Hair Transplantation


Hair transplantation is a surgical technique that involves moving skin containing hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. However, it is also used to restore eyelashes, eyebrows, and beard hair, and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants.

Hair Transplantation

Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin. Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today's most advanced techniques transplant these naturally occurring 1–4 hair "follicular units" in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This recent hair transplant procedure is called Follicular Unit Transplantation (FUT). Donor hair can be harvested in two very different ways;

1. Strip Harvesting - a strip of scalp is removed under local anesthesia, the wound is then sutured back together and this piece of scalp tissue is then cut in to small pieces of tissue called grafts which are then transplanted back in to the thinning area of the patients head. This method will leave a linear scar in the donor area, which should be covered by a patients hair (if long). The recovery period is around 2 weeks and will require the stitches to be removed by medical personnel.

2. FUE Harvesting - (Follicular Unit Extraction) individual follicles of hair are removed under local anesthesia; this micro removal uses tiny punches of between 0.6mm and 1.25mm in diameter. Each follicle is then reinserted back in to the scalp in the thinning area using a micro blade. Because this is single follicles and no large amount of tissue is removed there is no visible scars or post-surgery pain, with no stitches to be removed. Recovery from FUE is within 7 days.

Surgery

Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected topical anesthesia, and typically last about four hours. The scalp is shampooed and then treated with an antibacterial chemical prior to the donor scalp being harvested.

In the usual follicular unit procedure, the surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. The excised strip is about 1–1.5 x 15–30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts from the strip. Working with binocular Stereo-microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting. The latest method of closure is called 'Trichophytic closure' which results in much finer scars at the donor area.

FUE harvesting negates the need for large areas of scalp tissue to be harvested and can give very natural results with the right experienced surgeon.

The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The assistants generally do the final part of the procedure, inserting the individual grafts in place.

Advances in wound care allow for semi-permeable dressings, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have the patient shampoo the day after surgery. Shampooing is important to prevent scabs from occurring around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.

During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out ("shock loss"). After two to three months new hair will begin to grow from the moved follicles. The patient's hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.

Hair Transplantation

There are several different techniques available for the harvesting of hair follicles, each with their own advantages and disadvantages. Regardless of which donor harvesting technique is employed, proper extraction of the hair follicle is paramount to ensure the viability of the transplanted hair and avoid transection, the cutting of the hair shaft from the hair follicle. Hair follicles grow at a slight angle to the skin's surface, which means that regardless of technique transplant tissue must be removed with a corresponding angle and not perpendicular to the surface.


There are three main ways in which donor grafts are extracted today: strip excision harvesting and follicular unit extraction and direct hair implantation.

Strip harvesting is the most common technique for removing hair and follicles from a donor site, most commonly the area at the back and sides of the scalp. A single-, double-, or triple-bladed scalpel is used to remove strips of hair-bearing tissue from the donor site. Each incision is carefully planned to insure intact removal of hair follicles. Once removed, the strip is dissected into follicular units, which are small, naturally formed groupings of hair follicles.

One of the newest and most talked about method in hair transplantation is a procedure known as follicular unit extraction and transplantation, commonly known referred to as FUE transplantation.

The FUE transplantation procedure itself involves a different approach to extraction that pinpoints individual follicular grafts from the donor area as opposed to more traditional linear strip extraction. Each follicular unit graft, or compact bundle of 1 to 4 hair follicles, replete with oil glands, muscle and connecting tissue is removed individually and transplanted to the affected hair loss area.

An excellent procedure for selected patients. The transplantation procedure does not result in a linear scar which maybe a serious consideration for those who wear their hair short and wish to avoid a linear excision. Patients with very tight scalps or that have existing donor scarring that cannot be excised may also be good candidates.

The most significant drawback to follicular unit extraction (FUE) transplantation is the limit of donor supply and because each follicular unit is removed individually, the procedure takes a considerably larger amount of time. As such, each procedure is limited to approximately 500 grafts per session and the cost of each graft is almost double that of the standard linear extraction procedure. However there are skilled FUE surgeons that can make up to 4000 FUE in a single long session. If meticulous technique is used there is no need to be afraid about any transplanted graft, according to literature 98.7% is the possible live graft outcome rate. (Reference: Wikipedia.org)