l Hair Transplant
Hair transplant surgery involves removing thin strips of skin containing hair follicles from the back of scalp and replacing them in tiny holes in the bald or thinned area. Holes are carefully created through the use of a laser to create a natural appearance for each patient’s individual needs. The grafted hair falls out after the procedure but then grows back and should last as long as the hair from the area in which is was taken.
Hair transplantation began as a simple procedure where circles of skin from the back of the scalp were excised as single arbitrary units and implanted on the bald skin at the crown and hairline. This overly simplistic approach led to unsatisfactory cosmetic results that were clearly evident when considering the entire hairline was composed of connecting circles. Additionally, scarring on the back of the scalp could become very noticeable.
MINI GRAFT
Although the fine nature of micro-grafts is quite natural-looking, they are also less voluminous. With less than five hairs per graft, it would take many hours to transplant a full head of hair, risking safety of the excised donor tissue and recently transplanted tissue. For this, the specialist cuts mini-grafts of about five to twelve hairs each that can be used for the bulk of the balding skin, but behind the micro-grafts. This way, the fullness of the scalp is attained without sacrificing the meticulous work done with the hairline.
FOLICULAR UNIT TRANSPLANTATION
Follicular Unit Transplantation (FUT) is a hair restoration technique where a patient’s hair is transplanted in naturally occurring groups of 1 to 4 hairs, called follicular units. Follicular units also contain sebaceous (oil) glands, nerves, a small muscle, and occasional fine vellus hairs. In Follicular Unit Transplantation these small units allow the surgeon to safely transplant thousands of grafts in a single session, which maximizes the cosmetic impact of the procedure.
FUT is considered an advance over older hair transplantation procedures that used larger grafts and often produced a pluggy, unnatural look. In a properly-performed follicular unit transplant, the results will mimic the way hair grows in nature and will be undetectable as a hair transplant.
STEPS OF TRANSPLANTATION
The first step involved in a hair transplant is for the surgeon to draw a replacement hairline for the patient. Then the scalp is numbed and the donor hairs, usually from the back of the head, are shaved. Once this is completed, the skin that the donor hairs are attached to is removed from the head
The scalp then gets sutured or stapled together and the donor hairs are given to technicians. The technicians remove each individual hair follicle and place them into a saline solution where they will await transplant. In the mean time, the surgeon is busy cutting small incisions into the front of the head within the hairline that was drawn earlier. There needs to be a separate incision for every follicle that is to be transplanted. This number can be as high as 2,000 per transplant.
Once the surgeon has all of the cuts made, it is time to insert each hair follicle. This is done on an individual basis, very carefully, to ensure that the follicles are inserted in the right direction allowing the hair to grow straight. The doctor then examines the work that has been completed, when the desired result has been obtained, the hair transplant is finished.
In about a week or so, the incisions have started to heal, the scabs have fallen off, yet, it will take up to a year for real hair growth to appear. In order to avoid further hair transplant procedures, it is recommended that the patient use a drug such as Propecia. The continued use of this drug will help to minimize the need for another surgery.
Forehead Hair Transplant
The female hairline is variable in position. However, a “normal” female hairline is typically positioned 5 to 6.5cm above the eyebrows and usually begins at some point where the scalp slopes from a more horizontal position to a vertical one. This optimal position allows for ease of hairstyling and provides facial harmony and balance.
There are a number of women who have a hereditary high hairline (or high forehead). The appearance of a high hairline can make women look masculine and/or older than their years. The associated high forehead is often seen as unattractive and their hair styling is often limited to combing downward (bangs) to camouflage it. These women, even though there are no signs of hair loss, are dissatisfied with their naturally high forehead and wish they could lower their hairline to a more cosmetically pleasing location.
State of the art follicular unit hair transplantation can be an effective procedure to treat these patients and has a minimal risk of complications. However, this technique is labor intensive, time consuming, and can be expensive, especially since these patients often require multiple sessions to achieve the 2-4 cm of hairline lowering required with adequate hair density acceptable to women. In addition, these women may have to wait for 2-4 years for hair growth to see the full result after surgical hair replacement.
PROCEDURE
The female hairline lowering procedure starts by making a non-repeating, irregular trichophytic incision within the fine hair of the anterior hairline. This incision cuts across the hair shafts but leaves the bulb of the hair follicle intact. This trichophytic technique allows hair growth through the scar to help camouflage it. By these methods, we try to create a similar transition zone as seen in follicular unit grafting. The hairline subsequently appears natural and undetectable.
After the incision, the scalp lifted off of the skull all the way to the back of it. Tumescence is used to minimize bleeding. Extensive undermining (a process used to separate the scalp from the underlying muscles and supporting tissue to increase elasticity) is performed in this plane and is rapid and bloodless. In the forehead, dissection in this plane is done to just below where we want the hairline. The scalp is then advanced forward and the excess non-hair bearing forehead skin is excised with an incision that is parallel to the beveled trichophytic incision.
The wound is closed in two layers. The deep layer of the scalp is closed for strength and to approximate the wound edges. The skin closure is done with delicate fine stitches. To ensure a good cosmetic result, there is no tension on the wound. Other maneuvers such as incisions on the undersurface of the scalp and the placement of tack-like device (Endotine) are usually incorporated to get optimal results. A light dressing is placed and removed on the first post-operative day. A cosmetic result is appreciated immediately. The hair may be combed downward and there is minimal bruising and edema. Sutures are removed 4-7 days later. Many patients have resumed working and social actives in 2-5 days. Our out of town patients usually travel home one or two days after surgery.
BENEFITS
Because the hair follicles are planted dynamically, the hair will grow naturally and correct wide forehead in a more favorable shape.
REMINDER
Because you are extracting your own hair, there is a limit to the portion of hair transplantation.
AFTERCARE
It takes about 7 days for the follicles to settle down and survive. Until then it is important to avoid any penetration to the follicles such as brushing or shampooing hair. Also it is crucial that you try not to cause the scabs to fall off while washing your face or shampooing.
It is recommended that you apply hair growth solution. After 3 months, 75% of transplanted hair will fall out and the rest 25% will grow continually. The hair that fell out will grow; therefore, you should not be concerned.
