The following is a summary of the procedure that is routinely given to our patients when they are seen in consultation:

1. The patient is given a mild tranquilizer (usually Valium or Versed), either orally or intravenously, at the beginning of each session. This minimizes anxiety, reduces discomfort, and helps to prevent or decrease any side effects that might be caused by the anesthetic.
2. Hair in the donor area is clipped to a 2 mm length in one or two zones that are less than 12 mm (1/2 inch) wide, and a total of 10-25 cm (4-10") long. If the hair in the donor area is left 1 ½ - 2" long, the hair above the donor site can be combed over and completely camouflages these areas immediately after the procedure.
3. The donor area and the recipient area are anesthetized by injecting a local anesthetic with a very small gauge needle that is about the size of an acupuncture needle. In addition to using a small gauge needle, we reduce the sting when injecting the local anesthetic by neutralizing the pH of the anesthetic, which is normally stored in an acidic form. (The acidity is the main cause of the stinging one usually feels.) Nitrous oxide (laughing gas) may also be used simultaneously for particularly sensitive or nervous people.
   
   Anesthetizing the area is the only uncomfortable part of the session. Although it may be hard to believe, many patients have told us that the above technique usually causes less discomfort than a visit to their dentist.
   
   In order to accommodate patients who prefer "no needle" procedures, we can use an instrument called a "dermajet", which propels the anesthetic into the skin via pressure rather than a needle. Even though no needle is being used, such propulsion does cause a short-lived sting at each site. Most patients seem to find this method less satisfactory than the use of narrow gauge needles, but both options are available.
   
   For patients who are particularly anxious about pain, an anesthetist can be called upon to administer a very short-lived and very safe general anesthetic (Propofol), which induces sleep for 5 to 10 minutes during which all the potentially painful needles are given. It is, however, worthwhile emphasizing that this is rarely necessary as current techniques produce very little discomfort for the vast majority of patients.
4. After the local anesthetic has taken effect, a scalpel is used to cut narrow 'strips' or 'ellipses' of hair-bearing scalp from the donor areas and the wound is closed with sutures. (A similar method can also be used to remove scars in the donor area). This tissue is then divided into a variety of graft sizes.
5. Many types of grafts are now used in the recipient area. Their advantages and disadvantages are discussed elsewhere in this website—see “Types of Grafts”.  In general, the smaller the size of the graft used, the less noticeable treatment will be post-operatively and in between sessions. On the other hand, in general, the smaller the graft, the lower the density that can ultimately be achieved.  
6. Grafts are held in place by coagulated blood. To keep them secure and properly oriented, a turban-like bandage is usually applied after the operation and left in place overnight. The following day, the bandage is removed and the area is cleansed. If there is no more than the average amount of bleeding during surgery and you are willing to remain in the office for one or two hours after the procedure is completed, you can go home without a bandage. (Most patients seem to prefer the security of an overnight bandage). Whether or not a bandage is used, patients return the next day for follow-up cleansing, hair washing, and check-up.