Hair transplantation

What causes scalp hair loss?

Hair loss can result from many factors, including thyroid disorders, high fever, diet, childbirth and certain medications. The most common form of scalp hair loss is called androgenetic alopecia (male and female pattern baldness). This type of hair loss is not caused by poor circulation, clogged hair follicles, frequent shampooing or the wearing of hats or helmets.

Male pattern baldness results from a combination of hereditary factors and male hormones called androgens that include testosterone and dihydrotestosterone (DHT). The predisposition for male and female pattern baldness may be inherited from either side of the family and begins to develop after puberty. The hair on the scalp that is genetically affected by DHT (generally at the front and top of the scalp) starts to decrease until it is lost, whereas the hair on the back and sides remains because it is not affected by DHT.

What can be done about male pattern baldness?

People with thinning hair now have more options available to them than ever before. Hair restoration surgery offers a permanent, living solution to lost scalp hair. Moderately effective medical treatments are now offered in the form of pills and lotions. Cosmetic enhancers include colored creams, sprays and powders that when applied to the scalp help to camouflage areas of thinning hair, as long as there is still some hair present. Hairpieces and weaves are a non-surgical means to restoring the appearance of hair by covering bald areas of the scalp.

Hair Transplantation

Hair transplantation is an out-patient procedure performed under twilight local anesthesia, and patients are discharged 15 minutes after the surgery is completed. The procedure usually lasts 4-8 hours depending on the number of grafts being transplanted.

Modern techniques of surgical hair transplantation can restore lost hair and replace or re-shape your hairline with your own natural, growing hair, which needs no more care than the ordinary washing, styling and trimming you have always given it. Transplantation today can be performed so well that often even a barber or stylist cannot tell that grafts have been placed in the scalp.

Hair transplantation involves removing permanent hair-bearing skin form the back and/or sides of the scalp (the donor area). Then, using magnification, the tissue is dissected into follicular unit grafts, each containing 1-4 hairs. These small grafts are then meticulously planted into the bald or thinning areas of the scalp (the recipient area) so as not to injure any existing follicles and at the same match the exact angle of the natural hair. These very small follicular unit grafts enable the hair surgeon to create very natural, feathered hairlines, which do not have the abrupt, “pluggy look” that was commonly seen in the hair transplants of years past. At the Hair Restoration Clinic, we prefer to perform transplants exclusively with follicular unit grafts, while other facilities feel that placing the multi-follicular unit grafts into the central areas of the scalp allows them to better create a central density.

Depending on the degree of balding in the frontal, mid-scalp and vertex (crown) areas, 1-3 procedures are performed, with the number of grafts varying greatly based on the area of potential alopecia, the patient’s “safe” donor supply, the textural characteristics of the patient’s hair, whether or not multi-follicular unit grafts are used in addition to follicular unit grafts, and the individual goals of the patient.

Within 24 hours, small crusts will form on each graft, which are then shed in approximately 4-14 days. The grafted hairs will often start to grow within 10-16 weeks following the procedure and will continue to grow for most, if not all, of the patient’s life. However, as men and women age, many experience slight loss of hair density all over the head, which naturally also affects transplanted hair.

Who benefits from hair restoration surgery?

Anyone who has experienced permanent hair loss may be a candidate for hair restoration surgery, including:

• Men with male pattern baldness
• Some women with thinning hair (female pattern thinning)
• People with areas of scarring from injuries or hair loss after face lift procedures
• People who want to thicken or restore eyebrows, eyelashes and beards

What anesthesia and sutures are used in hair transplant surgery?

Hair transplant procedures generally take 4-8 hours and are performed using local or twilight anesthesia on an out-patient basis. Patients are often awake but feel relaxed as they are given a mild sedative, and there is usually little or no pain during the procedure. Nowadays, no bandaging is necessary on the scalp after the procedure but a small head band will secure the donor area to prevent swelling. The donor area, from where the permanent grafts are taken, is closed with both absorbable and non-absorbable sutures that are removed in 5-12 days.

What happens after hair transplant surgery?

Hair transplantation is a very safe, relatively minor surgical procedure. Patients are provided with a mild analgesic to relieve any discomfort felt on the night following the procedure. Small crusts may form on each graft, but you can comb over this area to cover these scabs. These crusts will flake off within 10-14 days following surgery. The transplanted hair seen above the scalp will initially be shed, but the roots will remain dormant for 6-12 weeks, at which time the new hairs will begin to grow. The numbness that may occur in the donor or recipient areas usually disappears within 2-8 months following surgery.

Complications are rare. Minor infections can occur around a newly transplanted hair follicle, similar to an infected ingrown hair or pimple, but these respond readily to antibiotics. The minor scars that occur in the donor area as a result of the removal of donor skin are narrow and can be easily hidden by the surrounding hair. The graft sites in the frontal recipient area heal with almost no visible scarring and are covered by the transplanted hair. Patients may experience mild swelling in the forehead for a few days following surgery.

When should I start treatment?

Patients may have hair restoration surgery at any age. It is often better to start before you are completely bald so that you can use existing hair to help camouflage the effect of the procedure. However, because hair loss tends to be both gradual and progressive, it is often unwise to undertake a surgical treatment in a patient who is very young. Medications such as Finasteride and Minoxidil may be offered to men with mild to moderate hair loss to help preserve the thinning hair in the crown.

Hair transplants can be used to fill in the front hairline and thicken the front half of the scalp, and medical treatments can be used to maintain hair behind the transplants and to possibly enhance the long-term results of hair restoration surgery. Your hair restoration surgeon will work with you to design an individualized plan to meet your specific needs.

How do I know if I am a good candidate?

An ideal candidate is someone with dense hair in the permanent fringe of the hair-bearing scalp at the sides and back of the head. A patient with light-colored hair and pale skin (as opposed to dark hair and light skin) may appear to have denser hair. Patients with very wavy, curly hair may require fewer sessions than someone with straight hair. While hair transplants look very natural, they may not achieve the density or total coverage that you had as a teenager, and results vary from patient to patient.