“I've heard hair transplants hurt a lot — can I still get one?”
Many people hesitate to have surgery because of concerns about hair transplant pain. “Does a hair transplant hurt a lot?” is one of the most frequently asked questions during consultations. Today, we'd like to answer that question. It helps to think about pain in two separate categories: pain during the surgery and pain after you return home.
Key Summary
✔ Hair transplants are performed under local anesthesia, so pain during surgery can generally be managed.
✔ Modi Hair Plant Clinic uses a dual anesthesia approach combining lidocaine and ropivacaine.
✔ We aim to reduce additional anesthesia during surgery in order to minimize tissue irritation and discomfort.
✔ Post-operative pain varies by individual, but in most cases it can be managed with anti-inflammatory analgesics and Tylenol.
Does It Hurt During Surgery?
Hair transplant surgery is based on local anesthesia. Because local anesthesia is applied only to numb the surgical area, sedation (sleep anesthesia) for a long period is not necessarily required. As a result, many patients spend the time comfortably during surgery — wearing earphones and watching dramas or movies on an iPad placed in front of them, or texting with friends on their phone.
About the Drugs Used in Local Anesthesia
The most widely used drug for local anesthesia is 2% lidocaine. However, lidocaine has a relatively short duration of action. To compensate for this, a small amount of epinephrine is usually added to the lidocaine.
Epinephrine is a potent vasoconstrictor. When blood vessels constrict, the injected lidocaine does not spread quickly through the bloodstream and instead remains longer in the area, allowing for a relatively longer duration of anesthesia. Two percent lidocaine containing epinephrine typically maintains anesthesia for about 2 hours, though this varies from person to person. In particular, the scalp has abundant blood flow, so the effect tends to wear off somewhat faster.
When Anesthesia Wears Off Midway
The issue is that hair transplant surgery generally takes about 4–5 hours, so it rarely finishes within the 2-hour window of anesthesia. This means anesthesia may wear off during the procedure, and the experience of pain differs depending on how this is addressed.
- Re-injecting midway — An injection is given again each time the anesthesia wears off. Reviews saying “it was fine at first, but it hurt because they kept giving injections in the middle” refer to this approach.
- Injecting a large amount at the start — A generous amount is injected early on so that it lasts longer. However, lidocaine itself can irritate tissue, and excessive vasoconstriction from epinephrine can place stress on the tissue, which may contribute to post-operative swelling.
Modi Hair Plant Clinic's Dual Anesthesia
| Category | Lidocaine | Ropivacaine |
|---|---|---|
| Onset of effect | Fast | Slightly slow |
| Duration | About 2 hours | About 6–8 hours |
| Role | Initial anesthesia | Maintaining anesthesia in the later stage |
At Modi Hair Plant Clinic, we use a local anesthetic called ropivacaine together with lidocaine. Lidocaine acts quickly but also wears off quickly, whereas ropivacaine begins slowly and wears off slowly, with the anesthetic effect lasting about 6–8 hours.
In the early stage of surgery, lidocaine provides the anesthesia, and as the lidocaine effect diminishes, ropivacaine takes over. This way, there is no need to add more anesthetic midway, and there is no need to inject an excessive amount of lidocaine at the beginning. This helps reduce the irritation placed on the tissue.
In addition, epinephrine is a potent vasoconstrictor, so injecting too much of it into the recipient area may interfere with the transplanted hair follicles settling in. For this reason, we aim to use only as much epinephrine and lidocaine as necessary. With this dual anesthesia approach, cases of patients reporting pain during surgery have decreased, and because less local anesthetic is used, post-operative swelling also tends to be comparatively less. However, responses may vary from person to person.
The Momentary Pain When the Anesthetic Injection Goes In
No matter how good the local anesthetic is, the stinging pain during the first 3–5 minutes as the anesthetic goes in is difficult to resolve through the choice of drug alone. For patients who wish, we may therefore apply conscious sedation during this time. This involves inducing a briefly drowsy state with a small amount of sedative medication so that the moment of anesthetic injection passes comfortably. Most patients wake up so quickly that they ask, “When did you do the anesthesia?” and then comfortably watch videos for the rest of the procedure.
Some patients come to us carrying concerns about pain based on past surgical experiences, and we would like to say that there is no need to worry excessively.
What If It Hurts After I Go Home?
The second type of pain is the pain felt after returning home. Since we began using ropivacaine, pain experienced at home has decreased considerably.
With the older incision method, some patients reported pain at home, so stronger analgesics were sometimes prescribed in addition. With the non-incision method, however, the number of patients reporting pain in the evening has greatly decreased, and now it can usually be managed with anti-inflammatory analgesics along with Tylenol. As those who have received prescriptions know, you may take additional Tylenol if you feel pain, and even if you have no pain, we recommend taking it before bed since pain may occur while sleeping. Many patients come in the next day with a smile for their hair wash. Of course, the degree of pain may vary from person to person.
Frequently Asked Questions
Is the local anesthetic injection the most painful part?
Most patients feel the stinging sensation most strongly at the moment the anesthetic first goes in, after which the pain tends to decrease considerably. There are individual differences.
Does a hair transplant have to be done under sleep anesthesia?
Hair transplants are based on local anesthesia. Since only the surgical area is numbed, sedation over a long period is not necessarily required. However, if desired, conscious sedation can be applied at the moment the anesthetic is injected.
Won't it hurt if the anesthesia wears off during surgery?
If surgery takes longer, the anesthesia may wear off midway. Modi Hair Plant Clinic uses dual anesthesia combining lidocaine and ropivacaine to extend the duration of anesthesia, reducing cases of patients reporting pain during the procedure. Responses may vary from person to person.
Does it hurt a lot at home after surgery?
Since the adoption of the non-incision method and the use of ropivacaine, pain at home has decreased considerably, and it can usually be managed with anti-inflammatory analgesics and Tylenol. Please take medication according to the prescription instructions; the degree of pain may vary from person to person.
In Summary
- It helps to think of hair transplant pain in two categories: pain during surgery and pain at home.
- Hair transplants are based on local anesthesia, and many patients comfortably watch videos during the procedure.
- Modi Hair Plant Clinic uses dual anesthesia combining lidocaine and ropivacaine, aiming to extend the duration of anesthesia and reduce the amount of medication used.
- Conscious sedation may be used at the moment the anesthetic is injected, and after surgery, pain is managed with anti-inflammatory analgesics and Tylenol. Responses may vary from person to person.
Rather than having vague worries about pain, it is important to receive a thorough consultation about your own hair loss condition and the surgical method. If you are concerned about pain or the anesthesia process, we recommend checking through a consultation which approach is suitable for you.
References
- Liu S, Carpenter RL, Chiu AA, McGill TJ, Mantell SA. Epinephrine prolongs duration of subcutaneous infiltration of local anesthesia in a dose-related manner. Correlation with magnitude of vasoconstriction. Reg Anesth. 1995;20(5):378–384. PubMed
- Moffitt DL, De Berker DA, Kennedy CT, Shutt LE. Assessment of ropivacaine as a local anesthetic for skin infiltration in skin surgery. Dermatol Surg. 2001;27(5):437–440. PubMed
Modi Hair Plant Clinic Consultation and Related Pages
If you have any questions about hair transplants or hair loss treatment, please feel free to contact us. Since the appropriate treatment method may differ depending on your individual hair loss condition and donor area, we recommend receiving an accurate consultation.
- 📞 Phone consultation: 02-544-8659
- 🌐 Website
- 💬 KakaoTalk consultation
This article is medical information reorganized based on YouTube content by Director Yoo Hwa-jung of Modi Hair Plant Clinic.
This article was written to provide general health information and does not replace diagnosis and treatment for individual symptoms.
This manuscript was uploaded after review by medical staff.