Hair transplantation is a popular surgical procedure for growing permanent natural hair over bald areas of the head. It is done by transferring a person’s own living hair from the back of the head (Donor Area) to grow permanently in areas of baldness (Recipient Area). It can also be done over the area which is not completely bald but where some hair is still present. Since all the roots are not taken out from one place; the donor area is not noticeable and looks the same.
What is Male Pattern Baldness (MPB)?
Male Pattern Baldness – also called androgenic Alopecia is the cause of hair loss in 90% of men. Androgenic Alopecia is an interplay of both genetic and hormonal factors. It results in shortening of the Anagen phase of the hair cycle and miniaturization of hair follicles leading to baldness.
Causes of Hair Loss:
- Androgenic Alopecia – Male/Female Pattern Baldness
- Physical stress – Surgery, illness, anaemia, rapid weight change
- Emotional stress – Mental illness
- Thyroid abnormalities
- Hormonal changes – Pregnancy, OCPs, menopause.
- Medications – High doses of vitamin A (sometimes present in diet supplements), blood pressure medications etc.
Brief History of Hair Transplantation (HT):
In 1959, Norman Orentreich from New York reported that hair-bearing scalp (auto-grafts) could be successfully transplanted from the back of the head to the balding front and top. Based upon his experiments, hair restoration surgeries were carried out all over the Western world using 10-20 hair follicles in each punch graft during the 60s. Owing to the problems of blood nourishment to the center of the graft along with the graft contraction – a peculiar unsightly toothbrush like appearance occurred. Dr. Nordstrom was the first to start 4 to 6 follicles in hair grafts & Dr. Headington, the first to start single follicle hair transplant.
Follicular unit hair transplant is a long procedure which requires 6-8 hours. It involves careful dissection of the follicles with the help of a trained staff. Single follicle hair graft has about 85-90% survival rate and 3 follicle hair grafts have an even higher survival rate.
- Medical- Topical Applications, Tablets.
- Surgical- Hair Transplant: provides the mainstay and the most natural looking results.
- Hair weaving
- Surgical Aspect of Hair Transplant
Follicular Unit Hair Transplant (Strip Method)
This method, also called FUT involves removal of a strip of superficial layer of the hair bearing scalp from the back and sides of the head (Donor Area). The strip is then further dissected into fine follicular units with the help of stereo microscopes and is transplanted on to the bald area (recipient area).
The big advantage this method provides is that it covers a relatively wide area as it provides scope for extracting more grafts in a single session. If the donor area permits, we can transplant up to 4000 follicular units in a single session. Hair Transplant centres that use stereo microscopes have a lesser chance of the precious graft wastage (transection) during graft harvestation.
This method leaves a linear suture line in the donor area which remains hidden beneath the hair even on the day of surgery. By virtue of the latest refinements in the surgical techniques, this can be minimized by tricophytic closure. This technique helps in minimizing the scar which is nearly invisible and new hair grows through it in most of the patients.
The survival rate of grafts is very important to achieve good results after hair transplantation. We at Dr. Kumar’s Relook Hair Transplant Centre take utmost care at every step of the procedure. This includes preparing fine micro holes on the bald area for implanting the prepared follicles, continually maintaining low temperatures, use of no-touch technique method along with an enhanced speed of transplanting. This results in a significantly increased survival rate of grafts when compared to the other centres. The centres having experience in performing this procedure along with skilled surgical assistants and microscopic magnification can provide the desired results. This is a time-tested gold standard in hair restoration surgery.
Follicular Unit Extraction (FUE)
This method involves extracting single follicular units from the back portion of the scalp (donor area) and transplanting them on to bald area (recipient area). These follicles should be extracted from the permanent hair bearing zone only. Follicles which are extracted very near to the vertex or nape of neck may go into baldness if the donor area is still susceptible for balding.
Being a relatively blind technique, it brings with it a lot of wastage in the form of hair transaction during extraction. This varies from 10-30%, depending upon the individual donor hair characteristics. These follicles are extracted with a punch where smaller sized punches are preferred. It is not the procedure of choice for covering large bald areas like Norwood IV or beyond. It is a fairly good option for covering small areas. It cannot be called a scar-less procedure as the donor site in a number of patients is speckled with tiny scars when closely shaved. It is a preferred choice for cosmetic surgery clinics that have few surgical assistants and a moderate infrastructure.
How to select a good hair transplant centre:
- A good Hair transplant centre should always have a highly qualified and experienced Plastic surgeon who is abreast with the latest happenings in the field of Hair restoration.
- Hair Transplant surgery is not a one-man show; it requires a big team of surgical assistants that is well trained at the graft separation. So, larger the team, the better the results can be expected.
- Hair Transplant centres that follow the latest advances and technique in hair transplant surgery are always a safer bet, as newer advances definitely bring better results.
- Hair Transplant and cosmetic surgery centres should be well equipped with all the latest equipment to carry out the procedure and should have the team capable of using Stereo microscopes.
- Transplanting a greater number of grafts in a single session always plays a major role in the outcome of the surgery. Hence, decreasing the rate of transaction of follicles and thereby wastage of the precious graft can be done by practicing the open and no-touch technique of implantation. Thus, improving the chances of survival of the grafts which is very important.
- A hair transplant surgeon who is well versed in Trichophytic closure & making micro-incisions between 0.6-1.3 mm required for achieving a good density of hair.
- Always look for a centre dedicated only to Hair transplant surgeries as they are doing it day in and out which definitely brings about the desired superior results.
During the procedure, once the strip is removed from the donor area, the two ends are approximated by suturing. The new method of suturing which significantly reduces the incidence of scar on the donor area is called “Trichophytic Closure”.
This method (Trichophytic closure) not only enhances the aesthetic outcome of the surgery but also reduces the post-operative complications by hastening the complete healing of the scar without leaving a trace of it. One can also appreciate the growth of hair from the scar area in the later stages which only underscores that the tissue at the suture area is alive.
To achieve mastery over such a subtle technique, it needs and involves lot of dedication and practice which is possible only at Hair Transplant and cosmetic surgery clinics devoted completely to Hair transplantation.
Who is a Suitable Candidate for Hair Transplant?
Not all patients with Hair loss are suitable/require Hair Transplantation.
Patients who are young and in the early stages of baldness can be treated with medical therapy to stop the progression of baldness, as well as promote hair growth. Frequently, even the younger patients require hair transplantation depending upon their psychological and social obligations like marriage issues, anxiety, low self-confidence, Location & Area of Baldness etc.
“The donor area always determines the outcome” and a Good donor area has:
- Laxity of the scalp
- Density of the follicular units per sq. cm (> 70 follicular units/ sq.cm)
- Thicker hair shaft
- Big donor area and lesser recipient area (the Demand and Supply Theory)
- No medical contraindications-Severe HT, Uncontrolled Diabetes etc.
- No bleeding disorders
Wig hair is made from either synthetic acrylic fibres or human hair. They are of two types: Interwoven and the worn-over. Though modern wigs provide immediate coverage, they can be easily spotted out by other people causing embarrassment and low self-confidence when dealing and interacting with others. They may become uncomfortably hot causing sweating during summers, thereby reducing patient compliance. They are usually associated with numerous problems like itching, dandruff, detectability and maintenance.
These pieces of wigs are arranged by different methods like:
- Hair weaving
- Hair bonding
- Hair clipping
- Hair gumming
All these methods have their own disadvantages and therefore cannot be worn for lifetime.
Though all these methods are swift and less expensive they are temporary in nature and can never match the natural appearance of hair transplantation which is gold standard in hair restoration and much more cost effective in the long run.
In cases where hair transplant cannot be performed due to various limitations (e.g. poor donor area), camouflaging techniques are recommended to boost the confidence levels of the patients and to improve the over-all appearance.
FAQ’s Regarding Hair Transplantation
Q. Does hair transplantation really work?
Hair transplantation is a time tested & proven surgery with very good results. The transplanted hair can have shampoo, regular normal hair-cuts and it re-grows naturally. The results depend on the number of grafts implanted. We at Dr. Kumar’s Relook Hair Transplantation Centre have performed 450 cases with excellent results in terms of direction of hair (360 degrees spatial orientation of the hair) and close density/sq. cm giving a natural superior cosmetic outcome.
Q. Why are an increasing number of people getting it done?
The increasing awareness from print & electronic media, seeing their favourite actors, cricketers, commentators and celebrities getting a new look after undergoing the procedure and looking much younger than before. Secondly, the increasing demands of certain job-profiles and personal reasons have made the people undergo this safe procedure. Thirdly, a procedure till now considered only for the rich and famous has been brought within the reach of the common-man.
Q. What is UR-Follicular UNIT Grafting?
With the advent of latest techniques in hair graft separation with stereo microscopes, it is possible to make very thin grafts, known as “ultra-refined follicular unit grafts”. With the incorporation of UR-FUG technique, we at Dr.Kumar’s Relook Hair Transplant Centre are able to make very thin slits with micro-instruments over the bald area & implant the ultra-refined follicular units giving you the most natural look.
Q. How safe it is to undergo hair transplantation?
It is a safe and superficial procedure with almost no complications. With the advent of the latest techniques, great care is taken to avoid any untoward complications during the procedure or even after the surgery.
Q. How painful is the procedure?
The surgery is done under local anaesthesia. We at Dr. Kumar’s Relook Hair Transplantation Centre have devised & innovated certain pain decreasing techniques during the procedure, it has become an almost pain free procedure, even for individuals with very low pain threshold. The patient is fully awake during the entire surgery, can watch television, listen to music or talk to the surgeon in a relaxed environment.
Q. Are there any major complications following the surgery?
No major complications are seen with hair transplantation except for mild transient swelling in a few patients over the upper part of face for 1-2 days which is self-limiting & subsides on its own.
Q. Duration of stay in the hospital following hair transplantation?
It is a day care surgery with the procedure taking an average of 6-8hrs depending upon the number of follicles to be implanted. One can go back walking after an hour of completion of the surgery and take rest at home.
Q. How long will I be away from work?
One can perform their normal home activities on the same day and can resume their office work from the third day onwards.
Q. Is it only for men? Is there any age limit & how much time does it take for complete re-growth?
A lot of women need & undergo hair transplant, there is no upper age limit. Even middle-aged to elderly can undergo the procedure and the time required to see appreciable hair growth is between 6-9 months.
Q. What are the benefits of the latest technique?
The latest technique involves URFUG method, which gives a cosmetically natural hair growth. This technique gives a far superior hair transplant results that cannot be noticed by a friend or even the hairdresser.
Q. Will the surgery produce big scar in the donor area?
We at Dr. Kumar’s Relook Hair Transplantation Centre have incorporated the latest Tricophytic Closure technique. This gives a very fine scar at the donor area which remains hidden under the hair. Only a few patients have developed a keloid or a detectable scar on very close shaving of the back of the head, depending on the healing characteristics of the skin of the patient.
Q. Does it affect the brain?
The entire surgery is done at the level of the superficial layers of the scalp and above the scalp bone so there is no injury or damage to the brain which lies below the scalp bone.
Q. Can I get a hair-cut after regrowth?
Yes, one can get a normal hair cut just as the other people get it done.
Q. How much time does it take for complete regrowth?
The minimum time required to appreciate the result of hair transplantation is between 6-9 months. As the time progresses, the hair becomes thick and achieve the thickness equivalent to the natural hair within 12-16 months.
Q. Is there any age limit for hair transplantation surgery?
There is no upper age limit, even elderly patient of 80 years can also think about the procedure provided they are medically fit and are willing to undergo the procedure.
Q. How many sessions are required for complete hair growth?
It depends on the size of the bald area and the density of the donor area. It can vary between 1-3 sessions depending upon the individual.
Q. How to compare the quality of hair transplantation?
The quality of hair transplantation can be judged by the direction & orientation of the hair, the creation of frontal hair line, the distribution of the grafts over the recipient area and the density of hair/sq.cm of scalp. All these together contribute to a good quality hair transplant.
Q. What is a Mega Session?
Mega session involves transplanting 2000 to 2800 grafts per session.
Q. What is a dense packing?
A dense packing means the number of follicles implanted/sq.cm of area. A good dense packing is usually >40 follicular units per sq.cm which prevents the scalp from getting visible between the hairs and giving a balding look.
Q. I am confused between FUT and FUE, which one should I undergo?
FUT (Strip Method) is the most effective method for covering larger bald areas. In this method, we can implant a greater number of grafts, sometimes amounting to even 3000 grafts or more in a single session. FUE, on the other hand, although doesn’t leave a linear scar in the donor area like FUT, but it leaves tiny scars at the donor site in some patients giving a mottled appearance when closely shaved. It cannot be called a SCARLESS procedure. Usually it is done at cosmetic surgery clinics, which have very few surgical assistants and moderate infrastructure.