The Bald Treatment Procedure in Toronto
- The day of surgery patients are asked to arrive at 7:30 am. A procedure can last from 4 hours up to 8 hours or more. For larger sessions patients are asked to bring snacks. However since the transplant procedure is performed under a local anesthetic, there are plenty of opportunities for the patient to get up, walk around, and have numerous bathroom breaks. Patients have the opportunity of choosing from over 250 movies available to watch during their procedure. At the beginning of each session, the patient is offered a mild tranquilizer (usually Valium) tablet. This minimizes anxiety, reduces discomfort and helps to prevent or decrease any side effects that might be caused by the anesthetic.
For a Strip Excision Procedure:
- Hair in the donor area is clipped in a horizontal row to a 2 mm length in 1 or 2 zones that are less than 1.4 – 2.0 cm in width and about 15 – 25 cm long. Once the donor strip is removed and sutured closed the hair above and below the donor site should completely camouflage these areas immediately after the procedure.
- 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). Anesthetizing the area is the only uncomfortable part of the session, and although it may be hard to believe, we have been told by many patients that the above technique usually causes less discomfort than a visit to their dentist.
- After the anesthetic has taken effect, a specially designed scalpel is used by Dr. Cotterill to cut an ellipse of hair-bearing scalp from the donor areas. (A similar method can also be used to remove scars). The ellipse, with the use of a stereoscopic microscope, is then carefully slivered into smaller loaves of hair, which are then further dissected into single or double follicular units ( follicular unit family ).
Microscopes are used to section every graft.
- In general, the smaller the size of the graft used the less noticeable treatment will be post-operatively. The following is a description of the types of grafts that can be employed:
- “Micrografts” are obtained by slicing the donor tissue into very small sections, regardless of whether the naturally occurring bundles are kept together or not. These types of grafts are called, “grafts cut to size”. Microscopes are not usually employed when creating these grafts but instead the grafts are cut without keeping the natural integrity of a follicular unit intact. Some surgeons feel that cutting through an FU can damage the valuable hair follicles. Dr. Cotterill agrees with this and USES MICROSCOPIC DISSECTION TO OBTAIN FUs ON ALL GRAFTS. Naturally occurring 1-3 hair bundles, as seen best with a dissecting microscope are called Follicular Units. Please see photo below.
All 1 – 4 haired FUs can be used to transplant an area. In some cases 2 FUs can be combined, called FU Families, and can be used behind the frontal transplant zone to allow for more coverage of the scalp.
While the donor grafts are being dissected by the hair transplant assistants, the patient has ample opportunity to take bathroom breaks, have a snack and to watch a movie. There are lots of breaks during an 8-hour operation. The patient will stop for lunch and stretch periods.
Once the donor grafts are all dissected then the recipient area, where the grafts are to be placed, is anesthetized. Dr Cotterill will then personally make all the recipient sites himself, taking care to ensure proper angle, direction, depth of incision site and spacing between grafts. Once Dr. Cotterill has made all the sites, then the surgical assisstants will plant the grafts into the sites under the supervision of Dr. Cotterill. Once all the grafts have been planted then the patient goes home, to be called by Dr. Cotterill that evening. Pain tablets are given and may be required for the first 6 – 8 hours after the procedure. The following day , when the patient returns for about 30 minutes to have the hair washed and area assessed by Dr. Cotterill, the patient will likely not need any pain medication. Grafts are held in place by coagulated blood. Bandages are seldom required anymore. The following day Dr. Cotterill likes to see all transplant patients from the day before so that the treated area is cleansed and the hair washed.
The patient is instructed to return 7-10 days post operatively for suture removal.
The patient is instructed to take 5-7 days off work due to the possibility of forehead swelling. Ice packs are given the day of surgery to be placed on the forehead and the patient is instructed to sleep at a 45 degree angle for 3 nights. A medication called prednisone can be offered and has the benefit of reducing swelling. The patient is asked to refrain from exercise for 1 week post operatively. The patient will then be called at 1 month and 6 months after surgery to enquire about how the patient is doing. We then call the patient at 1 year after surgery to return for the official assessment of the transplants.
IMPORTANT TIMELINE AFTER THE PROCEDURE:
- The sutures are removed at 7-10 days post operatively.
- Any forehead swelling is gone by day 7
- The crusts and scabs on to top of the grafts and sutures are gone by day 10-12.
- No sports or heavy physical activity for 1 week post operatively.
- No aspirin or alcohol for 1 week prior to surgery, but can be resumed the day after surgery
- The hairs in each graft usually all fall out (the roots remain dormant under the skin) 2-3 weeks after surgery. This is normal.
- The grafts will not start to grow until 2.5 - 3 months after surgery, this is normal, and the grafts will continue to grow.
- At 3 months there really is no cosmetic benefit as the grafts are just beginning to grow.
- At 6 months post operatively the grafts will be about 1.5 inches long. One can liken the appearance of cosmetic benefit after the surgery as being: 60% of the benefit at 6 months, 70% at 7 months, 90% at 9 months and full growth and width of the grafts after 12 months.
- The patient will be called at 1 and 6 months post operatively to ask how they are doing.
- The patient is called at 12 months to return to the office for full evaluation.
- Dr. Cotterill is also available any time after the surgery on his private cell if the patient has any questions.