Key finding
Studies examine injection pain, comfort during the procedure and postoperative soreness separately. Here is what research on local anaesthetic devices, buffered solutions, tumescence and FUE or FUT pain can—and cannot—tell you.
“Does a hair transplant hurt?” is not one question. A patient may mean the sting or pressure of local anaesthetic injections, discomfort while grafts are removed and placed, or soreness in the donor area afterwards. Studies of these experiences use different methods and measure different outcomes, so a finding about one stage cannot promise comfort at every stage.
The evidence reviewed here includes a comparison of a microprocessor-controlled injection device with a conventional syringe, a small split-scalp study of buffered local anaesthetic, a randomised trial of ropivacaine added to tumescent solution, an observational comparison of FUT and FUE postoperative pain, and an older uncontrolled series describing tumescence. Together they offer useful questions for a consultation. They do not establish a universally painless technique or predict an individual’s experience.
Three different kinds of discomfort
Injection pain occurs while local anaesthetic is being administered. Intraoperative comfort refers to what a patient experiences during the procedure after anaesthesia has been given; it can also be influenced by the length and circumstances of treatment. Postoperative pain is a separate recovery outcome, and it may depend on the donor-area procedure as well as individual factors. A study that measures one of these should not be cited as evidence about all three.
Local anaesthetic is used to reduce sensation in the areas being treated. A patient can still feel pressure, movement or discomfort, and pain ratings are subjective. In hair surgery, “tumescence” means fluid is placed into the tissue so it becomes swollen and firm. The expanded tissue can help create an operative working plane and may limit bleeding; it also carries local anaesthetic through the treated area. These are procedural aims, not a promise of less pain or a particular outcome. The studies below examine different parts of this approach. [3,5] The reports used different scales, patient groups and timepoints. Their numbers are not directly interchangeable.
Discomfort during local anaesthetic administration
True and Elliott compared a microprocessor-controlled infusion device (then called the Wand) with conventional syringe injection in patients treated at their US outpatient clinics between January 1999 and March 2001. Their abstract describes three cohorts: 101 patients comparing their experiences before and after the clinics adopted the device; 39 comparing treatment by 32 other medical groups with treatment using the device; and a separate blinded comparison involving 88 patients. The abstract does not say whether the cohorts contained any of the same people.
Pain was rated using the Wong–Baker Faces scale from 0 (no pain) to 5 (severe pain). Across the three cohorts, patients reported less pain with the device; 68% described its anaesthesia as a 0 or 1. The abstract reports better comfort during administration (P=.005), and also says comfort was better throughout the treatment session and during the first 48 postoperative hours. It does not give group-specific scores, a numerical between-group effect, confidence intervals, or enough design detail to assess randomisation and blinding. The retrospective comparisons may also involve recall. This is a signal from one clinic group’s study, not proof that a particular device eliminates injection pain. [1]
A single-blind split-scalp study examined a different question: whether adding bicarbonate to a local anaesthetic solution changed injection pain. It included 25 people having their first hair transplant at a clinic in Islamabad, Pakistan; mean age was 33.4 years (range 28–41), and 11 participants (44%) were smokers. One side of the scalp received the base solution and the other the same mixture plus 5 mL of 8.4% sodium bicarbonate. Both were injected with a 3-mL syringe and 30-gauge needle by the second author. Pain was recorded on the Wong–Baker scale mapped to 0–10.
The reported mean score was 4.96 (range 3–7) for the unbuffered mixture and 3.28 (range 2–6) for the buffered mixture (P<.05). The abstract also reports lower scores in smokers and non-smokers, but gives no standard deviations, confidence intervals, or exact P values. The side-order randomisation is not described in the abstract, and a single-blind design with one injector cannot answer every question about bias or generalisability. The result concerns injection pain in this small comparison; it does not show that surgery itself or recovery will be pain-free. The tested recipe is a study intervention, not a recommendation or dosing instruction. [2]
Tumescent solution and postoperative pain
A randomised, double-blind controlled study enrolled 314 people having their first follicular unit excision at a hospital in Guangzhou, China. It compared tumescent solution with ropivacaine against the solution without ropivacaine, using both between-patient groups and a right-versus-left scalp comparison. The sample included 166 men and 148 women; the abstract reports age as 32.15 ± 4.58 years (range 25–45) but does not identify what the ± value represents. No preoperative analgesic was given. Postoperative pain was measured with a five-point Wong–Baker scale, and follicle survival was assessed by dermoscopy during follow-up.
The abstract reports significantly greater postoperative pain relief with ropivacaine in both comparison types (P<.05). It does not provide group sizes, pain scores, the assessment schedule, confidence intervals, or exact P values, so the size and timing of the effect cannot be judged from the abstract. It reports no significant difference in follicle survival but provides no survival rates or equivalence margin; a non-significant result does not prove the groups were equivalent. The publisher lists funding from several Chinese national, provincial and hospital programmes, and the authors declared no conflict of interest. This study addresses postoperative pain after FUE, not the sting of anaesthetic injection. [3]
An older paper described tumescent anaesthesia in 50 consecutive hair-micrografting procedures. Its abstract says the author assessed anaesthesia in donor and recipient sites without additional nerve blocks, along with bleeding, bruising and morbidity. It reports qualitatively that the technique provided prolonged anaesthesia and could minimise bleeding, but gives no comparator, validated pain score, numerical outcome or adverse-event rate. This uncontrolled case series can describe a practice; it cannot establish that tumescence is less painful than another approach or works the same way for everyone. The full article was not accessible for this review, so protocol details and disclosure information remain unknown. [5]
Postoperative discomfort and the harvesting method
Kim and colleagues retrospectively reviewed records for 241 patients treated in South Korea from June 2015 to June 2016: 202 had follicular unit transplantation (FUT) and 39 had follicular unit extraction (FUE). The procedures were performed for several reasons, including male-pattern hair loss, scarring alopecia and hairline correction. Patients with prior hair transplantation or combined FUT/FUE were excluded. All received local anaesthesia with intravenous sedation, and patients were routinely prescribed an oral anti-inflammatory medicine for three days. Pain was rated daily on the five-point Wong–Baker scale on postoperative days 1, 2, 3, 4, 5 and 7.
Table 5 reports mean ± standard deviation on the 0–5 scale for 202 FUT and 39 FUE patients.
| Postoperative day | FUT | FUE |
|---|---|---|
| 1 | 2.03 ± 1.0505 | 1.26 ± 1.0442 |
| 2 | 1.47 ± 0.9982 | 0.67 ± 0.8983 |
| 3 | 0.91 ± 0.9702 | 0.31 ± 0.6136 |
| 4 | 0.56 ± 0.8575 | 0.21 ± 0.4690 |
| 5 | 0.36 ± 0.6995 | 0.18 ± 0.5064 |
| 7 | 0.21 ± 0.5430 | 0.13 ± 0.4091 |
In the direct comparison, FUT scores were higher on days 1–4 (P<.001 each day), while the differences were not statistically significant on day 5 (P=.066) or day 7 (P=.385). The ± values are standard deviations, which describe spread within each group; they are not confidence intervals. The unequal, non-randomised groups and routine post-operative medication limit causal interpretation; the comparison is between harvesting methods, not anaesthetic techniques. It should not be read as proof that one method is the right choice for an individual, or as a prediction of that person’s pain. [4]
These recovery scores also cannot be used to infer what anaesthetic injection felt like, or how comfortable a person was during the operation. A discussion of likely recovery should identify the specific procedure, the measures used and the uncertainty around them.
How to use this evidence in a consultation
Ask the clinical team to distinguish expected sensations during injection, during the procedure and afterwards. If a device, buffered mixture or tumescent approach is proposed, ask what it is intended to change, what evidence supports it for the planned procedure, and whether the evidence measures injection pain, intraoperative comfort or postoperative pain. Ask how the team will respond if you feel pain, and what the plan is for discomfort after you leave.
When comparing hair transplant costs in Turkey, ask how the proposed clinical plan and any anaesthesia-related arrangements are explained in the quote. The hair transplant packages directory is service information; it does not establish which anaesthetic protocol will be used or that a package ensures a more comfortable outcome. Just Clinic Istanbul is an independent marketing and lead-generation platform, not a healthcare provider or medical tourism intermediary. Enquiries may be shared with authorised healthcare partners with your consent.
Questions to ask before the procedure
- Which parts of the procedure are expected to involve injection, pressure or other sensations, and how can I communicate discomfort?
- What anaesthetic approach is planned, and what evidence supports it for this procedure?
- Are the pain figures you are quoting about injection, comfort during surgery, or recovery afterwards?
- What medication or other support is planned for postoperative discomfort, and whom should I contact if it is not controlled?
- How does the proposed donor-harvesting method affect the expected recovery, and what trade-offs matter for my case?
- Which parts of my plan depend on my medical history, medicines or previous reactions to anaesthesia?
Limits of the evidence
The studies use different pain scales, devices, solutions, surgical methods and follow-up periods. Four reports [1–3,5] were available to this review only as abstracts or publisher previews; they omit important design details and uncertainty estimates. The device study combines retrospective comparisons with a prospective blinded comparison, without clarifying possible participant overlap. The bicarbonate comparison is small. The ropivacaine trial reports a statistically significant difference without numerical pain scores or group sizes in its abstract. The harvesting-method study is retrospective and compares markedly unequal groups. The 1996 case series has no comparator or quantified pain outcome.
These limitations mean the evidence can help frame a conversation, but cannot establish a universally best anaesthetic plan, guarantee a painless procedure, or forecast an individual’s recovery. A qualified clinical team must tailor anaesthesia and pain management to the person and procedure.
References
- True RH, Elliott RM. Microprocessor-Controlled Local Anesthesia versus the Conventional Syringe Technique in Hair Transplantation. Dermatologic Surgery. 2002 Jun;28(6):463–468. doi: 10.1046/j.1524-4725.2002.01270.x. PMID: 12081672. Abstract reviewed; publisher full text unavailable.
- Mohmand MH, Ahmad M, Jabeen M. Pain Perception of a New Ahmad-Humayun Solution for Local Anesthesia in Hair Transplantation: One Step Ahead. Journal of Cosmetic Dermatology. 2021 Jan;20(1):222–226. First published online 18 April 2020 (publisher date; PubMed Epub date 5 May 2020). doi: 10.1111/jocd.13442. PMID: 32304608. Abstract and publisher record reviewed; full text unavailable.
- Dai D-M, Qu Q, Fan Z-X, Hu Z-Q, Miao Y. Relieving Postoperative Pain Using Tumescent Solution with Ropivacaine in Follicular Unit Excision. Journal of Cosmetic Dermatology. 2022 Oct;21(10):4697–4702. Accepted manuscript published online 20 April 2022; Version of Record published online 10 May 2022 (PubMed article date); issue October 2022. doi: 10.1111/jocd.15011. PMID: 35441795. Publisher abstract, funding and conflict statements reviewed.
- Kim YS, Na YC, Park JH. Comparison of Postoperative Pain According to the Harvesting Method Used in Hair Restorative Surgery. Archives of Plastic Surgery. 2019 May;46(3):241–247. doi: 10.5999/aps.2018.00843. PMID: 31113186; PMCID: PMC6536877. Full text reviewed.
- Hunstad JP. The Tumescent Technique Facilitates Hair Micrografting. Aesthetic Plastic Surgery. 1996 Winter;20(1):43–48. doi: 10.1007/BF02275575. PMID: 8746470. Abstract and publisher preview reviewed; full text unavailable.