Hair transplant surgery is surgery that is performed to restore hair to areas of the scalp that are bald or that have thinning hair. There are multiple types of hair replacement surgery. Most commonly, these involve hair transplantation, but flap surgery, tissue expansion of the scalp and scalp reduction surgery, are also methods used for hair replacement. Each of these types of surgeries can be used alone, or in combination, to provide the patient with the best possible outcome for hair replacement.

Hair transplantation involves removing small pieces of hair-bearing scalp from a donor site and using them as grafts to be relocated to a bald or thinning area of the scalp.

Flaps surgeries involve moving hair bearing scalp tissue into bald areas of the scalp.

Tissue expansion allows the hair bearing scalp to be expanded to help cover areas of the scalp that have no hair.

Scalp reduction surgery involves surgically removing bald areas of the scalp and advancing, or bringing together, the hair bearing areas of the scalp.

If you and your surgeon have determined that hair transplant surgery is the best option for you, you can feel comfortable knowing that board-certified plastic surgeons have been successfully performing these types of procedures for more than thirty years.

 

The truth about hair loss Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff and even excessive hat wearing. All of these theories have been disproved. It’s also untrue that hair loss can be determined by looking at your maternal grandfather, or that 40-year-old men who haven’t lost their hair will never lose it.

Hair loss is primarily caused by a combination of:

1. Aging

2. A change in hormones

3. A family history of baldness

As a rule, the earlier hair loss begins, the more severe the baldness will become.

 

Hair transplant candidates You may be a candidate for hair transplant surgery if you have healthy hair growth at the back and sides of the head to serve as donor areas.

1. Donor areas are the places on the head from which grafts and flaps are taken.

2. Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result.

3. There are a number of techniques used in hair replacement surgery. Sometimes, two or more techniques are used to achieve the best results.

Hair transplant surgery can enhance your appearance and your self-confidence, but the results won’t necessarily match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

It’s important to understand that all hair replacement techniques use your existing hair. The goal of surgery is to find the most efficient uses for existing hair.

Hair transplantation techniques, such as punch grafts, mini-grafts, micro-grafts, slit grafts and strip grafts are generally performed on patients who desire a more modest change in hair fullness. Flaps, tissue-expansion and scalp-reduction are procedures that are usually more appropriate for patients who desire a more dramatic change.

Remember, there are limits to what can be accomplished. An individual with very little hair might not be advised to undergo hair transplant surgery.

 

Hair transplant recovery How you feel after surgery depends on the extent and complexity of the procedure. Any aching, excessive tightness or throbbing can be controlled with pain medication prescribed by your physician. If bandages are used, they will usually be removed one day later. You may gently wash your hair within two days following surgery. Any stitches will be removed in a week to 10 days. Be sure to discuss the possibility of swelling, bruising and drainage with your surgeon.

Because strenuous activity increases blood flow to the scalp and may cause your transplants or incisions to bleed, you may be instructed to avoid vigorous exercise and contact sports for at least three weeks. Some doctors also advise that sexual activity be avoided for at least 10 days after surgery.

To make sure that your incisions are healing properly, your doctor will probably want to see you several times during the first month after surgery. It’s important that you carefully follow any advice you receive at these follow-up visits.

 

Getting back to normal How soon you resume your normal routine depends on the length, complexity and type of surgery you’ve had. You may feel well enough to go back to work and resume normal, light activity after several days. Many patients who have had transplants (plugs or other grafts) are dismayed to find that their “new” hair falls out within six weeks after surgery. You should know that this condition is normal and almost always temporary. After hair falls out, it will take another five to six weeks before hair growth resumes. You can expect about a half-inch of growth per month.

 

Follow-up procedures You may need a surgical “touch-up” procedure to create more natural-looking results after your incisions have healed. Sometimes, this involves blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts or slit grafts. Or, if you’ve had a flap procedure, a small bump called a “dog ear” may remain visible on the scalp. Your doctor can surgically remove this after complete healing has occurred.

In general, it’s best to anticipate that you will need a touch-up procedure. Your surgeon can usually predict how extensive your follow-up surgery is likely to be.

 

Hair transplant risks and safety Hair transplant surgery is normally safe when performed by a qualified, experienced board- certified plastic surgeon. Still, individuals vary greatly in their physical reactions and healing abilities, and the outcome is never completely predictable.

As in any surgical procedure, infection may occur. Excessive bleeding and/or wide scars, sometimes called “stretch-back” scars caused by tension, may result from some scalp-reduction procedures.

In transplant procedures, there is a risk that some of the grafts won’t “take.” Although it is normal for the hair contained within the plugs to fall out before establishing regrowth in its new location, sometimes the skin plug dies and surgery must be repeated. Sometimes, patients with plug grafts will notice small bumps on the scalp that form at the transplant sites. These areas can usually be camouflaged with surrounding hair.

When hair loss progresses after surgery, an unnatural, “patchy” look may result-especially if the newly-placed hair lies next to patches of hair that continue to thin out. If this happens, additional surgery may be required.

 

Hair Transplantation Methods : FUE vs FUT

Follicular Unit Transplant (FUT) Commonly referred to as the “strip method”, follicular unit transplant (FUT) is the more traditional hair transplant method. All hair restoration surgeons will agree that even if it is an older method, it yields more viable hair grafts than the newer and more technologically “advanced” follicular unit extraction (FUE) method.

The FUT procedure involves surgical removal of the strip of skin that holds hairs that are genetically resistant to thinning (the donor area). The strip is then placed under a microscope so follicular units can be harvested.

Since the FUT only takes hairs from the safe donor area, the FUT does have a higher survival rate of grafts when compared to the follicular unit extraction (FUE) method, which takes some hairs from outside the safe donor area which are prone to hair thinning.

In addition, it’s well known that 30% or more of FUE grafts are transected (even with advanced “technology”). “Transected” means that the dermal papilla (or root) is cut away from the graft. This is comparable to planting a tree without the root.

Survival of each follicular unit is dependent on preserving the soft, fatty tissue at the base of the hair that contains the root called the dermal papilla. After graft harvesting, the follicular units are placed on desired areas of the scalp using an implanting tool such as the Choi Implanter.

FUT is the Preferred Hair Transplant Procedure at Prasad Hair Restoration.

The FUT is the preferred transplant procedure of Prasad Hair Restoration because it yields better quality grafts, has less incidence of graft damage (known as transection), and because the strip scar at the back of the head can potentially heal with minimal scarring using Dr. Prasad’s advanced wound healing techniques and cosmetic surgery closure.

 

FUE ( Follicular Unit Extraction) – Avoiding the Strip Incision Follicular unit extraction (FUE) transplantation is considered a more “modern” hair transplant procedure assisted with technologies promoted as superior to “old” FUT methods. The FUE was conceived as a way to avoid the strip scar of FUT procedures.

The FUE extracts follicular units individually from the back of the scalp to avoid the larger FUT donor area scar. However, the FUE method trades off smaller scars in place of the one long extraction scar (which can now have enhanced healing with regenerative medicine technology).

The FUE is a procedure than can be done manually with a hair graft punch, and also robotically with the ARTAS FUE robot. The robot selects the best hairs for extraction faster than a human identifying the best hairs to extract.

Once grafts are harvested, hairs are implanted in the same or similar manner as done with the FUT procedure. FUE technology may imply that it is a superior hair transplant method, but technology does not change the size of the donor area, or the amount of available and viable hair grafts.

 

Drawbacks of the Follicular Unit Extraction (FUE)

1. With FUEs – follicular units are extracted using tools and punches that can retrieve the hair shaft, but may cut the root beneath the skin (since you can’t see through the skin). The loss or damage of the root (dermal papilla) known as transection. As much as 30% of hair grafts in an FUE can be damaged at the root, resulting in grafts that don’t take, die, or just don’t grow.

2. Less quality grafts – since the FUE doesn’t yield as many grafts in the true genetically resistant donor area as the FUT. A significant number of FUE grafts have to be harvested from outside the narrow genetically resistant zone of hair. Harvesting grafts from outside the donor area means that these hairs are not genetically resistant and more prone to hair thinning and loss.

3. Higher incidence of broken grafts – Extracting hair grafts in an FUE procedure is riskier to the graft than during an FUT procedure. Follicular units can be carefully extracted in the strip method since the skin is no longer attached to the body, preserving the all important root, or dermal papilla.

4. Longer procedure – the FUE is a longer hair surgery procedure than the FUT. FUT extractions are faster since the strip of hair is removed and hair grafts are prepared by technicians. In the FUE, the patient experiences each individual extraction which is a long and uncomfortable process compared to FUT. In fact, FUE surgery can take twice as long as an FUT.

 

Hair Transplant Recovery Time, Aftercare, and Healing Prior to your hair transplant surgery, you’ll be provided instructions about your aftercare and recovery. It’s important you provide your doctor and medical team all information about your health, current medications, smoking and alcohol history, allergies and previous surgeries and dental procedures. Medications may be prescribed for you as part of your aftercare.

If you’re undergoing FUT surgery, allow your hair length in the back to grow at least to 1 inch so the hair can cover your hair transplant scar. Hair transplant recovery in the first few days is managed by limiting strenuous activity and resting with your head elevated when you sleep or relaxing.

You’ll be instructed on how to minimize the hair transplant scar in the donor area and how to manage the hair transplant scabs where the hair grafts were placed. You will be seen in about 1 to 2 weeks for examination, suture removal and examination of your hair transplant scar in the back of the scalp and the appearance of the hair grafts.

Most people are able to return to work after 1 to 2 weeks depending on the type of surgery you undergo and the type of work you do.

 

Limitations of Hair Transplantation

Limited amount of genetically resistant hair in the donor area Hair that is genetically resilient to hair loss only grows in a limited area at the back of the head. Any hair taken above or below this area is vulnerable to hair loss after a transplant or as part of progressive hair loss. Given this scenario, it is easy to see the limitations of having to harvest hair from a small area in order to cover a much larger area of baldness at the front of the scalp and the crown.

 

Hair transplants do not stop hair thinning The main problem of hair transplantation is that they do not actually treat the progression of hair loss, since they do not directly address the hormones or other cellular signals that affect hair growth. It is important to understand that hair loss does not occur suddenly.

Rather, hair progressively grows thinner each time hair sheds and enters the growing phase. Hair grows in cycles and with every cycle, hair continues to miniaturize, until it eventually disappears.

 

Inadequate density of transplanted hair Most hair loss sufferers ideally want to achieve natural-looking hair density and coverage in a single session when undergoing a hair transplant. This is an unrealistic expectation, since only a limited amount of hair can be safely and effectively transplanted per square centimeter of the scalp.

Keep in mind that each transplanted hair comes with the entire follicular unit, including the dermal papilla and other soft tissue. These need enough space and blood and nutrient supply in order to grow, therefore, crowding grafts together is not a wise option. Native hairs may also be subjected to trauma during a hair transplant, which can also affect hair density.

 

Treatments to Maximize Hair Transplant Results

There are known ways in order to maximize the result of an hair transplant surgery, which comprise of medical therapy and regenerative medicine or adult stem cell based treatment.

 

Finasteride Oral Medication Finasteride (or Propecia) prevents the enzyme 5-alpha reductase from converting testosterone to dihydrotestosterone (DHT), which affects DHT sensitive hairs in some men. Consistent use of finasteride can help in slowing down hair loss; however, finasteride has been known not to work on all men. There is also an increasing concern of its long-term sexual side effects, which is one reason that many men are refusing to take finasteride. Finasteride must be taken daily for efficacy.

 

Minoxidil Topical Application No. Most of the time, when people seek out a hair transplant, they are not informed that there is a high likelihood that they will need more sessions in order to achieve satisfactory results. The most common reasons for multiple hair transplant procedures are due to the following:

A patient’s existing natural hair will continue to thin out until they are lost, leaving behind only the transplanted hairs. If a patient does not have another hair transplant to address the added hair loss, they will be at risk for the “pluggy look”.

Transplanted hair that remain are genetically resistant to the effects of DHT that cause hair thinning and loss. However, native hair is still prone to hair thinning and can be lost years after the transplant was performed.

The donor area itself is limited because only 1500-4000 grafts can be harvested safely in one transplant session. To ensure that the hair grafts survive and grow, only a limited number of hairs can be transplanted so the donor area can heal before having another procedure.

The safe donor area of hair genetically resistant to hair thinning is very limited.

In our experience, the cost of hair transplant has become commoditized in a cost per graft model. This makes people believe that all hair transplants are the same. This is not true. We believe that the best approach is to place the maximal number of hairs from a donor area while at the same time create a minimal scar in the donor area.

Every patient has different variables which affect the number of hairs available for transplantation.