You may be a candidate for hair transplant surgery if you have healthy hair growth at the back and sides of the head to serve as donor areas.
Hair transplant surgery can enhance your appearance and your self-confidence, but the results won’t necessarily match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
It’s important to understand that all hair replacement techniques use your existing hair. The goal of surgery is to find the most efficient uses for existing hair.
Hair transplantation techniques, such as punch grafts, mini-grafts, micro-grafts, slit grafts and strip grafts are generally performed on patients who desire a more modest change in hair fullness. Flaps, tissue-expansion and scalp-reduction are procedures that are usually more appropriate for patients who desire a more dramatic change.
Remember, there are limits to what can be accomplished. An individual with very little hair might not be advised to undergo hair transplant surgery.
Use this checklist as a guide during your hair transplant consultation:
Hair transplant surgery is normally safe when performed by a qualified, experienced board- certified plastic surgeon. Still, individuals vary greatly in their physical reactions and healing abilities, and the outcome is never completely predictable.
As in any surgical procedure, infection may occur. Excessive bleeding and/or wide scars, sometimes called “stretch-back” scars caused by tension, may result from some scalp-reduction procedures.
In transplant procedures, there is a risk that some of the grafts won’t “take.” Although it is normal for the hair contained within the plugs to fall out before establishing regrowth in its new location, sometimes the skin plug dies and surgery must be repeated. Sometimes, patients with plug grafts will notice small bumps on the scalp that form at the transplant sites. These areas can usually be camouflaged with surrounding hair.
When hair loss progresses after surgery, an unnatural, “patchy” look may result-especially if the newly-placed hair lies next to patches of hair that continue to thin out. If this happens, additional surgery may be required.
es removing small punch grafts from the hair bearing scalp or a larger piece of this scalp from a donor area and cutting this into smaller pieces to use as grafts. These grafts are then relocating to a bald or thinning area of the scalp. The grafts created in this manner differ in size and shape. Round-shaped punch grafts usually contain about 10-15 hairs. The much smaller mini-graft contains about two to four hairs; and the micro-graft, one to two hairs. Slit grafts, which are inserted into slits created in the scalp, contain about four to 10 hairs each; strip grafts are long and thin and contain 30-40 hairs.
Generally, several surgical sessions may be needed to achieve satisfactory fullness, and a healing interval of several months is usually recommended between each session. It may take up to two years before you see the final result with a full transplant series. The amount of coverage you’ll need is partly dependent upon the color and texture of your hair. Coarse, gray or light-colored hair affords better coverage than fine, dark-colored hair. The number of large plugs transplanted in the first session varies with each individual, but the average is about 50. For mini-grafts or micro-grafts, the number can be up to 700 per session.
Just before surgery, the “donor area” will be trimmed short so that the grafts can be easily accessed and removed. For punch grafts, your doctor may use a special tube-like instrument made of sharp carbon steel that punches the round graft out of the donor site so it can be replaced in the area to be covered—generally the frontal hairline. For other types of grafts, your doctor will use a scalpel to remove small sections of hair-bearing scalp, which will be divided into tiny sections and transplanted into tiny holes or slits within the scalp. When grafts are taken, your doctor may periodically inject small amounts of saline solution into the scalp to maintain proper skin strength. The donor site holes may be closed with stitches—for punch grafts, a single stitch may close each punch site; for other types of grafts, a small, straight-line scar will result. The stitches are usually concealed with the surrounding hair.
To maintain healthy circulation in the scalp, the grafts are placed about one-eighth of an inch apart. In later sessions, the spaces between the plugs will be filled in with additional grafts. Your doctor will take great care in removing and placement of grafts to ensure that the transplanted hair will grow in a natural direction and that hair growth at the donor site is not adversely affected.
After the grafting session is complete, the scalp will be cleansed and covered with gauze. You may have to wear a pressure bandage for a day or two. Some doctors allow their patients to recover bandage-free.
Another technique used in the treatment of baldness is called tissue expansion. Plastic surgeons are the leaders in tissue expansion, a procedure commonly used in reconstructive surgery to repair burn wounds and injuries with significant skin loss. Its application in hair transplant surgery has yielded dramatic results-significant coverage in a relatively short amount of time.
In this technique, a balloon-like device called a tissue expander is inserted beneath hair-bearing scalp that lies next to a bald area. The device is gradually inflated with salt water over a period of weeks, causing the skin to expand and grow new skin cells. This causes a bulge beneath the hair-bearing scalp, especially after several weeks.
When the skin beneath the hair has stretched enough-usually about two months after the first operation-another procedure is performed to bring the expanded skin over to cover the adjacent bald area. For more information about tissue expansion, ask your plastic surgeon for the American Society of Plastic Surgeons, Inc. brochure entitled, Tissue Expansion: Creating New Skin from Old.
Flap surgery on the scalp has been performed successfully for more than 20 years. This procedure is capable of quickly covering large areas of baldness and is customized for each individual patient. The size of the flap and its placement are largely dependent upon the patient’s goals and needs. One flap can do the work of 350 or more punch grafts.
A section of bald scalp is cut out and a flap of hair-bearing skin is lifted off the surface while still attached at one end. The hair-bearing flap is brought into its new position and sewn into place, while remaining “tethered” to its original blood supply. As you heal, you’ll notice that the scar is camouflaged—or at least obscured—by relocated hair, which grows to the very edge of the incision.
In recent years, plastic surgeons have made significant advances in flap techniques, combining flap surgery and scalp reduction for better coverage of the crown; or with tissue expansion, to provide better frontal coverage and a more natural hairline.
This technique is sometimes referred to as advancement flap surgery because sections of hair-bearing scalp are pulled forward or “advanced” to fill in a bald crown.
Scalp reduction is for coverage of bald areas at the top and back of the head. It’s not beneficial for coverage of the frontal hairline. After the scalp is injected with a local anesthetic, a segment of bald scalp is removed. The pattern of the section of removed scalp varies widely, depending on the patient’s goals. If a large amount of coverage is needed, doctors commonly remove a segment of scalp in an inverted Y-shape. Excisions may also be shaped like a U, a pointed oval or some other figure.
The skin surrounding the cut-out area is loosened and pulled, so that the sections of hair-bearing scalp can be brought together and closed with stitches. It’s likely that you’ll feel a strong tugging at this point, and occasional pain.
Before: Hair transplant candidates should have some noticeable hair loss with healthy hair growth at the back and sides of the head to serve as donor areas.
Step 1: A tube-like instrument punches round grafts from the donor site to be placed in the area where hair replacement is desired.
Step 2: A tube-like instrument punches round grafts from the donor site to be placed in the area where hair replacement is desired.
Step 3: When the skin beneath the hair has stretched enough, it is surgically placed over the bald area.
Step 4: During flap surgery, a section of bald scalp is cut out and a flap of hair-bearing skin is sewn into its place.
Step 5: The patterns used in scalp reduction vary widely, yet all meet the goal of bringing hair and scalp together to cover bald areas.
After: The results of hair transplant surgery can enhance your appearance and self-confidence.
How you feel after surgery depends on the extent and complexity of the procedure. Any aching, excessive tightness or throbbing can be controlled with pain medication prescribed by your physician. If bandages are used, they will usually be removed one day later. You may gently wash your hair within two days following surgery. Any stitches will be removed in a week to 10 days. Be sure to discuss the possibility of swelling, bruising and drainage with your surgeon.
Because strenuous activity increases blood flow to the scalp and may cause your transplants or incisions to bleed, you may be instructed to avoid vigorous exercise and contact sports for at least three weeks. Some doctors also advise that sexual activity be avoided for at least 10 days after surgery.
To make sure that your incisions are healing properly, your doctor will probably want to see you several times during the first month after surgery. It’s important that you carefully follow any advice you receive at these follow-up visits.
How soon you resume your normal routine depends on the length, complexity and type of surgery you’ve had. You may feel well enough to go back to work and resume normal, light activity after several days. Many patients who have had transplants (plugs or other grafts) are dismayed to find that their “new” hair falls out within six weeks after surgery. You should know that this condition is normal and almost always temporary. After hair falls out, it will take another five to six weeks before hair growth resumes. You can expect about a half-inch of growth per month.
You may need a surgical “touch-up” procedure to create more natural-looking results after your incisions have healed. Sometimes, this involves blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts or slit grafts. Or, if you’ve had a flap procedure, a small bump called a “dog ear” may remain visible on the scalp. Your doctor can surgically remove this after complete healing has occurred.
In general, it’s best to anticipate that you will need a touch-up procedure. Your surgeon can usually predict how extensive your follow-up surgery is likely to be.
Hair transplant surgery involves many choices. The first and most important is selecting a board-certified plastic surgeon you can trust who is a member of the American Society of Plastic Surgeons (ASPS).
ASPS member surgeons meet rigorous standards:
Do not be confused by other official-sounding boards and certifications.
The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name.
By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly trained plastic surgeon who is board certified by the ABPS or the Royal College of Physicians and Surgeons of Canada.