Hair restoration surgery has established itself as the most sought after solution for hair loss resulting from androgenic alopecia. While the surgery has been practiced for years, as reported by an article in Japan [1], it wasn’t until the advent of the newer techniques that the procedure evolved enough to give natural-looking results.
The number of procedures worldwide has increased by 76% since 2006, with the global hair restoration market being valued at approximately $2.5 billion annually [2]. But, what is this hair restoration surgery that has gained immense popularity over the years? Here, is a brief guide to what it is all about.
What Is Hair Transplantation?
It is a minor surgical procedure that involves moving hair in follicular units from the back and sides of the head to the region of hair loss. The procedure involves the removal of punch grafts with or without the tissue (depending on the method chosen) and relocation of these grafts to the region where hair thinning and balding are an issue. Here is a brief overview of the procedure.
Planning
The pros and cons of the procedure need to be assessed for every individual, but this is especially important in younger patients. The planning of the hairline is the most crucial step and often its quality is an indication of the quality of work of the surgeon [3]. All the factors that will influence the outcome need to be taken into consideration here.
Pre-operative Preparation
7 Days Prior to Surgery:
- The patient picks up medications
- Abstain from the following:
- Alcohol
- Aspirin
- Concentrated fish oils
- Vitamins or anything else that thins your blood
On the day of surgery, the doctor meets with you and confirms the number of grafts, where to place the grafts, designs the hairline, and goes over any other specific instructions or considerations.
Donor area Preparation
During this stage, the hairs in the occipital region (back of the head) are trimmed and anesthesia is injected below the donor region and the region itself is tumesced by administrating normal saline.
Harvesting
Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) are two popular techniques to extract hair follicles. While both the techniques are similar, since both offer the same results, the method of extraction of hair follicles is what differs. FUT involves removal of a strip of skin with all the hair follicles whereas FUE makes use of punch grafts to extract the follicles only.
Graft Preparation
Next is the graft preparation stage during which a single large strip (FUT procedure) is divided into smaller slivers, then ultimately into single follicular units that can contain anywhere from 1 to 4 individual hairs, and then immersed in chilled normal saline. In order to improve the survival rate of grafts, proper hydration is ensured throughout the procedure. For the FUE procedure, the grafts go straight into the chilled saline solution.
Grafts are prepared stereo-microscopically making the procedures time consuming and labor-intensive, but very accurate.
Preparation of Recipient Area and Graft Implantation
The recipient site is also made numb by injecting anesthesia at specific sites. The grafts are then placed in slits/holes such that there is minimal damage to the tissue. 2mm of subcutaneous tissue is left with FUT so that it settles well with the tissue in the recipient site. The grafts are placed such that they are neither too far below or too high above the surface of the skin.
Postoperative Care
Since it’s an out-patient procedure, the patient is discharged the same day and the head is covered in bandages along with a list of Do’s and Don’ts that need t to be followed religiously. Here is a link to our Hair Transplant Post Op Care Instructions.
Am I An Ideal Candidate?
Experiencing hair loss is not enough to make one an ideal candidate for the procedure. There are a number of factors that play an important role in making the right decision. The best way is to be assessed by a surgeon or a board-certified dermatologist who specializes in hair restoration procedures. Here are a few aspects that are considered before you’re good to go for it;
- Cause of hair loss- Hair restoration surgery is not effective if your hair loss is due to an underlying disease or genetic reasons. Therefore the root cause of hair loss is also one of the most important factors that determine the success of the procedure.
- The hair loss has to be sufficient enough for you to consider the surgery for cosmetic reasons
- Whether the donor region has enough hair to allow the procedure to be carried out successfully
- If you have initially tried medical therapy and that has failed to yield results
- Last but not the least, you have realistic expectations with respect to the procedure and realize that hair loss happens over time and it may not be possible to get a completely full look after one procedure. It comes down to math – normal hair density is about 80-85 hairs per square centimeter. Hair transplants can safely place approximately 30 hairs/sqcm. So, if you’re completely bald, then the best a surgeon can do is to place up to 30 hairs/sqcm, which is about 40% density. In order to get more density, then you’d have to come back in for a second procedure. However, if you have some hairs already in the area and you just want to add more density, then it’s possible to get very close to 100% density (depending on many factors).
What to Expect during Recovery?
Recovery, to a great extent, depends on the complexity and extent of the procedure. Mild discomfort, swelling, excessive tightness, and throbbing are few things that should be expected.
You might be asked to avoid any strenuous activity for a few days since any activity leading to an increase in circulation to the scalp may lead to bleeding from the incision. It is best to avoid exercise and any vigorous activity for a few weeks. Some other instructions will be provided to ensure that the newly transplanted hair is taken care of.
Within 5-6 weeks of surgery, transplanted hairs shed, which is normal. Within another 5-6 weeks, hair growth will resume, so results will take their time. The transplanted hairs go dormant for 3-4 months. Then, normal hair growth is at about half an inch per month. So, most people begin to see small hairs growing at about the 6-month mark, with full growth anticipated to be in the 9-12 month range.
Safety & Risks
With all the modern and advanced equipment, the surgery isn’t as uncomfortable as it was several decades ago. Overall the procedure is very safe if performed by an experienced and qualified surgeon. As with most surgical procedures, there are risks. While rare, here are a few of the side effects associated with a hair transplant procedure:
- Infection
- Excessive bleeding
- Scarring
- Graft rejection
The type of procedure, the decision to undergo the treatment itself and a lot of other decisions become easy to take when you chose the right doctor. A smooth procedure, with realistic expectations right from the start and minimal adverse effects, can be ensured only if your hair transplant surgeon and dermatologist are qualified enough.
References
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507484/#b1-ccid-8-361
[2] https://www.bernsteinmedical.com/hair-transplant/resources/statistics/
