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(D and E) , Pre-operative and post-operative views of patient looking down.

(H and I) , Pre-operative and post-operative right side views of patient.

Technique
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(A and B) , Before and after 8 months ungergoing two hair transplant megasessions in which approximately 1200 micrografts and minigrafts were implanted per session.

I use a four-person surgical team for all hair transplantation cases. The patient, who is in the supine position, is sedated with intravenous Versed (midazolam) and Sublimaze (fentanyl citrate). For a local anesthetic I use Marcaine (bupivacaine) 0.5% with epinephrine 1:200,000 (usually a total of 40 ml) to block the supraorbital, supratrochlear, and occipital nerves, Subsequently tumescence is induced in both the donor and recipient areas with use of 0.5% Xylocaine (lidocaine) with epinephrine 1:200,000. (Usually a total of 150 ml is used throughout the procedure.) With a No. 10 scalpel blade a horizontal ellipse of scalp measuring 10 to 25 cm long by 1.5 to 2 cm wide (depending on the number of grafts to be made and the thickness of the hair in the donor area) is harvested from the occipital area (Figure 1, A). The area is subsequently undermined and closed primarily.

With the patient in the supine position and his or her head turned to one side, I harvest half of the ellipse. As I am closing the donor site my assistants start making grafts from the harvested section of scalp (Figure 1, B and Q. The patient's head is then turned in the opposite direction so I can harvest the second half of the ellipse. Several interrupted sutures and a running suture of 3 "0" Prolene close the incision.

Personna prep blades or No. 22 blades are used to cut the grafts, which are then inserted through small slits made with a No. 65 Beaver miniblade or a Feather 11 Personna blade (Figure 1, D and E). The micrografts are inserted at the very front and the minigrafts are inserted posterior to the frontal hairline. I personally insert all the grafts to ensure uniformity. The procedure takes 4 to 6 hours, depending on the number of grafts. The bandage is removed 48 hours after the surgery, at which time the patient is allowed to shampoo his or her hair daily.

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