Most hair transplants are performed in men and women who have lost their hair because of age-related pattern baldness. But sometimes hair transplant surgeons restore hair that has been lost due to surgery or an accident. These hair transplant procedures, which are often more complex than standard hair transplants, are known as corrective hair transplants.
Women who have facial cosmetic surgery make up the bulk of corrective hair transplantation, says Edwin S. Epstein, MD, a hair transplant surgeon in private practice in Richmond, Virginia and Virginia Beach.
During a facelift, incisions are usually made near the hairline at the temple and run down to the front of the ear and behind the earlobe to the lower scalp. After removing fat and tightening muscle, the surgeon pulls the skin back, trims the excess and stitches the tissue together. The hairline is therefore pulled back on the head and hair loss may occur due to scarring. In men, the sideburns are often lost and women can lose their bangs. The hair loss may be especially problematic for women who like to wear their hair off their face in a ponytail.
Likewise, a forehead lift, also known as an eyebrow lift, can lead to hair loss because incisions are usually made at or behind the hairline and the skin is then pulled back. In men who are bald, the incision may be made at mid-scalp. Newer brow lift techniques leave less of a scar and cause less hair loss, but some people may still require a hair transplant.
"The goal of hair transplantation in these situations is to recreate and dense up the hairline," explains Bob Leonard, DO, founder and chief surgeon of the Leonard Hair Transplantation Association in Massachusetts and Rhode Island.
People may also seek corrective hair transplantation if hair loss has occurred as a result of trauma such as an accident or burn. The surgeon may perform hair transplants in the upper lips of men who had cleft palates repaired as babies, so that they can grow a mustache. They also do a lot of corrective procedures in people who had hair transplants performed with outdated plug techniques. These less precise procedures left wide spaces around each plug as well as scarring in the donor area in the back of the head.
Corrective procedures are more challenging procedures than standard transplants. Dr. Leonard says that's why it's particularly important that people find a hair transplant surgeon who has a great deal of experience performing transplants on a variety of patients.
When transplanting in a scarred area, surgeons have to be extra cautious about how close together they place the tiny grafts of hair to ensure that the hair is properly nourished. Hair growth in or near scarring may also be slower than it is healthy tissue, but Dr. Epstein says, "transplanted grafts often attract a blood supply, and that makes subsequent transplants work better."
People having this kind of transplantation may therefore require one or two additional procedures. In most cases, surgeons say, people who are patient and have enough donor hair are very satisfied with their new look.
"In people who have had a disfiguring scar, it doesn't always take a lot to make a dramatic improvement," Dr. Epstein says. "For them, a hair transplant offers a huge change in what they see in the mirror."