Hair Transplantation - an Emerging Need

Introduction

Hair transplantation is a surgical procedure in which a plastic surgeon or a dermatological surgeon will move hair to a bald area of the head. The surgeon will usually move the hair from the back or side of the head to the front or top portion of the head.

It will usually occur under local anesthesia in a medical office.

What Are The Causes Of Hair Loss?

The majority of hair loss is due to the pattern of baldness. Genetics is another cause. The other causes of hair loss are:

• Diet.

• Illness.

• Stress.

• Medications.

• Hormonal imbalance.

What Are The Types Of Hair Transplants Procedures?

There are two types of hair transplant procedures are:

• Slit grafts - Slit grafts will contain 4 to 10 hairs per graft.

• Micrografts - Micrografts will have 1 to 2 hairs per graft, depending on the amount of coverage needed.

Hair transplantation involves removing self hair follicles either from a strip of hair taken from the back of our scalp (occiput) or 0.5-1 mm scalp punch biopsies. The latest hair transplantation procedure is follicular unit transplantation (FUT) or follicular unit extraction (FUE).

Which is the Best Hair Transplantation Technique?

• FUE are naturally occurring groups of 1 to 4 terminal hairs along with sebaceous glands, arrector pilorum, neurovascular plexus, and occasional vellus hairs with a cuff of the adventitial dermis.

• As these individual units act as distinct anatomic and physiologic units, they give better results with good cosmesis and are preferred over other types of transplantation.

• The dissected follicular units are then repositioned into the scalp under local anesthesia.

• This process is highly skilled and time-consuming. It will take about six to eight hours for the transplantation of 2500 to 3000 hair follicles.

• There is considerable skill in fashioning a natural-looking hairline.

It is essential to assess the patient’s expectations before performing a transplant and give a realistic outcome.

Who Are The Candidates for Hair Transplantation?

• Men who have stable hair loss, whether frontal or vertex secondary to androgenic alopecia, with good occipital hair density.

• Women with female pattern hair loss (FPHL) may benefit from transplantation to the frontal hair margin.

• Individuals with stable scarring alopecia in whom the inflammatory process stops and is no longer active. Eyebrows and eyelashes transplant in case of long-standing scarring.

• Individuals with hair loss secondary to trauma, such as burns.

Who Are The Ineligible Candidates?

• Younger men with frontal recession or those with unstable loss at the crown on transplantation, leading to isolated transplanted hairs.

• Men or women with insufficient occipital density to transplant or have any dermatological illness at the donor site.

• Individuals with unrealistic expectations.

What Happens During A Hair Transplant?

After thoroughly cleaning the scalp, the surgeon will use a small needle to numb an area of the head with local anesthesia.

The number of grafts you receive will usually depend on the:

• Type of hair present.

• Size of transplant site.

• Hair color.

• Quality (including thickness) of hair.

Two main techniques used to obtain follicles for transplantation are FUT and FUE.

Follicular Unit Transplantation (FUT):

1. The surgeon will cut out a strip of scalp skin from the back of the head with the help of a scalpel. The incision is usually several inches long.

2. This incision is then closed with stitches.

3. The surgeon will next separate the removed portion of the scalp into small sections using a magnifying lens and a sharp surgical knife. When implanted, these sections will give an appearance of natural-looking hair growth.

Follicular Unit Extraction (FUE):

The hair follicles are cut out from the back of the head by hundreds to thousands of tiny punch incisions in this follicular unit extraction.

1. The surgeon will make tiny holes with the help of a blade or needle in the scalp area that is receiving the hair transplant. The hairs are gently placed in these holes.

2. During one treatment session, the surgeon will be able to transplant hundreds or even thousands of hairs.

3. After the grafting procedure, gauze or a bandage will be placed to cover the scalp for a few days.

A hair transplant session can take more than four hours. The stitches will be removed ten days after the surgery.

The patient may require up to 3 or 4 sessions to achieve hair transplantation in the whole head. There will be a gap between each session to allow proper healing of the hair implant.

What Happens After A Hair Transplant?

After a hair transplant surgery, the scalp will be sore, and you may need to take medications following hair transplant surgery, such as:

• Painkillers.

• Antibiotics are given to prevent infection.

• Anti-inflammatory medications are given to reduce swelling.

• The majority of the people will see some new hair growth within 8 to 12 months after surgery.

• The doctors will prescribe Minoxidil (Rogaine) or Finasteride (Propecia), the hair growth medication to improve hair regrowth. These medications will also help to slow or stop future hair loss.

Will Hair Transplant Work?

Hair transplants are usually the more successful treatment than over-the-counter hair restoration products. But some factors to be considered are:

• About 10 to 80 percent of transplanted hair would fully grow back in an expected three to four months.

• The transplanted hair will thin over time like natural hair.

• Hair transplants will not work for everyone. They are mainly used to restore hair due to balding or thinning naturally or injury.

Most transplants are done with the existing hair, so they are not as effective for treating people with:

• Patients with hair loss due to chemotherapy or any other medications.

• Thick scalp scars from injuries.

• Widespread thinning and baldness.

Expectations and Recovery:

After the surgery, the scalp will become very tender. The patient may need to take some painkillers for several days. The surgeon will apply bandages over the scalp and advise to keep it there for at least one or two days. An anti-inflammatory and antibiotics drugs will also be prescribed for several days. Most people will be able to return to work within 2 to 5 days after the operation.

Within 2 to 3 weeks after the surgery, the transplanted hair will fall out, but the patient should start to notice new growth within a few months. Most people will notice 60% of new hair emerges after 6 to 9 months. Some surgeons will prescribe the hair-growing drug Minoxidil (Rogaine) to promote hair growth after transplantation, but it is unclear how well it works.

What Are The Advantages of Hair Transplantation?

• In this hair restoration procedure, the hair is taken out from the back of the scalp.

• It grows naturally.

• The color of the hair will be the same as the original hair.

• Hair growth will typically start after 2 to 3 months, and the recovery time is within 8 to 10 months.

• The linear scar is always seen on the back of the scalp. A good surgeon will always try to minimize the scar from the donor area.

• In advanced surgical techniques like Follicular unit extraction (FUE), a meticulous method, a single hair is extracted and replanted in a designated area. Here the results are permanent and excellent.

• Hair transplants are a completely safe and natural procedure. No special chemicals or medicines that can damage your hair are not used.

• Amongst all other hair-growing methods, hair transplant surgery is the most natural and reliable method.

• The results are so good that most people will not tell you that you got a hair transplant.

• The patient will get very manageable hair.

• The transplanted hair will work just like the naturally grown hair, so no need to apply any special shampoos or chemicals to maintain its density.

• Hair transplant surgery is a long-term and permanent solution for your baldness.

• The most significant benefit of a transplant is that a person gets back his confidence, and there is no trouble handling the transplanted hair.

• The person can manage it as per his wish, like coloring, oiling, washing, and doing a hairstyle.

What Are The Disadvantages of Hair Transplantation?

• The candidate who undergoes a transplant must have good health. It is mainly recommended in Androgenic Alopecia, a progressive, irreversible disorder, so the person must be aware of it.

• If hair loss is due to genetics and a person undergoes a hair transplant at an early age, for example, 20 to 30 years, hair loss will continue after surgery.

• It is a procedure, which is performed under local anesthesia. The success of a transplant mainly depends on the nature of the existing donor area.

• Recovery cannot occur overnight, but it takes 8 to 10 months for complete healing, so it is time-bound.

Side Effects and Complications:

• Minor bleeding.

• Edema.

• Crusting.

• Itching.

• Postoperative hair fall (effluvium).

• Wound infections.

• Swelling of the scalp.

• Bruising around the eyes.

• Folliculitis.

• Neuralgia.

• Unnatural-looking tufts of hair.

• Sudden temporary loss of the transplanted hair can occur.

• Numbness or lack of sensation on the scalp area can occur where treatment is done.

• In addition, some esthetic complications may arise, like visible scarring, hypertrophic and keloid scarring, and poor density.

Conclusion:

Looking on the brighter side, a transplant can help cover bald areas with hair that does not need any maintenance. In addition, it improves the self-confidence and appearance of the person.