Definition and Overview

Also referred to as hair transplantation or follicular transplantation, hair replacement surgery is a procedure involving stripping bands of hair usually at the back of the head and transplanting them in small bundles at the front to address thinning or balding hair. It is therefore used to manage hair loss normally due to an underlying condition or genetics.

The growth of the hair can be likened to that of the tree. The hair begins to develop from the roots, which are located in the deeper part of the dermis, then into the follicles, which form part of the skin. Each hair is nourished by the nutrients carried by the blood through the blood vessels such as capillaries that are attached to the roots. As the strands are fed, they grow and are therefore pushed up until they become visible on the scalp.

Many factors, however, can affect the hair’s growth including lifestyle, age, genetics, and conditions such as hormone imbalance. In the end, the hairs appear to be thinning, they are prone to breakage, or the person develops hair loss.

Hair transplantation is one of the effective ways to correct balding and thinning hair since it creates a more natural-looking result.

Some of the most common surgical procedures are:

  • Hair grafts – it involves removing a scalp that bears the hairs. As to how many hairs will be transplanted depends on the location. For example, transplantation on the hairline will require fewer hairs than surgery on the middle of the head. A specific method used is called follicular unit surgery wherein the hairs are transplanted in units.

  • Flap surgery – the surgeon creates a flap (lifting the scalp from the surface without detaching it completely) and transplanting it to a new site by sewing it to keep it in place.

  • Follicular unit extraction – Also known as FUE, it is a variant of follicular unit surgery. In this case, the hairs are extracted by units to lessen the appearance of scarring.

Hair grafting is actually a time-consuming process, and depending on the specific surgery, it may take a few hours to an entire day to complete. A facial surgeon, who performs the operation, can perform at least a thousand grafts on a patient per surgery.

Although most of the hairs are obtained from the back of the head, body hairs may also be considered if the original intended donor site has an insufficient number of hairs.

Who Should Undergo and Expected Results

Hair replacement surgery is ideal for men who have hair loss problems such as androgenetic alopecia. Also referred to as male-pattern baldness, it is characterized by the thinning or balding hair, which, when looked closely, appears to be following a certain pattern. This one is associated with heredity or genetics. If an immediate family member has it, most probably the male patient will develop it too.

It is also recommended for men and women who have thinning or balding hair due to old age. By the time a person hits 50, the hair’s follicles may eventually stop growing hair, which can then lead to baldness. People with high hairlines may also have thin or missing hair in the front.

The procedure can also be reconstructive in nature such as when the patient suffered from trauma (e.g., burns) that resulted in hair loss.

For a more successful transplantation, the patient should have an adequate source of natural hair in the body, preferably the back. Moreover, the quality of hair should be consistent with the original to create a more natural look.

The hairs from the newly transplanted follicles do fall out within the first month, but this is completely natural. It is the transplanted hair’s response to being in a new location. By the fifth month, the patient will typically grow new hair on the transplanted follicles.

Since it is a surgery, proper post-operative care should be observed. The wounds should be dressed correctly and promptly. The surgeon may also provide a certain kind of shampoo to avoid shock loss, or falling out of hair particularly after transplantation.

While the procedure can be painful and uncomfortable, its ability to increase a person’s self-confidence makes it worth it for many people.

How Does the Procedure Work?

A local anaesthesia is administered prior to the procedure for the patient’s comfort. However, sedation or even general anesthesia may be necessary.

The surgeon selects the best source of follicles at the back of the head. As much as possible, the scars should be easily hidden by the natural hairs. Once the best site has been identified, it is numbed to reduce the pain and then removed using a scalpel. The remaining scalp is then closed.

From the lifted or removed scalp with follicles, the surgeon then divides it into small grafts, each with a few strands of hair. Sometimes they could contain as many as 40 while others could have just 1 or 2. A lab separates these hairs as follicular units. These are units that grow on every scalp. Contrary to popular belief, a follicle can grow more than a strand of hair. In FUE, the hairs are extracted as units from the donor site. That’s why the process is lengthy.

While the follicles are being prepared and bundled in the lab, the surgeon proceeds by creating holes or slits where the removed follicles with hair will be transplanted.

Possible Risks and Complications

The procedure is generally safe if performed by a professional and certified technician and surgeon. It’s normal to feel numbness, discomfort, and pain after the surgery. These can even last for a few days, but they should subside as the time passes.

As a surgery, it creates a wound, which can serve as an entrance for bacteria, which may then lead to infection. Doctors usually give medications to avoid that.

Aside from shock loss due to the new environment that the transplanted hair is not accustomed to, the transplanted follicles themselves may not hold out, which means even new hair growth will also fall out.

References:

  • American Hair Loss Association: "Hair Loss Treatment."
  • American Academy of Dermatology: "Hair loss: Diagnosis, treatment, and outcome."
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