At an initial consultation, the surgeon analyzes the patient's scalp, discusses their preferences and expectations, and advises them on the best approach (e.g. single vs. multiple sessions) and what results might reasonably be expected. Pre-operative folliscopy will help to know the actual existing density of hair, so that postoperative results of newly transplanted hair grafts can be accurately assessed. Some patients may benefit with preoperative topical minoxidil application and vitamins.

For several days prior to surgery the patient refrains from using any medicines which might result in intraoperative bleeding and resultant poor grafting. Alcohol and smoking can contribute to poor graft survival. Post operative antibiotics are commonly prescribed to prevent wound or graft infections.

Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested.

There are several different techniques for harvesting hair follicles, each with their own advantages and disadvantages. Regardless of the harvesting technique, proper extraction of the hair follicle is paramount to ensure the viability of the transplanted hair and avoid transection, the cutting of the hair shaft from the hair follicle. Hair follicles grow at a slight angle to the skin's surface, so transplanted tissue must be removed at a corresponding angle.

There are two main ways in which donor grafts are extracted today: strip excision harvesting, and follicular unit extraction.

1.Correct diagnosis and planning

2.Extraction of grafts without causing any damage.

3.Ensuring good storage conditions of the harvested donor grafts.

4.Accuracy of graft placement in terms of direction, angle and density.

5.Post-operative care

To cover each of the steps in more detail;

The First Crucial Step:  Correct Diagnosis and Planning

When planning the hair transplant, the first and most important step is to diagnose the cause of your hair loss. The diagnosis will provide an insight to the planning of hair transplant. As an example, if a person’s hair loss continues, during the planning phase it is necessary to predict future hair loss and include these potential areas to the hair transplant procedure. A person’s facial structure is not limited by its present appearance. During the planning of a hair transplant, the hairline of the patient should not only be tailored considering the appearance during his/her mid-twenties, but also take into account far beyond their thirties and forties. In addition, a straight hairline should be avoided when performing the hair transplant procedure. Such a hairline will give a artificial look.

The Second Crucial Step: Extraction of grafts without causing any damage

During the extraction of healthy hair follicles conducted one at a time via utilizing either the FUE technique orDHI, physicians should practice due diligence to ensure the integrity. During the extraction process of hair follicles, in order to avoid the pitfall of injury to the graft, it is important to determine the correct orientation, exit angle and direction of each follicular unit. In the contrary case the hair follicles and the surrounding connective tissues that nurture new hair growth may sustain an injury. If a hair follicle is damaged during the extraction process, unfortunately it is not possible to proceed any further. In other words, the follicles that fail to take root in its transplanted location, will remain transplanted for 3 to 5 days and then fall out.

The Third Crucial Step: Ensuring good storage conditions of the harvested donor grafts.

To increase the survival rate as well as to improve the effect of hair transplantation, the optimal storage temperature for graft preservation should be maintained at 4°C. Another significant point is to place the follicular units into a storage solution. Even if all these conditions are met and put into practice, what matters most is how long the grafts remain outside the body. In the traditional FUE method, the extracted hair follicles have to be preserved in the storage solution for various periods of time. The implantation process will be performed after all follicular units have been extracted. In the DHI method, once the hair follicles are extracted they are directly implanted into the receipt site. In the DHI hair transplantation method, once the grafts are extracted from the donor site, they are implanted into the receipt in about 1 to 2 minutes. Among other things, the extracted grafts do not require to be preserved at 4°C or stored in a storage solution. As follicular unit grafts are implanted as soon as they are harvested, the chance of follicle wastage is excessively reduced. At this point we consider it necessary to refer once again to the second crucial step which was; the extraction of grafts without causing any damage.

The Fourth Crucial Step: Graft Placement

Along with the previous crucial step that referred to the significance of good storage conditions of the harvested donor grafts, another critical phase that determines the final outcome is the graft implantation process. To begin with, we consider it necessary to make reference to an expression, quoted as; “Similar to fingerprints, everyone also has a unique hair growth pattern and only under the conditions where the required planning is carried out with a skilled as well as experienced physician can a successful hair transplant outcome be obtained.”

The points to take into account during graft implantation can be collected under four subtitles:

- Angle of the hair follicles exit from scalp skin

- The direction of the hair follicles

- Planning of the procedure in deference to the maximum density achievable with hair transplant

- Accurate alignment of hair follicles during the implantation process

Let’s take an in-depth look at the headings. To start with, we have the critical issue of the angle of the hair follicles exit from scalp skin. The generally accepted variance angle between hairs below the skin and hair exit angle above the skin is 40°. Of course this angle does not necessarily have to be the same for everyone. A person who has combed his/her hair starting from the front to the back his/her entire life may observe that the angle has widened a few degrees and with a person who has combed the opposite way round, i.e. back, then forward, narrowing of the angle. For this reason, the physician performing the operation must have precisely analyzed other hair follicles. The second issue is the direction of hair follicles. Hair will grow forward and horizontal at the frontal hairline and from the top towards the sideways, the direction will slightly deviate downwards. The direction of hair growth on top of the head is often much harder to determine, therefore a favorable outcome can only be obtained if it is well-handled by a experienced doctor and medical staff. The third issue, which is density of the hair, is associated with the number of grafts that is extracted. To achieve high density, a satisfactory number of grafts should be extracted. Hair is best extracted from the area at the back of the head between the ears, which is called the vertex posterior. The hair in this area is resistant to the male hormone Dihydrotestosterone (DHT), which is the cause of hair loss. For this reason, they are considered very important.With more hair follicles harvested and implanted in accordance with hair transplant specifications, these follicles will positively influence the final appearance.

The Fifth Crucial Step: Healthy care of your hair

If the person undergoing hair transplantation has certain habits such as smoking or intake of alcohol, the doctor will advise the patient to avoid smoking or drinking before and after the surgery. Smoking and drinking causes blood vessels to constrict and affects the amount of proper blood flow, which means that the ability of blood to carry oxygen is reduced.

As a result, the hair follicles will not be supplied with the nutrients they need for healthy hair growth. When it comes to taking care of the hair, vitamin intake and choosing a eating plan that is rich in protein will also have a beneficial effect on the treatment. Apart from these, washing your hair, keeping it clean and avoiding stress are significant factors that can affect the condition of your hair throughout your life.