The Technique
Today, there are two fundamental approaches to hair transplantation.
The first—which seems to be the most popular among Quebeckers—consists of grafting follicular family units. In the vast majority of cases, two sessions are required at a one-month interval.
The second approach consists of grafting pure follicular units. The transplantation can be done during a single session and, on average, it is possible to transplant 40 to 45 follicular units per square centimetre. With this option, very high numbers of grafts are transplanted, in the order of 3,000 to 4,000 in the case of a large surface (≥ 100 cm²).
Both approaches yield excellent results, and the choice is strictly personal and left to the discretion of the patient (although it is discussed at length during the consultation). The decision may be influenced largely by certain factors such as the duration and cost of the surgical procedure.
Full local anaesthesia ensures that the patient suffers no pain during the procedure. A needleless jet is used to ensure the patient remains comfortable throughout the procedure and bleeding is minimized.
If applicable, the two initial sessions are scheduled 4 to 5 weeks apart and the number of grafts transplanted per session may greatly vary from one patient to the next. As a general rule, two sessions are necessary to ensure adequate area coverage.
A follicular family unit transplant cannot be completed in a single session despite the claims of certain hair treatment representatives. A single session produces acceptable results, but they are far from excellent. This must therefore be factored in when considering hair transplantation. Also, the number of grafts cannot be used for comparative purposes given this number varies greatly from one patient to the next and even from one physician to the next.
In fact, the goal of the transplant is to achieve optimal results and greater volume while using the lowest number of grafts possible.
In most cases, new hair will appear on the surface from 12 to 16 weeks after the transplant. Thereafter, they will exhibit normal growth, i.e., approximately 1 cm per month.
We meet again with the patient 6 months later to determine if touch-ups are required or if more volume is needed.
During the initial consultation, the discussion will focus mainly on the patient’s motivation, state of health, specific baldness problem as well as possible treatments. If micrografting is the solution that will give the most satisfaction, we will take the necessary steps to develop the appropriate surgical procedure. The procedure will be explained to the patient in detail and it will only be carried out if the probability of success is high.
Hair transplantation is an extremely specialized field of medicine and is constantly evolving; it is therefore important to choose the right physician to carry out the procedure because the result of his or her work will be permanent and irreversible.
Surgical Steps:
1) Drawing the hairline
Drawing the hairline is an important step because it determines the height and shape of the transplant. It should be in keeping with the shape of the patient’s face and especially his age. If the hairline is drawn too low or in the shape of a heart, for example, it will look unnatural and be noticeable.2) Preparing the donor area and administering anaesthetic
The hair is first cut short in the area where the donor follicles will be extracted. The size of the donor area will vary according to the size of the recipient area. Note that the hair is kept 1 to 2 mm long so that the direction of growth is perceptible and the hair can be transplanted in the right direction. Anaesthetic is administered using a needleless jet, which greatly increases patient comfort during the procedure. Painful needle pricks in the scalp are a thing of the past.3) Extraction
Once the anaesthetic has taken full effect on the donor area, a thin strip of hair is removed. The scalp is then closed using staples or a suture that will need to be removed within 10 to 15 days. The staples or suture in combination with the trichophytic closure technique enable us to produce virtually invisible results. The trichophytic closure technique is a highly ingenious method that enables us to hide the scar with new hair growth once healing is complete. It renders follicular unit extraction (FUE)—whereby follicular units are extracted one by one from the donor area—obsolete.The patient remains seated throughout the procedure and may even choose to pass the time watching TV.
4) Preparing the micrografts or follicular units
The thin strip of hair is then dissected into tiny sections called micrografts or follicular units. This step, which requires the use of microscopes and lenses, is one of the longest of the entire procedure. We work with a team of ten or so assistants and a nurse to maximize chances of success. At this stage, you may choose either to remain present or take a break in the lounge area while watching TV or a video.5) Transplantation to the bald area
After needleless administration of the local anaesthetic, hundreds—even thousands—of tiny slits in the right direction and angle are made in the bald area to receive the grafts, which have been cleaned beforehand. Grafts are inserted using microsurgical forceps, so bandages are unnecessary. Patients can drive home and most likely return to work the next day.Our vast experience enables us to adjust or change the approach according to each patient rather than systematically using the same technique on all patients. The goal is to obtain the most natural looking graft and the most volume possible while keeping costs to a minimum.