ISHRS 2021 CME Webinar

Principles and Techniques of Anesthesia and Pain Control for the Hair Restoration Patient

Registration Fees Per Webinar:

  • ISHRS Physician Member, $50.00 USD
  • ISHRS Physician Pending-Member, $75.00 USD
  • Physician Non Member, $100.00 USD

Moderator: ​Steven Gabel, MD, FISHRS | USA

Program Description

The recorded program will be available for viewing on demand until Dec. 31, 2022.

This 2-hour webinar is being conducted to provide physicians knowledge on principles and techniques in local, oral, and intravenous anesthesia for the hair restoration physician. As a result of this activity, learners will be able to gain more knowledge in current practices to deliver appropriate anesthesia for their patients.  The online live component will include presentations, panel discussion, and audience participation via verbal questions and discussion, typing chat Q&A and polling.

Professional Practice Gap

Pain control is fundamental to any surgical procedure in medicine. Hair restoration surgery has unique challenges, as most of the procedures are performed on an outpatient basis in physician offices while the patient is awake or with mild conscious sedation. Every patient has a particular threshold of pain tolerance. Therefore, it is incumbent upon the physician to help control pain during and after their surgical procedure, and provide a suitable experience for the patients to keep them relaxed and comfortable. Additional challenges include the fact that providers are moving away from the use of opioid medications to control pain. There are a multitude of recent studies to show various regimens to control pain during and after surgery without the use of opioids. Along these lines, it is critical that the hair restoration surgeon has the fundamental knowledge and skills to administer local anesthetic with as little pain as possible, and to maximize its effectiveness. Large areas of the scalp, face, and body may be anesthetized during procedures which require the physician to be not only cognizant of the techniques to administer the anesthetic effectively, but also aware of complications of using the anesthetics during these cases. These topics will be presented in the webinar.

Educational Needs

Knowledge of local anesthesia, pain management, and mild or moderate conscious sedation are fundamental for a successful outcome and patient experience in hair restoration surgery. The surgeon must have a firm knowledge base of all the medications used during and after a surgical procedure. There is a crisis throughout the world with the use and abuse of opioid medications which has lasting negative effects with patients, such as addiction. Therefore, research has paid particular attention to finding solutions of pain control without the use of opioids in all areas of medicine.

Understanding the uses of non-opioid medications to control pain is essential for patient care. There is a large amount of data showing the science behind the administration of non-opioid medications, such as the combination of ibuprofen and acetaminophen to control pain, and how these compare to opioids like oxycodone and codeine. Hair restoration also is performed while the patient is awake and conscious, which can be difficult for patients during prolonged procedures. The use of oral and/or intravenous benzodiazepines, such as diazepam or midazolam, can help provide the patients a more comfortable experience, but these need to be administered correctly and cautiously to avoid complications such as respiratory depression.

Lastly, techniques in the administration of local anesthesia, particularly in facial or body hair excision where large amounts of lidocaine may be used, are imperative to provide adequate pain control for the surgical procedure and prevent complications such as the overdose of lidocaine. These techniques must be mastered to provide minimal discomfort in the administration of these medications and maximize their effectiveness.


  1. Hallway A, Vu J, Lee J, Palazzolo W, Walijee J, Brummett C, Englesbe M, Howard R. Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway. J AM Coll Surg. 2019 Sept; 229(3): 316-322.
  2. Sim V, Hawkins S, Gave A, Bulanov A, et al. How low can you go: Achieving Postoperative Outpatient Pain Control without Opioids. J Trauma Acute Care Surg. 2019 Jul; 87(1): 100-103.
  3. Yu JM, and Yu AY. Donor Area Harvesting Beard to Scalp. In: W.P. Unger and R. Shapiro, eds. Hair Transplantation, 5th Ed. London: Informa Healthcare, 2011; 300-302.
  4. Chang S. Virtual Painless Hair Transplant Anesthesia. Hair Transplant Forum Int’l. 2009; 19(4): 124-127.
  5. Garcia M, Garces M. Facial Hair Transplantation with Follicular Unit Excision: Effective Technique in the Micrograft of Beard and Mustache. Hair Transplant Forum Int’l. 2020; 30(6): 216-219.
  6. Gupta A, Bah M. NSAIDS in the Treatment of Postoperative Pain. Curr Pain Headache Rep. 2016 Nov; 20(11): 62.

Target Audience and Prerequisites

This webinar is taught at the physician level. It is geared toward intermediate- to advanced-level hair restoration surgeons.

Learning Objectives

As a result of participating in this activity, the learners should be able to:

  1. Describe the importance and justification of using non-opioid medications to control postoperative pain
  2. Recommend strategies using non-opioid medications for postoperative pain relief
  3. Explain the scientific basis in using non-opioid medications for pain control
  4. Identify several different regimens to maintain patient comfort using techniques and medications for mild and moderate conscious sedation
  5. Utilize new techniques for anesthetizing the face, beard, chest and body for graft harvesting
  6. Apply their knowledge of utilizing the greater and lesser occipital nerve blocks to anesthetize the posterior and lateral scalp for donor hair harvesting


Internet/online, via computer or mobile device. 

Official Language

The official language of the webinar is English. Simultaneous interpretation is not provided for this webinar.

Disclosures of Relevant Financial Relationships of Planners, Faculty, and Others

The following individuals have no relevant financial relationships with ineligible companies to disclose:

Conradin von Albertini, MD, FISHRS – Planner
Marco Barusco, MD, FISHRS – Faculty
Timothy P. Carman, MD, FISHRS – COI Reviewer
Victoria Ceh, MPA – Planner & Manager
Steven P. Gabel, MD, FISHRS – Planner & Faculty
Anil Garg, MBBS, MS, MDh, FISHRS – Planner
Rita Kaufman – Planner & Manager
Matthew Lopresti, MD – Planner
Paul J. McAndrews, MD, FISHRS – COI Reviewer
Humayun Mohmand, MD, FISHRS – Faculty
Masahisa Nagai, MD – Planner
Ratchathorn Panchaprateep, MD, PhD, FISHRS – Planner
Vladimir Ratushny, MD, PhD – Planner
Ken Reed, DMD – Faculty
Melanie Stancampiano – Planner & Manager
Robin Unger, MD – Faculty
Mark Waldman, MD – Planner
Ramiro Yane, MD – Faculty

The following individuals have relevant financial relationships:

Robert S. Haber, MD, FISHRS – Planner
Ellis Instruments, Inc: Royalty, patent or other IP
Transdermal Cap Inc: Consultant/Advisory Board

James A. Harris, MD, FISHRS – Planner & Faculty
Restoration Robotics: Consultant/Advisory Board

All of the relevant financial relationships listed for these individuals have been mitigated.

Commercial Support



The webinar content has been made available by the ISHRS for educational purposes only. The content is not intended to represent the only, nor necessarily the best, method or procedure appropriate for the medical situations discussed, but rather is intended to present views, statements, and opinions that may be of interest to others. The views expressed herein are those of the individual authors and not necessarily those of the ISHRS. The ISHRS assumes no responsibility or liability in connection with your use or misuse of the webinar content or any materials or techniques described in the content, and it makes no warranty or representation as to the validity or sufficiency of any information provided. 

Questions: Learners may contact the ISHRS Headquarters with questions about this activity at phone +1-800-444-2737 or +1-630-262-5399, or fax +1-630-262-1520, or email: [email protected]