hair transplant

Sagittal vs. Coronal Incisions

2008-05-26T15:01:00.000-07:00

Although coronal vs. sagittal incisions have been discussed over the years, there still are no definitive conclusions. Let us consider two aspects.

First, let's talk about the appearance of the results of the coronal vs. sagittal slits. The use of coronal incisions makes most sense only in areas where one can clearly see the hair's root. When viewing someone face-to-face one is able to clearly see the hairline, along with the hair's roots.

This is the part of the scalp where it makes most sense to use coronal incisions. When viewing the top of the head you can't see the coronal arrangements, because one cannot see the roots Therefore, using the coronal slits or the sagittal slits does not make much of a difference.

Secondly, we have not yet seen a study on the comparison of the regrowth rate of hair implanted using coronal vs. sagittal incisions. Therefore, we can only assume that because the coronal incisions are perpendicular to the blood vessels in the scalp, theoretically, they have a higher chance of damaging the blood supply. Therefore, the follicle survival rate should be higher when using the sagittal incision, due to less blood vessel damage.

According to the above reasons, we here at NHTMC only use coronal incisions for the hairline and sagittal incisions for the rest of the scalp. Here is a photograph for better viewing of our technique:

Happy Patients

2008-05-01T14:54:00.000-07:00

Great results don't require using all single follicular units. For this fine haired gentleman, we only used 50 single follicular units (SFU's). Please listen to his testimonial.

One Surgery
Donor Size=30 sq. cm, Coverage Area=92 sq. cm.

Density=30/92 which gives 32%
Number of grafts used: 50 single follicular units &

1232 modified follicular units. Total number of grafts=1282

Date of surgery-August 9, 2007 and then eight months after one surgery (Photo taken on April 24, 2008)

Super Dense Packing-92 grafts per sq.cm.

2008-03-31T14:09:00.000-07:00

Surgery Date: December 7, 2006

Patient designs preferred eyebrow shape.

The length of the eyebrow is about 5 cm.

The widest part is 0.6 cm.

The narrowest part is about 0.2 to 0.3 cm.
The eyebrow area is 5 cm x 0.6 cm=3 cm2 on each side.

The eyebrow outline is about 11 cm (5cm +5cm+0.6cm +0.3cm).
We made 125 slits on the outline, the distance between each graft is about 0.8 mm.

We made 277 slits on an area of 3 cm2.
(The slit number depends on graft number available.)

This photo shows same direction of transplanted hair and original eyebrow hair.
(Coarser hair is the transplanted hair and the fine hair is original eyebrow hair.)

We transplanted 277 grafts on one side of eyebrow (area=3cm2).
This is about 92 grafts in one centimeter square.

June 20, 2007
Six months after surgery- Our patient was very happy with the results. We have achieved his goal in one surgery.

Comments:
The average density on this eyebrow is 92 grafts per cm2. Should I be proud of it? No. Not at all. Every hair transplant facility should have no problem to achieve this super dense packing. As long as you make the slits very small and trim all the tissues around the hair.

Our clinic can achieve 92 % density easily, but why we do not perform super dense packing on all hair transplant procedures?

I have checked the growth rate of the eyebrow hair six months after the surgery; the total re-growth is 455 hairs. The growth rate is 82%. Our average growth rate for hair transplants on the scalp is about 96%. In other words, with the super dense packing technique, we have sacrificed 14% of hair.

The super dense packing method is not suit for all potential hair transplant patients. Factors such as skin color, contrast, hair quality, degree of baldness and the texture of someone's hair can require a different size of graft to achieve the best result. We will work with cases individually to best fit the wants and needs of the patient.

For comparison reasons, please see the following three photos:

Our regular hair transplant grafts

Grafts used for super dense packing

Grafts used in live surgery meeting

Which one do you think will have the best growth rate?

Hair Transplant Progress-with ten months photos

2007-04-10T15:37:00.000-07:00

Here you can see one of my patients' post-surgery progress.

Surgery Date: 08/26/2006

Coverage area: 68 sq. cm.
Donor area: 29 sq. cm.
Donor Density Increased: 40%

The photos are taken before surgery.

Immediately after the surgery-
For the first twenty-four hours, there will be a strip of bandage around the head. After that, you will be able to remove the bandage and shampoo your hair.
Some graft may appear whiter initially and will have same color as rest of grafts couple hours later.
The hairline design is irregular.
We implanted 200 single follicular units on hairline and 1200 modified follicular units.

9/8/2006
Two weeks after the surgery, scabs already fall out.

9/19/2006
The implanted area looks pink, the color should return to normal 4 to 8 weeks after surgery.

10/13/2006

Transplanted hair starts to fall out. Skin color returns to normal.

10/31/2006

Two months after surgery-

Pre-existing hair around or adjacent to the transplanted grafts may shed, giving a thinner look, but will begin to grow back within a few months.

11/29/2006

Three months after surgery-

One or more cysts may occur in the recipient area. They usually disappear by themselves after a few weeks.

12/12/2006

12/27/2006

Four months after surgery-

Transplanted hair should grow back 4 to 6 months after surgery.

1/22/2007

Five months after surgery-

More hair come out

2/7/2007

Hair look denser...

2/20/2007

And denser..

3/5/2007

Also coarser..

3/20/2007

4/5/2007

Seven months after surgery-

Ninety percent of the patients will be satisfied by 50% to 60% of donor site density. He received 40% density, which looks pretty good when seeing from the front.

6/22/2007

Ten months after surgery. :-)

Hair Transplant Progress Result

2007-04-06T14:05:00.000-07:00

After the surgery is complete, the results should appear within the next couple months.

24 Hours After-
Bandages can come off. Soreness may be felt at the donor area.

One Week After-
Tiny scabs on graft area will start to disappear.

One Month After-
Transplanted hair will fall out.

4-6 Months After-
New hair starts to grow.

6-8 Months After-
Transplanted hair continues to grow and thicken.

One Year and After-
Final appearance of procedure is usually present.

Please see video of the Hair Transplant Progress!

Punch Graft Correction

2007-02-27T16:18:00.000-08:00

The 4 mm size grafts were transplanted more than 20 years ago. Everyone blames the big grafts for causing the pluggy look. I think the big graft is only the indirect reason for the pluggy look. The graft is too big to place close enough to each other.

The direct reason is too big of the spaces among the grafts. If we are able to fill in all the spaces then the pluggy look will disappear. It is unnecessary to remove the big grafts. By not removing the large graft, they will help to increase the density and make the final result easier to achieve.

Please study the photos, to observe two facts.
1. Please notice the huge spaces among the grafts.

2. The large graft has the original density. Within the 4 mm graft, the distance among the hairs is kept in their original density. The hairs are appropriately spaced. The size of the graft is not the problem; the hairs are in their original form and not squeezed into a smaller space. The problem lies in the fact that the grafts (also known as plugs) are spaced too far apart from each other and the space in-between the grafts accentuate the pluggy look.

Immediately after we made the slits

The goal is to fill in all the spaces between the punch grafts.

Please see Surgical Correction of ‘Plugginess’ in Hair Transplants
Published on Hair Transplant Forum International
January/February 2006 Volume 16, Number 1

Scar Cover Up

2007-02-27T15:41:00.000-08:00

The scar is very small, but it always bothered her because it showed up in her part line. It is visible to everyone when she parted her hair.
Six months after a small touch up, she doesn't have to worry about people seeing her part line anymore.

Young Patients-#4

2007-02-22T16:52:00.000-08:00

This young patient is a 28 year old male who had been taking Propecia for three years. He had not noticed any changes in his condition and wondered if he should continue taking the medication, or even if he needed it in the first place.

Recommendation: Take photos on consultation date and discontinuepropecia for three months. Then take photos with the same angle, light, hair style and length tofor comparison purposes.

Lesson: Always take pictures before taking Propecia. The hair growthis slow (6-8 months)

making it difficult to notice the results. On the other hand, Propecia may not be the right hair loss solution for some patients. I have seen patients who don't think the medication is helping, but are so afraid of hair loss that they continue taking it anyway. Never forget to take pictures before taking Propecia to chart your own progress.

Question: Exclusive use of single follicular units (SFU) seems to be the current norm, why does NHT insist on using mixed sized grafts?

2007-02-22T15:58:00.000-08:00

Question: Exclusive use of single follicular units (SFU) seems to be the current norm, why does NHT insist on using mixed sized grafts?

Answer:
There are a number of reasons why many surgeons today use only SFU for hair transplants. Exclusively using SFU for hair transplants provides a more even "look" and fewer scabs immediately after surgery. As an additional benefit, surgeons can pack SFU more densely than modified follicular units.

However, there are three concerns:
1. Higher telogen (resting) stage hair loss due the process of thin graft preparation

Humans typically shed 60 to 100 hairs per day. These telogen stage hairs, or resting hairs, amount to 10% to 15% of our total hair at any given time. After about three months, the hairs re-grow and start the natural process over again. Telogen stage hairs are of concern for hair transplants because they are effectively invisible. In the process of preparing an SFU, the technician must trim off the tissue next to the SFU grafts possibly discarding the invisible hair inside the tissue. 10% to 15% of hair may be lost in this trimming process.

Photo: 10% to 15% of hairs are in Telogen Stage and are invisible.

2. Poorer growth rates when using thin grafts compared to "chubby" graft
Dr. Seager, Dr. Beener, Dr. Beeher, Dr. Reed and Dr. Raposio each conducted studies to compare the results of chubby and thin grafts. These studies found that growth rates for chubby grafts' are 20% to 51% faster than the thin grafts. So far we haven't heard any report indicating that the thin graft's growth rates are better.

Photo: Thin follicular units-almost no tissue attached

Photo: Thin Follicular Units - tissues are trimmed off

Photo: Chubby Follicular Units

Photo: Chubby Modified Follicular Units

3. Cost to patient is almost double when using SFUs only

The cost associated with a hair transplant surgery is also an important issue. We work hard to earn our incomes - why should we waste it if we have a more affordable alternative to achieve our goal.

For example, here is a cost estimate for a typical SFU-only hair transplant for a hypothetical patient.
Assumes:

A recipient area of 80 cm2
A donor size of 40 cm2 needed for a 50% transplanted density
Donor area contains about 100 FUs in one cm2
Total grafts needed are around 4000 SFUs
Total cost is around $20,000 at $5 per graft

In reality this surgery would likely cost much more than this estimate; in this calculation we didn't take into consideration potential hair loss during surgery or the growth rate.Remember that hair loss is a life long process. A patient needs to receive touch-up hair transplants once in a while to maintain a good "look". Over the longer term, the exclusive use of SFUs adds up to quite a sum!

Question: Do I need to come back for suture removal?

2007-02-07T13:56:00.000-08:00

Question: Do I need to come back for suture removal?

Answer:

At NHT Medical Center we use a polyglactin 910 suture to close the donor area. I prefer using sutures to staples because they are more comfortable for the patient and result in a less noticeable scar. In addition, these absorbable sutures begin to fall off on their own 7 to 10 days after surgery as the wound heals. The patient does not have to return for suture removal saving him a trip back to the office.

This photo is of a donor incision five days after surgery. At this point you can no longer see the suture.

An article in the 1999 Journal of the Canadian Dental Association reported on the advantages of the polyglactin 910 suture compared to staples. In the survey, researchers evaluated 42 patients with scalp wounds from cosmetic surgeries. They closed half the wound with the irradiated polyglactin 910 vicryl rapide fast-absorbing suture and the other half with traditional staples. In the study of these 42 patients they found:

· No inflammatory reaction in the areas closed with the absorbable sutures compared to 1 case in the wounds closed with staples
· An average pain score of 1.82 reported by patients for the sutures compared to average pain score of 6.7 for the staples
· No patient reported suppuration, hypertrophic scarring, or alopecia with either method
· All 42 patients in the sample preferred sutures to staples

Scalp Stretch Exercise

2007-02-05T15:57:00.000-08:00

To have the best scar and widest donor size possible, we strongly recommend you to do the Scalp Stretch Exercise twice a day, 60 repetitions per minute, ten minutes each time.

Why We Don't Use FUE

2007-02-01T11:04:00.000-08:00

When Dr. William Rassman first presented the Follicular Unit Extraction (FUE) method in 2002, almost every hair transplant surgeon criticized it as it taking us back to the old punch age. The FUE punch measured 0.8mm in diameter, much smaller than the 4mm original punch, and caused more transection than the older technique.

Over time Dr. Rassman convinced some surgeons to use his method. Dr. Jim Harris then improved the FUE punch to reduce the transection rate.

Let's evaluate the pros and cons of FUE.

The advantages of FUE:
1. No linear scar/minimizes scarring
2. Can use body hair as donor hair
3. Better for smaller surgeries (i.e. eyebrows, facial hair, touch-ups, scar cover-up)
4. For limited donor hair availability
5. For persons whom would like to wear their hair short

Rebuttal to Advantages:

#1-No linear scar does not mean no scar at all, it still leaves hundreds even thousands of small, round scars, whereas with the trichophytic closure method (discussed on 1/30/07 - Hair Can Grow Through Donor Scar), the linear scar is almost invisible.

#2-In Dr. Rassman's New Hair News volume 12, 2007 comment on body hair transplants, he stated: “in the live patient viewing, one doctor presented two patients who had body hair transplanted into the scalp. The aesthetic impact was negligible fuzz on the top of the scalp…Based upon what I saw, the value of body hair transplants to the scalp may only have experimental value in today’s surgical practice.”

#3-Surgeries requiring smaller amounts of donor leave minimal scarring due to the trichophytic closure.

#4-With limited donor hair availability the small scars are even more visible.

#5-Extremely short hair leads to the possibility of FUE scars and linear scars being visible.

Further disadvantages of FUE:
1. Price
2. Time in surgery

FUE costs 200-300 hundred percent more than the strip harvest method and requires more time in surgery. I know one surgeon in Australia who takes one week to finish one patient. Is it worth the time and money?

One hair transplant physician states that, "I have practiced FUE for the past five years. Most of my cases are strip FUT, but I perform an average of two FUE cases per week. Unfortunately, there are unscrupulous practitioners who advertise FUE as a scarless surgery and, therefore, many prospective patients present requesting FUE out of this expectation. Patients must understand that there are punctate scars. Granted, they are not visible when FUE has not been extensive, but can be readily detected when harvesting has been extensive and donor hair worn very short."

Hair Can Grow Through Donor Scar

2007-01-30T13:34:00.000-08:00

Since Dr. Mario Marzola presented Trichophytic closure in the 2005 July/Aug ISHRS Forum, (Dr. Patrick Frechet also presented a variation of the technique), the appearance of donor scars have been improved significantly. Now hair can grow through the scar.

This photo shows the scar on the donor site (shaved for purpose of picture taking). You can see that there are hairs growing on the red scar area.

If you keep the hair long, the scar is nearly invisible. (Click on photos to see enlarged images)

It is one of the most important discoveries in hair transplant history.

Previously, the hair transplant patient may have wanted to use the same donor area on the second surgery to remove the scar from the prior surgery. However, if we use the same donor area (where the scar is), we harvest 20-30 percent less donor hair. The density in that area was already reduced in the first surgery.

Now with Trichophytic closure, since the scar is not ugly, there is no point in using the same donor area anymore. If one needs a second surgery, we can use a new donor area.

Young Patients-#3

2007-01-26T13:49:00.000-08:00

A 26 year old male who is concerned that his scalp is visible in the daylight.

His hair doesn't show any sign of miniaturization.

The problem is his hair style, in which the hair sticks together. Also, the contrast between his hair and scalp color is too sharp.

My Recommendation: Consider changing the hair styling; or even changing the hair color to one more similar to the scalp color.

Young Patients-#2

2007-01-25T15:23:00.000-08:00

Case 2a

29 year old male lost his frontal hair. The coverage area is 64 square centimeters.

Vertex hair is coarse. No sign of miniaturization on his vertex area. Propecia alone will not be able to help to re-grow hair at hairline.

My Recommendation: surgery and Propecia as an option.

Case 2b

A 21 year old man came in with his parents. He was so depressed by his frontal hair loss he had difficulty concentrating on school.

I recommended hair transplant surgery and Propecia was advised.

Coverage area was 60 square centimeters with a 30% increase in density.

When he came back for follow up one year later, his hair had grown back with no further sign of miniaturization.

The whole family is very happy.

Before:

After:

Case 2c

When E.A. flew to Orange County from Wisconsin ten years ago for his hair transplant surgery, he was only 23 years old and very depressed about his hair loss.

I performed surgery and advised him to take Propecia to prevent future hair loss.

He is now 33 years old. I saw him recently and he is much more confident in his personality and appearance.

Please see his 21 day surgery diary at: http://www.hairtransplant.com/month/patient4.htm

Young Patients-#1

2007-01-24T13:35:00.000-08:00

Each patient is unique.

I offer individualized treatments to all my patients, especially the younger ones. Younger patients require particular attention because their hair loss progress is often unpredictable and donor hair limited. Under these conditions, hair transplant is not always the best option for young people. I have to use hair loss pattern, size, age, hair quality, gender and other factors to give them different plans.

These recommendations may include: surgery, Propecia, Rogaine, observation and sometimes a different hair style or hair color.

In the next several weeks, I will mention them one by one.

******************
Case 1a:

A 32 year old male came for a hair transplant consultation.

His concern is his vertex area.

His vertex hair is thin and fine; the frontal hair is thinner and softer than donor hair. This is one of the first signs of hair loss.

Vertex thinning area is about 90 square centimeters.

Family History: His father is a Norwood pattern class 6.

His main concern: He is young and has the potential to lose as much hair as his father did. If we do the surgery at the vertex now, we might run out of donor hair and be unable to cover the front in the future.

Treatment Suggested: No surgery right away, instead take Propecia for six months. I always take pictures for comparison. Without the photos it is always difficult to tell the difference.

Case 1b:

Some of my patients on Propecia end up not having surgery after taking the medication.

This patient is on Propecia and never had surgery.

Before Using Propecia

After Using Propecia

Case 1c:

23 years old patient came in for consultation. I advised him to take Propecia first.

The patient took Propecia for two years. The medication helped him grow hair on the crown area and prevented further hair loss.

There was still some thinning on the frontal area and receding hairline, so I performed a hair transplant surgery and used 12 square centimeters of donor. The surgery increased density by 25%.

Conclusion:

He is very happy with the results. By taking Propecia first, he saved both a lot of donor hair for future use and the surgery fee.

Painless Hair Transplantation

2007-01-23T12:56:00.000-08:00

We perform the NHT Anesthesia Technique. Ninety-nine percent of our patients consider the hair transplant experience almost as easy as having a hair cut.

The NHT Anesthesia Method is an art of modern anesthesia. Our facility uses minimal dosages of medication, so it is extremely safe. The patient relaxes without being put to sleep, and feels little to no discomfort throughout the entire process.

The two kinds of pain patients face are psychological and physical.

Physical Pain is not the only problem patients face. In many cases, the fear of surgery causes as much distress for the patient. Psychological fear causes patients to tense up or become pale. They start to sweat and their heartbeats slow down significantly, only to jump up with even the slightest touch. Therefore when discussing a painless procedure, we must consider both psychological and physical discomforts.

We use “Twilight Anesthesia” to reduce any psychological discomfort our patients might feel. The anesthesia relaxes our patients enough to remove the discomfort, while allowing them to follow oral commands and respond. Since Twilight Anesthesia is not a general anesthesia, patients are conscious throughout the procedure.

To reduce any physical discomfort, we use the finest needles available. We apply a vibration before the injection, warm up the local anesthesia and use nerve blocks. To further ensure the comfort of the patient, we pre-numb the skin before applying the stimulus anesthesia agent. Tumescent anesthesia is used to make the anesthesia last longer than 10-15 hours. Furthermore, to ensure our patients' comfort after surgery, we provide the latest, best oral pain reliever which can be taken once a day. Patients can now rest comfortably after the operation without disturbance by the suture on the donor site.

See one of our patient's video testimonial about our near painless anesthesia.

The gentleman had one very painful hair transplant experience in another facility. He tried to use a hairpiece because he didn't want to go through another surgery. He didn't like the hairpiece at all. Finally, he found our clinic and had the nearly painless procedure.

Hair, Eyebrow Transplant, Scar Revision

2007-01-12T11:20:00.000-08:00

Before and after two surgeries. 50% density added.

Eyebrow: 150 grafts on each side.

Scar revision: Scar due to car accident. We removed the scar and transplanted hair onto the surrounding area.

A Testimonial Letter

2007-01-03T15:39:00.000-08:00

I just received a testimonial letter from one of my patients.

****************************

I was ambivalent toward the hair transplant. For years, I would try to kid myself about baldness, try to be one of those who (apparently) are not bothered by it. At the same time, I took started spending a few minutes a few times a week on the Internet investigating hair transplants. That led me to Dr. Chang and NHT. (I also confirmed on the Internet that there were no complaints about his practice.)

My wife and I visited his office for an initial consultation, and were very impressed. I had seen ads for hair transplantation, and had heard a relative’s accounts about a couple of those clinics, and was expecting to encounter a sales environment. Instead, I found that Dr. Chang has a very gracious, humble manner without any attempt at persuasion. My wife read the diplomas and noticed that Dr. Chang practiced as an anesthesiologist prior to opening his hair transplant clinic. This is impressive, since that specialty is among the most accomplished and responsible in the medical field, and it assures the highest physical comfort level during the transplant procedure. Yet Dr. Chang does not use it as a selling point.

In all, the competent, helpful, and low-key approach of Dr. Chang made it easier for me to finally decide that I wanted to go ahead with the transplantation. At the initial consultation, I had expressed my inclination to tackle the rear area first. Dr. Chang explained why it would be better to take the front first, and ultimately on the day of the surgery I decided that he was right. (After the hair grew in, I realized how right he was.)

The first session consisted of the maximum donor area, 30 cm. That day went smoothly and painlessly, with the entire staff ensuring that I actually enjoyed the experience. The only discomfort was in the days following the surgery, as expected from the website information and literature. Through that period, the office was supportive, although I only needed to wait it out without any particular medical assistance.

We again visited Dr. Chang after the hair grew in. I was very pleased with the front-view result, but I realized from side and rear views that I wanted fuller coverage. He had done a lot with the 30 cm donor area, but I had started out with a lot to cover! Here, again, Dr. Chang did not act like a salesman. In fact, in his polite manner, he stated that my hair looked good, and asked if I was sure I wanted a second session. I appreciated that this gentleman was making it easy for me to make the right decision for myself, not for his business.

At this point, I am looking forward to the second session hair growing in. Having seen the results of the first growth, I know it will be great. It’s been only two weeks since the second session, and the NHT clinic sent me an email just to check in. It was in response to that email that I raised the possibility of writing a testimonial – it was my idea, not theirs! In all, I’m proud to write this, and to encourage you to go to NHT.

R.C.
California

What is NHT's philosophy for hairline design?

2007-01-03T15:37:00.000-08:00

Question: What is NHT's philosophy for hairline design?

Answer:

We believe that one’s hairline should be designed in according to one’s preference. In general, a hairline design should take into consideration the shape of one’s face. For instance, most Caucasians have longer and narrower faces, therefore, longer and narrower hairlines are considered. Whereas a flatter hairline may suit a square face better, as is the case for many Asian faces.

We also recommend that the center of hairline be at least 1.5 cm higher than the highest wrinkle in the face.

But person is unique and everyone has different preferences. A few people prefer to have lower and flatter hairlines. They are mature enough to drink, vote, and to be in a jury. Why can't they decide what kind of hairline they want? In situations like this, we will offer our advice repeatedly, but also respect the patient's decision. He or she has the right to have what they want. As long as the person feels great about his hairline, why should we judge him with our standard?

An example of a low hairline requested by my patient.

Happy with One Surgery

2006-12-29T16:01:00.000-08:00

One of my patients, B.J., just came back for his six month check-up. He expects to complete his hair transplantation in two sessions and is very happy with the result of the first surgery. No one can detect that he had the procedure done.

I performed the procedure for him on April 28, 2006. We delivered 35% density.

Post surgery photos are taken on December 8, 2006.

Please see his before and after surgery photos.

Please see his video testimonial!

The Bald Truth of Hair Transplant-

2005-05-23T15:57:00.000-07:00

The Bald Truth of Hair Transplant-
Why some surgeons can finish their job in 10 minutes in an 8-hour surgery?

There is no other cosmetic surgery similar to a hair transplant procedure.

In other surgeries, a surgeon can use different assistants without any impact to the surgery. The reason is that the surgeon is the only one who does the surgery.

But for a hair transplant procedure, it is a completely different story.

A hair transplant procedure utilizes team work and the technician’s responsibility is very significant. At times up to ninety-five percent of the work is handled by the technicians. I can say that if the technicians decide to quit then the surgery has to be cancelled. No hair transplant surgeon can finish the job alone.

Hair transplant surgery contains six steps:

Anesthesia
Donor Harvesting
Suturing
Slit making
Dissection
Implantation

Among them, anesthesia, sutures, dissection, and implantation can legally be handled by nurses. Slit making depends on which state the facility is located. Most states allow nurses to make slits (California is an exception).

The job left solely for the surgeon is donor harvesting.

Usually when we need surgery, the most important step is selecting a surgeon. When choosing a hair transplant surgeon, there are many additional factors to take into consideration.