DHI is performed under local anesthesia, making the extraction and implantation phases painless. The most uncomfortable moment is the initial series of anesthetic injections, which last about 10-15 minutes and feel like sharp stings. After numbing takes effect, patients feel only pressure and movement as the Choi Implanter Pen places grafts.
This article is for informational purposes only and does not constitute medical advice.
How Local Anesthesia Works During DHI
Local anesthesia for DHI involves injecting a numbing solution directly into the scalp tissue in both the donor area (back and sides of the head) and the recipient area (where grafts are being placed). The standard solution is a combination of lidocaine and epinephrine.
The Numbing Process Step by Step
The anesthesia administration follows a specific sequence:
- Donor area numbing: The surgeon injects along the perimeter of the planned extraction zone using a series of small injections spaced 1-2 cm apart. This takes approximately 5-8 minutes.
- Waiting period: The surgeon waits 5-10 minutes for the anesthesia to take full effect.
- Testing: The surgeon tests sensation by pressing on the area to confirm numbness.
- Extraction begins: Once the donor area is fully numb, graft extraction starts.
- Recipient area numbing: Before implantation, the surgeon numbs the recipient zone using the same technique. This can happen while extraction is ongoing.
- Top-ups as needed: For longer sessions (3,000+ grafts), the anesthetic may wear off in certain areas and require additional injections.
What the Injections Feel Like
Patients describe the initial injections as the worst part of the entire DHI experience. The sensations include:
- Sharp stinging as the needle enters the scalp skin
- Burning as the lidocaine solution spreads through the tissue
- Pressure as the fluid expands under the skin
- Decreasing intensity as each subsequent injection is placed into already-partially-numb tissue
The pain diminishes with each injection because the numbing effect spreads outward from each injection site. By the time the surgeon reaches the center of the donor area, the surrounding injections have already partially numbed the tissue.
Needle-Free Anesthesia Options
Many modern DHI clinics offer needle-free anesthesia delivery systems that reduce or eliminate the pain of the initial numbing process.
How Needle-Free Systems Work
Devices such as Comfort-In and DermoJet use compressed air to force the anesthetic solution through the skin at high velocity. The liquid penetrates the tissue through a microscopic stream rather than a needle puncture. Patients describe the sensation as a quick snap or flick rather than a sting.
Needle-Free vs. Traditional Injection Comparison
| Factor | Traditional Needle | Needle-Free System |
|---|---|---|
| Pain level (1-10) | 4-6 | 1-3 |
| Depth of numbing | Deep, reliable | Moderate, may need supplementation |
| Cost to patient | Included in procedure | May add $200-500 to total cost |
| Availability | All clinics | Select clinics only |
| Best for | Complete anesthesia | Initial numbing, anxiety reduction |
Some clinics use a hybrid approach: needle-free delivery for the initial surface numbing, followed by a few traditional injections for deeper tissue anesthesia. This significantly reduces overall discomfort while ensuring complete numbness.
Pain During the DHI Procedure
Once anesthesia takes full effect, the procedure itself should be painless. Here is what you may experience during each phase:
During Extraction
You will lie face-down or on your side while the surgeon uses a micro-punch (0.7-1.0mm) to extract follicular units from the donor area. You should feel:
- Pressure from the punch tool against your scalp
- Slight vibration if a motorized punch is used
- Tugging sensation as grafts are lifted out
- No sharp pain
If you feel any sharp or stinging sensations during extraction, tell your surgeon immediately. They will administer additional local anesthesia to the area.
During Implantation
The Choi Implanter Pen creates a small channel and inserts the graft simultaneously. During this phase, you typically sit upright or reclined. You should feel:
- Light tapping or clicking as the Choi pen punctures the scalp
- Pressure at each implantation point
- No pain if anesthesia is working properly
DHI implantation sessions for 2,000-3,500 grafts can take 4-8 hours. The surgical team should check in on your comfort level regularly and provide top-up anesthesia if needed.
Post-Operative Pain Management
After the anesthesia wears off (typically 4-6 hours post-procedure), discomfort begins. The level of post-operative pain varies between patients but generally follows a predictable pattern.
Pain Timeline After DHI
| Timeframe | Pain Level (1-10) | Description |
|---|---|---|
| Hours 0-6 | 0-1 | Anesthesia still active |
| Hours 6-24 | 3-5 | Tightness, throbbing, tenderness |
| Days 1-2 | 2-4 | Soreness in donor and recipient areas |
| Days 3-4 | 1-3 | Noticeably improving |
| Days 5-7 | 0-2 | Mild tenderness only |
| Week 2+ | 0-1 | Occasional sensitivity |
Medications for Post-Op Pain
Your surgeon will provide a post-operative medication plan that typically includes:
- Acetaminophen (Tylenol): First-line pain management, safe for most patients
- Prescribed analgesics: Stronger options for the first 1-2 days if needed
- Anti-inflammatories: Help reduce swelling which contributes to discomfort (avoid aspirin and ibuprofen if instructed, as they can increase bleeding)
- Ice packs: Applied to the forehead (not directly on the transplant area) to reduce swelling
Most patients find that over-the-counter acetaminophen is sufficient to manage post-DHI pain. Only a small percentage require prescription-strength pain medication beyond the first day.
Managing Anxiety About the Procedure
For patients with significant anxiety about the pain or needle phobia, several options exist:
- Oral sedation: A mild sedative (such as diazepam) taken 30-60 minutes before the procedure
- IV conscious sedation: Administered by an anesthesiologist, keeps you relaxed and drowsy but awake
- Distraction techniques: Watching movies, listening to music, or podcasts during the procedure
- Topical numbing cream: Applied to the scalp 30-60 minutes before injections to reduce needle sensation
Discuss your anxiety level with your surgeon during the consultation so they can recommend the most appropriate comfort measures for your situation.
For a full overview of the DHI procedure, see our DHI overview guide. To understand the full recovery timeline including pain management beyond the first week, read the DHI recovery timeline.
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FAQ
Does DHI hair transplant hurt?
The DHI procedure itself is painless once local anesthesia takes effect. The only painful part is the initial anesthesia injections, which feel like a series of sharp stings lasting 10-15 minutes as the surgeon numbs the donor and recipient areas. After that, you should feel pressure and movement but no pain during the extraction and Choi pen implantation phases. Most patients rate the injection pain at 4-6 out of 10.
What type of anesthesia is used for DHI?
DHI uses local anesthesia, typically a combination of lidocaine with epinephrine. The lidocaine blocks pain signals in the scalp nerves while the epinephrine constricts blood vessels to reduce bleeding and extend the anesthetic effect. Some clinics offer needle-free jet injection systems (like Comfort-In or DermoJet) that deliver anesthesia through high-pressure air, reducing the pain of the initial numbing process.
How much pain is there after DHI surgery?
Post-operative pain after DHI is generally mild to moderate during the first 2-3 days. Most patients describe it as tightness, tenderness, or a sunburn-like sensation rather than sharp pain. Over-the-counter pain medication such as acetaminophen or prescribed analgesics are sufficient for the majority of patients. Pain typically drops significantly by day 3-4 and resolves almost entirely by day 7.
Are needle-free anesthesia options available for DHI?
Yes, many DHI clinics now offer needle-free anesthesia systems that use high-pressure air to deliver lidocaine through the skin without needles. These devices (such as Comfort-In or DermoJet) significantly reduce the pain of the numbing process, which is the most uncomfortable part of the entire procedure. Some clinics use the needle-free system for the initial numbing and then supplement with traditional injections for deeper anesthesia if needed.
Can you be put to sleep for DHI?
General anesthesia is not typically used for DHI because the procedure requires the patient to be positioned face-down for donor extraction and sitting upright for implantation. Sedation options such as oral diazepam or IV conscious sedation are available at some clinics for patients with severe anxiety. These options keep you relaxed and drowsy without putting you fully to sleep, allowing you to reposition as needed during the procedure.