It is not until hair is gone that people understand the loss it represents; most people take a head of thick hair for granted. In most cases, a hair transplant procedure can help to bring back the appearance of a head full of hair.
There are a lot of myths about the causes of hair loss, like bad circulation in the scalp, nutritional deficiencies, and excessive use of hats, among others—but none of the theories have been proved. Likewise, it is false that men older than 40 years of age who have not yet lost their hair never will.
Actually, according to the American Society of Plastic Surgeons, hair loss is due to aging, hormonal changes, and inheritance (family history). In some cases, injuries to the scalp can cause hair loss, too—for example, burns and traumas. Some claim that hair loss is worse when it starts early.
The patient should understand that hair transplantation is just that—transplantation of hair that they already had, to a place where it is more visible. This procedure does not create new hair.
What is a hair transplant?
Hair transplantation is a surgery that involves removing a narrow strip (or small pieces of the patient’s own scalp) from a donor site and using it to fill an area with thin hair (or that it is bald), which is the recipient site.
In the United States, this procedure has been performed since 1950, so if a surgeon recommends this option as the best one for the patient, they can feel calm and sure in the hands of a qualified plastic surgeon because this procedure is widely known and has been practiced by them for many years.
Nowadays, a hair transplant can be performed with hair from the patient's own scalp. The hair can also be transplanted between identical twins because they have the same genetic constitution. However, there are a lot of scientists trying to find out a way to make hair transplants possible between different people without rejection.
Who is an ideal candidate for a hair transplant?
An ideal patient for a hair transplant should be a person with bald areas, but with healthy hair growth in other areas—for example, the sides of the head-sides and back. This is because these areas will be used as donor sites. The patient should be aware that hair characteristics (color, texture, and form such as straight, wavy, or curly) can alter the final results.
These days, there are a lot of techniques used to perform a hair transplant; in some cases, the plastic surgeon decides to combine a variety of these techniques in the same patient to obtain a more natural result (according to the patient's desires).
A hair transplant surgery can enhance the appearance and the patient's self-confidence, but before they decide to have surgery, they should be aware that the results won't necessarily match their ideal. Also, the patient should remember that the procedure has limits; the plastic surgeon can explain the possible outcomes. If the patient has very little hair, they may be not considered a good candidate for the procedure.
How much does a hair transplant cost?
The cost of hair transplantation can vary depending on the amount of hair to be transplanted, but it generally ranges from $4,000 to $15,000. The procedure is rarely covered by insurance, but when baldness is caused by trauma or burns, the hair replacement surgery is considered a reconstructive treatment, and may be covered by health insurance.
What should the patient do before a hair transplant?
Hair transplant surgery should be planned according to the patient's individual needs. The patient should consult a certified plastic surgeon to be sure which technique is the best for them. Likewise, it is important to choose a qualified plastic surgeon with wide experience in hair transplantation and replacement, and other techniques.
During the first consultation, the physician starts by evaluating the amount of hair, areas with healthy hair, and bald areas. In the medical record, a patient's hereditarian baldness should be included, and also, any prior treatment that they have undergone to correct it.
At this point, the surgeon can ask the patient about their lifestyle and discuss the desired outcome of the procedure and any current disease that may represent a risk factor during the surgery or during the recovery time (especially chronic conditions like hypertension, diseases that affect blood clotting, or a history of scarring). Likewise, the patient should communicate if they smoke, and inform the doctor of all drugs or current medications being taken.
One of the most important things before surgery is for the surgeon to explain to the patient how they will look once the surgery is performed, including the different stages of treatment.
What is the general procedure for a hair transplant?
In most hair transplant procedures, the patient is under local anesthesia, but in some cases the patient may need general anesthesia. Usually, the procedure is performed in the doctor's office, but it can also be performed in clinics or hospitals. In general terms, a hair transplant consists of removing small amounts of scalp tissue (containing hair) from the donor site to transplant them to a bald area. Depending on the extent of the procedure, the transplant will take approximately four to eight hours.
The plastic surgeon first cleans the scalp and then injects an anesthetic to numb the donor and recipient areas; after that, the graft of the scalp will be selected and removed from the donor area with a scalpel. These are different in size, but on average a round-shaped punch graft contains 10 to 15 hairs. Other sizes, like the mini-graft, contain about 2 to 4 hairs, and the micro-graft (the smallest) contains 1 to 2 hairs. Meanwhile, slit grafts contain about 4 to 10 hairs, and strip grafts (long but thin) contain 30 to 40 hairs.
The patient should know that in most cases, various sessions are needed to obtain the best results; likewise, between these different sessions, the patient should have several months of rest for healing. This is influenced by the patient's hair characteristics, as some types of hair cover better than others.
There is not a definite number of grafts or hairs to be transplanted during each session. This will vary according to the technique and individual needs. However, experts say that on average, 50 grafts can be used, but when mini-grafts or micro-grafts are used, more than 700 can be used in each session.
The small sizes of grafts—like mini, micro, slit, and strip—are mostly used on patients that desire modest and more natural changes in their appearance. On the other hand, techniques like flaps and tissue expansion are used to achieve more noticeable changes.
The grafts are processed to later be placed in the new location on the scalp. For this, the plastic surgeon creates small holes and slits with a scalpel or needle. To relocate the grafts, the surgeon uses a special instrument to replace the graft in the bald area. At this point, the doctor can alternate the grafted tissue with saline solution injections, in order to maintain the vitality of the scalp.
Finally, the small donor areas are closed with sutures and covered by the hair around them. When the plastic surgeon places the graft in the recipient site, they will be very careful to be sure that new hair will grow in the right direction. Likewise, they should be sure that the donor area was not affected and that the hair will continue growing properly. The last step is cleaning the scalp and covering it with gauze.
What is the postoperative care for a hair transplant?
After hair transplant surgery, the scalp will be very tender. The patient may need to take pain medications for several days, and will wear a surgical dressing over the scalp for at least 1 or 2 days. The surgeon will also prescribe an antibiotic drug to be taken for several days following surgery. Most people are able to return to work 2 to 5 days after surgery.
The patient should know that within 2 to 3 weeks after the procedure, they will lose the transplanted hair—but this is normal, and after a few months, it begins to grow again. In most cases, 60% of the new hair appears between 6 and 9 months. It may take up to 2 years before the patient can see the final results of a full transplant series.
What are the risks of a hair transplant?
Hair transplant surgery is normally safe when performed by a qualified and experienced physician; still, each individual has different physical reactions and healing processes, and the outcome is never completely predictable.
Like any plastic surgery, a hair transplantation has risks. Among them are bleeding, infection, scarring, and aesthetic problems like an unnatural look of the transplanted hair. In other cases, when the new hair growth starts, some people experience inflammation or infection of the hair follicles (folliculitis), but this can be relieved with antibiotics and compresses. Another potential risk—and fortunately, a less common one—is the sudden loss of transplanted hair or shock loss; the skin plug dies and the surgery must be repeated. However, this hair loss is rarely permanent.
Dr. Amjadi MD, DDS, FACS
Certified by the American Board of Plastic Surgeons
915 Gessner Rd #870
Houston, TX 77024