Step 1: Donor Harvesting
The goal of donor harvesting is to remove tissue of scalp from the permanent donor area in a way that limits transection of hair follicles. In addition, minimal scar should be minimal and possibly detectable.
A stripe of scalp having with about 1-2 cm and length of about 20-25 cm is removed from permanent donor area.
This donor site closure is done with trychophytic closure
t is important to remain within the permanent fringe area when removing the donor strip because if grafts taken from outside this area, those prepared grafts may be lost as time progress.
Patient with tight scalp are poor candidate for strip technique.
Step 2: Graft Preparation
The strip- harvested donor tissue is converted into grafts in two steps.
Slivering: Donor strip is cut into thin slices or slivers containing single row of follicles. This procedure is performed under microscope or magnification.
1) Grafts or FU dissection: from these slivers, individual units containing 1-4 follicles are separated under magnification.
2) All grafts are store in retaining solution usually Chilled Ringer lactate solution.
3)Temperature is maintained below 4 degrees.
Step 3: Creating Recipient Sites
Reciepient site incisions vary in size from 0.65 to 1.2 mm wide, with smaller incisions used for 1to 2 hair FUs and larger incisions are used for the 3-4 hairs FUs or curly hairs. While making slits the surgeon should create a pattern that imitate nature.
The incisions also have to enter scalp at same direction and angle as the pre-existing hair follicles.
Step 4: Placing Grafts:
The skill and ability to place grafts successfully is a critical step in hair ptransplant surgery. The potential for graft trauma leading to poor growth occurring at this step is high.
Fine tipped Jewelers forceps are used for placing grafts in slits. During this procedure loop magnification is essential to avoid injury to hair follicle.
In general procedure is very safe with few postoperative problems.
Forehead edema and eyelid occurs in about 20% patients and usually appears on 3rd postoperative day and last for 3 more days, which subsides on its own without any complication.
Usually forehead massage and ice fomentation is advices from day of surgery to be continued for three to four days.
Some patient may develop postoperative folliculitis.
Very rare complications are :
3) Discomfort in donor area
All these are minor and easily treatable.
In 20% of patient ,there is shedding of transplanted hairs within 6 weeks after surgery is known as shock phase.
The time frame for result is as follow :
Transplanted follicles usually shed by about 2 to 6 weeks at which patient looks like the day before surgery.
They start growing back after 3 months of surgery and after 4 ,visible results are seen. But these hairs are thin and sparse.
Between 6 to 8 months , transplanted hairs looks like normal hairs.
Improvement continue for up to 1 year and after that improvement usually taper off.