A frequent question to eventually surface during the initial consult is, "Does it hurt?". And as one would expect in this world where there never seems to be any simple answers any more, my answer is, well, yes and no.Yes, there is pain involved in attaining the local anaesthesia required to perform the procedure, but no, not really, as this represents a very small portion of your experience in the operating suite on the day of surgery. The beauty of this procedure is that it is performed under local anaesthesia, in similar fashion to the method used in most dental procedures. lidocaine, a local anaesthetic, is injected in quite small amounts in a circular distribution around the circumference of the head, much like the area a hat band would occupy when wearing a hat. The placement of these small amounts of lidocaine takes about two minutes at most, and, while annoying, most patients tolerate the the fleeting discomfort with no problem. Following this, the entire back and top of the patients' head is numb, so that removal of the donor strip from the back of the scalp as well as creation of the recipient sites on the top of the head can be accomplished with virtually no discomfort on the part of the patient whatsoever. We also make available mild sedatives which are complimentary to the local anaesthesia, allowing the patient to feel a sense of relaxation and relative "distance" from the actual experience. They also help the day to pass quickly, and this can be especially important in larger cases where the procedure may take up to seven or eight hours, a long time to spend in a reclined position for an extended period. Just prior to discharge home, the surgical area is reinforced with a longer acting local anaesthetic injection to keep the area "numb" throughout the night. As well, following the procedure, patients are given minor pain medications just in case they do experience any discomfort at home. Considering the donor strip taken to supply the grafts is a full thickness skin section, it is remarkable yet most patients describe the feeling the following day as "pressure" or "tightness" in the donor as opposed to frank sensations of "pain". In our center, the donor is closed using suture material in a running fashion, and this suture is removed at day 7-8, a process also typically described by our patients as a "non-event". All in all then, when performed correctly by an experienced surgeon and his/her team, the procedure remains relatively painless for the most part, with the majority of patients experiencing little to no post-operative discomfort.
