FUE Hair Transplant Anesthesia Principles

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This podcast is on FUE or hair transplant anesthesia. I was working on a lecture for a course on the global hair loss summit coming up this fall, doing a presentation for that as also wrote a chapter in my new textbook on FUE that’s coming out next year in 2021. And I thought, you know, I really should just talk a little bit about some anesthesia principles. The techniques are incredibly exhaustive. My chapter was about 40 typewritten pages. So of course I’m not going to get into those levels of details, but I want to talk about some principles of what makes good anesthesia the first one I’m going to start with safety. Just last week I had a hair transplant, outfit said the patient had some problems during the surgery and you should really go to see Dr. Lam to do the surgery cause it’s safe over there. And really the reason why we are much safer besides going through all the clearances and taking, making sure that we elect to have patients, very safely, cleared, medically chosen correctly for surgery. I also operated in a joint commission accredited facility, which allows us to do proper sedation to minimize discomfort. And also it allows us to perform very, very safe surgery because we have all the emergency protocols, of course nothing is 100% safe. You can never promise that, but 99.9% of clinics out there, I would say are not an accredited facility. They’re just doing things in an office setting, which I think can be risky. I always like to have the highest standard possible, and I think I did a podcast actually on accreditation. You can listen to that, but so the first principle is working on credit facility.

Second is having proper sedation and emergency equipment for any problems, making choices that are wise having an infrastructure for that. But then getting down into the details of actually anesthesia is a lot of places they do what’s called a ring block to start and just anesthetize it with the needle that goes around the scalp. Well, first of all, I was doing that for many years and patients were even feeling it because I have sedation. That’s very different, but now I’m always taking things to another level. So I’m doing, what’s called a nerve block and these little tiny nerves, if I block them, actually make the entire anterior scalp numb and the posterior scalp numb. And so that by doing that, it makes patients have a significant, lower level of discomfort. That is a huge thing, but a lot of places don’t do that because they don’t know where the nerve anatomy is.

And that, that requires someone who, and that’s my background as facial plastic surgery, actually one of my editors in my books said wow Sam, you’re actually almost intimidated it by your chapter because it goes through so much detail that I think most hair surgeons don’t even practice or even understand. So it really is a requisite knowledge of understanding anatomy to deliver painless anesthesia. The other thing that I do is a vibration technique and vibration is that our brain can either perceive pain or vibration only one signal at a time. So if I’m overwhelming your brain with a lot of vibration, you should not feel very much discomfort. I do that for all my techniques, whatever I’m doing anesthesia wise, that makes a big difference. The other technique that I do for the back of the head is something called two messiness.
It’s a very, very dilute long lasting anesthetic and somehow it makes no sense, but the more dilute the anesthesia, which also adds safety with a higher volume will actually last significantly longer and hurt a lot less. So I use a field, two messiness for the donor area that really works well for my patients. I do the same thing when I’m doing beard FUE harvest. So again, I’m not going to get into really the details of how I do the anesthesia, because again, it could take me, I mean, I could read my whole 40 page chapter, but I think I just want to go through some of the principles that make what I do different than other places and make you feel understand that this is involved, safety, comfort, and effectiveness.