There are 3 anesthesia options for hair transplant: Local Anesthesia, Local anesthesia with sedation (monitored anesthesia care), and general anesthesia. Local anesthesia with sedation is the most commonly used technique.

I will share my experience of doing many monitored anesthesia care for hair transplant surgeries. 

What is Conscious Sedation?

Conscious sedation is the administration of medication(s) so you feel comfortable when you’re getting the transplant done. If you receive this type of sedation you will be able to respond to any verbal commands either alone or if someone touches you lightly. The breathing will be normally going without any extra support the heart and blood pressure will be maintained close to normal.

What happens during conscious sedation?

Prior to injecting any local anesthesia, an intravenous line is placed. An anesthesia doctor will stay with the patient throughout the procedure. The doctor administers medicines like midazolam and/or fentanyl etc. to provide a calm relaxing environment to the patient so they can get this done comfortably. In addition to this, fentanyl helps with mitigating pain that the locals may not cover especially in the sensitive donor areas of the body. The conscious sedation rules may be different depending on which country you live in. An anesthesia doctor or a health care personnel who is not a doctor but specialized in sedation or administering anesthesia may care for you. Either way, make sure you have some presence there. The surgeon or the person performing the procedure cannot administer sedative medications. This has to be done by trained personnel. Because many people travel internationally for hair transplants make sure to check the local regulations. After all, you want to have a safe outcome.

What are the anesthesia options for Hair Transplant?

The options are Local Anesthesia, Local Anesthesia + Moderate Sedation also known as conscious sedation as discussed above, and the third option is General Anesthesia. 

Do I need general anesthesia for a hair transplant?

General Anesthesia consists of using anesthesia gas or intravenous medicines to have the patient fully off to sleep. This is used in complex hair transplants when someone has a burn or other types of medical problems. So for the purpose of elective cosmetic hair transplant procedure here for male pattern baldness, the risks of general anesthesia are not worth it. 

There may be clinics using medications like ketamine and propofol. Again I personally don’t think the risks of these are warranted for a procedure like an elective cosmetic hair transplant. You all may remember Michael Jackson. Local anesthesia with mild to moderate sedation should provide a comfortable experience.

What is the common anesthesia used during a hair transplant?

The main anesthesia used in a hair transplant procedure is local anesthesia. Before the local is injected, an intravenous line is placed and the patient will be placed on continuous monitoring. Monitoring will include an electrocardiogram (ECG), heart rate, oxygen saturation, and blood pressure. Check with your transplant clinic they do all this. 

The commonly used local anesthesia medicine is lidocaine or lignocaine mixed with dilute epinephrine or adrenaline. Some may also use longer-acting local anesthesia drugs like bupivacaine. Many times a cream called EMLA which is a mixture of lidocaine or prilocaine local anesthetics is used.

What is Tumescent Anesthesia?

You may also hear the name tumescent anesthesia. This is a practice where local anesthesia like lidocaine is diluted and mixed with epinephrine and sodium bicarbonate and is injected until the tissue become firm and tense. This was first done in liposuction or fat reduction surgeries and now is used in hair transplant surgery. The use of sodium bicarbonate makes the ph acidic, a little bit of chemistry here. This alkaline ph helps reduce pain with local injection and also is slowly absorbed into the body thereby reducing any toxicity or poisoning. Since the anesthesia is required for many hours, the injection may be topped off with more doses as required. The surgeon and the anesthesia doctor keep in mind the maximum dose that can be safely administered. 

What other techniques can reduce pain?

There are many additional techniques hair transplant doctors use to reduce pain associated with the injection of a local anesthetic. Typically what we do is inject local anesthesia in one site where you could feel a needle going in. Now this area will be numb. The local anesthesia is then injected starting from this area so no further needle pain is felt. Now surgeons use different methods here like vibration, pressure, etc. as a distraction to reduce the feeling of the injection and also a small gauge needle so patients don’t feel it. The same is done for donor and recipient areas.

If I am very anxious what medications will I get?

You may also be prescribed anxiety-reducing medicines like diazepam, lorazepam, clonidine, etc. In addition to all this, do talk to your surgeon about the conscious sedation and availability of experienced personnel. The presence of an anesthesia doctor or trained person to manage emergencies is so critical in these procedures.

Why is the presence of trained personnel to manage emergencies so critical?

The presence of an anesthesia doctor or a trained person to manage emergencies is so critical in these procedures. Although rare, the use of local anesthetics also can cause rare side effects like allergic reactions, local anesthesia poisoning, or toxicity which requires emergency management.  

Are there any complications during Hair Transplant?

Yes, there are reports from the print media about patients having complications and even dying during this procedure. Here are some links:

Man loses eye after hair transplant

A young boy dies during a hair transplant

Man dies due to allergic reaction

How do I be careful?

Do your research. There are too many clinics. Check the credentials of your doctor. Make sure the clinic is able to deliver what they promise. Speak to real patients. Make a wise choice.

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