Hair Transplant Surgery
Used to treat androgenetic alopecia, hair transplant surgery is a procedure which hair taken from a “donor” part of the body – generally the back of the head – and is transferred to the parts of the scalp that are balding.
History
Hair transplant surgery was first developed in the early 1950s.
Dr. Norman Orentreich performed the first modern, successful hair transplant surgery in New York City in 1952, and set into motion the theories and techniques that would be the basis for all subsequent hair transplant surgeries.
It is thanks to Orentreich’s research on patients with alopecia that the theory of donor dominance was established. Through this, Orentreich realized that hair would maintain the characteristics of the healthy, hair-bearing donor area rather than the characteristics of the weaker, balding recipient areas.
Of course, major advancements have been made in the fifty years since Dr. Orentreich performed the first hair transplant. Hair transplant surgery today can be completed in just one day – from the harvesting to transplantation – under local anaesthesia. Patients can be back to their routines within days of the transplant completion. The mini or micro grafts in which donor hair is inserted during surgery are significantly smaller than in Dr. Orentreich’s day — all but eliminating the “plug” look of years past. As well, techniques used to extract hair from the donor site have become increasingly sophisticated.
While it is still a monumental and life-changing decision, the advances made in technique and technology help to drastically reduce the possibility of a hair transplant ending in bad results.
Procedure
Hair transplant surgery is precisely that: hair transplanted from one area of the body onto the front of the scalp.
The first step in the hair transplant procedure is selecting the surgeon. It is crucial for patients to research hair transplant surgeons in their area. A potential patient should ask many questions about the procedure and the techniques that the surgeon uses. They should also ask to see examples of prior transplants and/or speak to previous transplant patients. A good surgeon will wait until patients are truly psychologically and physically ready before performing the transplant, and will never perform the surgery on men and women who are unfit candidates for the procedure. All patients should have a complete physical examination prior to surgery. This is important as health issues such as hypertension, artery disease, and lifestyle, may inhibit hair growth after surgery.
The first step in hair transplant surgery is to wash and treat the patient’s hair and with an antibacterial agent. Patients are often offered a mild sedative so they can better relax during the surgery. A local anaesthetic is injected into the scalp to numb any discomfort that may result from extracting and transplanting the hair follicles. After the patient has been made comfortable, the extraction of the individual hair follicles can begin.
Extraction is done in one of two ways:
The first method is called Follicular Unit Hair Transplantation, or FUT. With this technique, a strip of donor hair is removed from the back of the patient’s scalp. Most patients have 90 to 100 follicular units per square centimetre; generally, the donor strip is about 1cm high and 20cm wide for a projected yield of 2000 follicular grafts. After the strip is removed, the donor area is sutured or stapled shut, and the hairs are harvested by technicians beneath a binocular (stereo) microscope. Individual hair follicles are then separated and prepared for transplant.
The second method is called Follicular Unit Extraction, or FUE. An instrument is used to make a small, circular incision in the skin around a follicular unit, in order to separate it from the surrounding tissue. The unit is then extracted from the scalp, leaving a small open hole. This process is repeated until the surgeon has harvested enough units to complete the transplant. FUE takes longer than FUT, with the process lasting anywhere from several hours to 2 consecutive days. FUE is often the option selected by patients who do not want the cutting and healing related to FUT.
The number of follicles transplanted into the scalp is a decision made by the patient and surgeon beforehand. For men, the most commonly used rule is to multiply the patient’s rating on the Norwood scale (used to determine the level of baldness) by 1,000. Women use the Ludwig scale to help surgeons determine the number of follicles needed.
While the follicular units are being separated by technicians, the surgeon prepares the front of the patient’s head for the hair transplant.
Micro-blades or very fine needles are used to create small punctures into which the mini or micro grafts will be inserted. A good surgeon will make the punctures in an irregular fashion across the front of the scalp in order to create a more natural-looking hairline. The prepared mini and micro grafts are then inserted into the tiny punctures, one by one.
Since micro grafts hold 3 to 4 hair follicles, they are generally used towards the very front of the scalp in order to create the new hairline. Mini grafts can contain 3 to 8 shafts of hair, and are usually inserted behind the new hairline (where the thickness will appear far more natural).
Once the follicular units have been transplanted, the hair and scalp are gently washed, and a mild analgesic may be prescribed to numb the pain that post-op patients may experience. It is not uncommon for grafts to fall out within 2 to 6 weeks of having surgery. However, only the hair has fallen out; the follicles are sealed into place by fibrin, the body’s natural glue. New hair will grow back in the same amount of time that the rest of the patient’s hair grows.
Accessibility
Men and women are both candidates for hair transplant surgery.
One of the most important considerations for hair transplant surgery is the condition of the donor area. The surgeon has to determine if there is enough donor hair to achieve the desired effect. People who still have ample hair on the back and sides of the head are generally considered better candidates than those who are in a very advanced stage of androgenetic alopecia.
Patients with certain pre-existing medical conditions can be ruled out for surgery. One should never proceed with surgery unless a complete physical examination has been done prior to the procedure.
The cost of hair transplant surgery varies. The price is usually in the range of anywhere from $4 to $7 per graft. However, depending on the length and complexity of the procedure, the surgeon may set a standard price that will bring the overall cost down.
Side Effects
There are no serious side effects to hair transplant surgery. Patients report scalp sensitivity, headaches and pain in the donor area. A small amount of bleeding may occur but this is normal and need not be reported to the surgeon unless the bleeding is continuous or gets worse. In rare instances, swelling of the forehead and eyes has been reported. A dry, itchy scalp may also occur, but unless it appears to be an allergic reaction to the sutures or antibacterial shampoos, it will subside.
Links & Testimonials
Hair Transplant Docs is a great resource for those considering a hair transplant. The site not only allows users to search for hair transplant surgeons in their area, it also provides a wealth of information on the subject, as well as a discussion forum where people can ask questions and tell their own hair transplant surgery stories.
The Norwood Scale for men, to determine the stage of hair loss, and the Ludwig Scale for women, used for the same purpose.
In 2005, Dateline NBC devoted an entire episode to “The Follicle 5” — following five men with varying degrees of hair loss, who had each agreed to test some of the most common hair loss products, medications and procedures — including one volunteer who underwent hair transplant surgery. View all five parts of this extensive, year-long experiment on YouTube.
The Hair Restoration Network has an excellent discussion forum for people who are considering hair transplant surgery, or who have already had the surgery.
The Hair Club has a hair transplant webisode, divided into six parts, where viewers can follow the journey of a man named Julian as he undergoes hair transplant surgery.
Here’s a video of hair grafts being prepared for transplant using the Follicular Unit Hair Transplantation (FUT) technique. Another video shows donor hair being harvested using the Follicular Unit Extraction (FUE) technique.
The Journal of Cutaneous and Aesthetic Surgery has a very easy-to-read description of modern surgical hair restoration techniques. The International Society of Hair Restoration Surgery also offers a concise overview of what’s involved in hair transplant surgery.
