Understanding Surgical Hair Restoration

Newer techniques, such as follicular unit micro grafting, follicular unit transplantation, and follicular unit extraction, have made hair transplantation a virtually undetectable, viable option for many hair loss sufferers.

Currently, a hair transplant can only be performed by harvesting dihydrotestosterone (DHT)-resistant hair from the back of your own scalp, and then transplanting it into the balding areas. Hair can also be transplanted between identical twins who have the same genetic makeup.

In general, doctors believe that hair transplanted from one person to another will be rejected unless anti-rejection medications are taken for life. The risk of taking these medications far outweigh the benefits attained from the transplant, however. Scientists are currently researching ways to transplant hairs from one person to another without rejection.

Typically, men who have male pattern baldness will still have a permanent wreath of hair surrounding the sides and the back of their head. This is where hair is harvested from for transplantation. This hair is genetically programmed to continue to grow even in the worse cases of male pattern baldness.

The exception is men who have with diffuse hair loss. These men have a similar form of hair loss as women; the hair loss is distributed throughout the entire scalp leaving the sides and the back very sparse. If this hair were to be transplanted, there would be no guarantee that the hair would continue to grow in the new area because this hair seems to be inherently unstable and just as susceptible to DHT as hair lost on the top of the scalp.

The following questions and answers will prepare you to understand surgical hair restoration procedures and methods.

Whose hair will be transplanted onto my head?

Unlike organ transplants, you are your own donor for a hair transplant. There is no donor and recipient. If you received hair, follicles, and tissue from someone else (other than an identical twin), your body would reject them without immune-suppressant drugs. You donate your hair from what are called your donor sites.

Where are my donor sites?

Male pattern baldness and female pattern baldness are terms that include the word pattern. That's because there is a pattern to the baldness. Especially in men, no matter how much hair they have lost in the front, top, and crown areas of their heads, the sides and backs of their heads retain hair, sometimes a great deal of it. The sides and back are far less affected by the action of DHT on their hair follicles. These areas are the donor hair sites, along with the follicles and some surrounding tissue.

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Where does the surgeon put my donor hair during the transplantation?

Once it has been extracted, it is transplanted to the balding parts of your scalp, into tiny slits that the doctor has made in your scalp. The donated hair, hair follicles, surrounding tissue, and skin are called grafts, and each graft contains one or more hair follicles with accompanying hair, tissue, and skin.

Some people have naturally thick hair, and some don't. How does this factor into a successful hair transplant?

Hair density is the number of hair follicles you have per square centimeter of scalp. A related factor is scalp laxity, the flexibility and looseness of your scalp. More grafts of hair can be transplanted when your hair density is high and the scalp laxity is high.

How does the direction in which your hair naturally grows affect your hair transplant?

Coarse hair is bulkier and can therefore be transplanted using fewer hairs per graft since it gives more coverage of the scalp. Fine hair has fewer bulbs and can give a very natural look but less coverage than coarser hair. Wavy and curly hair lends itself to good visual results in transplantation because a single wavy or curly hair curls on itself, covering more scalp area than straight hair. Curly hair also rises from the scalp and holds its shape, and these factors also give the appearance of greater coverage.

Does hair color or skin color play a role in hair transplantation?

The closer your hair color is to your skin color, the better the appearance of the hair's coverage. African hair is dark and very curly and therefore provides the least contrast against various shades of dark skin, giving the best visual hair transplant results.

From a visual point of view, people with dark, straight hair and a light complexion pose the most artistic challenges in hair transplantation because they have the most contrast between their hair and skin shades.

What are some other visual considerations?

When designing your procedure, your doctor must keep in mind your future hair loss pattern and the rate of potential hair loss. The design of your restored hairline is crucial. Natural front hairlines vary in shape and density from person to person. Your doctor will choose the recipient sites for the transplanted hair based upon an overall design that may take more than one hair transplant session to achieve. These sessions typically take place months or even years apart, depending on the progression of your hair loss.

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How do doctors decide which part of my head will receive the transplanted hair?

The front and top of your head will receive transplanted hair first because these are the areas that frame your face and make the most impact on your appearance. The crown is usually the last area to receive hair (in later procedures), unless it's your only balding area.

How many procedures will I need?

The number of procedures depends upon the extent of your hair loss, the projected hair loss rate, the amount of donor hair you can spare, and other artistic and medical considerations.

Men can often have the results they're looking for in just one or two hair transplant sessions, when thousands of hairs are transplanted in follicular units of one to four hairs each. Women need more sessions to achieve proper density. These sessions can last between five and ten hours each. Future sessions can follow if necessary.

What should I expect during my first meeting with a hair transplant surgeon?

During your first consultation, the doctor should examine your head thoroughly and take a detailed medical history. The examination of your head should include the use of an instrument called the hair densitometer, which measures your hair density and allows your doctor to properly evaluate the number of hairs in each of your naturally occurring follicular units and the hair loss pattern you may have over time.

This instrument compares fine hair to thick ones, measuring the degree of miniaturization of your hair strands caused by shrinking hair follicles, the progressive diminishing of each hair's diameter and length. Your doctor should put into writing your hair transplant design and an estimated timeline for any procedures that may be necessary. The doctor should also explain the entire hair transplant procedure, including any associated risks, and tell you what you can expect in the months following the procedure.



Published on March 1, 2010

WebMD Medical Reference from the American Hair Loss Association
©2010 American Hair Loss Association. All rights reserved

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