HairSite's Personal Journal, September 2002
First Three Weeks After Follicle Transplantation at Gho Clinic

DAY 2 - Surgery Day

Breakfast
The surgery was scheduled for 9 am so I woke up at 7:30 am. I had a light breakfast at the restaurant downstairs and received a welcome package from Gho Clinic. The package was full of tourist information for Maastricht. Please read travelogue for details. I was a bit nervous about the surgery. Still somewhat obsessed about the possibility of shock fallout as a result of the procedure. I had a very light breakfast and then I went to my room and took a shower.

Ground Transportation
The car service arrived at 8:45 am sharp. I was then taken to Gho Clinic. A 15 minute ride from the hotel. I was then brought to the surgery area. All the staff were waiting already. There were Dr. Gho, Dr. Schreurs, and I think three assistants if I recall correctly. 

Show Time
The staff greeted me and introduced themselves. Then I was led to a room where they kept the video library. I wasn't really in the mood to watch anything, so I just picked several episodes of Friends hoping that would cheer me up .

Pre-operative preparation Dr. Gho first took more "before" pictures for me. Then both Dr. Gho and Dr. Schreurs reviewed the surgery plan in details with me once more. Again, we addressed issues such as the grafts angle, grafts placement, incisions, number of grafts etc. I took the opportunity and stressed to both Dr. Gho and Dr. Schreurs that I did not want my existing hair to be affected or damaged as a result of the procedure. Besides Dr. Gho and Dr. Schreurs, there were three other technicians or nurses (Dyonne, Marianne and Patricia) during the procedure to make sure that I was well taken care of .

Wendy Schreurs, MD

Local Anesthetic
In my first cover story on Follicle Transplantation (May 2002), I was told that local anesthetic was applied topically without needles and I reported accordingly in the cover story. However, I found that local anesthetic was actually applied using a high pressure injector. I do not have any medical background but somehow when people are talking about "topical anesthetic" I would assume that refers to rubbing the anesthetic over the skin with a cotton ball. While it is true that no needles were involved in administering the local anesthetic, I am not sure if a high pressure anesthetic injector could be considered as topical. Either case is fine by me but I just wonder if corrections are necessary in my first report on Follicle Transplantation. 

Preparing the donor site  It was decided that the donor site should be located immediately below the linear scar I inherited from my strip excision surgery. The technicians proceeded to put a tape around the back of my head in order to hold the hair above my linear scar up so that they wouldn't get in the way. Dr. Schreurs then started to shave the donor area. Note that my hair was grown to over 2 inches prior to the surgery and that was more than sufficient to camouflage the donor site.

Click to enlarge

Applying the Local Anesthetic
After the donor site had been shaved, the local anesthetic was administered about 8-10 times over the donor area. It felt like someone flicked my head with a finger very hard each time the local anesthetic was administered. That could hardly be described or labeled as pain.

Let the show begin: Donor Hair Extraction
The back rest of the recliner chair was lowered all the way until the whole chair turned into a something that resembled a massage table with a large opening in the head rest. I was asked to lie on my stomach with my face on the head rest so that I could see the floor. On the floor there was a tiny monitor where they played the videos I chose. Dr. Gho and Dr. Schreurs then started the donor hair extraction process with a needle. Another clarification here: the technicians and nurses were around but they were NOT involved in the actual extraction process or any critical part of the procedure. I didn't feel any pain at all.

There was absolutely no pain, but something else instead
The first hour and a half on the "massage" chair was a breeze. No problem at all. It was comfortable enough that I could fall asleep. But about two hours into the extraction process, I was overwhelmed by a nauseating sense of restlessness and discomfort as a result of lying on my stomach for an extended period of time. The discomfort was hard to describe. It was definitely not pain. I do not have claustrophobia but I would describe that restlessness and discomfort as a mild claustrophobic experience. I requested two bathroom breaks and started tossing gently in the latter part of the extraction process which drove Dr. Schreurs crazy  (sorry ! ). Dr. Gho commented that they are experimenting with new equipment that will alleviate the discomfort. On hindsight, the discomfort was not unbearable or anything. It just caught me by surprise because I wouldn't expect to feel uncomfortable lying on a massage table before. I think the key is to request 2 - 3 bathroom breaks during the process and that should be ok. The entire extraction process finally finished at 1 pm.

Donor Hair Spoilage/ Follicular Transection During the donor hair extraction process, Dr. Gho and Dr. Schreurs kept three petri dishes where the donor grafts are put.  Two of the petri dishes were for donor hairs that were suitable for grafting. The third dish contained no more than 10 grafts and these were donor hairs that were not likely to yield any hair growth. According to Dr. Schreurs, the third dish was for grafts that were not extracted deep enough in the follicle or did not have sufficient fat tissue attached to them. In essence, the 8-10 grafts represented spoilage in the extraction process or follicular transection.

These are good grafts

While I was upset that approximately 10 grafts were wasted, I was wondering if there was any chance that the lower portion of these follicles would continue to grow in the donor site considering that the bulk of these follicles still remained in the skin intact. I discussed with Dr. Gho after the surgery and he commented confidently that because the upper portions of these follicles were not extracted deep enough, there would be sufficient length retained in the lower portion of the follicles to regenerate new hairs.  In any case, I do not suppose that was a big issue because transection is pretty much inherent in all hair transplantation procedures. I am sure there will be a fair amount of transection associated with traditional hair transplantation too especially along the incision perimeter.

Lunch Break
My first comment after have spent several hours on the "massage" table was: "I never knew sitting up straight would feel this good". I forgot who took care of my lunch, either Dyonne or Marianne, I think. I requested soup and a sandwich and they were brought to me in the surgical room. For some reasons, I was still nervous about the rest of the procedure and my appetite wasn't at its best. I finished the soup which was delicious but I couldn't take more than one bite on the huge sandwich. The lunch break lasted 30 minutes. Lunch break was probably the great divider between lying on the stomach and sitting on a recliner chair. The procedures following lunch break were all performed me with sitting comfortably on a recliner chair. 

Preparation for the recipient area Local anesthetic was applied to the recipient site using the exact same high pressure gun that was used on the donor site. Dr. Gho then created the micro incisions using the same needle used for donor hair extraction. I did not experience any pain during the procedure. As previously agreed upon, some incisions were created by removing tiny bald tissue while others were not depending on hair density on the particular recipient site. Dr. Gho actually put all the bald tissues that were removed in the process in a petrie dish and showed me how not a single hair was removed or damaged while creating the incisions. I was pleased.

Click to enlarge Recipient site

Grafting
The grafting was done by Dr. Schreurs immediately after the incisions were created by Dr. Gho. I did not experience any pain during the grafting process. A technician or nurse was standing right next to Dr. Schreurs with a palm size meter counting each graft that was transplanted to the recipient area. During the process, a mirror was provided showing me exactly how the incisions were created and how each graft was transplanted. The final count was about 170 grafts. I was hoping for a final count that is closer to 200 grafts but 170 was fine too. I didn't want to be too critical considering that everything went pretty well. This constituted the last significant process of the entire procedure. I did not recall exactly what time we finished, I think it was approximately 3:00 pm.  

Post-op  Before the nurse gave me my post-op medications, she applied a topical anti-biotic on the donor site. Please read Post-op Instructions in FAQ for details. All medications are included in the overseas package.

Ground Transportation
A car service had been arranged for me. I was back in the hotel by around 5:00 pm. 

In need of a handheld mirror
By the time I returned to my hotel, I realized that I needed a handheld mirror so that I could apply the topical anti-biotic on the donor site before I went to bed. I went outside and there was a department store within 5 minutes walk from the hotel. I just made it on time because it appeared that most stores closed at 6 pm in Maastricht. I hung out in my room, looked into the mirror and checked out my grafts as well as the donor site about 300 times under 500 different lightings and angles. I was starting to get somewhat restless thinking that shock fallout would come back to haunt me a second time. 

Dinner
After obsessing with my hair for a good hour or so and soon after I started seeing doubles in the mirror, I decided that it was time for me to have dinner. I went to the restaurant on the ground floor and it wasn't long when I found myself engaging in some very pleasant conversations with the restaurant owner and his two children. Good food, great company but I was positive the people there knew what the deal was on my scalp. I did not wear a cap or anything for fear that it would disturb the grafts. Honestly, I couldn't care less because preserving the new grafts was more important. Besides, the restaurant was like the designated hangout joint for all Gho Clinic's overseas patients so I was sure they were familiar with balding guys with bloody red scalps. 

Bedtime Story
The anesthetic pretty much wore off by around 9 pm. My scalp regained sensitivity and the donor site felt somewhat tender. But no pain. Reflecting on how I felt the very night my strip excision surgery was completed in 1995, the difference was indeed night and day. At the end of my journal, you will find a comparison chart itemizing the differences between the two procedures. I applied the topical anti-biotic to the donor site and that was the final chapter on surgery day. 

In my mind, I was still obsessing about the possibility of shock fallout as a result of the surgery. To a certain extent, I was questioning myself if that was a right decision.