Dr. Prasad: I wanted to introduce a concept that we have been practicing in our office for many years now, and that is to elevate the practice of hair restoration surgery to a level of professional care that is comparable to any cosmetic surgical procedure. The reality about hair restoration surgery overall, is that it’s been practiced for decades in an almost in formulaic way where it was done with local anesthesia, straight local anesthesia, and the patient sat there, and waited for the procedure to be done. Now sometimes they would get lunch, sometimes they would watch movies, but there has been an issue that hair restoration specialists don’t talk about, and I made an observation as a surgeon, and that is this – when people have to sit for an extended period of time, and I’ll have to say particularly men, they start to get anxious, they start to fidget, and that can automatically raise their blood pressure. In addition, there are many people who even if they don’t have high blood pressure may at a time when they’re about to have the procedure, have an elevated blood pressure or if they already have hypertension or high blood pressure and they’re well-controlled medication the blood pressure may remain high during their procedure. Now, why is this important? It’s important because we can think of blood pressure like water pressure – when the water pressure is high then you can force things up, or put a lot of pressure. So in hair transplant, when you’re placing grafts, when you’re placing them individually one at a time, if there’s an elevated blood pressure something happens called “popping”.

Will: Popping is when the blood pressure is up and the heart rate is pumping and starts to push the blood through the openings and there you have, they made thousands of holes on top of your head. So there’s a lot of openings there so the blood is finding a way through the openings and popping out, so it’s like you’re putting a graft in and it’s popping it right back out. So the more, sometimes you got to put a graft in 3 or 4 times before you actually get it in right, so it’s a lot more labor intensive when you’re doing it under local (…)

Dr. Prasad: For years, practices which perform hair restoration surgery did not routinely give people any type of intravenous sedation, or do anything to manage and monitor blood pressure. So invariably a certain percentage of patients ended up, “popping grafts”. What that means in the end is that there were fewer grafts that would take. Now my perspective on this is that every follicle is gold. My logic was, in any cosmetic surgical procedure we hate bleeding, and so we do everything from the formal medical evaluation prior to surgery, or on the day of surgery where we first make an assessment on what a patient’s heart rate, and blood pressure is.

Sheryl: Working here with Dr. Prasad it’s very easy because he gives the patient sedation so the patient is so relaxed, the patient’s blood pressure is normal, less bleeding, it’s easy to plant a graft, no popping, we finish the planting faster so the grafts are out of the body less time.

Dr Prasad: Now, in the several years that we’ve been doing this I routinely use intravenous sedation, which is liquid valium that goes through an IV and with monitors, with nurses, with all the kinds of personnel that we would have if I were doing a facelift. We get much better results because the hairs that we placed are not being compromised. Our technicians are able to manipulate the hairs a minimal amount, and the less you manipulate the hair, the more comfortable you can place it, the better the results are. Our procedures have taken less time, the patients have had a much more favorable experience, and in the end they get higher density, or much more hair than they would have under a different circumstance. And it has been incredibly gratifying for me to be able to bring this to our patients. One of the things that happens in medicine is that when a concept like this is introduced, people who have been doing it their way for many years will always be resistant, and we’ve seen that. We’ve heard that, we heard from whether it’s patients who had it done already with local anesthesia, or by other doctors who we discussed this with in meetings, is that they feel like they’ve done something a certain way for so many years, why should they change. Well, my technicians and other technicians would give you the same feedback in that they notice for certain percentage of patients not doing as well as they could. And in fact what prompted me to do this video is today in our practice we did transplant on a patient who went to one of the big chains of hair restoration surgery in this country, and he had a large amount of grafts placed. He had quote a “megasession” and during the “megasession”. That means a large strip of hair was harvested, and then multiple grafts were placed. Well, in the end what we saw was that he didn’t have that many hairs that grew and when were placing the new hairs that there was scar tissue. And scar tissue means that there was actually hairs placed in those areas, but it never took. We have found that we have been able to really improve the overall quality of the experience, the quality of the surgery, and in the end get much better results. So, I want it to get this out there and help people learn a little bit about this option, and we welcome as always questions and comments and we’re here for you to help you understand this better.