Hair Transplantation & Techniques
Hair loss is accepted as a major issue affecting a large percentage of the population. Although there are various reasons contributing to hair loss, the most prominent cause is still androgenetic alopecia which is a hereditary condition associated with androgen sensitivity. While available non-surgical treatments may help the deceleration of hair loss to a certain extent, endless progressions on surgical hair restoration have turned hair transplantation into almost an impeccable safe and effective method for affected patients.
Hair transplantation is a consistently evolving type of procedure, providing solutions for patients struggling with androgenetic alopecia as well as hair loss resulting from other sources such as trauma or inflammatory hair disorders. The natural looking results acquired from hair transplant operations are acting as encouraging factors, and each passing day, more and more men and women are opting for hair restoration.
How to know that a hair transplant is right for you?
Desiring for a quick and effective solution is totally understandable, but a decision like undergoing a hair restoration surgery should not be made hastily. Before making an appointment, you should carefully consider following factors:
- If your hair loss is still at initial stages, before going for a surgery, you may opt for non-surgical treatment options. Hair transplant operations are mostly recommended for patients with moderate or severe hair loss.
- If your hair loss has become visible to your eye only for a couple days ago, instead of searching for surgical options, you should stay calm and consider what you can do to alleviate the early symptoms.
- There are several treatment methods available for hair loss except surgical interventions, such as medications, light therapies etc. You should collect all sorts of information and discuss those with your doctor in order to create a plan of action.
- If your hair loss has reached an unbearable state, you may consider about permanent solutions which will relieve your discomfort for good and all. In comparison with medication therapies, hair transplant surgeries provide permanent results, because the hormone, DHT, which causes hair follicles to shrink, does not affect the newly transplanted hair grafts even years after the operation.
- Another necessary condition of hair transplant is that you should lose sufficient amount of hair, since the hair loss, especially androgenetic alopecia, will continue for years. The most reasonable approach is waiting for several years after you have first noticed your hair loss, and then getting to action.
- Patience is an essential requirement of hair restoration procedures considering the necessary amount of time for the new hairs to become visible. Being an expected result of the operation, the newly transplanted hairs usually fall out a few weeks following the surgery, and typically they start to regrow in about three to four months.
The Basic Steps of a Hair Transplant Procedure
The planning of the hairline is one of the most crucial steps in hair transplantation. The hairline is the most visible landmark of a person’s face, and the quality of the hairline is usually regarded as an indication of a surgeon’s experience and proficiency. When designing a hairline, shape of patient’s face is analyzed, and the planning of the hairline is made accordingly. Also, the patient’s desires and wishes should also be considered as a determinant factor of a hairline designing period.
Preparation of the donor area
Just before the surgery is started, the hair in the donor area are trimmed so that the grafts can be easily accessed, and it is given local anesthesia.
In strip harvesting, known as FUT, healthy hair follicles on stripped tissues are transplanted in to the balding areas, and in follicular unit extraction, FUE, follicular units are harvested from the donor site and directly implanted to the recipient area using a punch of 1 mm. When grafts are removed, simultaneously injecting small amounts of saline solution into the scalp will be helpful to maintain proper skin strength, and the harvested donor strips are immediately immersed in chilled normal saline. Incisions resulted from strip-harvesting are close with sutures or staples, and the healing process proceeds without complications. The stitches are usually concealed with the surrounding hair.
Preparing the recipient site – incisions
As soon as the follicular grafts are ready to use, razor blades or needles of 1 mm in width and 5–6 mm in length are prepared, in order to use while making incisions in the recipient area. While making slits in the recipient site, it is very important to align with the direction of the existing hair in that region so that the hairline can have a natural look.
Next, the hair grafts are delicately and strategically implanted in each cut one by one, depending on the number of the hairs within each follicle. The grafts are placed into the recipient slits with the help of a fine-angled forceps, or a Choi pen in case of a DHI procedure. While inserting the hair follicles, a steady pressure is applied to ensure that the grafts are attuned with the surrounding skin. Burying the grafts beneath the level of the skin must also be avoided because it can result with a spotty look and also lead to occurrence of epidermal cysts. Grafting sessions can last up to five to six hours, and 2000 to 3000 follicular unit grafts can be transplanted.
After the implantation session is complete, the scalp will be cleansed and covered with gauze. While some doctors require wearing pressure bandages for a day or two, some others allow their patients to recover without bandages.
Techniques for Hair Transplant Operations
As its name signifies, the main principle of a hair transplant surgery is that the hair is taken from the back of one’s head which has hair follicles immune to loss, and transplanted where it is needed. However, various techniques are used to do this kind of surgeries, and it will be helpful to obtain more information on those.
Follicular Unit Transplantation (FUT)
While performing a Follicular Unit Transplantation, a strip of skin with hair follicles is removed from the donor site, typically the back of your head where hair is naturally fuller. Small groups of tissue with hair follicles are separated from this piece of tissue and prepared for transplantation. In the meantime, tiny incisions are made in the recipient site where the hair loss is happening. The prepared grafts are then individually placed into the recipient site, with utmost attention in align with the natural direction and the angle of the hair strands.
As in the case with any kind of operation, follicular unit transplantation comes with a few downsides too. The operation can take many hours, depending on the amount of grafts transplanted, and at the end, the patient will have a linear scar at the back of his/her head.
Follicular Unit Extraction
Follicular unit extraction provides similar outcomes with a different way of implanting without causing horizontal scarring. Unlike FUT which is execute with a scarring method of extracting, the hair follicles are harvested directly from the scalp with the help of a forceps and placed into tiny incisions prepared at the recipient area in advance.
While FUE technique requires more time in surgery, it does provide a way of avoiding the linear scar and the amount of care required for the post operation period is decreased to ana extent.
Direct Hair Implantation (DHI)
With Direct Hair Implantation, the follicular units still have to be manually prepared, but this time, a mechanical implantation tool, called Choi pen, is used for implantation. Choi pen is an advanced and relatively new device which is able to contain 1 to 4 follicular bundles at once. When the plunger of the pen is pressed, the hair is easily inserted to the scalp.
Direct hair implantation significantly increases the viability of the hair follicle as the amount of time the follicle is left out of the scalp is greatly reduced. Choi pen also provides complete control of angle, direction and depth of the implanted follicles which enhance the naturalness of the results.
Sapphire FUE is considered as an improved version of standard follicular unit extraction. In Sapphire FUE, the incisions required for the implantation phase is made with blades which are produced from a gem stone known as sapphire. V-shaped of these sapphire blades reduces the amount of time needed for the operation as they allow making more incisions with less effort and zero damage. Also, sapphire is a precious gemstone with anti-bacterial properties which shortens the duration of the recovery period.
Robotic Hair Transplant Surgery
Robotic hair transplant technique provides automation of unit graft harvesting and recipient site preparation, enabling flawless precision and consistency. The system uses cameras to capture video footage of the patient’s donor area and with the help of an image processing software, the system recognizes the different properties of the hair follicles. Robotic hair transplants have the same advantages as manual FUE procedures such as no linear scar, but, in addition, the risk of human error is completely eliminated.
What happens during the recovery period?
How you feel after surgery depends on the extent of the procedure. Mild harvest and donor site pain for 1 to 2 days postoperatively can be controlled with pain medications prescribed by your doctor.
If there are bandages covering your scalp, they will usually be removed one day later. You may gently wash your hair within two days following surgery on the instructions of your doctor, though you should be careful about scratching your scalp, and avoid direct water contact from a high-pressure showerhead. If there is any, stitches will be removed in a week to 10 days.
Since strenuous activity increases blood flow to the scalp and may cause bleeding at the transplanted areas, you should avoid vigorous exercise for at least three weeks. Likewise, smoking and consuming alcohol disrupt the circulation of the scalp, so you should refrain yourself from these substances for a while.
In order to minimize the risk of edema, you may put ice to your affected areas for the first two days, and sleep with your head elevated for one week. You will be given antibiotics in order to minimize the risk of infections; it is crucially important to take the medications prescribed by your doctor in order to ensure the success of the operation. You will be closely kept under supervision over the following months until the growth of the newly transplanted hairs completes.
Hair transplantation surgeries requires patience, because they do not produce instant results. In most cases, the hair grafts enter a phase called ‘shock loss’ and fall out of their new locations immediately after hair transplant, growing back after three to four months.
Possible Risks and Complications of Hair Transplant Procedures
Considering all surgical procedures carry some risk, being mostly minor and temporary, the common side effects or complications of hair replacement operation can be categorized as follows:
- Numbness or tightness
- Swelling of the forehead or face
- Scarring at donor site or recipient area
- Poor growth of grafts
- Unnatural appearance of transplanted hair
- Bruising around the eyes
- A crust that forms on the areas of the scalp where hair was removed or implanted
- Unnatural, patchy hair growth
- Continual hair loss if the hair is still in balding phase
- Noticeably thinner areas of hair
- Losing sensation around the surgical sites
- Inflammation of the hair follicles, which is known as folliculitis
- Pus drainage around the surgical sites
- Recipient area edema
- Cysts, usually disappear in a few weeks
- Epithelial cyst