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Hair Transplant Consent Form

FUE Hair Transplant Procedure

It is a legal requirement that before any surgical procedure you read and sign a consent form. The purpose of the form is to confirm the specific procedure agreed with your doctor following consultation and an understanding of the potential risks, complications and limitations relating to the procedure. It will also document any procedures or treatments that you do not wish to receive.

The Principal

Micro incisional slit grafting is a surgical technique that redistributes permanent donor hair in follicular units to a thinning or bald area. It can give excellent results but the prospective patient must understand the principal first. This form is here to help you with this.

When a man starts to loose hair, he normally loses it in one of the forms of male pattern baldness (MPB). This means that he has inherited this tendency and hair on the forehead and crown has been programmed to gradually stop growing. This eventually leads to baldness. Currently the only medications that have been shown to help with this are Minoxidil and Finasteride.

However even in a man who has experienced severe hair loss, he will have a horseshoe pattern of remaining hair at the back of the head and just above the ears. This is the donor (permanent) hair growing area. This area is limited in size and density and varies between individuals. It will normally contain up to 8000 grafts (range is 5000 to 10,000).

These can be transplanted over a number of sessions to the areas that need them, usually the forehead (forelock), mid-scalp and crown areas.

The actual pattern and speed of loss is any particular person is hard to predict. It is important to bear in mind that further hair loss is likely and so transplanting too much too soon will use up a limited donor area before your final pattern is established.

It is also important to realise that there is a limit to how closely together each transplant hair may be placed per session. Further sessions can place more transplants between the original ones and build up the density.

Human hair grows in tiny bundles called follicular units. The follicular unit of the adult human scalp consist of 1 to 3 terminal (full thickness) hair follicles. In areas of the scalp affected by genetic balding, the healthy terminal hairs are gradually replaced by hairs of smaller diameter and length called “miniaturized” hairs

In addition to the full terminal hairs, the follicular unit contains 1 to 2 fine vellus hairs, sebaceous (oil) glands, a small muscle, tiny nerves and blood vessels and a fine band of collagen that surrounds the unit. The follicular unit is thus the hair bearing structure of the skin and should be kept intact to ensure maximum growth.

The follicular unit is seen on the surface of the scalp as a tiny group of hairs that appear to be growing together. They are best viewed under a microscope where they are seen as well-formed structures in the skin.

There will also be a maximum density possible by surgery. This means that you are making a commitment to restoring your hair. There is also a limit to the number of sessions, usually no more than four per area. All results are individual depending on your personal hair characteristics and only the surgeon can say what he feels is possible. No conversations with personnel from the clinic or any other clinic, nor pictures demonstrating previous results implies guarantee that your results will be the same or similar.

The Procedure

Hair transplants are a minor surgical procedure carried out under local anaesthetic. You will be awake and can chat to the surgeon during it. You can also eat and drink before the procedure, which we recommend. However, for some patients we can offer a mild oral sedation. This could interfere with your ability to drive and so you should make appropriate arrangements if this is required.

Alternatives to Hair Transplants

At the consultation depending on the nature of your hair loss, we discussed that having a hair transplant was not the only solution. Other Alternatives include lifelong medication, wearing a wig to disguise the hair loss, or ongoing laser light therapy, and the fact that you don’t have to have this operation. You have chosen to have surgery and hence the details in this form.

For Follicular Unit Extraction (FUE)

A local anaesthetic is injected into the donor area of the scalp which does sting a little but is quite bearable and goes numb very quickly.

During FUE, the surgeon will individually remove a follicular unit (grafts) from the donor area using a special tool. The grafts are then prepared for transfer to the recipient area.

The balding area is also anaesthetised and the graft incisions are made using a specially shaped micro needle. The grafts are then placed into these slits.

After the anaesthetic wears off after three to four hours, the scalp will feel tight and sore but this soon eases off. Simple paracetamol or co-codamol will help. You may also get some forehead swelling and bruising which last a few days and is perfectly normal.

You will also have crusting around the grafts. These must not be scratched as the graft may be pulled out. These crusts will quickly dissolve once you start getting your hair wet after the treatment. Before leaving the clinic, you shall be given a spray to keep the grafts moist. This would also help minimise crusting and keep the grafts alive.  The graft area of the scalp will appear slightly pinker than usual for a few days but this soon passes.

The tiny hair that is transplanted in the grafts normally falls out within 3 to 4 weeks. This is normal due to “thermal shock” The hair will then grow normally from the root and will noticeable by approximately three months and carry on growing as fast and as long as your normal hair.

If the surgeon is transplanting into a thinning area, then this can occasionally cause temporary loss of some existing nearby hair shafts, but this re-grows. Unfortunately, any other hair loss is due to continuing male pattern baldness. It is important to realise that surgery does not stop future loss of non transplanted hair and it may take a number of sessions to replace all your thinning area.

Any surgery, however minor can have side effects such as infection, bleeding, scarring or scalp numbness. These are uncommon in hair transplantation but may occur in up to 1% of patients.

After reading this and discussing any questions with the surgeon, then please fill in the form and sign at the bottom of each page with the date you went sent this information. You will be asked to confirm your consent on the day of surgery after you have discussed with the operating surgeon and you both agree with the plan.

Risks Associated with Hair Transplants

An explanation of the nature and purpose of Hair Transplantation and Scalp Reduction, the risks involved, and the possibility of complications calling for procedures in addition to those originally contemplated have been given to me. 

I understand that the conditions and/or complications described below may accompany Hair Transplantation, as indicated:

This list of risks and conditions is not exhaustive. It is important that patients recognise that it is not always possible for the Surgeon to predetermine the individual and Psychological reaction of patients to post op complications and the results.

STATEMENT OF PATIENT

Please read this form carefully. If you have any questions you must ask. You have the right to change your mind at any time, including after you have signed this form.

Hairline Design

I understand that the design of the hairline is based on lots of elements. It is part art and part science and the availability of donor hair is the main limiting factor against a low hairline. The design of the hairline has been extensively discussed and I am happy with the hairline. I understand the reasoning behind having the hairline that has been proposed to me and that I was actively involved in the design of the shape and contouring of my hairline.

Consent for Vertex Hair Transplant, if applicable:

I have been explained that the results of vertex hair transplants are not as good as frontal areas even after implanting high densities. Even with a large number of grafts in this area, the scalp may still be visible due to variable angulations of hair entry into the scalp in this region.

Hair Transplant Consent Form Surgery Group
Working with COVID-protected facilities

Working Safely

  • Routinely asking patients for relevant COVID-19 history of their own health and people they are in contact with. It is important that patients provide accurate information.
  • Following social distancing guidelines by limiting the contact of patients with one another whether in consultation or in a procedure and will arrange waiting room seating accordingly.
  • Using suitable equipment/PPE (Personal Protective Equipment) as recommended by the Centre for Disease Control (CDC) or another equivalent governmental agency.
  • Routinely using relevant health histories and daily temperature monitoring of all clinic staff and patients as part of their strategy to prevent contagion. Additionally, and where available, follows all government guidelines on use of testing to monitor staff.
  • In addition to using proper PPE, each clinic uses appropriate cleansing, disinfecting and sterilization procedures throughout the office/clinic. Also, uses proper waste disposal methods for any materials that could be contaminated.
  • Advising patients of handwashing protocols in the office/clinic and how to change gloves, gown and masks.
  • Assuring the public that the staff have received additional training with regards to proper COVID-19 infection control methods
  • And perhaps most importantly, the surgeon you have chosen is the one performing the surgical steps of your procedure, rather than delegating it to unlicensed technicians.

 

Clinic Advice

Regarding COVID19, we are working with selected COVID-protected facilities who have now reopened. These clinics have started a phased return model for a new normal with various safety measures in place including a limited number of procedures, reduced footfall through the clinic and enhanced PPE for staff. On the day, you will be asked to complete a COVID questionnaire and have your temperature taken on entry, as well as being asked to wash your hands. You will be asked to wear a face mask so that theoretically you are protected and you protect staff members in case anyone happens to be positive whilst asymptomatic.

Surgery Group have adopted guidelines from the International Society of Hair Restoration Surgery for use in all clinics taking into account UK law and each clinic has completed a COVID19 risk assessment of the patient journey through the clinic and taken steps to minimise risk, and we hope that by doing so, the risk of contracting coronavirus is significantly less than your weekly supermarket shop, however, it is not possible to guarantee that the risk of catching it is zero, such as in the nature of the virus.

To be clear, the government’s advice for the time being remains to stay at home unless you need to leave the house for one of 4 reasons including “any medical need” –

Corona Virus Government Advice

Without specific national guidance on hair transplant clinics, we deem it safe to offer the service in a limited capacity with the measures we have taken, but it is up to you to decide if leaving the house to attend a hair transplant clinic constitutes a “medical need”.