Patient Consent Form

  • Patient Consent Form FUE Surgery Group
  • Name of proposed procedure: 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 lose 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 transplanted 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 consists 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 a 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:

    1. Swelling/bruising – Swelling may occasionally occur about the forehead, eyelids, and upper nose in some patients when transplants are placed in the front part of the scalp. Cool compresses and a sitting posture are helpful. Such condition may last about one to three days.

    2. Spotting or Bleeding – All bleeding is controlled prior to leaving the office by pressure dressing or suture. Spotting of blood may occur afterwards on the dressing. If this occurs, firm and constant pressure over the areas for 20 minutes will usually be sufficient. If brisk bleeding should occur, maintain firm pressure directly on the area and phone our office, or go immediately to the nearest emergency hospital. It may be necessary to place a suture directly over the bleeding area(s). In an extremely rare case, extensive bleeding could require hospitalization and blood transfusion.

    3. Numbness – Numbness may occur on the scalp and is the result of cutting small nerve endings in the skin during the course of taking donor grafts and creating recipient sites. It can also be associated with a tingling, burning sensation. This usually disappears within a few months, as nerve endings regrow. In very rare cases, permanent numbness may occur in some areas of the scalp.

    4. Pain/Discomfort – Before and during your procedure(s) you will be given local anaesthetic and other medications to help with the pain. The degree of discomfort experienced during and after the procedure varies among patients, however, the great majority of our patients are comfortable during and after their procedure(s). Before you leave our clinic you will be given a prescription or medications along with post-operative instructions.

    5. Infection – It is important to recognize that any surgical incision contributes to a risk of bacterial infection in the skin. Thankfully, this is extremely rare and is treated with antibiotics. If there are any concerns post-operatively you must contact us, especially if you develop a fever, new pain or discharge from the wound.

    6. Surgery Scarring – Hair restoration procedures may result in detectible scarring even with this technique. Hypertrophic (raised) / Keloid scars may occur as an unexpected reaction. They may be lessened with Cortisone injection or may flatten with the lapse of time. Occasionally, the graft areas are slightly depressed below the surrounding skin. Most of the time, however, grafts are flat and blend into the adjacent skin. Every effort will be exerted to make the scar as inconspicuous as possible. In some cases, a depressed scar may result; in very rare cases a rear slot appearance or some tissue necrosis may result. In almost all cases these conditions are able to be greatly improved with one or more subsequent procedures. Scar appearance is strongly influenced by your skin type and other characteristics. Some patients have more tendency to develop a widened or thick scar. The process of FUE involves taking grafts from the donor site in a wholesome manner. This involves coring the grafts with a sharp punch and I understand the very nature of this procedure can leave tiny scars resembling the size of the punch used.

    7. Foreign Body Reaction – This is a rare complication with red, raised areas in graft sites. This may necessitate treatment for removal.

    8. Itching - Some itching is common but rarely troublesome.

    9. Cysts – On occasions, during the healing process, cysts may develop in the site of growing hair or from where it was extracted. These can usually be easily treated.

    10. Blood Vessel Reaction – This is rare and is treated by electrodessication (electric needle) or suturing. The patient should return to the office if any transplants develop small bumps or firm swellings in the surgical areas.

    11. Graft Rejection – This is extremely rare. It is possible if you have underlying medical and/or skin conditions, smoke, bump your head post operatively, or do not adhere to the post-op instructions given to you by the surgeon. Smoking for the period leading up to your surgery and afterwards can seriously hinder your graft acceptance rates. You will need to wait at least 6 months to start seeing the results of hair growth. However, it is impossible to predict the reaction of individual patients and in extremely rare cases, growth may be limited. The quality and amount of existing hair is a major factor in the ultimate result. The continuing process of hair loss affecting hair adjacent to the grafted hair may affect the result in the long term.

    12. Adverse Reaction to Local Anesthetic – This is rare, it may be the result of individual sensitivity and is rarely significant in severity.

    13. Temporary Loss of Hair/Shock Loss – This is rare and in virtually all patients this hair re-grows within a few months after the procedure.

    14. Density/Subjectivity – Density in the recipient area is subjective and therefore, it may take more than one procedure to achieve your personal goal/expectation. Density in the transplanted area cannot be the same as in the donor area. The idea of transplant is to give an illusion of high density in the area, but it will never replicate the density in the donor area.

    15. Healing – Every reasonable effort is exerted to make the donor and recipient areas appear as inconspicuous as feasible during the healing process. Nevertheless, an occasional patient may wish to temporarily wear a hat after the procedure, depending upon individual requirements or preferences.

    16. Progressive Hair Loss – I acknowledge and understand that the hair transplant procedure merely transplants existing hair from the donor area to the recipient area on my scalp. This process does not, cannot, and has no control over the future, continued and progressive loss of existing hair in or near the recipient area or anywhere on the scalp. I acknowledge that I have been advised to seek and pursue other remedies to prevent the occurrence of progressive and future hair loss of existing, non-transplanted hair.

    17. Subjectivity – Patients must recognize that this procedure is performed for cosmetic reasons in areas of hair loss to improve self esteem and confidence and because of this the results can only be assessed subjectively. Therefore, it is important to understand that while you will be advised as to the probable results, this should in no way be interpreted as a guarantee.

    This list of risks and conditions is not exhaustive. It is important that patients recognize 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.


    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.

    - I agree to the procedure, or course of treatment described on this form, including anaesthetics and sedatives.

    - I understand that there are various hair restoration options available to me, including no treatment, medical therapies, scalp reduction / flap transfers, follicular extraction technique (FUE) and strip surgery (FUT).

    - I understand that the graft numbers agreed at the consultation is the intended number of grafts, but I am aware the actual number provided may be lower or higher and depends on many factors outside of the doctor’s control.

    - I understand that there are risks involved in any surgical procedure or treatment and that it is not possible to guarantee or to give assurance of a successful result or to assure an outcome that will meet my goals or guarantee my happiness.

    - I recognize that I have been given every opportunity to ask questions and have made the decision to proceed with surgery.

    - I have been told that hair transplantation is a generally safe procedure, but realize that the risks and complications outlined on this consent form may occur on a rare basis.

    - I acknowledge that my physician can take no responsibility for previous hair transplants and may not be able to correct the condition, although they will attempt to.

    - I consent to full face and scalp photographs being taken and kept confidentially on my medical records file. This does not include use in advertising without my own separate consent.

    This consent was read and signed by me while I was not under the influence of medications or other substances that can cause drowsiness or impair judgment.

  • 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.