Hair Transplant – Restoration
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Modern techniques of surgical hair transplantation can restore lost hair and replace or re-shape your hairline with your own natural, growing hair, which needs no more care than the ordinary washing, styling, and trimming you have always done. Transplantation can be done today so well that often a barber or stylist cannot even tell that grafts have been placed.
Hair transplantation involves removing permanent hair-bearing skin from the back and/or sides of the scalp (donor area). Then, using magnification, the tissue is dissected into follicular unit grafts (containing 1–4 hairs) and multi-follicular unit grafts (containing 3–6 hairs each). These small grafts are then meticulously planted into the bald or thinning area of the scalp (recipient area) so as not to injure any follicles already existing in the area and at the same exact angle as the other hairs present. The creation of very small follicular unit grafts has enabled the hair surgeon to create very natural, feathered hairlines, which do not have the abrupt, “pluggy look” that was commonly seen in hair transplants of years past. Some surgeons prefer to transplant exclusively with follicular unit grafts, while others feel that placing the multifollicular unit grafts into the central areas of the scalp allows them to better create central density. Depending on the degree of balding in the frontal, mid-scalp, and vertex (crown) areas, usually 2–3 procedures are performed, with the number of grafts used varying tremendously, based on the area of potential alopecia, the patient’s “safe” donor supply, the textural characteristics of the patient’s hair, whether or not multi-follicular unit grafts are used in addition to follicular unit grafts, and the specific goals of the patient. Hair transplant surgery today is remarkably well tolerated. Within 24 hours small crusts will form on each graft that are then shed in approximately 4–14 days. The grafted hairs will often start to grow by 10–16 weeks after the procedure and will continue to grow for most, if not all, of one’s life. (As men and women age, in many there is a slight loss of hair density all over the head, which would naturally also affect the transplanted hairs).
How is it done?
When undergoing a hair transplant most patients are put under local anaesthesia. The doctor then takes hair from an area of thick hair growth and moves it to bald areas. The doctor usually removes a piece of the scalp and then sews it closed. The hairs are then removed from the piece of scalp and the carefully placed in the tiny holes in the area of the scalp where there is minimal hair growth. Hundreds to thousands of hairs can be transplanted per treatment.
What happens during a hair transplant procedure?
Hair transplantation surgery is considered to be “minor out-patient surgery.” Hair transplant procedures can take from 3–8 hours and are usually performed using local anesthesia on an out-patient basis, often with some supplemental oral or IV medication for sedation. Patients are often awake, but feel very relaxed because of the effect of the sedative. There is typically little discomfort during the surgical procedure. The donor areas, where the grafts have been harvested, are usually closed with sutures or surgical staples, except in the Follicular Unit Extraction technique, which does not require surgical closure. These are usually removed in 7–14 days. Dissolvable sutures may occasionally be used in order to eliminate the need for you to return for suture removal. The recipient sites, where the grafts are placed on top, are essentially small, superficial needle holes or slits in the skin of the scalp. The surgeon should be willing to discuss with you the pros and cons of the various methods of donor, harvesting, and transplanting the grafts. At the end of the procedure, either a very light dressing is applied, or, in many cases, the doctor will have you stay for brief observation and then allow you to leave with no dressing whatsoever. At the conclusion of the procedure the surgeon usually checks the final placement of the grafts, and the doctor or an assistant then explains the postoperative instructions, which are usually supplied in written form as well.
What happens after hair transplant procedure?
Hair transplantation is a very safe, relatively minor surgical procedure. Significant complications are extremely rare. There is usually little or no discomfort in the grafted area. Most patients feel some “tightness” in the donor area for 1–2 days and are prescribed a mild analgesic to help cope with this. Patients may be asked to use moist compresses or sprays and to sleep in a semi-upright position for 2–3 days following the procedure to minimize swelling and bruising. Small crusts may form on each graft, and these can usually be camouflaged by any existing hair that can be combed over the recipient area, or with camouflage products such as DermMatch, Couvre, or Toppik. These crusts will flake-off by 5–14 days after the surgery, the smaller follicular unit scabs often falling off at 4–6 days and the multi-follicular unit scabs taking longer. The transplanted hair seen growing out of the scalp may initially be shed; however, the roots remain and will be dormant for 10–14 weeks, at which time the new hairs will all begin to grow. Numbness that may occur in the donor or recipient area usually disappears within 2–8 months following surgery.
The elements that a doctor assesses to determine whether a candidate is a good subject for surgical hair restoration include such things as: the patient’s general state of health; the hair’s texture—fine or coarse; the contrast between the patient’s hair color and skin color; the density, i.e., the number of hair follicles per square inch of the hair in the donor area; the size of the area to be covered; the size of the area of donor hair; whether or not previous grafting procedures have been done; and the patient’s goals and expectations. Making an accurate diagnosis and making treatment recommendations require an examination by a doctor and a frank discussion of possibilities between the patient and the doctor. The doctor should also give the patient a realistic estimate of the total cost of the planned procedure or procedures. The patient must understand that transplantation redistributes existing hair follicles and cannot create new hair follicles.
Risks of the procedure
Anyone who has experienced permanent hair loss may be a candidate for hair restoration surgery, including:
- Men with male pattern baldness
- Women with female pattern hair loss
- Men or women who want to restore or change the shape of their hairline
- People with areas of scarring from injuries or “scarring” skin diseases, and also patients who experienced some hair loss after surgery, such as face lift procedures
- People who want to thicken or restore eyebrows, eyelashes, and beards
- Men and women who want hair in an area where they have little or no hair