Updated: December 19, 2017
Hair transplantation is a surgical technique that moves hair follicles from a part of the body called the donor site to the recipient site. The recipient site could be a bald or balding part of the body.
In this procedure, grafts containing hair follicles that are genetically resistant to balding, such as the back of the head are transplanted to the bald scalp. Donor hair can be harvested in two different ways: strip harvesting and follicular unit extraction (FUE).
The surgeon will analyze the scalp of the patient and discusses their preferences and expectations at an initial consultation. He may advises them on the best approach which could be single or multiple sessions and what results might reasonably be expected.
This will help to know the actual existing density of hair. Preoperative topical minoxidil application and vitamins can be prescribed for some patient. The patient refrains from using any medicines which might result in intraoperative bleeding and resultant poor grafting for several days prior to surgery. Alcohol and smoking can contribute to poor graft survival. Post operative antibiotics are commonly prescribed to prevent wound or graft infections.
Transplant operations are performed on an outpatient basis with mild sedation and injected local anesthesia which is optional. Prior to the donor scalp being harvested, the scalp is shampooed and then treated with an antibacterial agent.
There are several different techniques for harvesting hair follicles. Each of them have their own advantages and disadvantages. Proper extraction of the hair follicle is more important to ensure the viability of the transplanted hair and avoid transection. Hair follicles grow at a slight angle to the surface of the skin. So transplanted tissue must be removed at a corresponding angle.
There are two main ways in which donor grafts are extracted. Those are strip excision harvesting and follicular unit extraction.
Strip harvesting is the most common technique for removing hair and follicles from a donor site. The surgeon harvests a strip of skin from the posterior scalp as this is an area of good hair growth. To remove strips of hair-bearing tissue from the donor site, a single, double, or triple-bladed scalpel is used. Each incision is planned so that intact hair follicles are removed. The excised strip is about 1Ã¢â¬â1.5 x 15Ã¢â¬â30 cm in size.
Assistants begin to dissect individual follicular unit grafts, which are small, naturally formed groupings of hair follicles, from the strip while closing the resulting wound. They carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting by using a binocular Stereo-microscopes.
The latest method of closure is called Trichophytic closure which results in much finer scars at the donor area.
The surgeon then puncture the sites for receiving the grafts by using a very small micro blades or fine needles. The receiving grafts can be placed in a predetermined density and pattern, and the wounds are angled in a consistent fashion to promote a realistic hair pattern. The technicians inserts the individual grafts in place which the final part of the procedure.
Strip harvesting will leave a thin linear scar in the donor area, which is typically covered by the hair of the a patient even at relatively short lengths. The recovery period is around 2 weeks. The stitches and staples should be removed by medical personnel or sub cuticular suturing can be done.
Individual follicular units containing 1 to 4 hairs are removed under local anesthesia in Follicular Unit Extraction or FUE harvesting. Tiny punches of 0.6mm to 1.0mm diameter are done for this micro removal. The surgeon then puncture the sites for receiving the grafts by using a very small micro blades or fine needles. The receiving grafts can be placed in a predetermined density and pattern, and the wounds are angled in a consistent fashion to promote a realistic hair pattern. The technicians inserts the individual grafts in place which the final part of the procedure.
FUE can be done in a single long session or multiple small sessions. The FUE procedure is more time consuming than strip surgery. Depending on the surgeons experience, speed in harvesting and patient characteristics, the time required for FUE surgery varies.
The advantage over strip harvesting is that FUE harvesting makes ineffective the need for large areas of scalp tissue to be harvested. So there is no linear incision on the back of the head and it does not leave a linear scar. Only small, punctate scars remain because of removal of individual follicles, which are virtually not visible and any post-surgical pain and discomfort is minimized. As no suture removal is required, recovery from Micro Grafting FUE is less than 7 days. FUE can give very natural results.
The disadvantages of this procedure is increased surgical times and higher cost. It is challenging for new surgeons because the procedure is physically demanding and the learning curve to acquire the skills necessary is lengthy and tough.
FUT is the traditional hair transplant method in which a linear strip of hair bearing skin from the back or the side of the scalp is extracted. The strip is then dissected to separate individual grafts.
This procedure utilizes cameras and robotic arms to assist the surgeon with the FUE procedure. Some of the disadvantages of this procedure are the size of the punches are relatively large in comparison to what is used in other methods of FUE, and the high costs associated with the devices is high.
Semi-permeable dressing can be done, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Shampooing is important to prevent scabs from forming around the hair shaft.
Hair thinning known as shock loss is a common side effect that is usually temporary. Bald patches are also common.