Hair Transplant is a surgical operation that should be performed with a multi-disciplinary surgical approach, examining the patient as a whole. It should not be simplified in any way, and all necessary research and planning should be done beforehand.
The patient needs to find a team that is specialized in sapphire hair transplantation, follows the developments in the world, has knowledge about hair loss and hair loss treatments, and can arrange not only surgical but also supportive treatments.
In Smile Hair Clinic, our doctors determine the hair loss types of patients and the areas that need treatment on the scalp, and plan the sapphire hair transplantation operation. Our patients come to the clinic on the morning of the hair transplant operation, immediately after the operation, they sign detailed informed consent forms about the hair transplantation and give the infectious disease panel tests required for safety of the patient and surgical operation.
The tests checked at this stage are Hepatitis-B, Hepatitis-C and HIV tests. Later, our doctors give a detailed briefing to our patients about hair transplantation operation, hair transplantation stages and details of the procedure, expectations regarding the result and the approach of our clinic.
Then, patients are transferred to the rooms where hair transplantation will be performed. During the one-on-one consultation, determination of the type of hair loss and areas of loss, determination of the donor area, and the estimated number of grafts, root features, age, head anatomy and aesthetic appearance are determined by considering the areas to be transplanted.
Each factor that will lead to success in hair transplantation is carefully evaluated and patients are clearly informed about the possible results, and drawings are made by considering the wishes of our patients. Afterwards, whether the patient should be operated with or without shaving is determined.
If shaved transplantation is decided, the medical personnel will shave all the hair. If unshaved hair transplantation is decided, only the donor area is shaved. Before the operation, healthcare professionals measure blood pressure and other vital signs, add them to medical file of the patient and inform the responsible hair transplant surgeon about the results.
How to create a natural hairline with FUE Hair Transplantation Method?
In hair transplantation, the hairline of patients has been determined according to Leonardo Da Vinci’s golden ratios or the criteria of various institutions, for many years. Despite these criteria, the surgeon who will perform the sapphire FUE procedure should remember that each patient is unique.
Thus, he should carefully evaluate the hairline of the patient, the patient’s age, head anatomy, ethnic origin, and how the patient wants to see himself, and design a natural and satisfactory hairline. If the area to be transplanted on the head of the patients is very large (the number of grafts is usually less in these patients), a more conservative, higher line should be determined in order to achieve a natural hair appearance and satisfactory density.
If it is thought that a sufficient number of grafts can be taken from the donor area with the FUE technique and hair loss can be covered at the desired rate, a suitable hairline can be drawn lower side of the forehead. Before hair transplantation, a design suitable for the shape of the patient’s face should be made from the front side while drawing the hairline. White race, Asian type face, African type face lines are different and they can be flat, oval, curved.
Under normal conditions, the hairline should start 6.5-7.5 cm above the eyebrows, and a hairline that starts in this range is drawn before hair transplantation in people with low hair loss. Although it is important that the hairline looks good from the front, it is absolutely necessary to evaluate how it looks from the patient’s eye with the help of a mirror and hair transplantation should be started with the patient’s approval.
It should be ensured that the hairline that will form after hair transplantation looks natural, by adjusting the side view of the hairline slightly upwards. If the age of the person to be transplanted is old, the temporal regions should be higher, and the side hair and front hair should be combined in the area where the separation is.
Another factor to consider while designing the hairline for hair transplantation is the muscle structure of the forehead, which can be easily detected by the patient raising the eyebrows. The evaluation of this muscle structure plays an important role in creating a natural line by providing information with the previous hairline, the ideal planning is to start the line just above this muscle structure.
Another helpful factor while planning the hairline for the surgeon who will perform hair transplantation is the photographs of the patient before the hair loss. Planning for hair transplantation by evaluating all these variables is a skillful process. An experienced hair transplant surgeon puts this plan into practice by taking into account the regional hair aspects during the incision/canal phase.
hair transplantation is an operation that requires the skill of not only the responsible surgeon, but the entire team. Although everything goes well, if grafts with multiple hair follicles are transplanted on the front line, unfortunately, it is not possible to achieve a natural appearance. For this reason, grafts containing a single hair follicle must be planted in the canals in the front line.
Stages of Sapphire Hair Transplantation
Sapphire hair transplantation process consists of three stages. These are Reception, Canal Opening/Incision and Planting. Sapphire hair transplantation is performed through local anesthesia, which means that a certain area is numbed with medications given under the skin.
Local anesthesia ensures that the patient does not experience any pain during hair transplantation and the procedure is performed comfortably. Sapphire hair transplantation operations take approximately 6-8 hours, local anesthesia takes approximately 15 minutes, and patients do not feel pain after the local anesthesia. A total of two local anesthesia is applied to the patient who will have hair transplantation, the first one is applied before the extraction phase and the second before the incision phase.
1. Intake (Extraction) Duration: 5-15 minutes Pre-operation 1.5-2 minutes Local Anesthesia
2. Canal Opening (Incision) Duration: 1 – 1.5 Hours Pre-operation 5-15 minutes Local Anesthesia
3. Transplantation (Implantation) Duration: 1.5-2 Hours
Total Sapphire Hair Transplantation Time including preparation and waiting: 6-8 hours
This phase is the most difficult phase for patients having hair transplantation, because they have to lie face down for about 2 hours. Immediately after the patient lies on the chair where hair transplantation will be performed, the donor area where the grafts will be taken is determined by considering the hair structure and hair loss.
Then, the first local anesthesia is applied, after which pain control is performed to make sure that the patient who will undergo sapphire hair transplantation will not feel any pain. Immediately after local anesthesia, another application of tumescent is applied, by reducing the circulation in the donor area, blood loss is minimized and it is ensured that the tissues will be damaged to a minimum level.
Hair transplantation is started by making control shots with a single-use punch, 0.70-1.00 mm wide and 4-5 mm long, which is connected to a medical device called Micro Motor and enables hair extraction, suitable for the size of the follicle of the patient. Due to the micro motors used, hair transplantation is also called hair transplantation in some sources.
The purpose of the shots made for control purposes is to ensure that the hair is removed as a whole tissue without breaking and damaging the hair with the correct punch detection. In the extraction phase, which is one of the most important stages of the hair transplant operation, the main purpose is to be removed smoothly with a percentage of 5% or less acknowledged all over the world without any damage.
Thus, the number of grafts planned for the patient is obtained through high quality with minimum damage, and the best possible result after hair transplantation is mostly achieved. In Smile Hair Clinic, this extraction process is monitored meticulously by both our supervisors and our doctors, and the quality of the operation and the good result of the hair transplantation are guaranteed. Doctors should closely monitor the percentage of damaged grafts.
When it comes to the number of grafts, the expectations of the patients are to get the highest possible numbers they can. Unfortunately, today, where all kinds of information can be accessed via internet, some clinics increase the expectations of the patients by promising the number of grafts that cannot be obtained as a marketing goal.
However, before the extracion process, the calculation should be made correctly and the determination of the number that the patient needs should be made without damaging the donor area, by considering the circulation of the area to be transplanted, whether this circulation will feed the transplanted grafts and how the patient’s posterior donor area will look after the process.
Although patients expect high graft numbers, the important thing is to get the number of grafts that the patient needs and that will not harm him. In short, it is to evaluate the patient as a whole and to draw up a treatment plan accordingly.
The number of grafts that can be taken from the donor area during the extraction process varies depending on a few factors.
1. Width of Donor Area
2. Density of Donor Area
3. The ratio of single/multiple hair
4. Ratio of Thick and thin hair
Width of the Donor Area in FUE Hair Transplantation
We can explain many events in the world with physics and mathematics, including hair transplantation. If physics and mathematical rules are taken into account, more grafts are taken from two donor areas with the same density than those with larger areas.
Spill areas (apex openings) of the patients may fall within the limits of the donor area, depending on the age and the type of the spill at times. This shedding may be incomplete or new, especially in the young patient group, this is one of the most important factors in determining the donor area.
The hair transplant surgeon can prevent the joining of the front area with the spill area and prevent baldness in the back, by ending the donor area in lower place. The middle area of the donor area is the area where more grafts can be taken, containing more follicles and where these follicles are thick, while the back of the ears and the sides are the areas where the thin and single grafts that will be transplanted on the front line can be taken more carefully in terms of circulation and density.
Density of Donor Area in FUE Hair Transplantation
Hair transplantation, the density of donor area varies from person to person, and it is one of the most factors that directly affect the result of hair transplantation, it is the number of follicular units in cm2. Worldwide research has stated that the density is between 40-110 FU/cm2 and the average is 60-80 FU/cm2.
After measuring width of the area, the total number of follicles is determined by multiplying these two variables. The maximum number of grafts that can be taken is calculated according to the total number of follicles. 30-40% of the follicles in the donor area can be extracted.
The aim here is to decrease the density in the donor area after the hair transplant operation and to prevent scar tissue formation in the donor area. Each follicle extracted using punch leaves a gap in the skin that varies according to the punch size. These holes are very small holes, and the tissues heal quickly and leave a little scar on the skin.
Care should be taken not to locate these holes very close to each other during the extraction, otherwise they will merge and reach large diameters, unfortunately, the combined large tissue losses do not heal easily and they will heal by leaving scar and mark on the skin. Some clinics do not pay attention to the appearance of the donor area after hair transplantation by taking more grafts to increase the number.
This situation causes the patient to experience distress, visual disturbance and dissatisfaction in the future. Avoiding this is one of the first rules of performing a quality transplantation.
In addition, if the patient is going to have a transplant in another session in the future, the fact that the holes did not join in the previous session provides the opportunity to extract the hair that could not be extracted because the hair taken before does not grow again.
Telling the patients that the maximum number of extracts will be performed is actually the extraction and transfer of the follicle in that session without damaging the donor area, creating scar, disturbing the circulation and feeding the circulation in the area to be transplanted.
It is obvious that the number that can be extracted in patients with low density in the donor area will be small, and in patients with high density and follicles are very close due to the frequency, and frequent extraction cannot be made from these areas. By paying attention to these factors, the image of the donor area of the patient is intact, and the patient is provided with healthy hair so that he will reserve for future sessions.
The ratio of single/multiple hairs in hair transplantation
People with healthy hair and no hair loss have a total of 100,000 hairs on their body, most of which are on the head. There are an average of 60,000-80,000 hair follicles on the head, and these hairs are distributed in units containing 1-5 hair, which we call follicle, and other tissues except hair.
As a result of researches around the world, it has been determined that there are 2.2 hairs per follicle. When purchasing for hair transplantation from the patients, the excess hair per follicle in the patient and especially the selection of the hair with more multiple results provides better results with less grafts.
However, in patients whose hairline is redesigned, it is necessary to select single and thin hairs and transplant them on the front line, and the transplantation of multiple hair in other areas just behind the hairline and in other areas where the hairline is transplanted, it is necessary for a desired beautiful density and natural looking result.
In hair transplantation, it is important to aim to get more hair after the single hair extraction required for the hairline. In order to remove multiple hair, larger punches that will not damage the hair are required (as the blade to be used during incision should be determined according to the graft size).
Because when more hair follicles are removed, a thin diameter punch can damage the follicle containing so much hair. Paying attention to these details is of great importance in keeping the transection rates we mentioned earlier at a minimum. These follicles taken are also classified and counted as single, double, triple and more by surgical assistants, and these numbers are recorded in the patient’s file.
Ratio of Thick and Thin hair in FUE Hair Transplantation
Patients with thick hair can get a better result with fewer grafts in hair transplantation. For this reason, thick hair in the donor area is the target during extraction. It should not be forgotten that fine hair will give a sparse appearance.
When patients use their hair long, they may actually have fine hair even if there is a dense hair appearance. We can think of the transplanted hair as a single mass. Smile Hair Clinic surgeons call the mass of transplanted hair as Absolute Density.
The value we call absolute density is the division of the thickness value obtained when all the hair extracted are aligned side by side, to the surface area to be transplanted. When we consider the absolute density, thick hair always gives a better density in the transplantation area.
Additionally, the purpose during the purchase is to choose thin hair for the hairline and after reaching a sufficient number, to obtain the best result that can be obtained in one session by targeting thick hair.
As a result, for the best possible results in hair transplantation, the maximum numbers to be taken from the donor area should not exceed a certain number for each patient, depending on the patient’s anatomy, donor area width, density and circulation status, and how much to be taken from which area should be determined.
High numbers should not be taken just like wining a race just to win. Although the high number of grafts taken from the donor area in hair transplantation makes the patient instantly pleased, those who have to live with that image will be sick afterwards, and since they do not have much information about the possible problems they may encounter in the future, they should be explained well by the doctor.
Incision of the Canal in FUE Hair Transplantation
Hair Transplantation, the number and characteristics of the grafts planned by the surgeon and taken accordingly are classified and separated by the surgical assistants according to the number of hair in them.
The first step of the canal incision process in hair transplantation is to determine the thinness and length of the grafts and to choose the correct sapphire blade for the procedure. For a natural and intense result, a natural canal direction should be created with a 10-20 degree inclination to the front lines, this angle should be incised by increasingly steepening towards the back.
The hair transplant surgeon should imitate the direction and extension of the patient’s own hair at this stage. Like the canal direction degree, the extension of the canal is an important factor in determining the natural appearance after another FUE hair transplant.
Canalls should be incised vertically to the front during the incision, the sides should be gathered towards the middle by changing from horizontal to right angle slowly, if necessary at the transition points of the sides, they should be in the same direction with the existing hair.
Since the width of the canal will directly affect the result, the canal should be incised in an interlocking manner. Thus, a more densed canal incision is provided. The number of grafts to be transplanted should be planned as 60-70 FU/cm2 depending on the thickness/thinness of the hair in dense areas.
If the patient does not have enough grafts, according to the priority of the patient, canals are incised with high density in priority areas and canal incision to other areas can be reduced up to 20-25 FU/cm2.
Another important factor after the direction and frequency during canal incision is to provide the right canal depth for the hair to be transplanted in the right place and without damaging it. Too deep or too shallow canals should not be incised. Too shallow canal causes the graft not to receive the necessary circulation, causing the graft to bend inside during sowing by surgical assistants. As a result, the transplanted hair does not grow.
When the canal is too deep, the incision damages the vascular and epithelial structure, collapses may be observed in the tissue, and the graft can be buried completely so that the grafts do not grow again. Before grooving, the surgeon should measure the transplanting area with rulers and determine the surface area, accurately.
In this way, the graft distribution can be planned and the doctor can design the canals, correctly. Again, before incision of the canal, the doctor should revise the number of grafts removed and his plan accordingly, and confirm the patient’s priorities.
While the canals are incised in hair transplantation, the other important issue is that the tumescent/inflation fluid, the fluid we injected with adrenaline and isotonic control, control the circulation of the area to be incised, reduce bleeding, increase the tissue number and not damage other tissues around.
The inflation expands the tissue surface during canal incision, and when the skin surface returns to normal, a more intense canal incision is obtained. At the end of the canal incision process, the doctor lifts the patient, the patient and the doctor check the hairline together and the patient’s approval is obtained, it is observed that there are no differences and the process is completed.
During the creation of the hairline, the canals should not be placed on a straight line, irregular and unlike indents and protrusions should be made at irregular intervals(nobody’s hairline is straight), after the hair grows, a non-artificial, natural and different appearance should be obtained.
The grafts taken from the patient during hair transplantation can wait up to 6 hours without any damage. In order to achieve this, the grafts should be stored in special fluids and certain cold temperatures during the operation. When transplantation begins, these factors should be strictly controlled.
Thus, its health is protected and the quality of the hair transplantation process is ensured. The healthcare personnel who will transplant must undergo a long training, know the graft and all its components, and have the manual skills to place the graft correctly without causing trauma.
Even if all other conditions are provided perfectly, the transplantation phase is vital for the result of the hair transplantation, and failure in transplanting in a proper wa will result in disaster. It is necessary not to hold the graft by its root, not to squeeze it too much, and to avoid possible trauma.
While placing, it should be ensured that the graft is not bent and it is placed in the incised canal. After the operation, the grafts should be checked with a lobe, the transplanted grafts should be removed randomly from different regions and it should be ensured that the transplantation is performed correctly. This is another quality control stage of the operation.
After all these stages, the patient is lifted and the donor area is dressed and bandaged. A bandaging should be applied to the forehead, which ensures the stability of the bandage and prevents the inflation from falling to the face with the effect of gravity.
After the bandage, photographs of the patient are taken in terms of filing and go to the main hall to wait for the doctor to discharge.
During discharge, the doctor should indicate the following factors that the patient should pay attention.
1.Protecting the head from trauma as it still has an anesthetic effect (especially when getting on and off the vehicle, passing over a place and bending over)
2.Keeping the head upright (especially using the phone, tying shoes and preventing bending)
3. Describing the lying position (adjusting the pillow and neck pillow so that the transplanted hair does not touch them during sleep)
4. Stay away from salty foods for 1-2 days
5. Staying away from substances such as coffee and cigarettes for the first few hours.
6. No alcohol consumption for at least 5 days (until the prescribed medication is over)
7. How to use anti-infection antibiotics, pain relievers, anti-inflammatory medications given in the bag
8. Avoiding hot, sunny and dusty environment
10. In order to reduce edema, he should massage the forehead area regularly at short intervals and apply cold if he can find it.
After the operation, pain complaints are very rare in patients, they may not get enough sleep at night because they feel obliged to be careful during sleep in order to prevent damage to the grafts that are frequently admonished. This is a common occurrence.
Also, during the night, there may be discharge from the donor area, which is actually tumescent fluid injected into patients. Although most of it is absorbed by the bandage, there is some leakage. Although this fluid, which looks like red, is often described as bleeding by patients, it is a tumescent fluid as we have mentioned, and it should not be worried. A cover is already given by the clinic for the pillow.
Things To Know About Local Anesthesia
At the beginning of the points that patients worry about in surgical operations is the fear of feeling pain and soreness. Since hair transplantation is also described as a surgical intervention, we often encounter the questions of patients about feeling pain. After local anesthesia, our patients do not feel pain, they listen to music, read books and watch movies.
However, the local anesthesia process is a painful procedure. The reason for feeling pain in local anesthesia is the burning sensation that the medication creates when it enters the tissue and lasts for a few seconds.
This feeling has nothing to do with the technique used to deliver the medication to the tissue. Unfortunately, there are a few global medications available and all of these medications have the same effect. The severity of this burning sensation varies according to the person’s pain threshold. Nevertheless, the feedback we receive afterwards is that it does not need to be exaggerated that much on the internet.
Local anesthesia is applied to our patients twice during the entire procedure and the total duration of these two procedures is at most 30 minutes. Considering that the operation takes about 6-8 hours, this is not really an important time.
In our clinic, local anesthesia is applied both by classical injection and with a needle-free anesthesia device. These two methods have their own positive and negative aspects. They do not affect the operation process and its success.
Although local anesthesia prevents the pain that will be felt during the operation, it may cause anxiety for patients with needle phobia or who are anxious about the pain they will feel at this stage.
The needle-free anesthesia method, which has been used in many developed countries in the world in recent years, is one of the local anesthesia methods, minimizing the anxiety of patients, and thus facilitates the working process of physicians.
Needle-free anesthesia in hair transplantation is performed with advanced technology devices. Anesthetic medications are sprayed onto the skin through the high air pressure applied by the device placed in the head area, allowing them to enter the tissue.
Then the medication spreads to the tissue with the diffusion logic. At this point, the most important point that patients should know is that after some numbness has been created with the device, the needles will still be used for the application of tumescent anesthesia.
NEEDLE-FREE ANESTHESIA IS NOT PAIN-FREE ANESTHESIA
Hair transplant is a big market. Unfortunately, some clinics introduce needle-free anesthesia as painless in order to be one step ahead in this market, and they want patients to choose their own clinic.
The reason for feeling pain in local anesthesia is the medicine itself rather than the technique applied. For this reason, even if needle-free anesthesia reduces pain, it is not completely painless. Patients should not rely on those who say the opposite on the internet.