Hair Transplant
Hair transplantation is the most common surgical hair replacement treatment. In technical terms, hair transplantation involves the the surgical removal of hair grafts from donor sites on the side and the back of the head, places where balding men still have plenty of hair. These hair follicles are not inhibited by DHT (dihydrotestosterone) because they lack the genetic instructions to be inhibited by DHT. They remain healthy permanently. Hair grafts from these DHT-resistant hairs are re-implanted into the balding and thinning areas of the scalp. This provides permanent hair since the donor grafts have healthy hair follicles which are genetically programmed not to shed. The follicles and hair are removed from one part of the head with either a tubelike instrument called a punch graft or with a scalpel. Stitches are used to close the opening made from removing the hair. The hair strands are then transplanted into tiny holes or slits in bald areas of the scalp. By virtue of this technique, a natural look on the forehead, abd a natural dense look on the top of the head can be achieved.
1. Technique
Most micro-hair transplant procedures (individual hair micrograft restorations) use local anesthesia and are performed on an outpatient basis.. After approximately six weeks, the transplanted hair will fall out and be replaced about three months later when the new hair grows in. To achieve sufficient density, several sessions may be required. Transplantation is a progressive process requiring hundreds of micro-grafts, each of which will generally contain from one to three hairs mini-grafted from a donor site on the side or back of the head. They are randomly implanted in the bald (or thinning) area so that they will grow in a natural pattern and produce an undetectable result.
2. Excision
The donor site is excised as an elongated fusiform ellipse of full-thickness scalp using a scalpel blade size 10 or 15.The resultant defect is closed using suture or skin staples, and the scar is minimal. Then, donor tissue is dissected carefully into the desired number of grafts, which can vary in size.
3. Micrografts And Minigrafts
After anesthetizing the hair donation scalp site, a strip of scalp about ½" to 1" wide and 4 to 5" long is removed. Since the scalp is very elastic, the resultant gap is easily pulled together and sutured shut. The hair on the back of the head conceals the small thin suture line.
The surgery team then divides the donor hair strip, which contains thousands of hairs, into individual "grafts”. Micro-grafts each contain 1 or 2 shafts of hair. Mini-grafts contain 3 to 8 shafts of hair per graft. With these techniques, the surgeon transplants as few as 1 or 2 hairs at a time, which creates a more natural look rather than the "toothbrush" or "plug" effect.
These hair grafts are then implanted into recipient sites in the balding area. Micro-grafts are inserted into tiny punctures in the skin and mini-grafts are inserted into extremely small (0.5mm to 2mm) openings. This achieves a more natural appearance and is an improvement over previous techniques, where transplants were inserted into slits in the scalp. This often resulted in an abnormal, compressed hair.
Recipient sites are made in several ways. Some physicians use punch holes, some use linear slits, and others use a "slot" method that creates a narrow, elongated oval incision. The goal of all these procedures is to obtain a more dense, natural appearance for the patient, while allowing the hair to grow in its natural manner.
4. Creating And Dissecting Grafts
The obtained grafts can be transplanted directly or cut into smaller grafts using a size 15 blade or razor blade. These round grafts can be cut into halves or quarters, or they can be dissected down to single hair grafts. Grafts harvested by strip harvesting can be cut to single grafts, minigrafts, or micrografts by using a size 15 blade or razor blade. Grafts obtained using an ellipse must be dissected using a size 15 blade.
Most surgeons use magnifying loupes to aid the dissection of grafts. More recently, dissecting microscope has been used by some surgeons to aid graft dissection. It is chiefly acknowleded that follicular grafts, ie, those that are essentially a single follicular unit, offer better results.
5. Follicular Unit Hair Transplantation
The obtained grafts can be transplanted directly or cut into smaller grafts using a size 15 blade or razor blade. These round grafts can be cut into halves or quarters, or they can be dissected down to single hair grafts. Grafts harvested by strip harvesting can be cut to single grafts, minigrafts, or micrografts by using a size 15 blade or razor blade. Grafts obtained using an ellipse must be dissected using a size 15 blade.
Most surgeons use magnifying loupes to aid the dissection of grafts. More recently, dissecting microscope has been used by some surgeons to aid graft dissection. It is chiefly acknowleded that follicular grafts, ie, those that are essentially a single follicular unit, offer better results.
6. Scalp Surgery
"Scalp reductions” or “lifts” consist of cutting out bald skin from the top of the head and stretching the hairy “sidewall” up over the crown. Some doctors are even doing complex surgery to take strips of hair from the sides of the head, swinging them into the front, and stitching them in place.
This procedure allows bald scalp areas to be reduced and is probably the most common hair restoration procedure other than transplantation. The scalp is usually somewhat loose and the balding area may be reduced. This can be very effective for persons with midline or posterior ("monk spot"). Most people have a limited amount of hair for transplantation and reducing the bald area reduces the amount of hair needed for transplants. Rather than increasing the hairs available, scalp reductions reduce the amount of scalp you have to cover with transplants.
Although different physicians have different techniques, in general, several reduction procedures may be needed to achieve the desired results. Since the skin will only stretch so far, several small stepwise reductions must be done. This allows the skin to stretch and grow after each reduction. Another technique is to expand the scalp before the reduction so that the entire scalp is looser and the bald area can be even further reduced.
After the scalp reduction has healed, hair transplants are implanted to cover any scarring and to achieve the desired results of the patient.
1. The Surgical Preparations
The operation will be conducted under the administration of local anesthetia. During surgery, a small strip of donor hair-bearing skin is excised from the back of the scalp and cut into a number of smaller pieces of skin called "grafts". These grafts, which vary in size, are cleaned and trimmed before being implanted into the bald area. Single hairs are also removed, complete with their roots and some surrounding tissue, then reinserted into the hairline. Over the past couple of years, we have adopted the philosophy of follicular transplantation which allows us to achieve an even better result than ever before. The donor area is closed with either staples or sutures. Both the recipient and donor sites are scrubbed with 4% chlorhexidine gluconate or Betadine. You will be required to take a prone position while harvesting follicular grafts.
2. The Treatment
The doctor first will mark the outline of your new hairline After this, you'll generally be given a relaxation medicine, and the process will begin. Many of our patients sleep for 20 to 40 minutes and miss the start of the procedure. They don't feel a thing. The doctor will closely examine the back of the head, or the donor area, and may estimate hair density, sometimes with a magnifying instrument. Based on the number of the grafts to be planted, he will decide how big an area needs to be removed.Next, the area is numbed, and the donor hair is removed. You may feel a little pressure during this process, but little or no pain. This donor site on the back of the head heals with a scar that is usually only visible to your hairdresser, unless you razor cut your hair extremely short. Rarely, patients may get spread or thickened scars in the back. While the technicians are working, the doctor numbs the scalp and makes tiny openings where the grafts are to be inserted. It's a lot like transplanting seedlings in a garden. The openings are made at the proper angle so that the hair grows correctly. In the front of the head the hair grows forward and somewhat to the sides, and in the back of the head it grows backward. Sometimes the doctor will even reproduce the irregular pattern or “whorl” that occurs in the crown. There is usually no significant discomfort during the procedure (the local anesthetic is in place). You can be awake and chatting with the doctor and technicians, or possibly a little sleepy from the relaxation medicine.
3. Anesthesia
The operation is carried-out under the administration of local anasthesia.
4. Location Of The Operation
The surgery will take place in the relaxed atmosphere of the clinic with the assistance of a full-licensed surgical nurse, including a certified anesthetist upon request. Our clinic is geared with the most advanced hair-trasnplantation utilities. We can assure you that the procedure will be a safe, painless and pleasant experience.
5. Length Of The Operation
Each hair transplant session takes from three to seven hours, after which you may return home to recover in your own surroundings. After two days, you will return to our office for removal of your dressing and follow-up care.
7. Bandages
The dressings will be used after the operation for two days.
8. Numbness
Numbness can occur in the scalp and may take 1-2 months to settle.
9. Scabs
Scabs form over each graft after a few days, acting as natures dressing during the healing phase. Please do not pick or disturb them during the first week as this may cause the graft to fail.
10. Discomfort
is not much discomfort involved, if any, this is mostly mild in degree.
11. Sterility
The sterility is one of our top priorites, we take the utmost cautions to ensure a totally hygienic circumstances for the treatment.
12. Pain
Pain is a very infrequently observed phenomenon concerning the treatment.
13. Nausea
There is no nausea involved in this operation.
14. Sutures
The donor area is closed with either staples or sutures.