Hair Transplantation
Introduction
Hair transplantation is an outpatient surgical procedure that removes hair follicles from donor site of the scalp, to a bald or balding part of the head known as the "recipient site". The procedure is primarily used to treat male scalp baldness, but occasionally it may be used to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars.
The latest hair transplantation techniques harvest and transplant hair “follicular units” in their natural groupings to achieve a natural appearance by mimicking original hair orientation. This procedure is called follicular unit transplantation (FUT), while the old technique is called strip harvesting.
Hair transplantation is an outpatient surgical procedure that removes hair follicles from donor site of the scalp, to a bald or balding part of the head known as the "recipient site". The procedure is primarily used to treat male scalp baldness, but occasionally it may be used to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars.
The latest hair transplantation techniques harvest and transplant hair “follicular units” in their natural groupings to achieve a natural appearance by mimicking original hair orientation. This procedure is called follicular unit transplantation (FUT), while the old technique is called strip harvesting.
Pre-operative assessment and planning
The surgeon starts with analyzing the patient’s scalp to evaluate the donor areas, and how big the recipient area is, then discusses their preferences and expectations, and advises the patient on the best approach either in person or through patient photos.
Folliscopy is a good way to know the actual existing density of hair, so that postoperative results of newly transplanted hair grafts can be accurately assessed. Of course a full history of the patient will be taken, along with full physical exam. The patient should avoid any blood thinner, or over the counter medicine at least 3 days prior the procedure.
Harvesting Methods
The transplant procedure is performed on an outpatient basis in the hospital under sterile conditions, and local anesthesia is applied for the donor scalp being harvested.
Generally there are two techniques for harvesting hair follicles, each with their own advantages and disadvantages, follicular unit extraction (FUE), and strip harvesting. Regardless which technique is used, proper extraction of the hair follicle is essential to ensure the viability of the transplanted hair. Hair follicles grow at a slight angle to the skin’s surface, so transplanted tissue must be removed at a corresponding angle.
1. Follicular unit extraction (FUE)
With this technique, individual follicular units containing 1 to 4 hairs are used; this is performed by using tiny punches of between 0.6mm and 1.0mm in diameter. The surgeon then uses very small micro blades or fine needles to prepare the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling in a consistent fashion to promote a realistic hair pattern.
Recently we start using a new tool to implant the hair follicles in the skin without the need for puncturing,
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 to 8 hours , depends on the number of hair grafts.
The advantage of FUE harvesting is that no linear incision is left on the back of the head and it doesn’t leave a linear scar, so no suture removal is required. The final result looks very natural.
Recovery time from Micro Grafting FUE is usually less than 7 days.
Disadvantages include that more visits are needed for the procedure and there is a higher cost to the patient. It requirs high skill and expertise from the surgeons because the procedure is physically demanding and the learning curve to acquire the skills necessary is lengthy and tough.
2. Strip harvesting
Strip harvesting is used to be 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. The strip size is about 1–1.5 x 15–30 cm. Then the surgeon or his team begins to dissect individual follicular unit grafts from the strip. Then they clean excess fibrous and fatty tissue in careful way to avoid damage to the follicular cells. Currently we apply ‘Trichophyte closure’ which results in much finer scars at the donor area.
Finally the surgeon uses fine needles with minimal pain to puncture the sites for receiving the grafts; the doctor has to place them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a normal hair pattern.
Disadvantages of Strip harvesting include a thin linear scar in the donor area, which is typically covered by a patient’s hair even at relatively short lengths, longer recovery period which is around 2 weeks, and the need for stitches/staples removal by medical personnel.
Folliscopy is a good way to know the actual existing density of hair, so that postoperative results of newly transplanted hair grafts can be accurately assessed. Of course a full history of the patient will be taken, along with full physical exam. The patient should avoid any blood thinner, or over the counter medicine at least 3 days prior the procedure.
Harvesting Methods
The transplant procedure is performed on an outpatient basis in the hospital under sterile conditions, and local anesthesia is applied for the donor scalp being harvested.
Generally there are two techniques for harvesting hair follicles, each with their own advantages and disadvantages, follicular unit extraction (FUE), and strip harvesting. Regardless which technique is used, proper extraction of the hair follicle is essential to ensure the viability of the transplanted hair. Hair follicles grow at a slight angle to the skin’s surface, so transplanted tissue must be removed at a corresponding angle.
1. Follicular unit extraction (FUE)
With this technique, individual follicular units containing 1 to 4 hairs are used; this is performed by using tiny punches of between 0.6mm and 1.0mm in diameter. The surgeon then uses very small micro blades or fine needles to prepare the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling in a consistent fashion to promote a realistic hair pattern.
Recently we start using a new tool to implant the hair follicles in the skin without the need for puncturing,
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 to 8 hours , depends on the number of hair grafts.
The advantage of FUE harvesting is that no linear incision is left on the back of the head and it doesn’t leave a linear scar, so no suture removal is required. The final result looks very natural.
Recovery time from Micro Grafting FUE is usually less than 7 days.
Disadvantages include that more visits are needed for the procedure and there is a higher cost to the patient. It requirs high skill and expertise from the surgeons because the procedure is physically demanding and the learning curve to acquire the skills necessary is lengthy and tough.
2. Strip harvesting
Strip harvesting is used to be 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. The strip size is about 1–1.5 x 15–30 cm. Then the surgeon or his team begins to dissect individual follicular unit grafts from the strip. Then they clean excess fibrous and fatty tissue in careful way to avoid damage to the follicular cells. Currently we apply ‘Trichophyte closure’ which results in much finer scars at the donor area.
Finally the surgeon uses fine needles with minimal pain to puncture the sites for receiving the grafts; the doctor has to place them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a normal hair pattern.
Disadvantages of Strip harvesting include a thin linear scar in the donor area, which is typically covered by a patient’s hair even at relatively short lengths, longer recovery period which is around 2 weeks, and the need for stitches/staples removal by medical personnel.
Post-operative care
Post care is very important to prevent the loss of the newly implanted hair graft, so it is crucial that the patient post care doctor recommendations.
1. Using semi-permeable dressing, which allows seepage of blood and tissue fluid, to be applied and changed at least daily. 2. The recipient area must be shielded from the sun, 3. Shampooing should be started two days after the surgery. Some surgeons will have the patient shampoo the day after surgery. Shampooing is very important to prevent scabs from forming around the hair shaft, and prevent any loss of newly transplanted hair follicles during the first 7 to 10 days post-op. |
Side effects
Hair thinning, known as “shock loss”, is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day.
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What to Expect
Some of the transplanted hairs will fall inevitably during the first ten days, because they are traumatized by their relocation. This is referred to as “shock loss”. After two to three months new hair will begin to grow from the moved follicles. The patient’s hair will grow normally, and continue to thicken through the next six to nine months.
Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.
Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.
