Hair Transplantation : Procedures, Types and Side Effects

Hair transplant is a surgical technique in which hair follicles are moved from a part of the body called the "donor site" to a bald or bald body part known as the "recipient site". It is mainly used in the treatment of male pattern baldness. In this minimally invasive procedure, flaps are transplanted onto the bald patch containing hair follicles, which are genetically resistant to baldness (for example, from the nape of the neck).

Hair transplantation can also be used to restore eyelashes, eyebrows, head hair, breasts, pubic hair and to fill scars caused by accidents or surgical procedures such as facelift and previous hair transplant operations. The procedure differs from skin transplantation in that the flaps contain almost the entire epidermis and dermis surrounding the hair follicle. In addition, the surgeon transplants a lot of tiny grafts, and not just a strip of skin. 

Since in natural conditions, hair grows in groups of 1 to 4 pieces, in modern techniques, "follicular associations" are collected and transplanted. Thus, modern hair transplantation allows to achieve a natural appearance, imitating the original direction of growth. This procedure is called follicular unit transplantation (FUT). Donor hair can be collected in two different ways: extraction of the graft band and extraction of follicular associations (FUE).

Hair Transplant Procedure Steps

During the initial consultation, the surgeon analyzes the patient's scalp, discusses his preferences and expectations, and advises on the choice of the best approach (for example, one or more sessions) and reasonably expected results. Preoperative follicroscopy will help you learn the actual density of your hair to accurately assess postoperative results for newly transplanted grafts. Some patients benefit from pre-operative topical application of minoxidil and vitamins.
Hair Transplantation : Procedures, Types and Side Effects
A few days before surgery, the patient should refrain from using any medications that can lead to intraoperative bleeding and, as a consequence, to transplant problems. Alcohol and smoking can contribute to poor graft survival. To prevent wound or implant infections, antibiotics are usually prescribed after the operation.

Methods for Collecting a Transplant 

Operations are performed on an outpatient basis, using a mild sedative (if desired) and local anesthesia. The scalp is washed and then treated with an antibacterial agent before collecting the donor material.

There are several different methods of collecting hair follicles, each of which has advantages and disadvantages. Regardless of the technique of collection, the correct extraction of the hair follicle is of paramount importance for the viability of the transplanted hair and the prevention of cutting and cutting the hair shaft from the follicle. Hair follicles grow at a slight angle to the surface of the skin, so the transplanted tissue must be cut at an appropriate angle.

There are two main ways of extracting donor transplants: extraction of the graft band and extraction of follicular associations.

Extraction of the Transplant Band

This is the most common method of removing hair and follicles from a donor site. The surgeon uses a scalpel to remove the strip of skin from the back of the head, in the area of ​​good hair growth. Each incision is planned in such a way as to extract undamaged hair follicles. The size of the excised strip is approximately 1-1.5 x 15-30 cm.

When the wound is closed, the assistants cut off individual patches of follicular associations from the strip, representing small, naturally formed clusters of hair follicles. With the help of binocular stereomicroscopes, excess fibrous and adipose tissue is carefully removed, avoiding damage to the follicular cells to be used for transplantation. The last method of closure is called "trichophytic closure", it leads to the formation of thinner scars on the donor site.

Then the surgeon, using very small microscopes or thin needles, punctures the spaces for obtaining grafts, placing them in a given density and structure, and evenly distributing the wounds to create a realistic hair pattern. Technicians usually perform the final part of the procedure by inserting individual transplants into place.

When removing strips in the donor zone, there remains a thin linear scar, which, as a rule, is covered by the patient's hair even in a relatively short length. The recovery period is about 2 weeks. Stitches / staples are removed by medical personnel or a subcuticular joint can be applied.

Extraction of follicular associations (FUE)

In this technique, individual follicular associations containing from 1 to 4 hairs are removed under local anesthesia. For micro-removal, tiny perforators with a diameter of 0.6-1.0 mm are usually used. Then the surgeon pierces the areas with very small microscopes or thin needles to obtain transplants, placing them in a given density and structure, and evenly distributing the wounds to create a realistic hair pattern. Technicians usually perform the final part of the procedure by inserting individual transplants into place.

To perform a FUE, one long or several short sessions are required. The procedure takes longer than other techniques. The time of operation varies depending on the surgeon's experience, the rate of collection of transplants and the characteristics of the patient. The procedure can take as a couple of hours (from extraction of 200 flaps to correction of the scar), and 2 consecutive days (megassession with 2500-3000 flaps). There are limitations on the candidacy of the patient. Clients are selected based on the test fox test, although there are disputes about the benefits of this method in the screening of clients.

FUE can give very natural results. The advantage is that this technique negates the need for cutting large sections of scalp tissue, so no need for a linear incision on the back of the head is absent and a large scar remains. Since individual follicles are removed, only small punctate scars remain, which are virtually invisible, and any post-surgical pain and discomfort are minimized. Since no removal of stitches is required, the restoration lasts less than 7 days.

Among the shortcomings - the duration of the operation and a higher cost for the patient. For an inexperienced surgeon, its implementation involves a number of difficulties, including long and intense training. Some surgeons note that the technique may lead to a lower ratio of successfully transplanted follicles compared to the removal of the graft band.

Follicular Unit Transplantation

Follicular Fusion Transplantation (FUT) is a traditional method of hair transplantation, which involves the extraction of a hair band from the skin from the back or side of the head. Then the strip is excised to separate the individual flaps.

Robotic Recovery 

Robotic hair restoration devices use cameras and robotic arms to help the surgeon in the FUE procedure. In 2009, NeoGraft became the first robotic surgical device approved by the FDA (US Food and Drug Administration) for hair restoration. The ARTAS system was approved by the FDA in 2011 for use in the collection of follicular associations in men with brown and black hair. Despite the advantages of robotic systems, they have some drawbacks, for example, the size of punches is relatively large compared to those used in other FUE methods, high costs associated with the use of devices.

Types of Operations

The operation is applied in the following cases:
  • Androgenetic alopecia.
  • Eyebrow transplantation.
  • Reduction or reconstruction of the frontal line of hair (naturally high hair growth line without balding)
With insufficient amount of donor hair from the back of the head, it is possible to perform hair transplantation from the body (BHT) from suitable candidates with available donor hair on the chest, back, shoulders, trunk and / or legs. The operation can be performed only by collecting the FUE and, therefore, requires special surgical skills. However, there are several factors for choosing a potential candidate for BHT, which are considered before surgery. This is an understanding of the natural differences in texture characteristics between hair on the body and on the head, growth rates and realistic expectations regarding the results of the operation.

Post-operative Care

Improvements in wound care allow you to change a semi-permeable dressing daily, through which blood and tissue fluid seeps. Vulnerable recipient zone should be protected from the sun, and shampooing is allowed 2 days after the operation. Some surgeons are allowed to use shampoo the very next day after the procedure. Washing is important to prevent the formation of scabs around the hair shaft. Scabs stick to the stem and increase the risk of loss of newly transplanted follicles within the first 7-10 days after surgery.

During the first 10 days, almost all hair transplanted, inevitably injured by movement, will fall out. This phenomenon has the definition of "shock loss". After 2-3 months, new hair begins to grow from displaced follicles. The patient's hair will grow normally during the next 6-9 months. Any subsequent hair loss can only occur from untreated areas. Some patients prefer to use drugs to slow this loss, while others plan a subsequent transplant procedure to cope with this unpredictability.

Side Effects of Hair Transplantation

The most common side effect is hair thinning, which is temporary and is known as a "shock loss". The appearance of bald spots is also common, because every day 50-100 hairs fall out. Postoperative abnormalities were observed in 5% of patients who underwent transplantation.