Hair Transplantation

This procedure consists of surgical transplantation of your own follicles from one part of your body to another. Patients often ask Dr. Elliott if hair from another individual can be used. The answer is no, as your immune system would reject this as foreign tissue. The good news is that nearly all patients with hair loss have enough of their own hair. The area used to donate follicles is usually the back and sides of the scalp, but with the newer techniques of Follicular Unit Extraction (FUE), any area of the body with hair may be used as a donor source without leaving a linear scar.

Grafting Techniques

Modern hair transplantation is performed using follicular unit transplantation (FUT), or with combination grafting with follicular units and multi-unit grafts (MUGs). Dr. Elliott uses both these techniques on a daily basis. He is an internationally-recognized expert in combination grafting, and has written chapters in the 2010 Hair Transplantation text by Drs. Walter Unger and Ronald Shapiro.

Donor Areas and Harvest Techniques

Although Dr. Elliott has performed beard, moustache, eyebrow and body hair transplants, the vast majority of hair transplantation involves male and female pattern baldness. In these situations, the donor area is always the back and sides of the scalp, either by strip harvest or FUE. Strip harvest is the most efficient and common donor harvest approach. A strip of scalp is clipped to a length of 3mm, removed, and the area closed with sutures. This produces a linear scar of 1mm or less in width in 95% of patients. No one will ever see this scar unless the hair in the area is cut to less than 1cm in length. Patients often tell us that their spouse or hairstylist can't find it. A small number of patients (5%) will form a wider scar (over 1.5mm) because of the nature of their healing process. This is still covered completely by regular hair styles.

Dr. Elliott has had transplants with strip harvests and has average scars that you can look at, with most patients being unable to find them on his scalp.

There are certain situations in which a linear scar of any size is unacceptable. This may be due to patient preference, the desire to keep the hair in the donor area clipped very short, or because of the location of the donor area (neck for beard follicles or body hair). In these instances, follicular unit extraction (FUE) becomes the procedure of choice. The disadvantage of FUE is the time involved. It is nearly 3 times more time consuming to harvest hair by FUE compared to strip harvesting. This means that it is more costly on a per hair or per graft basis.

In some patients whose donor scalp is tight, FUE may be the only option to harvest hair as strip harvests require adequate scalp laxity.

Donor Area Closure

When a strip harvest is performed, the scalp is closed with either sutures or surgical staples. Dr. Elliott uses sutures because they are more comfortable for the patient in the post-op period, but either method produces equivalent healing. The donor incision area is never visible after the surgery as the hair above covers it as long as it is at least 2 cm long. Sutures are removed 8-9 days post-procedure. Dissolving sutures are an option for patients unable to return for removal.

FUE donor sites do not require suturing and heal quickly within a week.

Recipient Site Appearance

Immediately after a transplant, the grafts will be visible for up to 10 days unless there is enough hair to conceal them. This is the case for strip harvest or FUE procedures. Dr. Elliott will advise patients whether enough hair remains to wear a hat to cover the area. Bandages are never used in his practice. For patients who cannot wear a hat and who need to return to work and social functioning immediately after their procedure, Long Hair Transplants (LHT) are the best option.

Long Hair Transplants

This procedure is quite unique. Dr. Elliott learned this technique from its innovator, Dr. Marcelo Pitchon, of Brasil. Put simply, grafts are transplanted with their full length hairs left long, rather than being clipped to 3mm length. This means that you leave your procedure with your new hair. This hair will still fall out by the 2 week mark like most grafts do, but in the meantime, you have a preview of your result. In addition, the presence of this hair completely conceals any evidence that you have had a transplant. This is very important for some patients.

The first patient that Dr. Elliott performed LHT on left the next morning for a hockey tournament on a bus with his teenage son, the rest of the team and parents. No one could tell he had a transplant.

Another patient told Dr. Elliott months after his LHT that he went back into his office the next day and no one knew. His wife had been out of town and returned 2 days after his procedure and did not know (the patient had not told her he was having a transplant).

Dr. Elliott is one of a very small number of physicians to offer LHT. It takes a little longer to do, but is well worth the time.

Pain

This is one of the main concerns for patients considering hair transplants. Hair transplants are not inherently painless. There are 3 main periods where patients may feel pain: during injection of the initial anesthetic, during the procedure, and afterwards. Dr. Elliott knows this from personal experience with his own first transplant that he underwent in 1995. His doctor used standard local anesthetics, without any special techniques for reducing pain during injection, and did not use any long-acting anesthetics to prevent pain post-procedure. With an approach like this, you feel pain with the injections and the anesthetic wears off within 6 hours.

Since that time, Dr. Elliott has become an internationally recognized expert in hair transplant anesthesia and pain prevention and has developed techniques and protocols that he has taught to other surgeons all over the world. His technique uses several key components to give patients a truly painless experience, with anesthesia lasting until the day after the procedure. Since the post-procedure pain of a typical hair transplant occurs the first night, his patients are spared this because their scalp is still numb.

Sedation

Light sedation is important for reducing pre-procedure anxiety and this is standard in Dr. Elliott's office.

Anesthetic Technique and Medications

Tiny needles, a gentle hand and advanced neuro-distraction techniques using pH-balanced dilute anesthetics mean that Dr. Elliott's patients don't feel a thing. He personally monitors your anesthetic during the procedure and adds long-acting anesthetic before the end to prevent any break-through sensation. You are given a very effective, but non-sedating pain medication prior to going home which means that you won't need anything else that night.

Surgical Technique and Pain Prevention

The technique of doing the actual surgery has also improved. The incisions now are much more superficial and tiny and Dr. Elliott's technique results in no injury to deeper vessels and nerves in the scalp and faster healing. Patients who had transplants years before are amazed at how much easier it is today.

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Dr. Vance Elliot