Hair Restoration Surgery (Transplantation)

      Read a paper by Dr Pedro Maduriera MD MTTS                                                                                        

Are you a balding male or female and desperate to do something positive about it?
The surgical restoration of growing hair at balding regions by hair follicle redistribution from ‘safe’ sites may be an option.
The hair cover obtained may be limited but.  Be careful to select an experienced surgical team.

This article offers general information only. Interested persons must seek advice with an appropriate specialist.
To locate reputable specialists listed with The Society visit CONSULTANTS  (Top Menu Bar).

Temporary Baldness:

Hair follicles are vacated  e.g. postnatal alopecia, alopecia areata, telogen effluvium etc. spontaneous new hair growth usually follows.

Permanent Baldness

Hair follicles cease to regenerate hairs. Men and women are affected. 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.

Female pattern loss may commence as bilateral temporal recession or as a single coin-sized thinning patch in a central position just behind a fringe of very short often stronger hair-growth.  Unlike men, thinning may extend to inculcate much of the scalp. Women may also experience a degree of hair thinning associated with illness, ageing, hormonal changes after menopause or heredity.  Prescription drugs may assist.  Wigs may be an option.  Hair transplant procedures may be worth investigating.

Surgical intervention techniques

Scalp reduction, micro-grafts (containing a single hair) and mini-grafts (containing two or three hairs), flaps and tissue-expansion procedures are available. More than one technique may be employed during a procedure. As suitability to each technique depends on individual circumstances, one to one advice with the surgeon 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 but provides the most natural results.


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.

 Micro & Mini Grafts – procedures

Points to be understood:

Only the patient’s hair follicles can be used.
Human scalp averages 400-500 sq cm.  Areas of baldness may extend to exceed 200 Whereas some patients provide an abundance of harvestable donor hairs from a densely populated donor site (the occipital region – between the ears), others less fortunate may provide insufficient numbers with which to establish even a modest hair covering of an extensively bald region.
Even subjects with good donor hair should understand that this surgical procedure has limitations and regaining good hair-shaft density over large regions of baldness may not be an option.  The technique may re-establish a modest level of hair cover at some bald sites.
Not all individuals are suitable candidates for this procedure.
Hair repositioned in this way is expected to thrive for much of the recipients natural life although this cannot be guaranteed.
Additional 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. Procedures are usually performed in private clinics.

Anaesthesia: 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 in the hospital environment 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 removed and re-sited directionally. The surgeon will use special instruments to remove sections of hair-bearing scalp, which will be divided into tiny sections prepared 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 may require sutures leaving a thin straight-line scar.
The surrounding hair should 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.

Residual hairs may be lost days or weeks following the relocation.  New growth may not appear for 4-5 months.

Caucasoid hair growth rates range from 1-1.25 cm per 28 days.
Mongoloid hair growth rates range from 1 -1.70 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 reconstructive surgery a flat balloon-like device (tissue expander) may be inserted beneath hair-bearing scalp adjacent to a injured / bald area. Over a period of weeks the device is gradually inflated with saline causing the skin to expand. This stretched hirsute skin then replaces the bald region.

Scalp reduction (tissue expansion):
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 which are expected to pass.
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 your progress.
Arrange some days off work following the surgery.

Follow-up procedures:
Further cosmetic detail may be required to create more natural-looking results. e.g. micro-grafts may be used to soften an anterior hair-line.

To locate specialists listed with The Society visit Hair Consultants (see top menu bar)

© B Stevens FTTS (Contact the author)