Hair transplantation is a surgical technique that involves moving individual hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, but it is also used to restore eyelashes, eyebrows, beard hair, chest hair, pubic hair and to fill in scars caused by accidents or surgery, such as face-lifts and previous hair transplants.
Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques transplant the naturally occurring 1–4 hair “follicular units” in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This hair transplant procedure is called Follicular Unit Transplantation (FUT). Donor hair can be harvested in two very different ways:
1. Strip Harvesting – a strip of scalp is removed under local aesthesia, the wound is then sutured back together and this piece of scalp tissue is then cut into small pieces of tissue called grafts which are then transplanted back in to the thinning area of the patient’s head. This method will leave a linear scar in the donor area, which should be covered by a patient’s hair (if long). The recovery period is around 2 weeks and will require the stitches to be removed by a medical personnel.
2. Follicular Unit Extraction or FUE Harvesting – individual follicles of hair are removed under local aesthesia; this micro removal uses tiny bunches of hair between 0.6mm and 1.25mm in diameter. Each follicle is then reinserted back in to the scalp in the thinning area using a micro blade. Since individual follicles are removed, only small puncture scars remain and any post-surgical pain is minimized. As no suture removal is required, recovery from FUE is within 7 days.
With the new “gold standard” of ultra refined follicular unit hair transplantation, over 50 grafts can be placed per square centimetre also known as “Dense Packing”.
There are several different techniques available for the harvesting of hair follicles, each with their own advantages and disadvantages. Regardless of which donor harvesting technique is employed, 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, which means that regardless of technique transplant tissue must be removed with a corresponding angle and not perpendicular to the surface.
At an initial consultation, the patient consultant analyzes the patient’s areas to be treated, discusses their preferences and expectations, and advises him/her on the best approach (e.g. single vs. multiple sessions) and what results might reasonably be expected.
For several days prior to surgery the patient must refrains from using any medications which might result in excessive bleeding. 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 local aesthetic. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested.
In the usual follicular unit procedure, the surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. The excised strip is about 1–1.5 x 15–30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts from the strip. 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.
FUE harvesting negates the need for large areas of scalp tissue to be harvested and can give very natural results with little or no scarring.
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.
Advances in wound care allow for semi-permeable dressings, 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 occurring 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, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out (“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.
