SURGICAL TREATMENT
We understand that every face is as unique as are the desires and goals of the patient. For this central reason, Paradigm adopts a multi-stage approach to treatment in order to ensure that all hairlines are designed in collaboration between myself, you and the design team.
THE PROCESS
Incremental hair-loss is part of the balding process yet there remains a certain amount of residual hair at the back and sides of the scalp. This residual hair is not susceptible to the hair loss process and is therefore resistant. However, there are only ever a limited number of these residual hairs available to transplant over a person's lifetime, which is why we treat the donor area with great attention and care. This is what we would call ‘privileged' hair.
The aim of hair transplantation is to repopulate the thinning frontal, mid scalp or crown hair by ‘filling in the gaps’ with the privileged hair taken from the back of the scalp. If too many grafts are removed in one surgery (or over a patient's lifetime) it can have a detrimental effect on the donor area and it can compromise future hair transplant options.
Transplanted privileged hair will never be suseptible to the balding process.Transplanted hair from the donor site will not fall out neither will it thin. This is why the donor hair matters so much.
The residual hair present on the top of the scalp, the crown and the temples will be susceptible to the balding process, depending on your inherited hair-loss pattern. The physiology is unaffected by the transplantation process. For this reason, a progressive process of treatment is called for as an individual patient ages and loses more hair. It is important to retain options for future transplants. A Paradigm hair transplant will look natural at any point in a patient's lifetime no matter how much hair they lose - but we will never deplete your donor hair. This is why the design of the transplant matters so much. Hair-loss is something that is on-going , fluid and individual. A Paradigm hair transplant should be outstanding - yet it will never stand out, irrespective of how much hair you continue to lose throughout your lifetime.
There are many technical aspects to this which is why the experience of our design team is important. Senior Nurse Joanne Scannell and Mr Brendan Fogarty have a combined experience of over 40-years of transplanting hair and have, between them, carried out over 10 thousand hair transplants. There are no short cuts to achieve an outstanding hair transplant. Our team at Paradigm is highly skilled in our unique GOFUE hair transplantation process so every patient can expect optimal growth, quality of design and naturalness of appearance.
Patients will be given all the information they need to comprehensively understand their individual process. At consultation/design consultation, Paradigm patients will have the opportunity to decide what type of hair line design is optimal for them, taking into consideration the multiple individual factors that are personally important
1. CONSULTATION AND DESIGN
FIRST CONSULTATION
The consultation is the cornerstone for a successful outcome. In surgery there is an age-old adage; “Choose well, cut well, get well”.
Regardless of whether or not a procedure is technically successful, if the operation is poorly planned and/or the aftercare deficient then the outcome is more likely to be suboptimal or even poor. It is for this reason that all Paradigm patients will be seen (from the very first consultation) by myself, consultant plastic surgeon Mr Brendan Fogarty.
The patients are absolutely under no pressure to make a decision to have a surgical procedure and to that end neither myself nor my staff, will ask whether you want a surgical procedure. This decision is best made by the patient themselves, in an unfettered fashion, away from any external pressures. Only in this way can patients feel totally comfortable in arriving at a decision that best suits them
When a patient decides that they would like to proceed with the surgical option, they can make an appointment to be seen for a second consultation with the design team. The patient can plan for a surgical procedure at a future date - but prior to their surgery they will come for a design consultation where a bespoke design and future plan is arrived at in concert with the patient’s goals.
DESIGN CONSULTATION
2. PREPARATION
Many hair-transplant clinics will ask their patients to shave their heads completely before they have surgery. At Paradigm, we wont ask you to do this. What we recommend is a type of haircut known as the ‘fade haircut’. This is a popular style which incorporates a fairly short/shaved back of the head cut. This is useful as it’s the back of the head where the grafts are taken from in FUE surgery. The hair here is strong and residual which is why it is the optimal quality of hair for the transplant.
We recommend the fade haircut as the hair is very short at the back yet remains a longer length everywhere else. The head is not noticeably shaved in a prelude to the transplant. It is a simple way of ensuring the hair is the appropriate length for extraction yet enables the patient to continue with day-to-day life and for the transplant to go unremarked upon.
Hair grows in groups of one, two, three and four. The surgeon can easily determine which hairs to replant where - as long as it is possible to identify how they cluster and group together in the donor area. Using the microsurgical techniques of FUE subtle but significant decisions can be made in an exacting and rigorous manner. Planting the wrong type of hair in an inappropriate location results in a poor-quality hair transplant. Paradigm clinic will pay attention to detail in order to ensure this doesn’t happen.
And with the fade haircut there is also a very minimal disruption on terms of appearance in the run-up to the transplantation.
For women we recommend the Pixie Undercut Bob.
3. SURGICAL PROCEDURE
On the day of surgery, patients will have prepared for their surgery by adopting a suitable hair style depending on the plans made at the design consultation.
In addition, they will have made suitable arrangements regarding medication and lifestyle in order to optimize the results of surgery.
All of the back of the scalp (or part of it) will be shaved by staff to facilitate the procedure. The transplantation procedure is all carried out under local anaesthetic (see comfort measures below).
The area where the grafts are taken from (ie harvested) is known as the donor site. In larger transplantation procedures, we have to shave all of the back of the scalp so as to facilitate the procedure by being able to identify the best hair for transplantation. This will depend on several factors, including such unique variables as hair colour and hair calibre. Generally speaking, the donor site usually heals up within days. Grafts are taken from this site in a particularly precise yet random manner. This is in order to ensure that there is never a noticeable 'donor site'. There will be no discernible 'pattern' from where the grafts have been removed. This requires careful planning and a well-trained eye. Surrounding hair growth will disguise the small marks that are left behind. If one is not normally in the habit of having a very short haircut, then adopting a short hairstyle for a period of time before the surgery will ease the post-operative transition after you resume normal social activities.
In smaller transplants (particularly for a patient who has long hair) the back of the entire scalp does not necessarily have to be shaved. We can instead shave narrow lengths of the donor site.
4. PATIENT COMFORT MEASURES
The procedure can be carried out under local anaesthetic. Thus patients do not have to fast from food and indeed should have a normal breakfast. During the procedure most patients like to relax and watch programmes on their tablet device/ipad.
Local anaesthetic injections, like any injection, can potentially sting. Crucially, however, the procedure is carried out in a gentle sequential fashion so that subsequent injections are carried out through already anaesthetised skin. This greatly reduces any discomfort. With the initial injection sites, we can minimise any discomfort through the use of a vibration anaesthesia device (VAD). Rest assured that these 2 or 3 initial injections to start the anaesthesia are the only ones that should be in anyway uncomfortable. Any subsequent injections will be carried out through the frozen skin ie through the previously anaesthetised area. The local anaesthetic works for a number of hours but ‘top up’ anaesthesia may be required. Clearly this will be dictated by the duration of the surgery as well as the effectiveness of the local anaesthetic. Every patient is unique and Paradigm will make sure that good communication with the patient at all times is a central part of the work that is carried out.
If at any stage during the procedure you wish to use the toilet or have a comfort break this can be accommodated easily. Patients usually have a break mid-way through the surgery when they also can have their lunch.
Overall most patients actually enjoy the procedure and view it as an opportunity to rest ! Patients at Paradigm often tell us that they have enjoyed the day with us during the course of their procedure. Many take in their own devices and ear pods so that they can watch a movie on a streaming service, listen to music or keep up with whatever interests them.
5. POST-OP
THE CONCEPT OF RISK
Doctors have to be honest and patients realistic about the concept of risk. As one can see from the list of possible complications below, the risk of these occurring is small but can never be zero. Science has not conquered the vagaries of mother nature. Fortunately the consequences of a post-operative problem occurring can be significantly mitigated if it is treated correctly and in timely fashion. The importance of
a long-term relationship with the clinic is vital to minimise the consequences of any possible post operative complications and hence ensure an optimal outcome. As a consultant plastic surgeon who has very significant experience of such conditions, especially through my NHS referrals, patients can rest assured they will receive the best possible advice in this regard.
The degree of bruising is unpredictable but is usually limited to the recipient sites at the hairline. However, if one has a hairstyle which is long enough, this will help to disguise the area for the first number of days. The bruising rapidly settles within days and will thus be less conspicuous to others in relatively rapid fashion. A break from work (or social occasions) may be desirable if one is concerned about others seeing any bruising.
BRUISING
PAIN
Usually the process has very minimal pain. The local anaesthetic works for a number of hours after the surgery. If there is any need for painkillers post operatively, this is usually minimal i.e. in the form of paracetamol, and this will be given to you on the day of the surgery. All patients have a different pain threshold but in general it is unusual to require any analgesia after the surgery.
Having such an abundant blood supply, infection is rare (1%). Some infections may require antibiotics while other infections may be in the form of localised collections of pus. The regular washing of hair minimises the risk of either. In the strip harvest technique of transplantation (where there are stitches in the skin) the risk of skin infection is increased through the presence of a ‘foreign body’ - the stitch. In the FUE process there is no need for sutures and this reduces the potential risk of infection.
INFECTION
The risk of graft failure is small. There is approximately only a 5% risk of some of the grafts failing. The process of any grafting process means that skin requires in-growth of new blood vessels into the hair follicle grafts. This is a process open to the vagaries of natural wound healing. Overall, the chances of success are however very good (greater than 95%).
GRAFT FAILURE / POOR GROWTH
This refers to the phenomenon of temporarily losing adjacent normal hair, either in the region of the recipient site or the donor site. Shock loss again is extremely rare and occurs in <1% of patients. The shock loss is a temporary phenomenon and the hair grows back within a number of months. Fortunately, with the FUE process, there is no stitching of skin and therefore no tension on the donor-site skin. This means there is potentially a lower risk of donor-site shock loss.
SHOCK LOSS
As mentioned above, localised infections can occur (rarely) around hair follicle sites or donor sites. These are managed with regular cleaning and release of any pustule within the clinic. Occasionally cysts can develop in the skin which, if troublesome, may require surgical excision, but again, this is rare (<1%).
CYSTS / PUSTULES
Like any surgical procedure, there can be numbness in the scalp which can last for a number of months. In the vast majority of cases, sensation returns - although in a very small number of cases residual numbness can be permanent.
SCALP NUMBNESS
One of the benefits of the paradigm FUE procedure is that the scars are virtually invisible even with a shaven head. The small and randomly-sited pinpoint scars of an FUE process contrast with the long continuous linear scar that is seen in the alternative strip harvest technique. This different configuration of the scarring enables the tiny FUE scars to be disguised by the surrounding hair. Only with a fully shaven head could such FUE scarring be discerned - but even then only on very close inspection. All scarring is unpredictable to a degree, but the risk of forming a troublesome lumpy scar e.g. a keloid scar is very small ~1/1000.
SCARRING
"The procedure itself was well explained beforehand, with a great deal of care taken throughout to ensure comfort and understanding of what was next. The team were also incredibly professional and a pleasure to be around, constantly making sure the procedure was successful"