Consultation	Presurgery Prep
Anesthetizing	Donor Removal
Graft Dissection	Recipient Sites
Graft Placement

After arriving shortly after 8:00 am, I conducted a pre-op interview on the patient which lasted for approx. 15 minutes after which we moved into Doctor Bauman’s office for a brief official introduction. Shortly prior to the interview, the patient was given a valium to relax.

This was followed by a cleansing wash which was administered by an automated hair washing machine located in a small partially enclosed area diagonally across from the doctor’s office. The machine closes over the patients scalp and a moveable section rotates back and forth across the head while spraying a solution of water, hydrogen peroxide and anti-bacterial agent similar to Hibiclens.

This lasted about 5 minutes after which the patient was brought back into the doctor’s office to discuss the cosmetic aspect of the procedure and mark out a new hairline. Any other pre-op concerns are addressed and questions answered at this time.

The next step, at about 9:15 a.m., took us of to the operating room (O.R.) where the patient was prepared for surgery. The patient was seated in what is a slightly modified dentist chair after which a surgical sheet was placed over his body and padding placed around his neck.

This was followed by the administering of local anesthesia to both the back of the head and the forehead by two medical techs. They make use of an automated machine which applies a low pressure, regulated and constant amount of medication. This minimizes the pain usually associated with this procedure. This took about 30 minutes. Doctor Bauman himself then administered additional local anesthesia manually, but only to the back of the head; all the while making sure the patient was experiencing little or no discomfort.

While waiting for the anesthesia to take effect, the techs were preparing the O.R. for the strip removal and dissection process.

Once completely numb, the patient was raised and moved into an upright position in preparation for the removal of the donor strip. Bandaging and padding was placed around the head both above and below the donor area. Doctor Bauman then took a dual-bladed scalpel and proceeded to remove the donor strip from the patient. It was 30 cm in length and approx. 2 cm in width. He was assisted by Doctor Polo who made sure that bleeding was kept to a minimum by attaching numerous forceps to various arteries and veins within the exposed donor area.

The strip was then handed to the techs who began to dissect it into 5 parts. Each part was then given to one of 5 techs for follicle retrieval. There were 4 techs and Doctor Polo who worked on this. All but one of the techs used glasses with magnification lenses while one used a microscope for detailed dissection of the strip itself. While the techs were doing this, Doctor Bauman proceeded to suture the donor area closed. This procedure took approximately 15 minutes.

The patient was then lowered in the chair and rotated back to a more comfortable reclining position. An aptly chosen movie, “My Cousin Vinny”, was started and the patient began to fall into a more relaxed state. It was at this point that Doctor Bauman tumessed (spelling?) the recipient site after which he began the follicle recipient incisions at the front of the patient’s head. He made sure to emulate the direction of the patient’s existing hairs and re-create a natural looking hairline. Doctor Bauman uses a foot-operated counter in order to accurately keep count of and subsequently calculate the correct number of incisions to make relative to the number of follicles that will be available. He regularly checks a marker board in the O.R. which is continually updated by the techs with information regarding the number of follicles that they have harvested from the strip. This process took approximately an hour.

This stage was completed around the same time that the techs had completed harvesting follicles from the strip. The follicles from each tech were placed in a moistened, shallow container and covered until ready for placement. The patient was then allowed to get up to go to the bathroom and have lunch which was provided by the clinic. The techs also took the opportunity to have lunch and Doctor Bauman conducted a follow-up consultation with a previous patient.

After lunch, another movie, “Analyze That” was inserted into the DVD player and the patient was re-seated. Three techs then began on the follicle insertion process rotating between the four available and Doctor Polo. Doctor Bauman came in regularly to monitor their progress and work. The patient’s scalp was regularly cleansed by hand with a solution of hydrogen peroxide and antibacterial agent. This was the most time consuming part of the procedure taking about 2 ½ hours. The patient fell asleep during most of this process.

At the end of this stage, the patient was moved into a more upright position and two low-level lamps and a hair dryer were focused on his head to allow the recipient sites to coagulate. This continued for about 20 to 30 minutes during which the O.R. was cleaned and sanitized. Near the end of this stage, the patient was informed on the dos and don’ts regarding post-operative care and concerns about pain, etc. Once over, I proceeded to conduct a short post-op interview with the patient in which he discussed the experience. The patient was then discharged and allowed to go home with a family member who had been present and waiting in the lobby throughout the day.