Hair Restoration Blog

Picture taken During a Hair Transplant -- when transplantation of single hair grafts for hairline are almost completed

Hello Doctor how are you?

Thanks for giving me my pics.  I cant wait to start my blog. I attached some post op pics. Dr.Mohebi just a quick question, what is that white stuff during my post op?just curious since my brother brought it up when i showed him the pics.i was looking around the net to see other post op pictures,i wanted to find out what it was,but i didnt seem to see it on other patients.

thanks Dr.Mohebi.

A:

Hi there,

The white part of the grafts that you can see is the top part of the graft that is above the skin level.  As you know, a hair transplant does not implant hair but an entire organ.  This includes the collagen band around a follicular unit, microscopic muscle, small supporting vessels and a small portion of epithelium (superficial layer of skin) within each graft.  The white portion on the picture is the skin part or epithelium.  During hair transplant surgery, the goal is NOT to bury the grafts.  Buried grafts may folliculitis, sebaceous cysts and/or dimpling of the skin.  Here at US Hair Restoration, in order to prevent those complications, we make sure to keep the grafts slightly elevated from the skin surface.  Obviously the white part that you can see will dry up and fall off after a few days after a hair transplant surgery but this little mechanism alone can certainly prevent many problems that are seen by buried grafts.

Have a great weekend,

Best,
Parsa Mohebi, MD

Continue from the question “FUE - Body Hair Transplant“

Question 4: What is your view on “out of body” time for grafts?

Answer: There are articles on out if body time for grafts, what we do is to keep grafts in chilled physiologic solution (0-4 C). If grafts are kept in this condition the survival rate is over 90% in up to 12 hours. That number starts to drop gradually after 12 hours.

Question 5: Do your charges apply for every graft extracted, even if transected, or only charge for each intact graft?

Answer: Only the grafts that are intact and transplanted are counted.

Question 6: How much of the work do you do and how much of the work do your Assistants do? What specific tasks are allocated to Assistants and what do you undertake? To what degree are you present in the room where surgery is being carried out? Do you use needle or blade to make incisions?

Answer: In FUE procedures either body hair transplant, or scalp transplant I am present in the OR the whole time because the majority of the work is done by me. I score the grafts and remove them. Techs generally help me in retracting the grafts from scalp. Trimming under microscope is done by technicians. I constantly observe them for the quality and integrity of the grafts. Every now and then, we may have to change our methods for removing FUE grafts in different areas so the surgical team should be constantly communicating with me in the OR. For incisions I usually use solid core needles to minimize the trauma to tissue and preexisting hair.

Here are a series of very good questions on hair transplant with FUE (follicular unit extraction) and body hair transplant from a patient who did his homework and educated himself on his upcoming surgery.

Question 1: Do you have a pre op protocol for chest to scalp?

Answer: For FUE from chest I want to have a clean wet shave from the whole chest one week before the surgery day so in a week when we do harvest the grafts we only remove growing hairs (the ones that are in anagen phase). Scalp hair on the other hand, I don’t want it shaved at all and I will do my own clipping right before the procedure. We do FOX test for all new patients to determine their candidacy for FUE with a small number FUE harvesting under local anesthesia.

Question 2: How many grafts can you transplant per day and how many hours is a typical working day?

Answer: Just for you to get the idea of how long does a FUE hair transplant may take, the last two FUE that we did in US hair restoration office were 1500 grafts per day each. One of them took 9 and the other one 11 hours. In both surgeries we used scalp hair only.

Question 3: Are grafts that are extracted placed straight into the recipient incisions or are they checked under the microscope first?

Answer: All grafts need to be visualized under microscope to make sure they are intact (not transected). Most of them need to be trimmed too. We usually have to remove some of the upper layers of skin and a little of extra fat around the grafts for them to be in the ideal size for transplant.

I will post the rest of this Q and A series in next few days.