In this method, a strip of a certain area from the back of head (occiput) is removed with the help of the local anesthesia and without feeling the pain. The cause of selecting this area (which is called the Donor Safe Area) is the point that the hair roots of this area are not consisted of the male hormone receptors (testosterone) and therefore, they are not affected by the hair loss effects of this hormone.
The area of removing hair in the back of head (the dark colored area)
The area of removing hair in the back of head (the area that its hairs are short)
The length of this strip is between 20 and 30 centimeters and its width is between 10 and 18 centimeters. The dimensions of this strip have constraints because the length and the width should be selected in a way that no damages are provided in the skin of the back of head and the skin can tolerate it and more important than all, no pressures are provided in the stitches of the back of head (which are superfine and microscopis) to make the above stitch scar in the form of a hairline and it becomes unclear (the discussed hairline which is the area of skin closure is very thin and it is hidden under the hair directions of the back of head).
Afterwards, this strip is divided into small pieces using the microscope and superfine tools while each piece should have 1 to 3 hair stands (and rarely 4-5 hair stands) (each piece is a so-called graft. The obtained grafts are placed in the cool normal saline (salt) solution. In this cool solution, grafts can be maintained alive and without damaging their vital tissues up to 2-4 hours.
For achieving the best result, the single hair grafts are transplanted into the hairline part because this part of the head is naturally consisted of single hairs.
Grafts with single hairs
Two-hair and three-hair grafts are transplanted behind the hairline and in front of the head to provide an entirely natural result.
Grafts with 2-3 hairs
Grafts with four hairs and more than four hairs are transplanted at the top of the head to provide the maximum density.
Grafts with 4-5 hairs
In the following figure, the different parts of the bald area can be contemplated. In the front thin strip (that the hairline is in front of the head), the single hairs are transplanted and in the back strip which is a little wider, the two and three hairs are transplanted and the grafts with 4-5 hairs are transplanted at the top of the head.
Designing different areas of hair transplant in the bald area
The results obtained from the natural hair transplant in the first session will be always better than the next sessions. As an example, if one hundred grafts are transplanted in one session, more hairs will grow and if one hundred grafts are transplanted in two sessions i.e. fifty grafts for each session, the hair growth will not be as good as one hundred grafts in one session. Accordingly, it is better to finish the hair transplant in one session. After completely anesthetizing the hair recipient area, different gaps are created in the bald areas using the small and thin blades. The longitudinal axis of these gaps and the angle and depth of sticking the blade are different for each hair transplant area and carefully doing this step can determine the final result of the hair transplant.
The most important factor about the direction and angle of the hair grown after the hair transplant is the direction and angle of the created gap and it is not related to the direction and angle of the hair while entering the created gap, in another word the hair which is being transplanted follows the direction and angle which is provided when creating the gap. Consider the accurate direction and angle of the gaps and their delicacies in the following figure. Also it can be observed that the front hairline has some irregularities to provide a completely natural result.
The delicate gaps created for transplanting the grafts
Then, each graft is inserted in one gap. This step is time consuming and it takes about 4-6 hours. The transplanted hairs are better to have the height of 3-4 millimeters. Transferring the grafts from the cool salt solution to inside the gaps is done using the superfine and thin forceps to provide no damages to them. The time of the transfer should not be exceeded from 2-3 minutes and the mentioned graft is continuously wetted by the cool salt spray serum during this time to prevent the graft from being dried because one of the most common reasons of the transplanted grafts fails is to become dry while transferring and transplanting them inside the gaps.
After transplanting the hair, one of the three states may happen to the transplanted grafts:
- The grafts fall out after 2-4 weeks (but the hair root is alive and healthy) and they grow after 3-4 months (the growth time is 2.5 to 8 months in average). This is the most common situation for the grafts.
- The grafts are remained inactive for 10-14 days after the surgery (i.e. they do not grow) and then they start to grow without falling out.
- The grafts are remained inactive for 3-4 months after the surgery (i.e. they do not grow) and then they start to grow without falling out. This state is observed only in 5% of the cases.