Hair Restoration Surgery
(transplantation)

This portal lists surgeons who may be consulted visit Hair Consultants

The surgical redistribution of scalp hairs from 'safe' to bald areas. Modern techniques can provide amazing results.

An independent opinion is available from reputable trichologists also listed on this web site (see Hair Consultants).

Specialist surgeons are invited to apply to the Registrar for membership and listing on this web site. Please contact the Registrar

Surgery Explained

Are you a balding male or female and desperate to do something? Hair restoration (transplant) surgery may be worthy of consideration.
This article offers general information only. Interested persons must seek proper advice with an appropriate specialist. To locate reputable specialists listed with The Society see Consultant Practitioners Listings Worldwide

Baldness: Temporary or Permanent:

Temporary baldness: Hair follicles are vacated temporarily e.g. postnatal alopecia, alopecia areata, telogen effluvium etc. Hair re-generation should occur.

Permanent baldness: Hair follicles cease to regenerate hairs.
This may be due to disease, skin damage, androgenic (hormonal) or genetic (inherited) factors. Rarely is this associated with hat wearing, circulatory or vitamin deficiency. Men and women are affected.
Female pattern loss may commence as a single coin-sized thinning patch in a central position just behind the fringe area. This thinning may extend to inculcate much of the scalp. One in five women will probably experience some degree of hair thinning associated with illness, ageing, hormonal changes after menopause or heredity. Wigs may be an answer. Topical prescription drugs may assist, but rarely is lost hair replaced-naturally.
Hair restoration surgery may offer a solution. The best candidates for this procedure are sufferers of scalp damage, Androgenic or Genetic Alopecia.
The procedure involves the redistribution of an individual's hair bearing follicles from safe 'donor' sites at the occiput (between the ears) to the balding regions.
A skilled specialist surgeon can produce cosmetically satisfying results.

Techniques used: may include scalp reduction, micro-grafts (containing a single hair) and mini-grafts (containing two or three hairs), flaps and tissue-expansion. More than one technique may be employed during a procedure. As suitability to each technique depends on individual circumstances, one to one advice is essential
FUE (Follicular Unit Extraction) involves removing single-follicle hair grafts with 1 mm. punches. This avoids lineal scarring and facilitates more rapid healing.
It is time consuming procedure which costs more to perform and produces a lesser number of grafts per session.

Cloning: Hair follicle cloning or more correctly 'Tissue engineering' (hair follicle creation from stem-cells) is currently a focus of great interest. The procedure will be the most significant advancement in the effective treatment of androgen related hair loss. Current tests are encouraging - we await the results with interest.

The Micro & Mini Grafts Procedure

Points to be understood from the outset:
Only the patient's hair follicles can be used.
Areas of baldness may extend to exceed 400 sq.cm. Whereas some patients provide an abundance of donor hairs from densely populated donor sites, others less fortunate may provide insufficient numbers with which to establish even modest hair cover. Whereas subjects with good donor hair will not regain the density of hair coverage possessed prior to their hair loss this proven surgical technique can re-establish a modest level of hair cover at bald sites and increase the density at thin areas in the majority of individuals. This repositioned hair is expected to thrive in its new location for the remainder of natural life.
Several surgical sessions may be needed to achieve satisfactory fullness.
A healing interval of several months is recommended between sessions.
It may therefore take some years before the final result is achieved.
The cosmetic result may be influenced by: hair colour texture and levels of wave or curl.

All surgery carries some uncertainty and risk. However this is minimal when performed by a competent experienced surgeon.

Preparing for surgery
Your surgeon will advise you regarding: any prescriptive drugs being taken, diet, alcohol and smoking prior to surgery.
Venue: Hair reconstructive surgery is not usually performed in a hospital.

Anesthesia: is usually 'local' and you may be given sedation to make you relaxed and comfortable. The procedure should be painless although some sensations (e.g. pressure) may be experienced.
General anaesthesia may be used for more complex cases involving tissue expansion or flaps.
The 'donor' area hair will be trimmed short so that the graft material can be easily accessed and removed. The surgeon/doctor will use a scalpel to remove small sections of hair-bearing scalp, which will be divided into tiny sections and transplanted into tiny slits at the recipient graft area. Your surgeon may periodically inject small amounts of saline solution into the scalp to maintain proper skin strength. The donor site will require stitches leaving a thin straight-line scar.
The surrounding hair will conceal the stitches and any subsequent minor scaring.

After a session of surgery
You should NOT drive yourself home.
You should ideally take a few days rest.
You may be required to wear a pressure bandage for a day or two.
Do NOT engage in risky sports (e.g. squash) until healing is complete.
Sutures may need to be removed at an appropriate time.

Caucasoid hair growth rates range from 1-1.25 cm per 28 days.
Mongoloid hair growth rates range from 1 -1.50 cm per 28 days.
Afroid hair growth rates range from 0.5 - 1.0 cm per 28 days.

Other Procedures

Tissue Expansion:
Plastic surgeons employ this procedure in reconstructive surgery where burn wounds and other injuries have created significant skin loss. In hair reconstructive surgery a balloon-like device called a tissue expander is inserted beneath hair-bearing scalp adjacent to a bald area. Over a period of weeks the device is gradually inflated with salt water causing the skin to expand. This stretched hirsute skin then replaces the bald scalp.

Flap Grafting:
During flap surgery, a section of bald scalp is surgically removed and a flap of hair-bearing skin almost detached but still attached at one end is sewn into its place.
Hair usually grows to the very edge of the incision.

Scalp reduction:
This procedure involves the removal of a section of bald scalp. The surrounding hairy skin is then made free and stretched to cover the area. The procedure is employed at the top and the back of the head but is not advised at the frontal hairline. Extensive areas may benefit from this method.

After surgery:
Sensations include tightness and occasionally discomfort for which pain medication may be necessary.
Any swelling or bruising should be reported. Bandaging if used will be removed the following day and the hair /scalp carefully washed. Sutures remain intact for up to 10 days. Your surgeon may want to examine you at somm time.
Please arrange some days off work following the surgery.
Resumption of your normal life may take a few weeks.

Follow-up procedures:
Further cosmetic detail may be required to create more natural-looking results. e.g. micro-grafts may be used to soften the anterior hair-line.
Transplanted follicles often reject their hair-shafts within the first 3 weeks of the procedure. This hairloss is temporary and new hair growth will appear within approximately14 weeks.

To locate specialists listed with The Society visit Hair Consultants (see title bar

© B Stevens FTTS (Contact the author)

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