One Week Before Surgery
Continue your usual medication unless stopped by doctor.
Stop Plavix, Aspirin, Vitamin E, Chinese herbs
Blood Pressure Tablet / Antihypertensive
If you take Propanolol please discuss with your family doctor to temporarily change to something else
For FUT / Strip, please leave hair long enough (about 1 inch) to cover donor wound.
For FUE, please trim short the hair at the back of your head, or you can leave it to us.
Stop or cut down
You can colour you hair few days before
The Night Before Surgery
Shampoo your hair with our antiseptic shampoo
Do not use your usual Minoxidil Lotion (G Hair, Rogaine, Headway…)
Do not drink alcoholic beverages
Do not sleep too early, as we want you to sleep though the whole procedure.
Day of Surgery
Take a light breakfast, but no tea or coffee
Will be provided but do not bring along valuables
Wear comfortable Button shirt or Polo Shirt. Do not wear T-Shirt
Notify the doctor in case of fever or any other sickness
Bring along your I-pod or MP3 (with headphone).
We will provide a custom made cap but you can bring a clean loose hat, baseball cap, or bandana to wear home
All balance payment must be settled before surgery
Question & Answer
You have plenty of time to clarify any concern. The procedure will be explained again before signing a consent. It's just like any other medical treatment. Inform the doctor regarding any drug allergy.
Antiseptic Hair Wash
To reduce bacterial colonization on the scalp we wash your hair one more time with antiseptic.
Two types of medicine will be given: a pain-preventer and a relaxant.
We do not use antibiotic as routine as we have successfully cut down postoperative infection to less than 1%. The relaxant helps to reduce any anxiety or discomfort during the procedure.
Hairline Design and Surgical Plan
Now is the time to re-confirm what you want. The Doctor will design the hairline for you. Total area is measured again to estimate the final count. The surgical plan must be agreed and approved by you before commencing the procedure.
Selecting Donor Hair
The doctor will examine your occipital area carefully looking for permanent hair. The donor area ia then marked.
Counting Hair Density
We trim the donor hair and count the density with a computer device called Folliscope. The length and width of the strip can then be accurately measured.
You will be lying face down during donor harvesting. Our hair transplant chair will provide you comfortable support. Most patients just fall asleep and then wake up for lunch.
A monitor is connected to check you body response during injection to ensure safety.
Pain Less Injection
Massage, vibration, ice cube are very effective measures to distract you from feeling pain during injection. We are using the very small 30G needle and special technique. Inject very slowly is the key to minimize any discomfort.
Specially prepared fluid called Tumescence is injected to lift the skin up and away from the bone. This prevent any possible damage to the deep seated nerves and blood vessels, and provide good skin turgor for easy dissection.
Graft Harvesting By FUT / Strip
We dissect the strip with a single blade using magnified loupes. The blade is angled parallel to the hair follicles to minimize transection. Excision is made quite superficially with minimal bleeding. We use the Trichophytic Technique described by Dr Frechet with 2 layers suturing to maximize approximation and to minimize scar.
The strip is then sent to our assistants to be dissected under 10X microscopic magnification into individual graft. Each graft contains 1 hair ( 1-hair FU-graft ), 2 hairs ( 2-hair FU-graft ), or 3 hairs ( 3-hair FU-unit-graft ). The intact follicles are stored in ATP enriched saline to maximise graft survival.
Graft Harvesting By FUE
We use our own designed titanium FUE punch. Size 1.0mm in diameter is used for Asian thicker Hair, whilst 0.8mm is reserved for Caucasian. This size keeps grafts intact yet leaves minimal scar. Depth control is set to avoid graft transaction. We use bothe manual and automatic FUE depending on hair character. Every graft is extracted one-by-one carfefully not to damage any follicle.
The extracted grafts are sent to our assistants with all redundant tissues trimmed under 10X microscopic magnification. The follicular unit grafts are then sorted into 1-hair FU, 2-hair FU, 3-hair FUs. Follicles are stored in ATP enriched saline to maximise graft survival.
20 minutes break to enjoy your free lunch, return call, and check email. We can show you the grafts under a microscope.
We inject tumescence to lift the skin from the bone. This avoids damage to the deep seated nerve and vessels when making incisions. Our solution is formulated to prevent Ischaemic Reperfusion Injury to the grafts and postoperative facial swelling.
Incision is the creating of small pockets in the skin (called a slit) to accommodate the graft. Slit sizes range from 0.7 to 1.2mm. The doctor studies the angle, direction, and orientation of your existing hair in the recipient area. Incision and insertion must be planned to mimic your natural hair flow. Loupes are worn to magnify the surgical field and prevent damage to existing hair follicles. Incision is the most important step in the entire hair transplant procedures as the slits determined the final hair direction.
Grafts outside the body has a limited survival time and must be implanted ASAP. Currently we are using 3 different Isertion Techniques.
1. Forceps technique
Fine tips jeweler's forceps are used to gently grasp the fat beneath the follicle to avoid trauma. It's our preferred method.
2. Stick and Place
For dense packing we have to eliminate any empty spots between hairs. We keep about 10% of grafts at the end to fill in these spaces. After creating a slit a graft is inserted immediately. This technique of Stick and Place allows more grafts to be inserted per area.
3. Implanter Technique
This is commonly used in Korea and Japan, especially for those using FUE. The follicle is first dragged into its metal tube before inserting the implanter into a slit. On withdrawal the graft is pushed out and left in the slit. We have abandoned implanter because of 2 reasons:
• More tissue trauma - the metal tube has thickness so holes larger than grafts have to be made
• Popping - insertion of an implanters will pop-up neighboring grafts, very difficult to dense pack.
How Long The Procedure Takes ?
Obviously that depends on the number of grafts. Even 3,000 grafts may just take 8 hours. However if you have to take frequent breaks or cannot keep still, more time is required. We reserve the whole day for you to ensure the procedure is accomplished to full satisfaction.
Some of the grafts may be dislodged during the procedure. On completion we spend another 20 minutes double- checking every graft. Any loosen ones will be re-inserted to ensure maximum survival.
For large session or the crown we may put a dressing overnight. Otherwise a head band will be applied.
Going Home Safely
Most patients are fully awake by the end of the procedure. A cup of coffee usually helps. We will check and make sure you are in good condition before letting you do. There is a taxi stand within 2 minutes walk just across the street.