Hair transplant is any surgical or non-surgical technique that removes hair follicles from one part of the body to a bald or balding part of the body. Hair transplanting is mostly common in African countries and by people who have lost their hair by medical problems for example cancer which is a very common case.
The most common means of hair transplant is the Follicular Unit Transplantation (FUT) which can be done in two ways follicular unit extraction and strip harvesting.
This procedure is done where hair is naturally transplanted in groups of one to four and these small units allow the surgeon to safely and accurately carry out large graft and transplant procedures and many grafts and maximizes the cosmetic impacts of these procedures. FUT results are undetectable since it allows hair growth to resumes to normal. FUT is the most common procedure for hair transplants and can accomplish:
Due to its use of follicular units, FUT has a distinct physiological and anatomic organization that preserves the hair intact during grafting which maximizes growth. In FUT, after hair is removed from the back of the scalp in a single strip, stereo-microscopic dissection allows the individual follicular units to be removed from this strip without being damaged.
In more ancient mini-micrografting procedures, hair was mainly harvested in multiple strips together with the follicular units in each strip which caused severe damage from the harvesting blades then the harvested strips were cut into small pieces which would break the follicular units and risk more damage to the follicles.
FUT also allows for the hair transplantation to look more natural in regard to the overall grafted distribution of the hair and the individual follicular unit level since normally scalp hair grows in one to four follicular units which makes FUT more likable due to the uniformity nature of its transplant.
This also helps the surgeon in distributing the grafted implants more evenly hence giving a natural look in the overall distribution of hair.
The density of naturally-occurring follicular units in a normal scalp is relatively constant and measured to be approximately 1 unit per mm2.
This helps in the planning of a hair transplant in two ways where the surgeon doing the hair transplant is able to accurately determine the number of follicular grafts that can possibly be obtained from dissecting a donor strip of a particular size.
The same number of follicular units can be used to cover a specific size bald area regardless of the patient’s actual hair density. For patients with higher density, sufficient number of follicle units in the donor area are usually used to achieve the patient’s objectives.
However, for patients with low hair density, alternatives are used but the compromises are guided by the follicular unit constant of one to four. If the surgeon transplants a low-density hair patient using the same number and spacing as that of a high-density hair patient, a thinner look is achieved but will still allow proper conversion of donor hair in case of future procedures.
FUT is an important aspect in minimizing trauma to the scalp since naturally appearing hair transplants transplant emerges from perfectly normal skin.to accomplish this, excess tissues appearing around the follicular units are trimmed and then are inserted to the small recipients’ sites on the patients’ scalp.
The excess tissue around the follicles can surgically be removed without injuring the follicles through a procedure known as stereo-microscopic dissection. Follicular units are usually relatively compact structures that are surrounded by bald skin.
Unlike the punch grafts and some mini-grafting techniques; each of which removes a small bit of tissue in the recipient area; the trimmed follicular unit grafts used in FUT fit into small, needle-made incisions without any need for removing tissue.
It is possible to replace the small, trimmed follicular unit grafts by incisions in the scalp which minimizes damage to the connective tissues and to the scalp and facilitates blood supply.
FUT transplantation also offers ability for hair restoration to be performed and completed quickly hence reducing the interference of patients’ lifestyle.
The large number of grafts used can compensate for the baldness that comes with a hair transplant called telogen effluvium and by using these grafts, each transplant session preserves the donor supply decreasing the number of times incisions are made in the donor area.
In addition, the extraction of large numbers of grafts sufficiently provides a one to two hair graft that creates a soft front hair line and enough three and four hair grafts that provides the patient with the fullest possible look.
These are the reasons why FUT procedures allow the surgeon in transplanting large number of grafts during each session.
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.
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.
Strip harvesting 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.
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.
FUE involves the hair transplant takes place in the hair follicles and involves the use of local anesthesia where the removal involves use of tiny punches of between 0.6mm and 1.0mm in diameter.
Here, the surgeon uses fine needles or small microblade for incision into the area receiving the grafts, placing them in a predetermined pattern and density and to promote a realistic pattern, angling the wounds in an orderly and consistent manner.
For desired results, a professional need to insert the individual grafts in place which in the final procedure. Follicular unit extraction generally has a quicker patient recovery time and significantly lower post-operative discomfort than follicular unit transplantation (FUT). In addition, the risk of long-term nerve damage, leading to chronic numbness and/or pain in the donor area, is significantly reduced with FUE vs the strip (FUT) procedure.
Additionally, FUE provides an alternative to FUT when the scalp is too tight for a strip excision and enables a hair transplant surgeon to harvest finer hair from the nape of the neck to be used at the hairline or for eyebrows.
However, with FUE, the follicles are harvested from a much greater area of the donor zone compared to FUT, estimated to be eight times greater than that of traditional strip excision so requires patients to have hairs trimmed in a much larger donor area.
Follicles harvested from borderline areas of the donor region may not be truly “permanent,” so that over time, the transplanted hair may be lost. Due to the scarring and distortion of the donor scalp from FUE it makes subsequent sessions more difficult, and grafts are more fragile and subject to trauma during placing, since they often lack the protective dermis and fat of microscopically dissected grafts.
The survival of follicular units upon extraction from the scalp is one of the key variables of successful hair transplantation. If follicular units are transected in the extraction process, there is a greater likelihood that they will not survive the transplant, and the hair transplant will fail.
Hair with plenty of volume, movement, and shine is what most people consider healthy. So, when you look down at the drain and see a clump of lost hair strands, it’s easy to assume that there’s a health problem causing hair loss. But some hair loss is normal for everyone and at every age.
When you wash your hair thoroughly in the shower, hairs that are already loose or disconnected from your scalp congregate near the drain. While it might look like a lot, you’re probably seeing normal hair shedding.
In a day, According to the American Academy of Dermatologists, it’s normal to lose anywhere from 50 to 100 strands of hair per day and for people with longer hair strands, losing them may be more noticeable. Since there are 100,000 hair follicles or more on each person’s scalp, the loss of 100 or so hair strands a day doesn’t make a big difference in appearance.
However, women have been seen to lose more hair strands per day than men. There’s no way to measure the difference objectively, because daily heat styling and frequent hair coloring plays a big part in how much of your hair sheds.
Approximately 40 percent of women Trusted Source lose extra hair every day because of the way they style it. Women are also more likely than men to experience periods of increased hair shedding due to life events like pregnancy and menopause.
Very few women have the type of hair loss that make them good candidates. Most women have diffuse hair loss instead, an overall thinning in all areas of the head, including the sides and back, which are the areas that act as donor sites in men.
It is from these sites that the hair is removed for hair transplantation to other areas of the head. In female pattern baldness, however, these donor areas are usually unstable. They are thinning, just like the other areas of the head. The donor areas in women are affected by follicle-killing DHT. That means that if you remove hair and accompanying follicles from these donor areas in women and transplant them to other areas, it’s just going to fall out.
Any doctor who would attempt to transplant hair from an unstable donor site is potentially unethical and may just be trying to take economic advantage of the patient.
• Women who have suffered hair loss due to mechanical or traction alopecia.
• Women who have had previous cosmetic or plastic surgery and are concerned about hair loss around the incision sites.
• Women who have a distinct pattern of baldness, similar to that of male pattern baldness. This includes hairline recession, vertex thinning, and a donor area that is not affected by androgenetic alopecia.
• Women who suffer hair loss due to trauma, including burn victims, scarring from accidents, and chemical burns.
• Women with alopecia marginalis, a condition that looks very similar to traction alopecia.
In men, the donor sites are called stable sites, which means that the hair and follicles in those areas are not affected by the dihydrotestosterone (DHT) that shrinks follicles elsewhere on the head.
This is the situation in those with androgenetic alopecia, or what’s commonly called male pattern baldness. Another difference between male and female pattern baldness is the frontal hairline. Unlike men, women with hair loss tend to keep their frontal hairline.
They don’t have to worry about needing a hair transplant to frame their face and are instead more concerned about the loss of volume from the top and back. Hair transplants, though, don’t do much to increase volume. It just moves hair from one place to another.
• Men who have been losing their hair due to male pattern baldness for more than five years or who have progressed to class 3 or above on the Norwood Scale.
• Men who have realistic expectations and who understand that their hair loss might continue to progress after surgery, even if they are taking prescription medication to stop this progression. Some men have to continue these medications after surgery to retain as much of their hair as possible.
• Men who have been balding for many years, whose pattern has stabilized, and who are interested in adding some hair to provide a more youthful appearance.
• Men and women who have lost hair due to trauma or burns.
• Men and women who have lost hair due to other cosmetic procedures such as facelifts
There are a number of applications for hair transplant surgery, including:
• Androgenetic alopecia
• Eyebrow transplant
• Frontal hair line lowering or reconstruction
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.
Advances in wound care allow for semi-permeable dressing, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery.
Some surgeons will have the patient shampoo the day after surgery. Shampooing is important to prevent scabs from forming around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.
During the first ten days, some of the transplanted hairs, inevitably traumatized by their relocation, may fall out. 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.
Within 2 to 3 weeks after surgery, the transplanted hair will fall out, but you should start to notice new growth within a few months. Most people will see 60% of new hair growth after 6 to 9 months. Some surgeons prescribe the hair-growing drug minoxidil (Rogaine) to improve hair growth after transplantation, but it’s not clear how well it works.
The price of a hair transplant will depend largely on the amount of hair being transplanted, the area of the hair transplant and the risks involved in the transplantation, but it generally ranges from $4,000 to $15,000.
The costs are brought about by pain medications during recovery stage, anti-inflammatory medications which reduce swelling on the hair implant area and antibiotics which help reduce the risk of infection.
Other factors that determine the cost of an implant include: the place of residence, the type of procedure selected, the skills of the surgeon, travel costs and mainly the amount of hair to be transplanted. Most insurance plans don’t cover it. However, the cost is steep but worth it if quality is desired.
During the surgery, the patient may experience some discomfort and some mild pain and some may experience some inflammation and itchiness on the area areas. Others may have some infections of the hair follicles commonly known as folliculitis where some anti biotics maybe administered to relieve the problem.
Shock loss is also a common condition where patients experience sudden loss of their original hair in the area where the new hair was transplanted and at times temporary thinning of the original hair. Bleeding may also take place but for some time and presence of cysts on the skin which are fluid filled scars that occur on the hair transplantation area.
Post-operative hiccups have also been seen in around 5% of transplant patients. However, some of these occurrences are just temporary and fade away with time as the transplanted area heals.
There are many known hair products that are known to increase hair volume, or help grow and replace damaged hair. But most aren’t all that effective. The best and highly recommended way to add, replace or increase hair to an area can be with a transplant. Though the costs of a hair transplant are high, they are safer and highly reliable since there is limited use of cosmetic products that may contain chemicals that may cause irritations and allergic reactions to the skin.