Dr. Dennis D. Russell fingers the hair at the back of his patient's scalp. Finding a thick, healthy section, he carefully cuts out a strip 6 inches long and about an eighth of an inch wide.
While he sews up the incision, an assistant takes the strip into another room and cuts it into tiny sections each containing between one and three individual hairs.Those few hairs will form the basis for a new head of healthy hair for the patient, whose former male-pattern baldness should soon be a thing of the past. If all goes well - and it usually does, Russell said - the patient will have a thick head of vital, growing hair within a few months, fed by the micrografting procedure.
Russell, a dermatologist, has done hair transplants for more than 25 years. Until a few years ago, he did mainly large grafts, but those leave a more tufted appearance and don't look as natural as the new micrografting technique he now employs.
Besides looking better, micro-grafts have fewer complications and side effects, he said.
Micrografting is a technique that's been around for almost 40 years, begun by the Japanese in 1959. For decades, doctors in the United States, including Russell, thought it was too tedious.
But new instruments have made it possible to do the grafts with less scarring from the site of the donor strip, and the results are much more natural. Healing time has been decreased, as well.
The procedure itself is done in sessions. How many depends on the extent of the baldness and how much hair is desired. Cost is from $5 to $7 for each micrograft, in which a small hole is punched in the scalp and one to three hairs implanted.
Most of Russell's patients are men - and with very few exceptions, they are extremely reluctant to talk about the procedure, since they don't want identified as having baldness, he said.
Most sessions include about 200 to 300 micrografts. Someone with significant baldness, extending all the way to the crown, may need three or four sessions, each a month or two apart and lasting two to three hours.
Russell marks the scalp with "freckles" indicating where the hair will go, then uses a topical anesthetic to numb to scalp. With special instruments, tiny holes are punched in the skin, into which the miniscule hair plugs are planted. When he's done, Russell bandages the head.
That bandage will be worn for a day or two. Some patients take those days off work, others just wear a cap. After four days, patients can gently wash their hair.
The only common side effect is an itching scalp as healing takes place, said Russell. Pain isn't much of a problem. More than half his patients don't bother with painkillers after the procedure, which is considered minor surgery.
The beauty of the micrograft, he said, is that the hairs being surgically implanted will grow, even though hormones killed other hair before on the same location.
And Russell said that, while it takes six to ninth months to see a full head of hair, scarring is minimal and usually disappears in a short time.