The importance of pain control in hair transplantation cannot be overemphasized. Adequate preoperative sedation to reduce anxiety, raise pain threshold, and induce amnesia is fundamental to minimizing operative pain. Most of the pain associated with the procedure results from injection of the local anesthetic. Once initial anesthesia is achieved, proper maintenance of anesthesia is of paramount importance especially with the trend toward larger numbers of grafts being performed in one session with prolonged operative times. The choice of local anesthetic agents, infiltration technique, optimal field blocks and nerve blocks, proper hemostasis, timely repetition of anesthesia, and use of analgesics intraoperatively, with the goal of maintaining the patient pain-free during the procedure, are fundamental. In addition, reduced pain on infiltration can be achieved with buffering and warming of the local anesthetic solution as well as techniques to decrease sensation or partially anesthetize the skin prior to injection. Techniques such as bupivacaine donor area field block in the immediate postoperative period and early administration of analgesics can greatly influence postoperative pain. Along with excellent cosmetic results attainable with modern techniques, improving patients’ experiences during the surgical process will enhance the public perception of hair transplantation and will encourage prospective patients to seek this treatment modality.
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Seager DJ. Local anesthesia in hair transplantation. In: Stough DB, Haber RS. Hair replacement surgical and medical. St Louis (MO); Mosby, 1996: 81–9
Unger WP. Anesthesia. In: Unger WP, editor. Hair transplantation. 3rd ed. New York (NY); Marcel Dekker, 1995: 165–81
Wolf B. Donor and recipient site pain [letter]. Hair Transplant Forum Int 2000; 10 (3): 80
Sadick NS, Stough DB. Nitrons oxide in hair restoration surgery. In: Stough DB, Haber RS, editors. Hair replacement surgical and medical. St Louis (MO); Mosby, 1996: 104
Seager DJ, Simmons C. Local anesthesia in hair transplantation. Dermatol Surg 2002; 28 (4): 320–8
Haber RS, Khan S, Stough DB. Nerve block anesthesia of the scalp. In: Stough DB, Haber RS, editors. Hair replacement surgical and medical. Mosby, 1996: 89–93
Swinehart J. The ice-saline-xylocaine technique. J Dermatol Surg Oncol 1992; 18: 28–30
Puig CJ, Haenschen R, Clark DM, et al. Iontophoretic anesthesia in hair transplantation. Int J Aesth Restor Surg 1993; 1: 9–12
Straub PM. Buffered lidocaine and postoperative edema. In: Stough DB, Haber RS, editors. Hair replacement surgical and medical. St Louis (MO); Mosby, 1996: 96–7
Harris AJ. Heated lidocaine: warming up to an old idea. Hair Transplant Forum Int 2000, 10 (6): 172
Nusbaum BP. Reducing pain during hair transplant lidocaine infiltration. Dermatol Surg 2001; 27 (1): 98–9
Fosco SW, Gibney MD, Harrison B. Repetitive pinching of the skin during lidocaine infiltration reduces patient discomfort. J Am Acad Dermatol 1998; 39: 74–80
Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971–9
Parsley WM. Vibrators [letter]. Hair Transplant Forum Int 2000; 10 (1): 25
Barusco MN, Leavitt HL, Kirk R. The use of a computerized anesthesia injection system to minimize pain during hair transplant surgery. Hair Transplant Forum Int 2001; 4: 107–8
Epstein JS. Barusco’s use of a computerized anesthesia injection system to minimize pain during hair transplant surgery [letter]. Hair Transplant Forum Int 2001; 4: 109
True RH, Elliot RM. Microprocessor controlled local anesthesia versus conventional syringe technique in hair transplantation. J Dermatol Surg 2002 Jun 6; 28: 463–8
Reichl M, Quinto D. Comparison of 1%. lignocaine with 0.5% bupivacaine in digital ring blocks. J Hand Surg [Br] 1987; 12: 375–6
Bernstein RM, Rassman WE. Limiting epinephrine in large hair transplant sessions. Hair Transplant Forum Int 2000; 10 (2): 39–41
Elliot VW. Recipient site anesthesia and hemostasis. Hair Transplant Forum Int 2002; 12 (2): 47–8
Epstein E. Post-hair transplant protocols. Hair Transplant Forum Int 2002; 12 (2): 43
The author did not receive any funding for this review and does not have any conflicts of interest directly relevant to the content of this review.
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Nusbaum, B.P. Techniques to Reduce Pain Associated with Hair Transplantation. Am J Clin Dermatol 5, 9–15 (2004). https://doi.org/10.2165/00128071-200405010-00003