Our procedure involves surgically removing hair from the back of the head at the base of the neck, dividing the grafts, and relocating the hair follicles to the top and front of the head. Dr. Frayser himself performs this removal process. The hair at the back of the head is resistant to the chemical DHT or dihydrotestosterone. Because of this it is resistant to falling out of the scalp. This is why we often see men with only a wreath of hair at the back and sides of the head.

After the application of a local anesthetic, Dr. Frayser will proceed with the removal of a small strip of hair at the back of the head (called the donor area). He will then suture the incision. The wound will quickly heal, and while it will leave a minor scar, this will always be hidden by the hair at the back of the head which falls down over the scar area.

Dr. Frayser will then instruct his surgical team precisely how to divide up the grafts. The strip is then dissected into very small follicular units or hair group grafts. These grafts may contain 1, 2, 3, 4 or more hairs. Each of these units is essentially an organ. They have a blood supply, are chemically regulated like other organs of the body and when transplanted will quickly return to homeostasis. 

Dr. Frayser will then create small slits in the area in which the grafts will be transplanted. This involves quite a bit of artistry and skill. The slits (or receptor sites) are created very carefully and in such a way as to re-create the original hair pattern. The specific depth, angle, direction, size and width are crucial to proper placement and growth of the transplanted hair. This is by far the most critical and time-consuming phase of the procedure.

Following this Dr. Frayser will supervise the actual placement and relocation of the grafts to the receptor area. While the actual placement of the grafts is performed by the surgical staff, Dr. Frayser is supervising every step of the procedure. It is important to note that the grafts can only be placed into the receptor site one way, similar to placing a square peg into a square hole.

The relocation process is minimally invasive and is a minor surgical procedure, not much different than having a filling or crown at the dentist. While there may be some discomfort, there is rarely serious pain involved. Patients are awake and alert during the entire procedure and they can have a friend or spouse present.

While a typical procedure of 800 to 1000 grafts can take no more than 4 or 5 hours, we strongly recommend that patients plan for the entire day. Shower and wash and dry your hair thoroughly prior to the surgery. It is also important that patients remember NOT TO CONSUME ANY ALCOHOL or take ANY ASPIRIN for a period of 24 hours prior to the surgery. This may cause excessive bleeding during the procedure.

Some people are concerned about how they will look after the procedure. Since hair restoration is a minor form of surgery, directly following the procedure it may be possible to return to normal activities such as work. We do however recommend rest during the day of the procedure. 

During the days following the procedure, the patient can return to work and recreational activities. We recommend refraining from strenuous activities such as weight lifting, racquet ball or tennis for a week or two to avoid accidentally damaging the grafts. The hair can and should be washed gently with the fingers and a very mild shampoo.

After a few days, the redness will subside at the top of the head and the grafts will blend in with the existing hair.

During the first 1 to 3 weeks, new hairs appear to be growing quickly. This in actuality represents the beginning phase known as “shedding,” the time when the hair follicles actually go dormant.

From the transplant surgery, the hair follicles go into shock, or a dormant phase. This is normal, expected and predictable. This phase typically lasts 3 to 6 months so you will not begin to see new hair growth until the follicle moves out of this phase and onto the next growth phase. Many patients get anxious waiting to see if the transplant was successful. However, if you know that this “shedding” is typical and normal it sometimes eases anxiety.

Typically, hair growth starts within 2 to 4 months. Hair growth occurs in cycles, with each cycle starting a few days or weeks from the previous cycle. Initial hair growth produces a smaller than usual shaft. This changes as the hair reaches about 1/2 inch in length. Most men actually prefer this slower hair growth process because it makes any change subtle and less obvious.

By 6 months, most people can see the effect of the process, and by 12 months, the growth and bulk will have reached 90% of its total growth. Hair can, and sometimes does, continue to mature for sometimes as much as another 24 or more months following surgery. For this reason we advise patients to not evaluate the results until a full year has passed.

Wound healing is also fairly fast. Within 1 to 2 weeks the specific sights that received donor “hairs” have healed. However, it might take many months to regain full strength.

About half of our patients see results on the crown area within the first 1 to2 weeks. And even when they do, the hair is just barely visible. The existing hair can easily hide the donor incision.

If you have previously had a Follicular Unit Transplantation, your previous obvious wounds can make you skeptical about what to expect with our procedure. If this is the case, we strongly urge you to speak with a patient of ours who is one or two weeks post surgery and ask them about their experiences. Most patients are all to glad to share their experiences and help you decide if this procedure is right for you.

What happens post surgery?

Before you leave, we will provide you with explicit written instructions detailing how to care for your scalp until you return. You may receive prescriptions at that time (or before the procedure).

Many doctors prescribe an analgesic such as Tylenol with codeine. Sometimes antibiotics are also prescribed to prevent infection. Occasionally doctors administer medication to prevent swelling, but we have found these have limited value. Patients also receive prescriptions for pain to facilitate restful nights immediately after surgery.

Immediately following surgery:

Comparatively speaking Follicular Unit Transplantation is a relatively minor surgical procedure and most people recover in several days and return to work right away. There is some discomfort at the graft sites for the first few days. Most patients can manage this pain with Tylenol.

Athletic activities should be suspended for 1 to 2 weeks. The donor sights should also not be subjected to undue stress for several months. However normal activity can be resumed 1 to 2 weeks after the procedure.

You have several options regarding post-surgical treatment:

Scabs that accumulate on your scalp should be washed as they accumulate for the first few days after procedure. Follicular Unit Transplantation only creates very small crusts; therefore, there are not likely to create another after the second day. After the first week, the only visible signs of the procedure are stubble of transplanted hair and fading redness. In fact, your procedure will feel and look like a 5:00 shadow. Swelling of the forehead is present in 25% of people between the third and fifth day, but rarely lasts more than one day. Eyelid swelling rarely occurs.