In the early days of hair transplantation, the surgery usually failed cosmetically, undermining the very reason patients sought it out: to improve their appearance. Balding patients were left with scars and unattractive hair "plugs," or bundles of 10 to 25 hairs with large gaps of bald skin between them. The problem was that hair transplantation was performed using a 4 mm punch. Hair in the center of these large grafts tended not to grow because of the lack of oxygen. And even careful surgeons could not help cutting some of the hair follicles, which were then incapable of growth.
As a reaction to the poor cosmetic results produced by plugs, hair transplant surgeons began using smaller grafts. These were obtained from tissue removed in strips from the donor area in the back of the scalp. The harvesting was accomplished using surgical scalpels rather than the punch. By the early 1990s, doctors had completely abandoned the punch in favor of the knife.
The next major breakthrough came with the introduction of Follicular Unit Transplantation (FUT) in 1995. In this procedure, the entire hair restoration is carried out using the naturally occurring follicular units of the patient's scalp, which each usually contain between one and four hairs. The donor tissue is obtained via single, rather than multiple, strips from the back of the scalp, and the individual follicular units are then dissected from this strip. When performed skillfully, FUT enables the surgeon to produce cosmetically acceptable results.
In the past year or so, a new technique called Follicular Unit Extraction—again performed with a punch—was proposed as an alternative method to remove the donor tissue for transplantation. This procedure was initially dismissed by most hair transplant surgeons as inefficient and labor intensive. It also left some potential transplant patients wondering why leaders in the field of transplantation had returned to the much-maligned punch and for whom this approach is preferable.
It turns out that a punch, albeit one that is only 1 mm in size, can be used to harvest individual follicular units in some patients. One of the pioneers of follicular unit extraction, Dr. William Rassman, president and founder of the New Hair Institute in Los Angeles, explains that a 1 mm punch is just the right size to grab the follicular unit and remove it intact from the donor area.
"Follicular Extraction is the removal of individual follicular units from the scalp without a traditional incision," Dr. Rassman says. "You just remove the individual follicles and leave the skin behind." The primary advantage of this technique is that people do not end up with the linear scar across the scalp that results from traditional transplants. "The scars [from Follicular Unit Extraction] are a millimeter in size at the time of surgery but, within a few days, contract down to something less than that," Dr. Rassman says. "After a few weeks, you can't find any distortion of the skin."
Although a scar-free surgery would be appealing for all patients, there are some drawbacks to Follicular Unit Extraction, and most hair transplant physicians are selective about its use. Dr. Marc R. Avram, who is in private practice in hair transplant surgery in New York City and an assistant professor of dermatology at Cornell Medical Center, says he performs the surgery in only about 5 percent of his patients, in part, because it's a more time-consuming surgery. "In the standard transplant, you'll remove 1,000 to 1,500 grafts in about three hours," he says. "With the punch, you don't get that much hair in as long as five or six hours, so patients have to come in multiple times."
Another limitation of Follicular Unit Extraction is that it can't provide as much donor hair as Follicular Unit Transplantation. Because Follicular Unit Extraction only removes the hair follicles, as opposed to a strip that can be closed up with stitches, some of the intervening donor hair must be left behind to cover the scalp, or there will be a bald area where the grafts were taken. Additionally, the procedure itself takes a long time.
Still, Dr. Walter Unger, a professor of dermatology at Mt. Sinai Medical School in New York City who has private practices in New York City and Toronto, says this technique can produce consistently natural results, but that it requires a large staff and a highly skilled surgeon. "It is far easier to produce follicles using our current techniques," Dr. Unger explains. "In order to excise a follicle using a tiny punch, the instrument must be directed absolutely perfectly."
Given the difficulties, Drs. Rassman, Avram and Unger all warn against "mega-sessions" in which 3,000 or more grafts are transplanted at one time, noting that very large sessions of densely packed grafts may compromise the blood supply. Additionally, the increased technical demands of the surgery decrease the likelihood that all of the transplanted hair will grow.
Yet experts agree that follicular unit extraction can be an excellent alternative surgery for a select group of patients. The technique is best suited for people with limited hair loss, or those seeking eyebrow restoration. Physicians will also offer the surgery to people who wear their hair very short or might one day shave their heads, so that no scar is visible, as well as to people whose scars widen over time. It's also recommended to athletes or other people who must resume full activity right after the procedure. The other major group for whom this technique is appropriate is people who have had a lot of prior transplant surgery that has left bothersome scars. As Dr. Unger explains, follicular unit extraction allows the doctor to work around the scars and select individual follicular units.
Another consideration when choosing candidates is the individual's follicle type. In the definitive study of this technique, Dr. Rassman and his colleagues evaluated 200 patients and published their results in the August 2002 issue of Dermatologic Surgery. (They coined the term "Follicular Unit Extraction" but also refer to it as the FOX procedure for simplicity.) The researchers found that the success of Follicular Unit Extraction was partially dependent upon the surgeon and partially upon the patient's follicles.
To determine who is a good candidate for the procedure, Dr. Rassman performs the FOX test, which is a biopsy used to ascertain hair and scalp characteristics. According to Dr. Rassman, "While some people have follicles that are easily removed, others have follicles that don't want to come out." Thirty-five percent of the 200 patients in the study were good candidates. Dr. Rassman says he is working on newer instrumentation that may increase the number of candidates for this procedure.
Most physicians charge more for follicular unit extraction than the standard transplant because of the extra time and staff it requires. However, regardless of the cost, the experts warn that people should use caution when choosing a physician for this procedure because it requires such technical skill. Says Dr. Rassman, "Any prospective patient should ask to see other people who have had the procedure to become more comfortable with both the procedure and the physician."
Thursday, February 28, 2008
Incision Decisions: Dealing with Displaced Hairlines After a Lift
Today, more and more people over 50 look at least a decade younger than they really are. While some people are the beneficiaries of good genes, others may be just reaping the rewards of a healthy non-smoking lifestyle that consists of a good diet, an exercise regimen and lots of sunscreen. And some of these "youthful-looking" men and women may have taken advantage of the expertise of a plastic surgeon. But what not everyone realizes is that the surgery may not end there.
Facial cosmetic surgery is popular among people seeking to smooth wrinkles, tighten sagging facial skin or jowls, or get rid of that double chin. And some may seek it out because of facial disfigurement. While new cosmetic surgery techniques have minimized the risk of scarring, not everyone knows that hair loss can be a side effect of these procedures. In some cases, the loss may be significant enough to merit a hair transplant.
Who is at Risk for Hair Loss after Plastic Surgery?
The cosmetic surgeries that are most likely to cause hair loss are facelifts and forehead lifts. "Anytime there's an incision in the scalp that creates hair loss or a hairline is displaced because of cosmetic surgery, there is a need for hair restoration surgery in those areas," explains James E. Vogel, MD, an assistant professor of plastic surgery at the Johns Hopkins School of Medicine in Baltimore, Maryland.
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 further on the head, and hair loss may occur due to scarring.
In men, the sideburns are often lost, and women can lose hair affecting their bangs as well as hair on and around the scar. 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 near the hairline and the skin is then pulled back. Endoscopic browlifts involve newer techniques in which multiple, tiny incisions are made in the hair-bearing scalp rather than at the hairline. Even though this surgery is often favored because the small scars heal quickly, the hairline can shift back noticeably.
So for someone with thinning hair, Dr. Vogel says, placing the incision at the hairline instead of farther back on the head might be the preferred approach. "The incision choice is tempered by the landscape," he explains. "Sometimes people who have thin hair or high hairlines don't want to take a chance on making things worse, so we'll use an incision that doesn't affect the placement of the hairline."
Fixing the Problem with Hair Transplantation
Women who have facial cosmetic surgery make up the bulk of corrective hair transplantation, according to Edwin S. Epstein, MD, a hair transplant surgeon in private practice in Richmond, Virginia and Virginia Beach.
As when performing the standard hair restoration surgery, most hair transplant surgeons will use the follicular unit transplantation technique. With this approach, 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. A decade ago, donor hair was harvested and transplanted in large bunches of 10 to 20 hairs, creating a "pluggy look." Today, surgeons transplant tiny bundles of one to four hairs that grow together in what are called follicular units for a more natural appearance.
When transplanting in a scarred area, surgeons have to be extra cautious about how close together they place the tiny grafts of hair they are transplanting 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."
Although people are usually happy with the results of their hair transplant, if you're considering facial cosmetic surgery, be sure to also discuss hair loss risk with your plastic surgeon so you don't end up with more surgeries—or less hair—than you bargained for.
Facial cosmetic surgery is popular among people seeking to smooth wrinkles, tighten sagging facial skin or jowls, or get rid of that double chin. And some may seek it out because of facial disfigurement. While new cosmetic surgery techniques have minimized the risk of scarring, not everyone knows that hair loss can be a side effect of these procedures. In some cases, the loss may be significant enough to merit a hair transplant.
Who is at Risk for Hair Loss after Plastic Surgery?
The cosmetic surgeries that are most likely to cause hair loss are facelifts and forehead lifts. "Anytime there's an incision in the scalp that creates hair loss or a hairline is displaced because of cosmetic surgery, there is a need for hair restoration surgery in those areas," explains James E. Vogel, MD, an assistant professor of plastic surgery at the Johns Hopkins School of Medicine in Baltimore, Maryland.
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 further on the head, and hair loss may occur due to scarring.
In men, the sideburns are often lost, and women can lose hair affecting their bangs as well as hair on and around the scar. 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 near the hairline and the skin is then pulled back. Endoscopic browlifts involve newer techniques in which multiple, tiny incisions are made in the hair-bearing scalp rather than at the hairline. Even though this surgery is often favored because the small scars heal quickly, the hairline can shift back noticeably.
So for someone with thinning hair, Dr. Vogel says, placing the incision at the hairline instead of farther back on the head might be the preferred approach. "The incision choice is tempered by the landscape," he explains. "Sometimes people who have thin hair or high hairlines don't want to take a chance on making things worse, so we'll use an incision that doesn't affect the placement of the hairline."
Fixing the Problem with Hair Transplantation
Women who have facial cosmetic surgery make up the bulk of corrective hair transplantation, according to Edwin S. Epstein, MD, a hair transplant surgeon in private practice in Richmond, Virginia and Virginia Beach.
As when performing the standard hair restoration surgery, most hair transplant surgeons will use the follicular unit transplantation technique. With this approach, 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. A decade ago, donor hair was harvested and transplanted in large bunches of 10 to 20 hairs, creating a "pluggy look." Today, surgeons transplant tiny bundles of one to four hairs that grow together in what are called follicular units for a more natural appearance.
When transplanting in a scarred area, surgeons have to be extra cautious about how close together they place the tiny grafts of hair they are transplanting 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."
Although people are usually happy with the results of their hair transplant, if you're considering facial cosmetic surgery, be sure to also discuss hair loss risk with your plastic surgeon so you don't end up with more surgeries—or less hair—than you bargained for.
Corrective Hair Transplantation
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."
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."
Hair Transplant FAQs
Why have a hair transplant?
The reason why men get hair transplants is to achieve a more or less “permanent” correction of hair loss in order to improve self-esteem and restore a more youthful self-image.
Who can get a transplant?
Any person with noticeable hair loss that includes thinning hair and bald areas, and whose remaining hair is capable of growing in a transplanted location (called a donor-dominant condition), is a candidate for hair transplantation. A donor-dominant condition is one in which transplanted hairs are able to survive at a new location and will live and produce hairs as long as they would have in their previous location. The most common condition seen is so-called male- and female-pattern androgenic alopecia (hereditary hair loss). However, other conditions such as scarring disorders resulting from injury, diseases, or previous surgery of the scalp, can also be treated with hair transplantation.
When should a hair transplant be done?
A hair transplant can be done any time after there is enough hair loss in a particular area, such as the front, middle, or top of the scalp so that noticeable thinning is present on casual examination of the affected area. Hair loss actually begins long before it is noticeable and approximately 50 percent of the hairs in a given area are lost before noticeable thinning becomes apparent.
How is a hair transplant done?
A variable sized section of living scalp containing live hair follicles is removed from the back of the head (donor area) and subsequently microdissected into small so-called follicular unit grafts that are implanted into small surgically produced recipient sites in the balding area (recipient area). The surgical sites are well-healed in 7 to 14 days, and after a delay of 8 to 12 weeks, the transplanted hairs begin to produce new hair shafts.
Where is a hair transplant done?
Hair transplants are done in an outpatient setting. Patients walk in and walk out the same day. Patients are given oral, or in some cases inhalant/intravenous sedation, followed by local anesthesia to the donor and recipient sites.
What are the main difficulties experienced by a patient before, during, and after a hair transplant?
The main problems encountered by patients before hair transplantation are usually concern about the cosmetic down time in the postoperative period, and varying degrees of anxiety about potential discomfort during and after the procedure. During the procedure, the patients often become restless due to the prolonged time required to achieve the results and because of this, sometimes have difficulty refraining from talking and moving, which makes the procedure more difficult for the surgeon and the assistants. Finally, after the procedure, the patients experience variable degrees of discomfort at the donor site and variable degrees of swelling of the forehead that resolve in a few days. Also, there are variable degrees of self-consciousness caused by the tiny scabs that are present in the recipient sites. However, most patients will say that the difficulties experienced in the postoperative period in no way equal the level of anxiety experienced during the preoperative period. The subconscious fear of detection by casual observers is not realized in the vast majority of patients during the postoperative period.
Which regions of the scalp are best suited for hair transplantation?
The frontal scalp and the midscalp are the areas best suited for microsurgical hair restoration. The so-called bald spot (vertex) can also be corrected, but is somewhat less desirable.
Can a completely bald head be completely restored by hair transplant surgery?
The answer is no, but this is a trick question. Obviously, a completely bald head cannot be transplanted because it has no donor hair to transplant! However, even a very bald scalp cannot be completely transplanted since the size of the donor area and the number of hairs present are smaller than the potentially bald area on the top of the head. However, if the potential donor site is sufficiently large and reasonably dense, a surprisingly large number of hair follicles are available for transplantation to the top of the head, and fairly large areas of balding scalp can be covered adequately with hair that is both natural and reasonably dense in appearance.
The reason why men get hair transplants is to achieve a more or less “permanent” correction of hair loss in order to improve self-esteem and restore a more youthful self-image.
Who can get a transplant?
Any person with noticeable hair loss that includes thinning hair and bald areas, and whose remaining hair is capable of growing in a transplanted location (called a donor-dominant condition), is a candidate for hair transplantation. A donor-dominant condition is one in which transplanted hairs are able to survive at a new location and will live and produce hairs as long as they would have in their previous location. The most common condition seen is so-called male- and female-pattern androgenic alopecia (hereditary hair loss). However, other conditions such as scarring disorders resulting from injury, diseases, or previous surgery of the scalp, can also be treated with hair transplantation.
When should a hair transplant be done?
A hair transplant can be done any time after there is enough hair loss in a particular area, such as the front, middle, or top of the scalp so that noticeable thinning is present on casual examination of the affected area. Hair loss actually begins long before it is noticeable and approximately 50 percent of the hairs in a given area are lost before noticeable thinning becomes apparent.
How is a hair transplant done?
A variable sized section of living scalp containing live hair follicles is removed from the back of the head (donor area) and subsequently microdissected into small so-called follicular unit grafts that are implanted into small surgically produced recipient sites in the balding area (recipient area). The surgical sites are well-healed in 7 to 14 days, and after a delay of 8 to 12 weeks, the transplanted hairs begin to produce new hair shafts.
Where is a hair transplant done?
Hair transplants are done in an outpatient setting. Patients walk in and walk out the same day. Patients are given oral, or in some cases inhalant/intravenous sedation, followed by local anesthesia to the donor and recipient sites.
What are the main difficulties experienced by a patient before, during, and after a hair transplant?
The main problems encountered by patients before hair transplantation are usually concern about the cosmetic down time in the postoperative period, and varying degrees of anxiety about potential discomfort during and after the procedure. During the procedure, the patients often become restless due to the prolonged time required to achieve the results and because of this, sometimes have difficulty refraining from talking and moving, which makes the procedure more difficult for the surgeon and the assistants. Finally, after the procedure, the patients experience variable degrees of discomfort at the donor site and variable degrees of swelling of the forehead that resolve in a few days. Also, there are variable degrees of self-consciousness caused by the tiny scabs that are present in the recipient sites. However, most patients will say that the difficulties experienced in the postoperative period in no way equal the level of anxiety experienced during the preoperative period. The subconscious fear of detection by casual observers is not realized in the vast majority of patients during the postoperative period.
Which regions of the scalp are best suited for hair transplantation?
The frontal scalp and the midscalp are the areas best suited for microsurgical hair restoration. The so-called bald spot (vertex) can also be corrected, but is somewhat less desirable.
Can a completely bald head be completely restored by hair transplant surgery?
The answer is no, but this is a trick question. Obviously, a completely bald head cannot be transplanted because it has no donor hair to transplant! However, even a very bald scalp cannot be completely transplanted since the size of the donor area and the number of hairs present are smaller than the potentially bald area on the top of the head. However, if the potential donor site is sufficiently large and reasonably dense, a surprisingly large number of hair follicles are available for transplantation to the top of the head, and fairly large areas of balding scalp can be covered adequately with hair that is both natural and reasonably dense in appearance.
All You Need to Know About Hair Transplantation
Hair transplantation is a relatively simple operation that can do wonders for people who suffer from hair loss-whether it is hereditary, due to an illness or accident. Getting a full head of hair often provides the confidence that allows people to feel better about their appearance. Below, Dr. Michael Reed answers some common questions about this procedure.
Why have a hair transplant?
Men get hair transplants to achieve a more or less permanent correction of hair loss in order to restore a more youthful self-image and improve self-esteem.
Who can get a transplant?
Any person with noticeable hair loss-including thinning hair and bald areas-and whose remaining hair is capable of growing in a transplanted location (called a donor-dominant condition), is a candidate for hair transplantation. A donor-dominant condition is one in which transplanted hairs are able to survive at a new location, and will live and produce hairs as they would have in their previous location.
The most common condition treated is so-called male-and female-pattern androgenic alopecia (hereditary hair loss). However, other conditions such as scarring disorders resulting from injury, diseases, or previous surgery of the scalp, can also be treated with hair transplantation.
When should a hair transplant be done?
A hair transplant can be done any time after there is sufficient hair loss in a particular area-such as the front, middle, or top of the scalp-so that noticeable thinning is present on casual examination. Hair loss actually begins long before it is noticeable; Approximately 50 percent of the hairs in a given area are lost before noticeable thinning becomes apparent.
How is a hair transplant done?
A variable sized section of living scalp containing live hair follicles is removed from the back of the head (donor area) and subsequently microdissected into small follicular unit grafts that are implanted into small surgically prepared recipient sites in the balding area (recipient area). The surgical sites heal in 7 to 14 days, and after a delay of 8 to 12 weeks, the transplanted hairs begin to produce new hair shafts.
Where is a hair transplant done?
Hair transplants are done in an outpatient setting. Patients walk in and walk out the same day. They are given oral, or in some cases inhalant or intravenous sedation, followed by local anesthesia to the donor and recipient sites.
What are the main difficulties experienced by a patient before, during, and after a hair transplant?
The main problems encountered by patients before hair transplantation are usually concern about the cosmetic down time in the postoperative period, and varying degrees of anxiety about potential discomfort during and after the procedure. During the procedure, the patients often become restless due to the prolonged time required to achieve the results and because of this, sometimes have difficulty refraining from talking and moving, which makes the procedure more difficult for the surgeon and the assistants. Finally, after the procedure, the patients experience variable degrees of discomfort at the donor site and variable degrees of swelling of the forehead that resolve in a few days. Also, patients often experience self-consciousness caused by the tiny scabs that are present in the recipient sites.
Which regions of the scalp are best suited for hair transplantation?
The frontal scalp and the midscalp are the areas best suited for microsurgical hair restoration. The so-called bald spot (vertex) can also be corrected, but is somewhat less desirable.
Can a completely bald head be completely restored by hair transplant surgery?
The answer is no, but this is a trick question. Obviously, a completely bald head cannot be transplanted, because it has no donor hair to transplant! Even a very bald scalp cannot be completely transplanted since the size of the donor area and the number of hairs present are smaller than the potentially bald area on the top of the head. However, if the potential donor site is sufficiently large and reasonably dense, a surprisingly large number of hair follicles are available for transplantation to the top of the head, and fairly large areas of balding scalp can be covered adequately with hair that is both natural and reasonably dense in appearance.
Why have a hair transplant?
Men get hair transplants to achieve a more or less permanent correction of hair loss in order to restore a more youthful self-image and improve self-esteem.
Who can get a transplant?
Any person with noticeable hair loss-including thinning hair and bald areas-and whose remaining hair is capable of growing in a transplanted location (called a donor-dominant condition), is a candidate for hair transplantation. A donor-dominant condition is one in which transplanted hairs are able to survive at a new location, and will live and produce hairs as they would have in their previous location.
The most common condition treated is so-called male-and female-pattern androgenic alopecia (hereditary hair loss). However, other conditions such as scarring disorders resulting from injury, diseases, or previous surgery of the scalp, can also be treated with hair transplantation.
When should a hair transplant be done?
A hair transplant can be done any time after there is sufficient hair loss in a particular area-such as the front, middle, or top of the scalp-so that noticeable thinning is present on casual examination. Hair loss actually begins long before it is noticeable; Approximately 50 percent of the hairs in a given area are lost before noticeable thinning becomes apparent.
How is a hair transplant done?
A variable sized section of living scalp containing live hair follicles is removed from the back of the head (donor area) and subsequently microdissected into small follicular unit grafts that are implanted into small surgically prepared recipient sites in the balding area (recipient area). The surgical sites heal in 7 to 14 days, and after a delay of 8 to 12 weeks, the transplanted hairs begin to produce new hair shafts.
Where is a hair transplant done?
Hair transplants are done in an outpatient setting. Patients walk in and walk out the same day. They are given oral, or in some cases inhalant or intravenous sedation, followed by local anesthesia to the donor and recipient sites.
What are the main difficulties experienced by a patient before, during, and after a hair transplant?
The main problems encountered by patients before hair transplantation are usually concern about the cosmetic down time in the postoperative period, and varying degrees of anxiety about potential discomfort during and after the procedure. During the procedure, the patients often become restless due to the prolonged time required to achieve the results and because of this, sometimes have difficulty refraining from talking and moving, which makes the procedure more difficult for the surgeon and the assistants. Finally, after the procedure, the patients experience variable degrees of discomfort at the donor site and variable degrees of swelling of the forehead that resolve in a few days. Also, patients often experience self-consciousness caused by the tiny scabs that are present in the recipient sites.
Which regions of the scalp are best suited for hair transplantation?
The frontal scalp and the midscalp are the areas best suited for microsurgical hair restoration. The so-called bald spot (vertex) can also be corrected, but is somewhat less desirable.
Can a completely bald head be completely restored by hair transplant surgery?
The answer is no, but this is a trick question. Obviously, a completely bald head cannot be transplanted, because it has no donor hair to transplant! Even a very bald scalp cannot be completely transplanted since the size of the donor area and the number of hairs present are smaller than the potentially bald area on the top of the head. However, if the potential donor site is sufficiently large and reasonably dense, a surprisingly large number of hair follicles are available for transplantation to the top of the head, and fairly large areas of balding scalp can be covered adequately with hair that is both natural and reasonably dense in appearance.
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