Hair Transplant Surgery
Male Pattern Baldness
Typically, male pattern baldness begins with the hair at the front of the head thinning and the hairline receding. At the same time, the hair on the crown of the head also begins to thin and a bald patch gradually develops in the middle of the scalp.
Male pattern baldness develops in most men at some stage and is the common type of hair loss. Some men can go bald in less than a 5 year period, whereas this usually takes a period of some 15-25 years.
Hair growth occurs in hair follicles. The hair growth occurs from the follicle over a period of about 3 years before the hair is shed and new hair growth occurs. This cycle continues throughout life.In Male Pattern Baldness, it is thought that the hair follicles of the scalp gradually reduce in size and as the follicle shrinks, the hairs produced become thinner. The period of growth also reduces prior to the shedding of the hair itself; Over time, this results in a much smaller hair follicle and hair which does not grow beyond the skin surface.
Hair Replacement
Hair replacement involves the use of your own growing hair. Once re-positioned, the hair requires no additional or special maintenance in relation to washing, grooming and cutting etc.
In hair replacement treatment, living hair from the back and side of the head, where the hair is much denser and genetically programmed to grow for life, is surgically removed and re-positioned (transplanted) to areas where the hair has stopped growing.
The hair replacement procedure is a minor day case surgical procedure. It only deals with the surface layers of the skin - the epidermis and the dermis. When the hair grows, it recreates the natural distribution of hair while leaving the surface of the scalp smooth and unaltered.
Although medically almost all peopleare suitabletohave a Hair Transplant this does not mean the procedure is suitable for allpatients.Factors such as age, hair loss stage, potential for future loss, donor management and patient desiresmust beevaluated.
Follicular Unit Hair Restoration Surgery
Every person is individual and has his or her own objectives, be it cosmetic or psychological these have to be taken into consideration to ensure long-term aesthetic goals can me reached. Follicular Unit Extraction "FUE" and Follicular Unit Transplant "FUT"also known as Strip Surgery or Follicular Unit Strip Surgery "FUSS" are the two recognised scalp to scalp hair transplant techniques.
When deciding which procedure is best for you various factors need to be considered by both patient and surgeon. These include donor hair density, hair characteristic, hair calibre, age, goals and expectations. All are vital to deciding the best technique.
"FUT" using the Tricophytic Closure will minimise the look of the scar line onthe scalp whereas with FUE the punch size can be small enough for the scarring to be non visible to the eye. FUE & FUT hair transplant surgery can be combined (Elite Hair Restoration Surgeonsperform bothFUT& FUESurgery)under the correct circumstances to maximise the donor area and provide the most follicular units to be harvested in one procedure. This could benefit those in an advanced Norwood Scale of hair lossthat arelooking to achieve the best coverage and density in one hair transplant session.
Follicular Units (FU - grafts)
FU's are natural genetic groups of hair; each unit contains anything from one tothreehairs, usually in the donor area they average out at 2.2 hairs per FU.
The original density of follicular units prior to hair loss can be anywhere from 60 and 110 groups per square centimetre, dependent on genetic makeup, ethic background and natural hair characteristics.
Depending on the type of hair some individuals may not be able to treat the entire area of hair loss and will have to settle for less coverage. We find that we do not need to match the density you were born with to give you the illusion of a healthy coverage and density; only 60% density is required to block the transmission of light.
All Hair Surgery Options
Hair Restoration Surgery may be the only reliable way to replace your lost hair, and the techniques for restoring hair growth are constantly improving. These procedures include:
A hair transplant, where the surgeon moves non-sensitive hairs from the back of the head to the top. This is best for men whose hair loss is limited to the front of the scalp. Factors that determine whether a person is a suitable candidate include age, hair colour, the nature of hair loss, and whether the hair type is straight or curly.
A scalp reduction, a technique that is most suitable for men with a small, well-defined bald spot on the top of the head.
A flap-surgery, which involves making the part of the scalp that still contains hair larger. This is a possibility in cases of hair loss over a small area.
Hair loss in Women
Women can also suffer hair loss, especially those with many relatives who are also prone to losing their hair.
The female pattern sets in at a later age than in men and is usually limited to the top of the head. Total baldness is rarely seen in women.
The only treatment licensed for hair loss in women is Regaine for Women.
Advantages Of Follicular Unit Extraction (FUE)
1. Virtually scar less procedure with no linear scar.
2. Suitable for patients with short hair preference or who would like to keep their hair shaved.
3. Suitable for people with limited hair loss and those who would need a limited number of grafts.
4. Shorter recovery time
5. Suitable for those requiring, eye brow, eye lash or mustache transplants.
6. Suitable for people with a heavily scarred donor area from previous strip procedures which have been badly performed.
7. Suitable for patient with very tight scalps and therefore not suitable for Strip surgery where the skin is difficult to put back together by stitching.
8. Suitable for patients with tight scalps due to previous multiple strip surgeries
9. There are no linear scars with this technique which is therefore suitable for people with an inordinate fear of scars or scalpels.
10. Enables the surgeon to harvest finer hair from the nape of the neck and therefore extends the donor area.
Disadvantages of Follicular Unit Extraction (FUE)
1. Maximum follicular unit graft yield is lower than Strip surgery and is therefore more suitable for those needing smaller numbers of hair grafts.
2. Greater patient variability in terms of those who are considered good candidates for this technique compared to Strip surgery(FUSS)
3. Size of sessions limited in time scale and this requires multiple sessions to equal the results/number of grafts achievable in a single Strip surgery session .(FUSS)
4. Longer operation time and more expensive than strip surgery.
5. Problem of Buried grafts or those hair grafts that are unsuccessful.
6. Growth of Transplanted hair is very slightly less than growth by strip surgery.
Complications In Hair Restoration
No medical or surgical procedure is immune to potential complications. The following are some of the known but very infrequent complications.
1. Infection
2. Temporary swelling especially in the face after frontal scalp hair transplant surgery
3. Paraesthesia, a temporary tingling sensation and numbness of the donor and recipient area lasting anything from days to weeks and even months (Strip Surgery)
4. Poor growth of hair
5. Cysts, pustules
6. Ingrown hair, epidermoid cysts.
Eye Brow Replacement
Eye brow restoration is a very delicate but highly rewarding procedure that can restore eye brows to become denser in a matter of a few hours. Eye brows may be lost or thinned out due to excessive and over plucking, scaring from trauma or burns, alopecia or simply due to aging.
Hair grafts are taken from the usual donor scalp area using an Individual Graft Harvesting (FUE) technique or a small strip. They are then prepared under magnification and implanted into micro incisions in the recipient. The surgeon has already decided on the angles and direction that the new hair is to be transplanted in order to achieve the most natural results in line with patients existing hair growth.
Transplanted hair will normally grow in 2 to 4 months and can initially be curly and will need trimming from time to time.
What is Shock Loss?
The medical term for shock loss is effluvium, meaning shedding. This can occur when grafts are placed in an area which has hair; there can be some trauma and tissue reaction to the surgery that can cause the existing hair to shed prematurely. Shock loss usually affects the miniaturised hair nearing the end of its life span and is most likely to be shed at some point in the near future. Some healthy hair will be shed, but it invariably regrows. Shock loss is more common when a large session is performed through thinning hair. Shock loss can also occur in the donor area, more so with larger strip procedures; it is less common, but can still occur.
For most patients, effluvium is not a major issue and should not be a cause for concern; their hair looks a little thinner or loses some body and lustre. This is generally during the first months post the transplant when the transplanted hair is still in the dormant phase.
It is certainly easier to place grafts around hair that is shaved, but this does not mean shock loss does not occur, it is just not as noticeable because the hair is shaved. Incisions must be customised to the individual patient; if you limit/customise the size of the incision site, and limit the width and length of the tool used to make recipient sites then you can greatly reduce the chances of shock loss. There seems to be a multitude of factors that can help reduce the effects of shock loss, smoking/drinking in the coming days to the procedure. In general, the more miniaturisation one has the more likely will be shedding from surgery. In addition, the number of grafts placed in one surgery and the proximity in which they placed to one another will increase the trauma to surrounding follicles.
Dense Packing is a phrase used to describe a large amount of grafts placed per cm2; the amount of grafts and the definition of how large the number is you may find vary.
It has been shown that the higher number of grafts placed in an area the more chance there is of a lower yield, or growth rate. The cause of this could be because of excessive trauma to the skin, insufficient blood flow to concentrate on the new activity or incorrect slit placement. Dense packing allows a natural result to be achieved in one pass, opposed to multiple procedures in the same area potentially causing more trauma. It is a technique that requires skill and an understanding of the hair placement within the scalp; making the new slit for the graft has to be carefully made so as not to impair the growth and skin tissue surrounding.
It is important to dense pack to a certain degree to ensure a natural looking result, be it hairline, mid-scalp or crown. That said it should be noted that there are varying views on dense packing and it is not just the density that is the issue, but also hair characteristics. Do not just rely on figures of density, but look at all the factors involved in a particular transplant.
The Donor Area
A good donor area can yield over 7000 follicular units, how these can be harvested will rely on a number of factors, the technique used and the scalp laxity being maybe the two most important. Combining FUE and FUT will allow the maximum grafts to be harvested safely as it maximises the donor surface area.
The scalp laxity is an important and sometimes forgotten aspect of hair transplant; especially with multiple procedures. Scalp laxity will determine the length and width of the strip that can be taken with FUT; and less thought of the amount of grafts that can be removed without trauma to the follicles with FUE. If the scalp is too tight this can limit the number and size of strips that can be excised, or cause larger than expected scarring or a high transection with FUE.
FUT Surgery relies on a strip being removed around the back and side of the scalp, the length and width will be determined by the amount of grafts required for the procedure. The position of the strip is important to not compromise the laxity of the scalp anymore than necessary; when a second procedure is required the scalp laxity will have been impaired to a and this may affect the width and length of the new strip; therefore reducing the potential number of grafts that can be harvested.
With FUE the donor surface area is larger because a single strip is not removed but the FU are taken individually from the entire donor area, from ear to ear. This does not mean there are more FU to be taken though, just that the scarring is dispersed and if done well not visible to the naked eye.
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