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Results
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At the time of this publication, I had performed 12 such procedures with a follow-up of 6 to 18 months. All patients had hair loss and were quite pleased that we had recycled hair that would have otherwise gone to waste; furthermore, all were satisfied with the results of the combined procedures.
Discussion
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To be able to do these two procedures in a single setting, one most be efficient and have a well-coordinated surgical team.
As with any other surgical procedure, the more we do the same procedure, the more we can avoid unnecessary motions; this allows us to save time without compromising the quality of our work and enables us to safely accomplish more in a single procedure.
For certain procedures, a surgical team approach is a must. Such is the case in hair transplantation, particularly when using the micrograft and minigraft megasession technique. I normally have three surgical assistants when doing such a procedure.
When combining face lift and upper and lower eyelids with hair transplantation, or face lift alone and hair transplantation, I normally have a scrub nurse assisting me with the face-lift and eyelids and an experienced surgical assistant cutting grafts. There is plenty of time to cut the grafts, because they are inserted after the face-lift and eyelid procedures are completed.
The assistant who is cutting the grafts then lines them up in rows in preparation for insertion. Usually it takes me about 4 to 5 hours to be done with the face lift and eyelids, which is how long it takes my assistant to have 1000 to 1500 grafts ready for insertion.
It may be necessary to have two or more assistants cutting grafts (depending on their experience, proficiency, and speed, which clearly varies).
Once we are done with the facial work and prepare the grafts, we (the surgical team) take a 5- to 10-minute lunch break. After which, feeling much better, an assistant and I return to the operating room, where in I to 1.5 hours we usually transplant all of those grafts.
The only area that is difficult to graft under these circumstances is the crown, as the patient is supine. If the crown needs grafting, I usually do that at a later date, when I can have the patient in a sitting upright position (in the office with the patient awake).
I have done these combined procedures (face lift and hair transplantation) under intravenous sedation and local anesthesia in my office surgical suite, with the patient going home the same day. This, however, makes for too long a day for the patient, necessitating a more prolonged period of sedation than when the procedures are done alone.
For patient comfort and my convenience, as mentioned earlier, I prefer to do these cases under general anesthesia, usually with an overnight stay in the hospital.
When I am doing the hair transplantation as a separate procedure (without the face lift), we usually do 1500 to 2500 micrografts and minigrafts. It is easy on the patient to be sedated for the initial part of the procedure with Versed (midazolam) and sublimaze while nerve blocks are done (occipital and supraorbital) with Marcaine (bupivacaine). The patient is then allowed to be fully awake as he or she is totally pain free (because of the nerve blocks). More than half of the procedure is done in about 3 hours. Often, we all take a break during which the patient has a chance to eat, stretch, and go to the restroom. We have not had any patient become nauseous or vomit, and most of them take a good lunch.
In contrast, patients undergoing the face lift and hair transplantation combined as a single procedure usually do not have the luxury of this nice break. This makes them very tired and sometimes anxious. For that reason, I prefer that these patients be under general anesthesia.
In patients concerned about their aging face and hair loss, provided that they are good candidates for both procedures, I have found that combining face lift and hair transplantation as a single procedure can be done safely and provides a very high level of patient satisfaction.
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