Pre-operative assessment and planning At an initial consultation, the surgeon analyzes the patient's scalp, discusses their preferences and expectations, and advises them on the best approach (e.g. single vs. multiple sessions) and what results might reasonably be expected. Pre-operative folliscopy will help to know the actual existing density of<unk> , so that postoperative results of newly transplanted<unk>  grafts can be accurately assessed. Some patients may benefit with preoperative topical minoxidil application and vitamins. For several days prior to surgery the patient refrains from using any medicines which might result in intraoperative bleeding and resultant poor grafting. Alcohol and smoking can contribute to poor graft survival. Post operative antibiotics are commonly prescribed to prevent wound or graft infections. Harvesting methods Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested. There are several different techniques for harvesting<unk>  follicles, each with their own advantages and disadvantages. Regardless of the harvesting technique, proper extraction of the<unk>  follicle is paramount to ensure the viability of the transplanted<unk>  and avoid transection, the cutting of the<unk>  shaft from the<unk>  follicle.<unk>  follicles grow at a slight angle to the skin's surface, so transplanted tissue must be removed at a corresponding angle. There are two main ways in which donor grafts are extracted today: strip excision harvesting, and follicular unit extraction. Strip harvesting Strip harvesting (also known as follicular unit<unk>  or FUT) is the most common technique for removing<unk>  and follicles from a donor site. The surgeon harvests a strip of skin from the posterior scalp, in an area of good<unk>  growth. A single-, double-, or triple-bladed scalpel is used to remove strips of<unk> -bearing tissue from the donor site. Each incision is planned so that intact<unk>  follicles are removed. The excised strip is about 1–1.5 x 15–30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts, which are small, naturally formed groupings of<unk>  follicles, from the strip. Working with binocular Stereo-microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting. The latest method of closure is called 'Trichophytic closure' which results in much finer scars at the donor area. The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic<unk>  pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place. Strip harvesting will leave a thin linear scar in the donor area, which is typically covered by a patient's<unk>  even at relatively short lengths. The recovery period is around 2 weeks and will require the stitches/staples to be removed by medical personnel or sub cuticular suturing can be done. Follicular unit extraction (FUE) With Follicular Unit Extraction or FUE harvesting, individual follicular units containing 1 to 4<unk> s are removed under local anesthesia; this micro removal typically uses tiny punches of between 0.6mm and 1.0mm in diameter. The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic<unk>  pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place. FUE takes place in a single long session or multiple small sessions. The FUE procedure is more time-consuming than strip surgery. An FUE surgery time varies according to the surgeons experience, speed in harvesting and patient characteristics. The procedure can take anywhere from a couple hours to extract 200 grafts for a scar correction to a surgery over two consecutive days for a megasession of 2,500 to 3,000 grafts. With the FUE<unk>  Transplant procedure there are restrictions on patient candidacy. Clients are selected for FUE based on a fox test, though there is some debate about the usefulness of this in screening clients for FUE. FUE can give very natural results. The advantage over strip harvesting is that FUE harvesting negates the need for large areas of scalp tissue to be harvested, so there is no linear incision on the back of the head and it doesn't leave a linear scar. Because individual follicles are removed, only small, punctate scars remain which are virtually not visible and any post-surgical pain and discomfort is minimized. As no suture removal is required, recovery from Micro Grafting FUE is less than 7 days. Disadvantages include increased surgical times and higher cost to the patient. It is challenging for new surgeons because the procedure is physically demanding and the learning curve to acquire the skills necessary is lengthy and tough. Some surgeons note that FUE can lead to a lower ratio of successfully transplanted follicles as compared to strip harvesting. Follicular unit transplant Follicular unit<unk>  (FUT) is the traditional<unk>  transplant method which involves extracting a linear strip of<unk>  bearing skin from the back or the side of the scalp. The strip is then dissected to separate individual grafts. Robotic<unk>  restoration Robotic<unk>  restoration devices utilize cameras and robotic arms to assist the surgeon with the FUE procedure. In 2009, NeoGraft became the first robotic surgical device FDA approved for<unk>  restoration. The ARTAS System was FDA approved in 2011 for use in harvesting follicular units from brown-haired and black-haired men. Types of surgery There are a number of applications for<unk>  transplant surgery, including: * Androgenetic alopecia * Eyebrow transplant * Frontal<unk>  line lowering or reconstruction (naturally high<unk> lines without an existing<unk>  loss condition) If donor<unk>  numbers from the back of the head are insufficient, it is possible to perform body<unk>  (BHT) on appropriate candidates who have available donor<unk>  on the chest, back, shoulders, torso and/or legs. Body<unk>  transplant surgery can only be performed by the FUE harvesting method and, so, requires the skills of an experienced FUE surgeon. However, there are several factors for a potential BHT candidate to consider prior to surgery. These include understanding the natural difference in textural characteristics between body<unk>  and scalp<unk> , growth rates, and having realistic expectations about the results of BHT surgery. Post-operative care Advances in wound care allow for semi-permeable dressing, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have the patient shampoo the day after surgery. Shampooing is important to prevent scabs from forming around the<unk>  shaft. Scabs adhere to the<unk>  shaft and increase the risk of losing newly transplanted<unk>  follicles during the first 7 to 10 days post-op. During the first ten days, some of the transplanted<unk> s, inevitably traumatized by their relocation, may fall out. This is referred to as "shock loss". After two to three months new<unk>  will begin to grow from the moved follicles. The patient's<unk>  will grow normally, and continue to thicken through the next six to nine months. Any subsequent<unk>  loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality. Cost The cost of<unk>  depends on the individual<unk>  loss and consequently on the number of necessary grafts. The average price per graft ranges between $1.07 USD in Turkey up to $7.00 USD in Canada. Some clinics also offer all-inclusive packages.
Hair transplantation
Face transplant
Facial feminization surgery
Ozone therapy
Alveolar cleft grafting
Laser hair removal
Organotherapy
Irradiation