Needle-Free Anesthesia: How It Really Works (And What It Doesn't Do)

This gentleman flew all the way from Switzerland for his second surgery. A year ago, he had undergone surgery in his home country, and he was not entirely satisfied with the results. But on the day of the surgery, this is not what he was thinking about. He was worried about the anesthesia.

While under anesthesia for the first surgery, the patient said, he endured such excruciating pain during the injection that he could see the specialist going away halfway through the surgery and another specialist taking over. The pain continued anyway. Sitting in our clinic, a year after that surgery, the patient was calm about the result he never got — and nervous about the procedure he had to go through beforehand.

This is the biggest worry we face in our work. Surgery? Outcome? No way. It's the needle.

Fears of patients

Hair transplantation is conducted with local anesthesia. The whole process is conducted with the patient fully conscious – he is able to communicate, watch TV and make requests. As soon as the patient is made numb, the operation itself is not painful – long, perhaps, and boring, but certainly not painful.

Any pain that exists during a hair transplant occurs at once, during the very short period of making the patient numb. All fears of patients related to hair transplant surgery fit within that period.

This factor actually deters patients from the operation. There were patients we talked to who spent two years researching and choosing the right clinic but did not undergo the procedure because of injections. This fear is not irrational – injections done badly can hurt.

What is needle-free anesthesia

Needle-free anesthesia, otherwise known as Comfort Anesthesia, works by pressure, not by a stab.

The instrument that is used is a pen-shaped device. Instead of injecting the anesthesia via a hole in a hollow needle, the anesthesia is injected via a thin and high-pressure stream. This stream is fine enough not to cut your skin but to go through it.

What patients feel is a quick shot of pressure. This sensation is similar to being tapped with a rubber band; it takes no longer than a second.

As a result, the anesthetic penetrates the surface layers of your skin and blocks the nerves.

The truth in all of this is that it does not eliminate the needle

This is the area where clinic marketing gets ahead of the actual science involved.

"Needle free hair transplant" means exactly what it implies – a hair transplant without any needles whatsoever. That is not possible, and no clinic can deliver it. A hair transplant procedure needs a level of anesthesia that jet cannot penetrate. This level of anesthesia is necessary to ensure that your scalp is comfortable throughout the whole procedure. And for such a level of anesthesia, a needle is necessary.

Therefore, the correct thing to say is this: "needle free anesthesia does not eliminate the needle from your procedure. It eliminates the discomfort from the needle."

What happens is that the jet anesthetizes the skin first. When it comes to delivering the deeper anesthesia, the needle goes through the numb tissue. For most patients, this is barely perceptible.

When a clinic tells you that they will give you a totally needle free hair transplant, they either mean it loosely or they are trying to sell you something. Find out which it is.

The five minutes that make the magic happen

After applying the jet, we wait. For five to seven minutes, each and every time.

This is the part that gets skipped elsewhere, and this is the part that makes it all worthwhile. That time allows for the anesthetic to take its full effect through the skin. If you rush the procedure, your patient will feel the sting of the needle — and the point of having gone through the first step has been entirely defeated.

So we wait. After that, the stronger anesthesia goes in through skin that's already anesthetized.

Five minutes. In a whole day of surgery, it's not much at all. Multiplied across every patient in a busy clinic, it's just the sort of thing that gets sacrificed.

Why doesn't this exist everywhere?

This question arises from our patients all the time, in one form or another, along the lines of: If this can be done in Istanbul, why couldn't my home clinic do this?

Availability isn't the issue here; the technology itself is not difficult to acquire nor is it somehow exclusive to or even Turkish in nature. In the end, it boils down to what it means for the clinic to offer this.

It requires an investment to begin with. Consumables need to be taken into account. It adds time to the procedure, the application and then the wait. Finally, someone who understands how to use the tool is required, because pressure, angle, and distance make all the difference. Done improperly, it won't numb and the effort will have been wasted.

Therefore, in most clinics it is either a service you pay more for or something that just quietly gets dropped from the protocol. Neither has anything to do with the practice of medicine.

A real-life story: Mr. Hotic

Switzerland · Second Procedure · Manual Sapphire FUE · 4,200–4,500 grafts · ~3 years post-operative period

Mr. Hotic sought our assistance after having gone through a procedure he wasn't really happy with previously. Fortunately for him, there was an upside to that – his previous clinic had worked conservatively, so his donor site stayed intact for the operation. That left some space to maneuver. According to our analysis, Mr. Hotic was able to get 4,200–4,500 grafts.

On the procedure day, however, all that didn't matter much. He was nervous, and he was clear about the reason. He remembered the injections.

We'd already discussed Comfort Anesthesia with Mr. Hotic. This made absolutely no difference. No matter how clearly you try to explain it – a patient with a bad experience won't believe you until it happens.

So we explained everything to him live. First application.

He looked up at us and asked: "Is that all?"

He didn't mean the volume of the substance. He meant: is that not going to hurt?

We assured him that this was all there was.

And then came what even surprised us. He relaxed completely right away. After waiting for five to seven minutes, we proceeded to the more intense anesthesia. Somewhere halfway through the procedure, he started talking to his interpreter while being injected.

This is how we could tell that he was okay. Not that he said so, but that he stopped thinking about it.

He kept returning to the same question later. Why did the first one hurt so much? If this is possible in Istanbul, why is it not possible in Switzerland?

Three years have passed since, and he is happy with the result he got. It is all documented on our website. However, the time of the day that he remembers is those first ten minutes.

Why it is the norm here, not an addition

Mr. Hotic is not an exception. He just stands out as the clearest example of something we have been seeing repeatedly.

As we had many discussions like that, it became obvious to us that Comfort Anesthesia could not remain an option with an added fee anymore. It is rather weird to establish one's practice on the principle of charging a frightened patient extra not to be hurt.

It comes included into our all-inclusive €2,250 service for any patient, free of charge. It is impossible to find any variation of our health facility services where you will get your comfort for an additional payment.

This is not charity. It is the only possible arrangement which gives us the opportunity to provide you with unbiased recommendations.