.

In patients who have already lost significant hair, however, medical therapy is not, by itself, usually sufficient to recover bald areas or rebuild a receding hairline. In these cases, as well as in cases of surgical scars with resultant hair loss, microscopic follicular unit hair transplantation is often the best option.

During a hair transplant session, sturdy, growing hair from the back of the head is transferred in 1 to 4 hair groups to areas of the crown, midscalp, or hairline, where it is needed most. Due to the advanced techniques used, the area where the hair was “borrowed” generally heals almost invisibly (even with very closely-cropped hair), and the newly growing transplanted hair looks natural, with no “hair plugs,” “clumped,” “bristly,” or “doll’s head” appearance.

Dr. Nayak performs his hair restoration procedures in his office AAAHC-accredited operating suite under local anesthesia or mild sedation. For patients who would like to be more deeply sedated or fully asleep, Dr. Nayak prefers Frontenac Surgery and Spine Care Center or Des Peres Hospital.

The Consultation

During your consultation for hair restoration, Dr. Nayak will ask you about your hair loss history and your family history of hair loss. He will also review what, if any, therapies you have used in the past, and what therapies you are willing to use in the future to achieve maximum results from your hair transplant.

Dr. Nayak will then review your medical history form, and may ask for some additional information from you. Current and past smoking habits, or the use of nicotine gum or patch products, are especially important to mention to Dr. Nayak during this part of the consultation as nicotine dramatically reduces the chances of proper healing. Dr. Nayak will also pay special attention to parts of your medical history that need to be considered carefully when undertaking face lifting surgery, such as uncontrolled high blood pressure, or any medications or supplements you may take that thin the blood. In general, all over-the-counter pain/fever reducers (except Tylenol) are off-limits for 2 weeks before and after facelift surgery, as are ginkgo biloba, St. John’s Wort, or high doses of fish oil, flax seed oil, or vitamin E.

The Physical Examination

Dr. Nayak will then examine your scalp to determine exactly what must be corrected to achieve optimum results. Your extent of hair loss will be determined, as well as areas that are on the verge of losing hair. Your donor area will also be examined to estimate how much hair is available for transplantation, and your scalp looseness will be assessed. Dr. Nayak will then discuss with you which areas are most important to restore to meet your goals, and to create the most natural finished result.

The Preoperative Visit

Once you have decided to undergo hair transplant surgery, Dr. Nayak’s staff will help you schedule your surgical date, and, about 2 weeks preceding that, a preoperative visit. Expect to spend about 90 minutes in the office on the day of your preoperative visit. During this visit, you will be educated on before instructions, after instructions, and prescriptions. Written copies of all of these will be given to you at this visit, as well, and you will be able to fill your prescriptions ahead of time. You will also be reminded at this time to avoid for 2 weeks before and after surgery any medications and supplements that thin the blood.

Also at the preoperative visit, your private preoperative photographs will be taken, the surgical consent form will be read to you, and you will have an opportunity to discuss with Dr. Nayak any questions you still have remaining. Finally, at the conclusion of this visit, the balance of your surgical, facility, and anesthesia fees will be due.

The Surgical Visit

In general, you will be asked to arrive at 7:30 AM the morning of your planned surgery. If you are having your surgery at an outside facility, you may be asked to arrive earlier. You should have nothing to eat or drink (not even water, candy, or gum) after midnight the night before your procedure. If Dr. Nayak prescribed antibiotics, oral sedatives, or if you take blood pressure medication in the mornings, you may take these with a small sip of clear water.

You will need an adult driver on the day of your surgery to bring you and to take you home. Your companion may wait in our comfortable reception area, watching TV, reading, and enjoying coffee, soda, and snacks. Alternatively, if your companion wishes to leave a cellular telephone number, we can call him or her with updates and also at the conclusion of the procedure.

Upon your arrival, Dr. Nayak’s staff will greet you and review your medical history, looking for any new changes since your initial consultation. Dr. Nayak and his staff will also confirm that they and you are in agreement about which procedures are to be performed, and those areas will be marked with you sitting upright in a chair. If you are a woman under 50 and have not been surgically sterilized, a urine pregnancy test may be performed. In any case, you will have one last opportunity to have last-minute questions answered and use the restroom, and will be escorted to our AAAHC-accredited surgical suite.

Once there, you will be positioned comfortably in either a seated or face-down position. Pillows and warm blankets are available if needed. You may also bring your own iPod or CD’s, or listen to our choice of soothing music.

Painless blood pressure and oxygen monitors will be placed on your arm and finger, and massaging air-filled stockings will be placed on your legs and thighs to encourage excellent circulation while you are lying down. Most patients truly enjoy these stockings and find them very soothing.

Dr. Nayak and his staff will then perform one final “time-out” aloud to ensure they are about to embark on the appropriate procedure on the appropriate patient. Your scalp will then be slowly, gently numbed with local anesthesia, and sterile towels will be placed around your scalp and neck.

By this time, most patients feel very relaxed. Once numb, the majority of patients actually fall asleep intermittently. Those who do not remain relaxed but awake, and Dr. Nayak and his staff get the welcome opportunity to talk with you during the procedure.

The hair to be transplanted will then be removed from the donor area at the back of the head, and and the donor area will be meticulously closed to produce the finest, most imperceptible scar line possible. At that point, you will be allowed to return to a seated or face up position, and have breakfast, use the restroom, read a book, or take a nap while the individual microscopic follicular unit grafts are prepared. When the follicular unit grafts are ready, they will be placed into individual needlestick slots – 1 to 4 hairs per slot, in a very natural pattern – in the previously-numbed hairline, crown, or other desired area. This process is very detailed, and can take several hours. You will have the opportunity to eat, watch TV or movies, read, or nap during this process. At the end, a loose wrap or cap will be applied to protect your new hair.

Your Recovery – Day 1

At the conclusion of your procedure, Dr. Nayak will tell your companion how everything went, and he or she will have the opportunity to see you. You will have essentially no bruising or swelling at this point, and your only dressing will be a loose wrap or cap on top of your head.

You will be asked to spend 1 hour with us prior to being discharged. Dr. Nayak will call you the evening of the procedure to check on your progress, and you will also be given Dr. Nayak’s personal cellular phone number in case questions should arise after hours or on the weekends.

Your Recovery – Week 1

Most patients feel no pain whatsoever immediately after surgery. Many patients find they nap intermittently the first afternoon. Later in the evening, most patients report a mild to moderate headache and/or feeling of tightness in the scalp. This sensation is greatly aided by pain medication, and is generally gone by the next morning.

Most patients take their prescribed pain medication for 24-36 hours after the procedure, and then switch to Tylenol – all other over-the-counter pain preparations are off-limits. Many patients take Tylenol alone right from the start.

On the day after surgery, you will have the option of returning to Dr. Nayak’s office, where he will remove your dressing and examine your face to make sure you are healing properly. Alternatively, you may remove the dressing yourself at home. You should bring a baseball cap with you that day to wear home.

You will be able to shower and get all sutures wet the first day after surgery, as soon as you have your dressing removed

Most patients have very little visible bruising or swelling, and many return to work in only 2-3 days. Those who have hairline restoration may notice swelling around the 3rd day, often in the forehead and upper eyelid region, which has usually resolved by the 5th to 7th day.

On the 9th or 10th day after surgery, you will return to the office for a painless suture removal visit.

Your Recovery – Long Term

Over the ensuing weeks, most patients notice their newly-transplanted hair will “fall out.” Some of the surrounding, original hairs may also fall out or thin due to a phenomenon called “shock.” While this is very distressing when it happens, it is entirely normal, temporary, and expected. Over 2-3 months, both the new and old hairs begin to grow again, and full thickness is evident around 12 months. The newly-transplanted hairs are, at this point, generally permanent, and even more resistant to balding than the hair that was originally present!

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