The patient arrives at the clinic early in the morning, usually around 7.30 h and is looked after by our nursing staff. It’s not necessary to fast but it is prohibited to drink coffee (decaffeinate is OK) or consume greasy foods that morning. A briefing with the surgeon covers any last minute details or questions which may arise. Once the consent forms have been signed, the patient is brought to the washroom area of the clinic where the scalp is washed for the last time before the procedure, either by the nursing staff or the surgeon. This is also the part of the clinic where the donor area is shaved, in cases where shaving was previously deemed necessary.

The patient is now ready to enter the operating theatre. A muscular relaxant is administered to the patient (optional), which helps them cope with the long hours during the extraction phase.

There is no need for an intravenous drip as the entire procedure is performed with local anesthetic

The anesthetic produces immediate numbness in the working area (in contrast to dentists, we are anesthetizing skin so we don’t have to search for a particular nerve or nerve dependent area).

For this reasons there is total loss of feeling in 2 seconds without having to wait, therefore minimizing any discomfort.

The surgeon begins to extract follicles. He decides which areas are the best to extract hairs from individually, cleanly and without any trauma. The follicles are placed into cooled and prepared containers, placing being done according to the number of hairs each FU contains.

An electronic counter placed on the patients left counts each follicular unit so that the patient can see how the procedure is progressing.

Turn nurses make a second accounting while grafts will classifying according to the number of hairs. As mentioned, while it is realized this classification are also being made statistics that allow us to control quality of such removal.Next is a rest period, we have been operating for an hour and a half and we advise the patient to stretch the legs or maybe use the bathroom. Its 11.30 in the morning so refreshments are offered: juice or a sandwich perhaps?.

The breaks are random, to be determined by the surgeon when deemed necessary.

We continue extracting hair during the entire morning. In transplants of 900 FU´s, we can finish before lunch time. Depending on the characteristics of the hair, skin and patient, we can extract between 150 and 400 FUs per hour. Below are some factors that can slow down the harvest:

• Hair color: more blonde hair is more difficult to extract.
• Turgidity: the finer the hair then the more difficult is the extraction.
• Texture: curly hair is more difficult.
• Shaving: probably the factor that exerts most influence.The complete shaving of the donor area makes our job much easier.

At lunch time, there are various menu options available, except for patients on a diet specified beforehand. We have now extracted all of the units which are kept refrigerated until it’s time for reinsertion. With food now in the patient’s stomach, we administer the medicine (anti-inflammatory, anti-biotic, gastric liner and pain killer)

First thing in the evening is to begin with the design of the area to be repopulated.

After administering local anesthetic, the surgeon draws with small incisions the distribution to be used for the grafts as he sees most suitable. It’s a method which helps to ascertain the correct design of the recipient area.

Insertion of the grafts begins. This is a very quick process thanks to the use of the IMPLANTER

As the auxiliary staff loads the implanters with follicles, the surgeon inserts the hairs into the scalp by following the design already prepared in the donor area. Further,.

the implanter assures us the exact depth at which we want to leave the hair bulb

the implanter helps avoid trauma which is produced if one tries to position the hair with tweezers. It also gives us the exact angle required for the hair and very importantly, reduces the wound as a result of the graft which gives rise to better healing (meaning the implanted hair is undetectable). Using the implanter produces less sanguineous crusting (scabbing) during post-operatory, less danger of folliculitis or infections and also allows us to create more density.

We conclude the procedure sometime in the evening, depending on the number of FU´s extracted.  The more grafts that have been transplanted then the later we finish.

Once finished there is NO NEED FOR ANY BANDAGES

In some cases some gauze may be required for the donor zone just so that the pillow remains clean while sleeping. The patient returns to the changing rooms where they change clothes and are then received in the waiting room where the surgeon explains the exact post-operatory instructions with which the patient must comply during the next few days e.g.: medication, washing of the hair, secondary effects, minoxidil…Everything is provided to the patient in writing with emphasis placed on the importance of washing after the transplant. Usually, if the patient isn´t travelling until the next day or is from Madrid, then we perform the first wash at the clinic the next day and the day after if necessary.

In cases where the amount of units transplanted is large and so the transplant was performed over several days,

we organize it so that the patient next session is the following morning.

The great advantage of the FUE technique is that the patient decides the number of grafts they want to transplant in each session, how many sessions per year, what frequency etc. Some patients decide to undergo the procedure in one go, organizing 1 – 3 consecutive days, depending on the amount of grafts required. Other patients, however, prefer to undergo a mini-session every 3 months…All forms are possible, the patient decides depending on their time available, vacations, economy or any other reason.