Hair Loss & Restoration Article: Anesthesia

International Society of Hair Restoration Surgery (ISHRS) - Treating Hair Loss

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Anesthesia: Maximizing Patient Comfort in Surgical Hair Restoration

December 2007

An important-and for some prospective patients the most important-question regarding hair restoration surgery is: Will it be painful? Different people have different levels of susceptibility to the unpleasant sensations associated with physical trauma. Those with a low level of susceptibility can tolerate skin injury with a "grin and bear it" attitude. People with higher levels of susceptibility do not tolerate pain well, and may go to considerable lengths to avoid circumstances that can cause pain. In the mid-range between those with very high and very low tolerance for pain are most people who avoid pain when they can but will bear it when they must.

Discomfort and Hair Restoration Surgery

Hair transplantation and other surgical hair restoration procedures (See Surgical Hair Restoration) are "elective" procedures. An elective surgical procedure such as hair restoration is one that a potential patient chooses to undergo, in contradistinction with a procedure that the patient needs to undergo (such as removal of a cancer or a diseased organ).

A frequent question from people who are considering surgical hair restoration is: How much will it hurt? In other words, will the cosmetic benefit of hair restoration be worth the discomfort of surgery? Fear of discomfort can be a potent reason to avoid elective surgery.

Sharing Fears and Doubts with the Physician Hair Restoration Specialist

Fear of pain should not be a "hidden" reason to avoid surgical hair restoration. The physician may suspect that this is the case when a prospective patient expresses interest in surgical hair restoration, then suddenly decides against it. However, the subject is difficult to discuss unless the prospective patient shows willingness to talk about it.

Once the concern about pain is raised, the prospective patient and physician can work together to explore the patient's preoperative anxiety.

Facts About Anesthesia

Anxiety can often be alleviated by objective information. It isn't irrational to be nervous about fear of pain, but with objective information there is less to be nervous about. For example:

Hair restoration surgery isn't painless, but pain control is much more effective today than even in the recent past. Medical research has improved understanding of nociception-how a sensation of pain is received, transmitted and interpreted by nerves from the site of injury to the spinal cord and the brain. Better understanding has translated into more effective uses of anesthesia.

There is better understanding of the relationship between effective anesthesia and limitation of bleeding or "oozing" during surgery. An inadequately anesthetized, anxious patient may have increases in heart rate and blood pressure that increase risk for bleeding; thus, anesthesia level and physical signs such as heart rate and blood pressure are carefully monitored during surgery.

Many choices are available today for (1) type of anesthesia, and (2) route of administration. Type of anesthesia and route of administration are selected for optimal effectiveness and safety in the individual patient. In broad definition, anesthetics used in hair restoration surgery are (1) locally active for local nerve block, and (2) systemically active for more generalized anesthesia. Locally active anesthetics are delivered locally by infiltration or injection. Systemically active anesthetics are delivered by mouth (in pill or capsule form), by injection into subcutaneous tissue or muscle, intravenously or by inhalation. Rarely used is general anesthesia that renders the patient completely unconscious; it is better if the patient can respond to instruction from the physician during surgery.

Preoperative anxiety about discomfort may be alleviated by administration of anti-anxiety medication. Patients who believe that they cannot endure discomfort of injections for local anesthesia may be pretreated with an anesthetic applied to the skin that temporarily reduces the patient's ability to sense pain at a local site.

Anesthesia Safety

Proper selection of an anesthetic includes safety considerations. In preoperative screening, the physician will ask if the patient has ever had an adverse reaction or side effect from an anesthetic; adverse reactions and side effects include allergic reactions, nausea, vomiting, itching, breathlessness, increased or decreased heart rate, or severe systemic effects that required emergency medical treatment or hospitalization. While such reactions are infrequent, it is essential that the physician know if they have been experienced by the patient.

The patient should ask the physician to discuss what anesthetics are to be used, with explanation of the rationale and potential side effects.

Anesthesia as Gateway

Safe and effective anesthesia is the gateway to the elective surgical procedure of hair restoration. Anxiety about discomfort can be a roadblock. Effective patient/physician communication and rational use of medications can remove the roadblock and open the way to successful hair restoration.

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