The procedure today was our patient's third overall. It was his second procedure with Dr. Wolf for adding more density.

Hairline Design	Donor Removal
Donor Suturing	Graft Dissection
Recipient Sites	Graft Placement

The technician anesthetized the recipient sites with nerve blocks in the forehead to allow the patient to last the entire day without any need for follow up anesthesia. After the anesthetization, Dr. Wolf showed me the previous donor scar and how he'd reduced the scar from the previous surgery. Dr. Wolf commented on several occasions he wished he could have done more to reduce the existing scar from the first surgery at the 'other clinic' but there is only so much physically possible. I felt his corrective work was exceptional. If a patient makes a mistake and goes to a hair mill for his first surgery there is only so much a surgeon can do to correct the damage.

Dr. Wolf carefully removed the strip. The strip was taken to the surgical techs who began to sliver and dissect the grafts. Dr. Wolf meticulously sutured the donor area to ensure a pencil line scar. Dr. Wolf commented he takes his time with every aspect of the surgery to ensure superior results. He said he may take longer than others to close the donor area, but has to ensure he has done everything human possibly for a donor line scar. Since he only has one patient per day there is no worry of not being finished for the next patient.
While the graft technicians began the graft dissection Dr. Wolf showed me his Cutting Edge custom cut lateral slit blades and how they are custom cut for the width of the follicles. These are the same blades used by most leading edge physicians using the lateral slit technique such as Hasson and Wong.

Using a marker board on the back wall of the surgical room the technicians estimated how many 1, 2, and 3 hair grafts they were going to be able to dissect from the strip to allow Dr. Wolf to custom cut his blades appropriately and plan for the overall placement design.

Dr. Wolf began pre-punching his recipient sites using the lateral slit blades. I interrupted him a few times with incessantly annoying technical questions and he politely asked me to stop interrupting his punch count. Dr. Wolf is so mild mannered and charismatic that it's almost impossible to rattle him. I came close to succeeding since I have such a fascination with hair transplant surgery and an unending list of questions.

I noticed Dr. Wolf was meticulous and painstaking in his approach to recipient site creation as with everything else. I commented that I had seen other surgeons punch quite rapidly. He responded that he probably punches more slowly than most other surgeons, but likes to take the time to do it right the first time and avoid transecting existing follicles at all costs. I noticed this was the general atmosphere of the entire office. Everyone had the expectation that they were going to take as long as needed to make sure everything was done correctly. If you decide to go to Dr. Wolf for surgery, don't make any evening plans. You should plan to stay late into the evening, as they will do the same for you.

Dr. Wolf kept a tally of his recipient site punches on the other side of the white marker board to ensure the counts matched exactly for the grafts. He discussed that some doctors always makes the recipient sites too big for every graft to ensure they will always fit. This is an easier method of hair transplants since less work has to be done in quality control for graft matching. The problem with larger grafts is pitting as too much skin is removed for the graft. The extra two hours a doctor spends per surgery on proper quality control and custom cutting isn't much time in the grand scheme of things, but the final results are night and day.

We took a short lunch break and Dr. Wolf met with two patients for follow up visits while we waited for the first batch of grafts and for the first group of recipient sites to coagulate.

Our first grafts were delivered to us in chilled saline. The technicians took turns placing while I watched the technicians finish the strip dissection and follicular unit graft placement. Dr. Wolf returned to finish the graft placement and demonstrated to me how popping can occur when two follicles are densely packed. I found it interesting that popping can occur even with pre-punched recipient sites and the use of custom cut lateral slit blades.

We live in an age where so many of the products we buy are sold through giant warehouse centers and health care is provided by sprawling hospitals. I've learned that less is often more in the hair transplant industry and choosing a small team of surgical specialists completely dedicated to one patient for the day is the best choice anyone can make in hair transplant surgery.