Thursday, February 28, 2008

Hair Transplantation 101

It's not hard to spot a man with a bad hair transplant. The transplanted hair looks unnatural, as if it were plugged into the head. What few people realize, however, is that it's likely they've also seen a man or woman with a good hair transplant. The trick is that a good hair transplant is virtually undetectable.

Hair transplantation has changed dramatically over the last decade. "It's almost unfair to call it the same the same thing, it's so different," says Robert Haber, MD, president of the International Society of Hair Restoration Surgery, an educational organization, and an assistant professor of dermatology at Case Western Reserve School of Medicine in Pittsburgh. "There have been huge improvements in every aspect of transplantation."

New techniques

In the transplant procedure, hair is taken from a donor area, usually at the back or sides of the head, and moved to the area where there is hair loss. While donor hair used to be harvested and transplanted in large bunches of 10 to 20 hairs, surgeons now transplant tiny bundles of three or four hairs that grow together in what are called follicular units.

"Surgeons used to use instruments called punches, which looked like cookie cutters, to make circular incisions in the head, and it gave the appearance of a doll's head," says Dr. Ivan Cohen, an associated clinical professor of dermatology at Yale University School of Medicine and a hair transplant surgeon in private practice in Fairfield, Conn. "With new techniques, we take hair from the back of the head in tiny strips and then separate it into follicular unit. We then use tiny needles to plant the hairs back into the scalp."

This technique, known as follicular unit transplantation, is most widely used transplant approach. Some surgeons, however, use a technique called follicular unit extraction in which hair is removed and transplanted with a 1-mm punch that can grab the follicular unit. Follicular unit extraction is considered most appropriate for people with limited hair loss, athletes who need to resume activity right after surgery, and those whose scars widen over time.

With the new techniques, experts say most people with pattern baldness who have a sufficient amount of donor hair are good candidates for hair transplantation. This includes people with any kind of hair type, and women, who are having more and more transplants.

Surgeons note that a large part of their practices is devoted to corrective work, which usually involves repairing old transplants by dividing the transplanted hair into follicular units and re-transplanting it.

In order for patients to be truly satisfied with surgery results, it's essential that they have realistic expectations of what can be accomplished. "The amount of coverage will be determined by how extensive their balding pattern is," says Bernard Nusbaum, MD, a board-certified dermatologist and hair transplant surgeon in Coral Gables, Fla. "An extremely bald individual may only be able to achieve coverage of the front area, while someone with a more limited balding area can achieve total coverage."

The surgeon and patient should discuss the patients' expectations prior to the procedure. As Dr. Haber explains, "If they give me a photo of themselves at 16, I can't help them. But I can help those who are interested in turning the clock back a little and creating a better frame for their face."


Hair transplantation is an outpatient surgery, which usually requires two or more sessions. With follicular unit transplantation, patients should expect a thin scar in the harvest area, but even three-quarters of an inch of hair should hide the scar. Potential side effects such as bleeding and infection are rare. Patients should abstain from strenuous activity for the first 48 hours, however, and avoid exposure to prolonged sunlight for the first month.

According to Dr. Nusbaum, patients initially develop scabbing over the transplanted area that can last for up to 14 days. Within four weeks, the transplanted hair, which has been shaven before harvesting, falls out, and new hair begins to grow within four months.

It's generally recommended that patients use FDA-approved medication after surgery to prevent further hair loss. These include Propecia, for men, and Rogaine, which is available to men and women. People who continue to lose hair, however, may want more transplants over time.

Choosing the Right Surgeon

Hair transplant surgeons come from a wide variety of medical backgrounds. While many are dermatologists, others are former family practioners, plastic surgeons or even urologists. Experts say the important thing is that hair transplant surgeons are open about their backgrounds.

To check the credentials of the surgeon they are considering, patients can look for membership in professional organizations such as the International Society of Hair Restoration Surgery, board certification in hair restoration surgery or another specialty, journal publications, and hospital and academic affiliations.

It's also suggested that patients view photos of other people whose hair the surgeon has transplanted, and possibly meet with other patients of that doctor. A good comfort level with the surgeon is also important.

Getting recommendations is also a good idea, though it might be hard to know who to ask. "People ask me why more people aren't having transplants," says Dr. Cohen. "But unless someone shares that information, you just don't know if they've had one."