How long does a hair transplant procedure take?

Amount of grafts transplanted per day during a hair transplant procedure

In my practice we comfortably manage 2000 grafts per patient per day and up to 2500 grafts per patient per day. We can do 3000 grafts per patient per day but mostly I prefer to do cases in excess of 2500 grafts over two days. The first day we do 2000 grafts or 2500 grafts and the next day we finish off with 1000 or 500 grafts. So the second day is basically a half day. In other cases where we transplant 4000 grafts or 5000 grafts the spread would be more even by doing 2000 to 2500 grafts on each day over two days.

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Follicle unit graft care and preparation for transplantation

A very important factor in achieving optimal results is taking great care of the follicle units during the procedure. This means several things: Firstly we don’t want to injure the grafts during the harvesting process, therefore we minimize transection either via FUE harvesting or cutting grafts under Stereomicroscopic magnification from a FUT strip harvest. We also take great care not to expose the grafts to air for any length of time to prevent dehydration and keep them submerged in storage solution which includes Normal Saline as a basic solution combined with Hypothermosol; Liposomal ATP and Bepanthen. The grafts are stored in petri-dishes containing the storage solution mixture which in turn is kept at 4 to 5 degree Celsius temperature.

We also want to minimize the “out-of-body” time, so the grafts are placed into the recipient area incisions as soon as possible in order to maximize survival. When grafts are harvested from the body’s donor area, the temperature of the tissue is 37.2 degrees Celsius and then starts cooling down to the storage temperature which is around 4 to 5 degrees Celsius, and similarly when placing the grafts into the recipient area the graft temperature increases from 4 to 5 degrees Celsius to 37.2 degrees Celsius once back into the recipient sites on the scalp. We take great care with creating a gradual transition in temperature from 37.2 Celsius to 4 or 5 Celsius and back to 37.2 Celsius. So when grafts are harvested, they are immediately submerged into a graft storage solution to prevent dessication (dehydration), but we let them cool down to room temperature 19 degrees Celsius over a 30 minute to 60 minute time frame first, after which they are cooled down further to 4 and 5 degrees Celsius and the same process of gradual increase in temperature is followed after graft storage before placing the grafts. The main reason for this is to diminish the “shock” effect of rapid cooling and rapid warming as this increases the incidence of Ischaemic Reperfusion Injury (IRI) which results in tissue damage with release of free radicals, reducing graft survival. Hypothermosol is used as an organ storage solution and we use it in hair transplant surgery because it benefits graft metabolism outside the body and so also does Liposomal ATP. These products help to diminish the effects of anaerobic metabolism (low oxygen metabolism) that reduces graft survival. So there are several things we do to optimize the graft survival during the graft preparation and storage process prior to grafts placement. All the time we work against the clock to get the grafts placed into the recipient sites as soon as possible, but also take care in treating the grafts with the utmost care and respect. Furthermore, during placing of grafts great care is taken to prevent physical injury and also to ensure they are not exposed to air for longer than 30 seconds. We do manual placing of grafts and placing via Follipens. The Follipen is loaded with a graft and then the graft is placed into a recipient site via a trochar plunging delivery mechanism. Follipens encase the grafts and provide physical protection to grafts and in the right hands are the safest way of preventing graft injury during placement.

The most important factors that influence how long hair transplant procedures take

So all these factors play a role in the length of time that a hair transplant procedure takes. To recap, the most important factors that would influence the procedure time are:

  • Experience and competency of the surgeon and his team
  • The number of follicle units (grafts) that will be transplanted
  • Whether the recipient area is shaved or not
  • Patient selection and pre-operative evaluation and assessment of pre-morbid conditions, such as high blood pressure and how well it is controlled; also, is the patient taking Aspirin or Warfarin or any other vitamins or supplements or mediations that may affect the bloods clotting profile
  • The presence of popping (some patients have a more “oily” type of serum due to possibly the sebum composition from the sebaceous glands); Increased hydrostatic pressure also plays a role as well as degree of scalp laxity
  • The presence of more than average bleeding during surgery (factors that increase intra operational bleeding are – taking alcohol within 7 to 10 days of surgery date; Aspirin; Warfarin; Vit E and other vitamin supplements)
  • The comfort of the patient during the procedure. Patients who are comfortable and who experience no pain are more relaxed, with a normal blood pressure and pulse.
  • Avoiding tight head bands and regulating the theatre temperature (relatively cooler) and making sure the operating lights don’t generate heat on the scalp and the patient’s head position all play roles in increasing or diminishing bleeding.
  • Using diluted adrenalin mixed with Tumescence and local anaesthetics used in the scalp intermittently during the procedure in order to create a relative and temporary vaso-constriction that minimizes bleeding of the scalp. This is a medical way of manipulating the scalps vasculature via a combination of the vaso-constrictive effect of adrenaline on blood vessels and also the pressure effect of Tumescence (Normal Saline) on tissues
  • Ensuring a good fit between graft size and recipient area incisions by customizing incision site calibre with graft calibre.
  • Staying superficial to the subcutaneous vasculature in the dermis by using adequate Tumescence and elevating the scalp from the vascular plane and making relatively shallow and angled incisions

So there are several factors to consider and monitor during a hair transplant procedure that can influence the length of time it takes to complete the procedure. Careful attention needs to be given to all of these.

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