"I heard a hair transplant hurts a lot—can I still get one?"
Many people hesitate over the procedure because of the pain associated with a hair transplant. "Does a hair transplant hurt a lot?" is one of the most frequently asked questions during consultations. Today we'll answer this question. It's helpful to think about pain in two broad categories. One is the pain during surgery, and the other is the pain after returning home.
Key Summary
✔ A hair transplant is performed under local anesthesia, so pain during surgery can be controlled in most cases.
✔ Modi Hair Plant Clinic applies dual anesthesia using lidocaine and ropivacaine together.
✔ We strive to minimize tissue irritation and discomfort by reducing additional anesthesia during surgery.
✔ Post-surgical pain varies between individuals, but in most cases it can be controlled with anti-inflammatory analgesics and Tylenol.
Does It Hurt During Surgery?
A hair transplant is a procedure based on local anesthesia. Because local anesthesia is applied only to numb the surgical area, sedation anesthesia (sleep anesthesia) is not necessarily required for a long period. That's why many patients spend the time comfortably during surgery—wearing earphones and watching dramas or movies on an iPad placed in front of them, or exchanging messages 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 tends to have a short duration of action. To compensate for this, a small amount of epinephrine is usually added to the lidocaine.
Epinephrine is a powerful vasoconstrictor. When blood vessels constrict, the injected lidocaine does not spread quickly through the blood and instead stays in the area longer, allowing a relatively longer anesthetic duration. Lidocaine 2% with epinephrine usually maintains anesthesia for about 2 hours, though this varies from person to person. In particular, the scalp has abundant blood flow, so it tends to wear off a bit faster.
When Anesthesia Wears Off Midway
The problem is that a hair transplant usually takes about 4–5 hours, so it rarely finishes within the 2-hour anesthetic window. As a result, the anesthesia may wear off during surgery, and the experience of pain differs depending on how this is addressed.
- Re-injecting midway — Injections are given again each time the anesthesia wears off. This corresponds to reviews saying, "It was fine at first, but it hurt because they kept giving injections in the middle."
- Injecting a large amount at the start — This method uses a generous amount at the beginning to make it last longer. However, lidocaine itself can irritate tissue, and excessive vasoconstriction with epinephrine can stress the tissue, which may cause swelling after surgery.
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 latter half |
At Modi Hair Plant Clinic, we use a local anesthetic called ropivacaine together with lidocaine. Lidocaine acts quickly but wears off quickly, whereas ropivacaine starts slowly and fades slowly, so its anesthetic effect continues for about 6–8 hours.
In the early part of surgery, lidocaine handles the anesthesia, and around the time the lidocaine's effect diminishes, ropivacaine takes over. This way, there is no need to add anesthetic midway, and there is no need to inject an excessive amount of lidocaine at the start. This helps reduce the irritation applied to the tissue.
Also, since epinephrine is a powerful vasoconstrictor, injecting too much of it into the transplant area can interfere with the transplanted hair follicles settling in. That is why we aim to use only as much epinephrine and lidocaine as necessary. With this dual anesthesia approach, cases of patients reporting pain during surgery decrease, and because less local anesthetic is used, post-surgical swelling also tends to be relatively less. However, responses may vary between individuals.
The Momentary Pain When the Anesthetic Injection Goes In
No matter how good a local anesthetic is used, the stinging pain during the first 3–5 minutes as the anesthetic first enters is difficult to solve through the type of drug alone. So for those who wish, we may apply conscious sedation during this time. This is a method of inducing a briefly drowsy state with a small amount of sedative medication to help patients pass comfortably through the moment the anesthesia is administered. Most patients wake up so quickly that they ask, "When did you give me the anesthesia?" and then comfortably undergo the surgery while watching videos.
Some people come in carrying the burden of pain based on past surgical experiences, but we would like to say that there is no need to worry excessively.
What If It Hurts After I Get Home?
The second type of pain is the pain after returning home. With the use of ropivacaine, the pain felt at home has been greatly reduced.
With the older incision method, some patients reported pain at home, so additional stronger analgesics were sometimes prescribed. However, with the non-incision method, the number of patients reporting pain in the evening has dropped considerably, and now it can usually be controlled with an anti-inflammatory analgesic along with Tylenol. As those who have received prescriptions will know, take additional Tylenol if it hurts, and even if there is no pain, since it may hurt while sleeping, we recommend taking it in advance before going to bed. Many patients come in the next day smiling to have their hair shampooed. Of course, the degree of pain may vary between individuals.
Frequently Asked Questions
Is the local anesthetic injection the most painful part?
Most people feel the stinging sensation the most at the moment the anesthetic first goes in, after which the pain tends to decrease considerably. There are individual differences.
Does a hair transplant always require sleep anesthesia?
A hair transplant is based on local anesthesia. Because only the surgical area is numbed, sedation anesthesia is not necessarily required for a long period. However, if desired, conscious sedation can be applied at the moment the anesthesia is administered.
Won't it hurt if the anesthesia wears off during surgery?
If surgery runs long, the anesthesia may wear off midway. Modi Hair Plant Clinic extends the anesthetic duration through dual anesthesia using lidocaine and ropivacaine together, reducing cases of patients reporting pain midway. Responses may vary between individuals.
Does it hurt a lot at home after surgery?
Since the introduction of the non-incision method and the use of ropivacaine, pain at home has been greatly reduced, and it can usually be controlled with an anti-inflammatory analgesic and Tylenol. Take medication according to the prescription instructions, and the degree of pain may vary from person to person.
In Summary
- It is helpful to think of hair transplant pain in terms of pain during surgery and pain at home.
- A hair transplant is based on local anesthesia, and many patients undergo it comfortably while watching videos during surgery.
- Modi Hair Plant Clinic aims to extend the anesthetic duration and reduce the amount of drugs used through dual anesthesia using lidocaine and ropivacaine together.
- Conscious sedation is applied at the moment the anesthesia is administered, and after surgery, pain is controlled with an anti-inflammatory analgesic and Tylenol. Responses may vary between individuals.
For a hair transplant, rather than vague worry 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 confirming the method suited to you through a consultation.
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 and hair loss treatment, please feel free to contact us. Because the suitable treatment method may differ depending on each individual's 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 reconstructed based on YouTube content by Director Yoo Hwa-jeong of Modi Hair Plant Clinic.
This article was written to provide general health information and does not replace diagnosis and treatment based on an individual's symptoms.
This manuscript was uploaded after review by medical staff.