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Okay, so the important thing follicular unit extraction is to delineate the permanent zone. We can see that this is the area that separates the permanent zone from the area that's balding, and we're going to prep this area. Normally, we shave the scalp to about one millimeter, so we're going to use regular clippers, just to delineate the area.

So, for a follicular unit extraction, it's really important to have the hair very short and uniform length. So, first we demarcate the area that we're going to harvest, so demarcating the permanent from the non-permanent area, and then we use clippers to cut the hair about one millimeter from the scalp, and it has to be very, very short. Even a day's growth will make it too long for the robot to see the hair and we use Wahl Peanut clippers just for this purpose, because it's able to cut the hair short.

We're going to give a ring block with a local anesthetic. The local anesthetic contains 0.5% lidocaine. We use about 60% of that, 40% will be bupivacaine, at 0.25% and we add one to 200,000 epinephrine. Now, we'll just go around the base of the donor area. To make the injections a little bit more comfortable, we use some vibration. So, we'll start basically at the mid-line. Okay, little pinch. We advance the needle first and then, just very slowly, inject as we withdraw. Okay, I'm going to do this very, very slowly.

You can add bicarbinate to decrease the sting a little bit of the injection but the most important thing is just the rate of injection. You want to inject it as slow as possible. Then, we're just going to go around his entire scalp. Here's the way we usually go. So, what we do is we keep on advancing the needle into an area that has prior anesthesia, so it will be partially numb and then we advance around the total perimeter of the scalp. The vibration just negates the sensation of pain, to make it a little bit more comfortable for the patient.

Robotic FUE Hair Transplant Procedure, Part 1: Donor Area Preparation

In Part 1 of a three-video series on Follicular Unit Extraction (Robotic-FUE), Dr. Robert Bernstein walks through the preparation of the patient’s donor area for a follicular unit extraction procedure.