Hair Transplant Surgery

What is hair transplant surgery?

Hair transplant surgery is surgery that is performed to restore hair to areas of the scalp that are bald or that have thinning hair. There are multiple types of hair replacement surgery. Most commonly, these involve hair transplantation, but flap surgery, tissue expansion of the scalp and scalp reduction surgery, are also methods used for hair replacement. Each of these types of surgeries can be used alone, or in combination, to provide the patient with the best possible outcome for hair replacement.

Hair transplantation involves removing small pieces of hair-bearing scalp from a donor site and using them as grafts to be relocated to a bald or thinning area of the scalp.

Flaps surgeries involve moving hair bearing scalp tissue into bald areas of the scalp.

Tissue expansion allows the hair bearing scalp to be expanded to help cover areas of the scalp that have no hair.

Scalp reduction surgery involves surgically removing bald areas of the scalp and advancing, or bringing together, the hair bearing areas of the scalp.

What is FUE?

Follicular unit extraction (FUE), also known as follicular transfer (FT), is one of two primary methods of obtaining hair follicles, naturally occurring groups of one to four hairs, for hair transplantation. The other method is called strip harvesting.

FUE is a surgical technique that removes individual hair or follicular units, “one at a time” from the posterior donor harvesting site. This method of hair transplantation is a minimally invasive procedure that involves using small circular punches (1.0 mm) to remove the individual follicular units from the back of the scalp, and then reimplanting the harvested follicular units back into the scalp in the balding recipient areas.

The truth about hair loss

Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff and even excessive hat wearing. All of these theories have been disproved. It’s also untrue that hair loss can be determined by looking at your maternal grandfather, or that 40-year-old men who haven’t lost their hair will never lose it.

Hair loss is primarily caused by a combination of:

  • Aging
  • A change in hormones
  • A family history of baldness

As a rule, the earlier hair loss begins, the more severe the baldness will become.

What You should know / Frequently Ask Questions

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.

  • Donor areas are the places on the head from which grafts and flaps are taken.
  • Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result.
  • There are a number of techniques used in hair replacement surgery. Sometimes, two or more techniques are used to achieve the best results.

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.

Some doctors estimate that one in five women will experience some degree of hair loss usually caused by aging, illness or hormonal changes after menopause. Women tend to experience a subtle thinning all over the scalp rather than losing hair in patches as is common in men. To correct the problem, some women choose to wear a wig or hair extensions. Others have had some success using a topical prescriptive drug. The effectiveness of such drugs varies in some patients and simply prevents further hair loss without stimulating any appreciable new growth. Hair transplant surgery may be the answer for those who feel uncomfortable with either of these options.

Because mini-grafts are usually the surgical treatment of choice for filling-in thinning areas, good candidates for this procedure should have dense hair growth at the back of the head. Mini-grafts are harvested from this dense area and replanted in thinning areas to create a fuller look. Occasionally flap and tissue expansion procedures may be used if the individual is judged to be a good candidate.

If you’re considering a hair transplant procedure, it’s important to understand that you will never have the coverage you had prior to your hair loss, but surgery may camouflage the thin areas and give you more fullness.

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.

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it’s especially important to stop at least a week or two before surgery; smoking inhibits blood flow to the skin and can interfere with healing.

You should arrange for someone to drive you home after your surgery. Plan to take it easy for a day or two after the procedure and arrange for assistance if you think you’ll need it.

Hair transplant surgery, no matter what technique is used, is usually performed using a local anesthesia along with sedation to make you relaxed and comfortable. Your scalp will be insensitive to pain, but you may be aware of some tugging or pressure. General anesthesia may be used for more complex cases involving tissue expansion or flaps. If general anesthesia is used, you’ll sleep through the procedure.

Hair transplantation involves 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.

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.