Even men with advanced hair loss have hairs growing on some parts of the scalp. The parietal and temporal areas usually feature permanent hair growth and are used as so-called donor areas for the surgical treatment of baldness.
Hair follicles from these areas may be grafted during one or more sessions, depending on the necessary amount of transplanted hair. The corners of the frontal hairline or the vertex (crown) of a scalp are the most frequent places for transplantation.
A hair transplant is a procedure performed under local anesthesia and usually without any overall complications. The patient is conscious and may co-operate with the surgical team. During the procedure, hairs with follicles are relocated from the places of permanent growth to places that are bald. In the case of relocation of hairs into the corners and frontal hairline, this line is carefully drawn and consulted with the patient before the procedure. There are two different methods of hair harvest:
1. Using the so-called strip method the surgeon dissects an anesthetized posterior part of the scalp with a scalpel to harvest a strip of skin with hair and hypodermis. This excised, boat-shaped strip is about 15 – 25 cm x 2.5 – 4 cm in size, depending on the size of the patient’s head. After excision, the wound is closed by simple interrupted sutures which will remain for 10 – 14 days based on the tension of the wound’s edge. Because the wound is closed under tension, a scar may be stretched and in the case of a haircut shorter than 1 cm in the place of excision, it may be visible.
2. Using the more innovative FUE method (follicular unit extraction – the harvest of single hair units) the place of harvest is also locally anesthetized. The harvest is a time intensive procedure because each hair unit is extracted separately. After the extraction of every hair unit, a small 1 mm incision remains in the place of the harvest and is left to heal spontaneously. It is not true that there is no scar in the donor area when using the FUE method. There are numerous tiny scars which are so small however that they cannot be seen even if the hair is cut short.
When the follicular unit grafts are prepared (it differs in each method) the transplantation starts again with the anesthesia of the transplantation (recipient) area. Depending on the method used, the transplantations further differ by the preparation of an incision for the implantation of a hair follicle; either the incisions are prepared separately before each graft or they are all done together. When the transplant is complete, the grafted area is covered with an antibiotic cream and sterile dressing. The sterile dressing covers the scalp for a time period which depends on the method of implantation used; at least until the second day.
What is a follicular unit?
There used to be an opinion that hair grows on the scalp individually. However, detailed research discovered hair occurs and grows on the scalp in groupings. These groupings usually contain 1, 2, 3 or 4 hairs. Every such a hair grouping is denoted as a hair follicular unit.
What can I expect from the procedure?
Above all it is important to have a realistic vision about the possibilities of surgical treatment of baldness. The resulting density of the hair is influenced by many factors, mostly by the transplant technique used. The available methods are mainly influenced by the fact of how close to each other the follicular units may be grafted in one procedure. Hair density in the grafted area may be enhanced by another procedure. The second procedure of enhancing the hair density in the grafted area is performed usually a year after the first operation. The number of sessions is individual according to the extent of the hair loss.
Recommendations before the procedure
To achieve the best conditions for hair grafting and with respect to possible complications and preservation of hair follicles, please, follow these recommendations:
Do not take drugs containing acetylsalicylic acid (Aspirin, Anopyrin,...), non-steroidal anti-inflammatory drugs (Ibuprofen, Brufen, Ibumax,...) and propanolol (beta blocker).
Do not drink alcohol two days prior to the operation.
In the case of hair grafting using the strip technique, leave the hair in the donor area at least 1 cm long to enable the cover of the harvest place.
In case of hair grafting using the harvest of individual follicular units, have a short haircut. The hair in the donor area will be shaved to the required 2 mm length at the clinic on the day of the procedure. Do not shave the donor area on your own, you may disable the extraction of follicular units.
It is recommended to wash your hair daily a week before the operation. It removes dandruff and hair that would soon fall out spontaneously.
Take a shower or bath the evening before the operation.
The operation day
For the operation, please wear an old shirt or other loose garment that opens at the neck with buttons or a zipper. It is necessary that your clothing does not have a narrow neckline that needs to be pulled over your head.
Have a light breakfast on the day of the operation. Tea or coffee is not recommended on operation day.
Get another person to drive you home. You may be given drugs during the procedure that could affect your driving performance. Your surgeon will inform you about the expected finish time according to the extent of the transplantation. You should expect the operation to last approximately 6 – 8 hours.
Catering is provided by the clinic.
Inform your surgeon about possible allergies.
Inform your surgeon of all drugs you take.
Inform your surgeon if you have a cold or any other disease.
When the dressing is removed there are numerous scabs in the recipient area as well as in the donor area in the case of the FUE technique. We let the scabs fall off gradually. Gentle removal of the scabs is important, particularly for the recipient area, as the grafted hairs are not resistant to mechanical pull-off within 14 days after the operation. Transplanted hairs fall out within a month, only a small number remain in place and new hair growth is apparent 3 – 4 months after the transplant. It is necessary to realize the grafted hair follicles need blood supply to survive and it may take a long time and vary from person to person. The success of the transplant may be evaluated only 6 – 9 months after the procedure; when the resulting hair density is apparent in the grafted area.
Plastic surgeon Evžen Trupar, M. D. deals with hair transplants at the Laurea Clinic.