The Surgical Process: What Happens During Surgery

The Surgical Day, Phase by Phase

The procedure typically takes 4-6 hours depending on the size of your procedure.

1. 1

   Donor Harvesting

   The primary difference in hair transplantation techniques is the manner in which donor is extracted from the donor area.

   Follicular Unit Extraction (FUE) Follicular Unit Transplantation (FUT)

   During FUE, follicular units are extracted individually using a 0.9mm circular punch. The donor area has been shaved to 1 cm and anesthetized prior to extraction.

   • Positioning: You'll be positioned in lateral (side-lying) and prone (face-down) positions during extraction to provide optimal access to different areas of the donor zone.
   • The extraction process: The 0.9mm punch size allows us to extract the entire follicular unit precisely to the depth of the hair follicle while preserving protective surrounding tissue. This size represents a careful balance: smaller punches risk transecting follicles, while larger punches remove excess tissue and create more visible scarring.

   During FUT, a horizontal strip of scalp tissue is removed from the donor area in a single excision. The donor area has been shaved to a minimum of 2cm and anesthetized prior to extraction.

   You'll be seated upright during the harvesting phase.

   • Donor site selection: The strip is taken from the occipital scalp superior to the occipital protuberance. This location experiences minimal movement during healing, which reduces scar widening over time.
   • Strip removal & closure: After the strip is excised, the wound is closed using a bilateral trichophytic approach with multi-layer suturing. This closure technique allows hair to grow through the scar line for improved concealment.

   Mid-procedure break: after donor harvesting is complete, you'll have time for a restroom break and lunch. During this time, the surgical technicians begin preparing your harvested grafts under stereoscopic magnification.

2. 2

   Graft Preparation

   While you're resting, a team of surgical technicians dissects the donor tissue into individual grafts under stereoscopic magnification.

   Why Microscopic Dissection Matters

   Hair grows in natural groupings called follicular units (1-4 hairs per unit). The stereoscopes provide magnification that reveals not only visible hairs but also resting follicles that aren't currently growing. These represent 10-15% of the total hair in your donor tissue.

   Grafts Cut and Sorted by Size

   Three graft sizes allow for natural hairline design while maximizing density and hair yield.

   • 1-2 hair follicular units: Used for creating a soft, natural hairline.
   • 2-3 hair follicular units: Placed behind the hairline for gradual density increase.
   • 3-4 hair bi-follicular units: Used for maximum density in areas requiring fullness.
3. 3

   Recipient Site Creation

   Once graft preparation is underway and you're repositioned comfortably in a reclining chair, your surgeon creates the recipient sites where each graft will be placed.

   The Process

   Using ultra-fine 19-gauge needles, your surgeon makes thousands of precisely angled micro-incisions in your scalp. Each incision is oriented to match your natural hair growth pattern.

   Site Design Considerations

   • Hairline and frontal area: Horizontal incisions for 1-2 hair grafts at the hairline edge. Three rows of vertical incisions for 2-3 hair grafts. Vertical incisions for 3-4 hair grafts behind the hairline for density.
   • Crown: Circular/spiral incision pattern radiating from the natural whorl, primarily 3-4 hair grafts to achieve adequate density under light.
4. 4

   Graft Implantation

   The final phase involves placing each prepared graft into its designated recipient site.

   Precision Placement

   Two to three surgical technicians work simultaneously using specialized micro-forceps to pick up individual grafts and carefully insert them into the pre-created sites. They ensure that each graft is:

   • Oriented correctly, following the natural growth direction.
   • Handled with minimal trauma to preserve follicle integrity.
   • Matched to site size, with smaller grafts at the hairline and larger grafts for density.
5. 5

   Procedure Completion

   Once all grafts are implanted, the dressing depends on which technique you had:

   Leaving the Clinic

   • After FUE: No bandage is required. You may wear a loose-fitting hat if desired.
   • After FUT: A bandage is placed around your head to provide gentle pressure on the donor incision site. You can wear a hat over the bandage and remove it yourself after 24 hours.

   What You Go Home With

   • Post-operative care instructions.
   • Prescription medications (pain reliever, antibiotic, anti-inflammatory as needed).
   • Follow-up appointment scheduling.

   Patients who opted for oral sedation cannot drive a vehicle after the procedure and must arrange for alternative transportation.

   Most patients feel alert and comfortable at this point, as the local anesthesia continues to provide numbness for several hours after the procedure.