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Hair transplantation is a surgical technique that moves individual hair follicles from a part of the body called the ‘donor site’ to bald or balding part of the body known as the ‘recipient site’. It is primarily used to treat male pattern baldness. In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding are transplanted to the bald scalp. It can also be used to restore eyelashes, eyebrows, beard hair, chest hair, pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. 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 groupings of 1 to 4 hairs, today’s most advanced techniques harvest and 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 hair transplant procedure is called Follicular Unit Transplantation (FUT). Donor hair can be harvested two different ways.
A strip of scalp tissue is removed under local anesthesia, the wound is then sutured back together and this piece of scalp tissue is then cut into small pieces of tissue called grafts which are then transplanted into tiny recipient sites made by the surgeon in thinning area of the patient’s scalp. This method will leave a “pencil thin” linear scar in the donor area, which is typically covered by a patient’s hair even at relatively short lengths. The recovery period is around 2 weeks and will require the stitches/staples to be removed by medical personnel or sub cuticular suturing can be done.
Follicular unit extraction
Follicular unit extraction or FUE Harvesting – individual follicular units containing 1 to 4 hairs are removed under local anesthesia; this micro removal typically uses tiny punches of between 0.6mm and 1.0mm in diameter. Each follicle is then inserted into tiny recipient sites made by the surgeon using a placement tool. Because individual follicles are removed, only small, punctate scars remain and any post-surgical pain is minimized. As no suture removal is required, recovery from FUE is within 7 days. However, some surgeons note that FUE can lead to a lower ratio of successfully transplanted follicles as compared to strip harvesting. Others also suggest that in case a patient would need more than one transplant, it would be difficult to find a good strip after a FUE
At an initial consultation, the surgeon analyzes the patient’s scalp, discusses his preferences and expectations, and advises him/her on the best approach (e.g. single vs. multiple sessions) and what results might reasonably be expected.
For several days prior to surgery the patient refrains from using any medicines which might result in intraoperative bleeding and resultant poor “take” of the grafts. Alcohol and smoking can contribute to poor graft survival. Post operative antibiotics are commonly prescribed to prevent wound or graft infections.
Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia, which typically last about six hours. The scalp is shampooed and then treated with an antibacterial agent 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 virtually no visible scarring.
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 technicians generally do the final part of the procedure, inserting the individual grafts in place.
Advances in wound care allow for semi-permeable dressing, 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.