I’m thinking about getting a hair transplant. But, I have three questions:
- What drugs would the doc give/inject me with in a hair transplant operation?
- Will I be prescribed drugs after the operation?
- Do any of these drugs cause sexual impotence of any kind?
This varies considerably from doctor to doctor. During surgery, every doctor has to inject some local anesthetic (“Novocaine” being the generic word most commonly used) in the form of Lidocaine and in addition Marcaine (bupivacaine), which is a longer acting one. Those are always given in the form of a “ring block” around the scalp to numb both the donor and the recipient areas on top. Some hair restoration physicians use a nerve block in the area of the inside eyebrows to block the supraorbital and supratrochlear nerves, which can greatly reduce the amount of local that has to later be used.
Most hair transplant physicians also give some form of a cortisone steroid medication, either mixed into the solution that is “tumesced” into the scalp before the holes/slits are made or in the form of pills. In our clinic we give 60mg of Prednisone just before surgery and 40mg daily for three more days. These are given to help reduce the chance of forehead swelling after surgery.
During surgery most clinics give some sort of a sedative to help allay anxiety and make the time go by faster. It also keeps the patient from getting antsy and moving around, which makes the placement of the follicular unit grafts much more difficult. Some docs also give a narcotic along with the sedative, which helps raise the pain threshold. In our clinic we use subcutaneous Versed (midazolam) and IM Demerol for this purpose, which does a nice job of keeping the patient comfortable and also gives a nice amnesic effect.
After surgery, the commonest medications given out are a few days of Prednisone or another steroid (Medrol Dose-pak) for swelling, some pain pills (to use if needed) and something for sleep. Some hair restoration clinics routinely give antibiotics also, even though there is no proof they help except in the case of diabetics and persons with immune problems.
No doubt the reason you bring up the impotence issue is because of the drug Propecia (finasteride), which is probably our best medication for slowing down hair loss and actually increasing hair mass in about a third of those using it. Many men who have a hair transplant have already been on this med for some time and simply continue taking it. If not, some are started around the same time as the transplant in order to maximize or increase the contribution of the native hair to the overall cosmetic appearance. Studies show a 2.9% incidence of sexual side effects (the commonest being reduced erection or reduced libido) which is pretty darn low. The hair surgeon you go to will undoubtedly tell you of its benefits and also the small incidence of side effects and then you are free to go on it or not. I can tell you that the patients that do both (hair transplants and finasteride) often have spectacular results later on that wouldn’t have been possible with only the hair transplant. You end up with an addition of transplanted hair and increased native hair versus a subtraction due to the progression of male pattern balding and the loss of the remaining native hairs.
Mike Beehner, M.D.
David – aka TakingThePlunge
Assistant Publisher and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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