Hair transplant

A hair transplant is a procedure to move hair to an area that’s thin or bald

Having a hair transplant is a big decision. Find out as much as you can, so you know what to expect.

Procedure

Pre-operative assessment and planning

Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested.

There are several different techniques for harvesting hair follicles, each with their own advantages and disadvantages. Regardless of the harvesting technique, proper extraction of the hair follicle is paramount to ensure the viability of the transplanted hair and avoid transection, the cutting of the hair shaft from the hair follicle. Hair follicles grow at a slight angle to the skin’s surface, so transplanted tissue must be removed at a corresponding angle.

There are two main ways in which donor grafts are extracted today: strip excision harvesting, and follicular unit extraction

Harvesting methods

At an initial consultation, the surgeon analyzes the patient’s scalp, discusses their preferences and expectations, and advises them on the best approach (e.g. single vs. multiple sessions) and what results might reasonably be expected. Pre-operative folliscopy will help to know the actual existing density of hair, so that postoperative results of newly transplanted hair grafts can be accurately assessed. Some patients may benefit with preoperative topical minoxidil application and vitamins.

For several days prior to surgery the patient refrains from using any medicines which might result in intraoperative bleeding and resultant poor grafting. Alcohol and smoking can contribute to poor graft survival. Post operative antibiotics are commonly prescribed to prevent wound or graft infections.

Strip harvesting (FUT)

Strip harvesting (also known as follicular unit transplantation or FUT) is the most common technique for removing hair and follicles from a donor site. The surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. A single-, double-, or triple-bladed scalpel is used to remove strips of hair-bearing tissue from the donor site. Each incision is planned so that intact hair follicles are removed. The excised strip is about 1–1.5 x 15–30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts, which are small, naturally formed groupings of hair follicles, from the strip. Working with binocular Stereo-microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting. The latest method of closure is called ‘Trichophytic closure’ which results in much finer scars at the donor area.

The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place.

Strip harvesting will leave a thin linear scar in the donor area, which is typically covered by a patient’s hair even at relatively short lengths. The recovery period is around 2 weeks and will require the stitches/staples to be removed by medical personnel or sub cuticular suturing can be done.

Follicular unit extraction (FUE)

With Follicular Unit Extraction or FUE harvesting, individual follicular units containing 1 to 4 hairs are removed under local anesthesia; this micro removal typically uses tiny punches of between 0.6mm and 1.0mm in diameter. The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place.

FUE takes place in a single long session or multiple small sessions. The FUE procedure is more time-consuming than strip surgery. An FUE surgery time varies according to the surgeons experience, speed in harvesting and patient characteristics. The procedure can take anywhere from a couple hours to extract 200 grafts for a scar correction to a surgery over two consecutive days for a megasession of 2,500 to 3,000 grafts With the FUE Hair Transplant procedure there are restrictions on patient candidacy.

Clients are selected for FUE based on a fox test, though there is some debate about the usefulness of this in screening clients for FUE.

FUE can give very natural results. The advantage over strip harvesting is that FUE harvesting negates the need for large areas of scalp tissue to be harvested, so there is no linear incision on the back of the head and it doesn’t leave a linear scar. Because individual follicles are removed, only small, punctate scars remain which are virtually not visible and any post-surgical pain and discomfort is minimized. As no suture removal is required, recovery from Micro Grafting FUE is less than 7 days.

Disadvantages include increased surgical times and higher cost to the patient. It is challenging for new surgeons because the procedure is physically demanding and the learning curve to acquire the skills necessary is lengthy and tough. Some surgeons note that FUE can lead to a lower ratio of successfully transplanted follicles as compared to strip harvesting.

Robotic hair restoration

Robotic hair restoration devices utilize cameras and robotic arms to assist the surgeon with the FUE procedure. In 2009, NeoGraft became the first robotic surgical device FDA approved for hair restoration.

The ARTAS System was FDA approved in 2011 for use in harvesting follicular units from brown-haired and black-haired men.

Applications

There are a number of applications for hair transplant surgery, including:

Androgenetic alopecia
Eyebrow transplant
Frontal hair line lowering or reconstruction (naturally high hairlines without an existing hair loss condition)

If donor hair numbers from the back of the head are insufficient, it is possible to perform body hair transplantation (BHT) on appropriate candidates who have available donor hair on the chest, back, shoulders, torso and/or legs. Body hair transplant surgery can only be performed by the FUE harvesting method and, so, requires the skills of an experienced FUE surgeon. However, there are several factors for a potential BHT candidate to consider prior to surgery. These include understanding the natural difference in textural characteristics between body hair and scalp hair, growth rates, and having realistic expectations about the results of BHT surgery.

What a hair transplant involves

A hair transplant is usually carried out under local anesthesia and sedation, which means you’ll be awake but will not feel any pain.

There are 2 types of hair transplant.

Follicular unit transplantation (FUT, or strip method):

a thin strip of skin with hair is removed from the back of your head and divided into pieces, each containing 1 to 4 hairs (hair grafts)
the grafts are placed into tiny cuts made in the scalp
the site where the hairs are taken is closed with stitches
you’ll have a scar on the back of your head, but it should not be visible unless you have very short hair

The head does not need to be shaved – only the area where the skin is removed is trimmed.

Follicular unit extraction (FUE):

the back of the head is shaved
individual hairs are removed 1 by 1 (grafts)
the grafts are placed into tiny cuts made in the scalp
you’ll have lots of tiny scars, but they will not be very noticeable

Hair transplants usually take a day, but you should not need to stay overnight.

If a large area is being treated, you may need to have 2 or more sessions a few months apart.

Your surgeon will tell you how to look after your graft. You should be given a spray to use to help recovery and hair growth.

Recovery

Most people are able to return to work about 3 days after having a hair transplant.

You need to be very careful with your transplanted hair for the first 2 weeks after your operation. The grafts will not be secure.

You may be told to cut down on exercise in the first month to reduce scarring.

After 2 to 5 days: any bandages can usually be removed, but you should not touch the grafts.

Day 6: you should be able to wash your hair gently by hand.

After 10 to 14 days: any non-dissolvable stitches can usually be removed.

After a few weeks: the transplanted hair will often fall out, and later start to grow back.

After 6 months: new hair will usually start to appear.

After 12 to 18 months: the full results should be seen.

Side effects to expect

It’s common after a hair transplant to have:

a tight, achy and swollen scalp for a few days
temporary scabbing where the hair was transplanted
a single scar or a number of very tiny scars
Cost
The cost of hair transplantation depends on the individual hair loss and consequently on the number of necessary grafts.

What could go wrong

A hair transplant is generally a safe procedure, but as with any type of operation there’s always a small risk of:

bleeding
infection
an allergic reaction to the anaesthetic

Your surgeon should be able to treat these problems quickly.

There’s also a small risk the transplant will not take and the hair falls out, or a noticable scar may form.

Your surgeon should explain how likely these problems are and how they would be treated.

Your hair might continue to thin around the transplant. Your surgeon should plan the design of the transplant to make sure the hair looks natural as time passes.

Who can have a hair transplant

A hair transplant is suitable for people with permanent baldness, the type that runs in families.

It’s not usually suitable for people with other types of hair loss, such as the type that causes bald patches (alopecia areata).

How does one look after hair transplant?

There will be punctate red scabs at the bottom of the transplanted hair shafts on the recipient site and donor sites, which will be visible for about 7-10 days. Usually the patient gains his/her normal appearance within 10-15 days post-op. Only slight redness might be visible after this period.

A hair transplant can be permanent- lasting a long time >20 years and in most cases for life. Hair transplantation relocates lifelong hairs not subject to the hair loss process from the back and sides of your head to areas you are balding in.

Can you grow long hair after transplant?

Yes, it is possible for a patient who had a hair transplant to allow the hair to grow to a length where a ponytail could be worn. The only thing that really determines how long the hair will grow after hair transplantation is how long the patient decides to wait before he or she has a hair cut.

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