Hair replacement surgery involves acquiring a strip of hair-bearing scalp from
the back of the head, dividing them into several hundred smaller grafts and then
inserting these grafts into tiny slits in the scalp. The key factor in hair replacement
is the presence of donor hair on the side or the back scalp, which is then used
to replace hair where loss has occurred. Total baldness makes replacement surgery
impossible. Hair quality is another factor. Hair that is light in color and course
in texture produce a look of greater density than fine or dark hair.
patients looking for alternatives to hair transplants, many doctors
now offer scalp flaps and scalp reductions to produce a new,
natural-looking head of hair. Of all hair restoration procedures,
scalp flaps move the greatest amount of hair in the shortest
amount of time. As with hair transplants, scalp flap surgery
involves removing hair from a section of the scalp where hair
follicles are abundant and transferring some of those to the
instead of cutting the section of hair into smaller grafts and
then inserting them into thinning areas, scalp flap surgery is
performed by moving the entire strip to a completely bald section
of the head. The hair then continues to grow, in its new location,
at the same rate of growth as the previous location. It will
not thin or die unless hair in the area it came from also thins
or dies. Scalp flaps are sometimes performed in combination with
hair transplants for a more natural look, or with scalp reduction,
to more effectively cover a large bald area.
of significant surgical advances with improved results, interest
in hair replacement has increased significantly during the past
loss affects both men and women of all ages. Some people begin
to lose hair in their twenties. Frequent shampooing, poor circulation,
wearing hats or any other personal habits are not factors that
cause hair loss. For men, heredity is the major factor in hair
loss. For women, hormonal changes, including those that occur
in menopause, are mainly responsible for female "pattern
changes," which include thinning and loss. Accidents, burns,
and disease can also trigger hair loss. It is important to understand
that you will never have the coverage you had prior to your hair
loss, but surgery may camouflage the thin areas and give you
more fullness. Hair replacement surgery can enhance your appearance
and your self-confidence.
is hair replacement surgery performed?
transplantation involves removing small pieces of hair bearing
scalp grafts from a donor site and relocating them to a bald
or thinning area. Grafts differ by size and shape. Round-shaped
punch grafts usually contain about 10-15 hairs. The much smaller
mini-graft contains about two to four hairs; and the micro-graft,
one to two hairs. Slit grafts, which are inserted into slits
created in the scalp, contain about four to10 hairs each; strip
grafts are long and thin and contain 30-40 hairs.
techniques, such as punch grafts, mini-grafts, micro-grafts,
slit grafts, and strip grafts are generally performed on patients
who desire a more modest change in hair fullness. Flaps, tissue-expansion
and scalp-reduction are procedures that are usually more appropriate
for patients who desire a more dramatic change.
several surgical sessions may be needed to achieve satisfactory
fullness-and a healing interval of several months is usually
recommended between each session. It may take up to two years
before you see the final result with a full transplant series.
The amount of coverage you'll need is partly dependent upon the
color and texture of your hair. Coarse, gray or light-colored
hair affords better coverage than fine, dark-colored hair. The
number of large plugs transplanted in the first session varies
with each individual, but the average is about 50. For mini-grafts
or micro-grafts, the number can be up to 700 per session.
before surgery, the "donor area" will be trimmed short
so that the grafts can be easily accessed and removed. For punch
grafts, your doctor may use a special tube-like instrument made
of sharp carbon steel that punches the round graft out of the
donor site so it can be replaced in the area to be covered-generally
the frontal hairline. For other types of grafts, your doctor
will use a scalpel to remove small sections of hair-bearing scalp,
which will be divided into tiny sections and transplanted into
tiny holes or slits within the scalp. When grafts are taken,
your doctor may periodically inject small amounts of saline solution
into the scalp to maintain proper skin strength. The donor site
holes may be closed with stitches-for punch grafts, a single
stitch may close each punch site; for other types of grafts,
a small, straight-line scar will result. The stitches are usually
concealed with the surrounding hair.
maintain healthy circulation in the scalp, the grafts are placed
about one-eighth of an inch apart. In later sessions, the spaces
between the plugs will be filled in with additional grafts. Your
doctor will take great care in removing and placement of grafts
to ensure that the transplanted hair will grow in a natural direction
and that hair growth at the donor site is not adversely affected.
After the grafting session is complete, the scalp will be cleansed
and covered with gauze. You may have to wear a pressure bandage
for a day or two. Some doctors allow their patients to recover
surgeons are the leaders in tissue expansion, a procedure commonly
used in reconstructive surgery to repair burn wounds and injuries
with significant skin loss. Its application in hair replacement
surgery has yielded dramatic results-significant coverage in
a relatively short amount of time. In this technique, a balloon-like
device called a tissue expander is inserted beneath hair-bearing
scalp that lies next to a bald area. The device is gradually
inflated with salt water over a period of weeks, causing the
skin to expand and grow new skin cells. This causes a bulge beneath
the hair-bearing scalp, especially after several weeks. When
the skin beneath the hair has stretched enough-usually about
two months after the first operation-another procedure is performed
to bring the expanded skin over to cover the adjacent bald area.
surgery on the scalp has been performed successfully for more
than 20 years. This procedure is capable of quickly covering
large areas of baldness and is customized for each individual
patient. The size of the flap and its placement are largely dependent
upon the patient's goals and needs. One flap can do the work
of 350 or more punch grafts.
section of bald scalp is cut out and a flap of hair-bearing skin
is lifted off the surface while still attached at one end. The
hair-bearing flap is brought into its new position and sewn into
place, while remaining "tethered" to its original blood
you heal, you'll notice that the scar is camouflaged-or at least
obscured-by relocated hair, which grows to the very edge of the
recent years, plastic surgeons have made significant advances
in flap techniques, combining flap surgery and scalp reduction
for better coverage of the crown; or with tissue expansion, to
provide better frontal coverage and a more natural hairline.
technique is sometimes referred to as advancement flap surgery
because sections of hair-bearing scalp are pulled forward or "advanced" to
fill in a bald crown.
reduction is for coverage of bald areas at the top and back of
the head. It's not beneficial for coverage of the frontal hairline.
After the scalp is injected with a local anesthetic, a segment
of bald scalp is removed. The pattern of the section of removed
scalp varies widely, depending on the patient's goals. If a large
amount of coverage is needed, doctors commonly remove a segment
of scalp in an inverted Y-shape. Excisions may also be shaped
like a U, a pointed oval, or some other figure.
skin surrounding the cutout area is loosened and pulled, so that
the sections of hair-bearing scalp can be brought together and
closed with stitches. It's likely that you'll feel a strong tugging
at this point, and occasional pain.
long does a hair replacement procedure take?
doctors perform more than one session of transplanting to achieve
the best results. Each transplanting session takes between two
and four hours, depending on the extent of the treatment.
type of anesthesia is used?
replacement surgery, regardless of the technique is used, is
usually performed using a local anesthesia along with sedation
to make you relaxed and comfortable. Your scalp will be insensitive
to pain, but you may be aware of some tugging or pressure.
anesthesia may be used for more complex cases involving tissue
expansion or flaps. If general anesthesia is used, you'll sleep
through the procedure.
is the procedure performed?
replacement surgery is usually performed in a physician's office-based
facility or in an outpatient surgery center. Rarely does it require
a hospital stay. A hair transplant can be done in an outpatient
surgery center or in an office surgical suite. Most hair transplants
are performed under local anesthesia (like that used by dentists)
combined with a sedative to make you drowsy. You'll be awake
but relaxed, and although you may feel some tugging and mild
discomfort, you won't feel any pain.
can I return home and resume normal activities?
should arrange for someone to drive you home after your surgery.
Plan to take it easy for a day or two after the procedure and
arrange for assistance if you think you'll need it.
do I prepare for hair replacement surgery?
your initial consultation, your surgeon will discuss the changes
that you would like to make to your appearance. Since the appearance
of your hair is a matter of personal perception and preference,
you will need to discuss your concerns in detail so your surgeon
can determine the appropriate alternatives. You also should make
arrangements ahead of time for someone to drive you to and from
your procedure and to assist you with your daily activities during
your recovery period.
to your surgical procedure, the surgeon will perform a complete
health history and physical. Knowledge of your allergies, medications
and previous surgeries should be brought to your surgeon's attention
at this time. Specific instructions to assist you in preparing
for this procedure will be given to you after the health history
and physical is complete. Depending on your individual health
status, the instructions may include guidelines regarding your
diet, alcohol intake, smoking and which medications to take or
avoid. Your experience will be much smoother if you remain compliant
with your surgeon's instructions.
precautions are necessary during recovery?
you feel after surgery depends on the extent and complexity of
the procedure. Any aching, excessive tightness, or throbbing
can be controlled with pain medication prescribed by your physician.
bandages are used, they will usually be removed one day later.
You may gently wash your hair within two days following surgery.
Any stitches will be removed in a week to 10 days. Be sure to
discuss the possibility of swelling, bruising, and drainage with
strenuous activity increases blood flow to the scalp and may
cause your transplants or incisions to bleed, you may be instructed
to avoid vigorous exercise and contact sports for at least three
weeks. Some doctors also advise that sexual activity be avoided
for at least 10 days after surgery.
make sure that your incisions are healing properly, your doctor
will probably want to see you several times during the first
month after surgery. It's important that you carefully follow
any advice you receive at these follow-up visits.
are the possible complications after hair replacement surgery?
replacement surgery is normally safe when performed by a qualified,
experienced physician. Still, individuals vary greatly in their
physical reactions and healing abilities, and the outcome is
never completely predictable.
in any surgical procedure, infection may occur. Excessive bleeding
and/or wide scars, sometimes called "stretch-back" scars
caused by tension may result from some scalp-reduction procedures.
transplant procedures, there is a risk that some of the grafts
won't "take." Although it is normal for the hair contained
within the plugs to fall out before establishing re-growth in
its new location, sometimes the skin plug dies and surgery must
be repeated. At times, patients with plug grafts will notice
small bumps on the scalp that form at the transplant sites. These
areas can usually be camouflaged with surrounding hair.
hair loss progresses after surgery, an unnatural, "patchy" look
may result-especially if the newly-placed hair lies next to patches
of hair that continue to thin out. If this happens, additional
surgery may be required. It is always important to be informed
about the possible complications before any surgery. Be sure
to discuss any concerns you may have with your surgeon.
results can I expect after hair replacement surgery?
soon you resume your normal routine depends on the length, complexity
and type of surgery you've had. You may feel well enough to go
back to work and resume normal, light activity after several
patients who have had transplants (plugs or other grafts) are
dismayed to find that their "new" hair falls out within
six weeks after surgery. Remember, this condition is normal and
almost always temporary. After hair falls out, it will take another
five to six weeks before hair growth resumes. You can expect
about a half-inch of growth per month.
may need a surgical "touch-up" procedure to create
more natural-looking results after your incisions have healed.
Sometimes, this involves blending, a filling-in of the hairline
using a combination of mini-grafts, micro-grafts, or slit grafts.
Or, if you've had a flap procedure, a small bump called a "dog
ear" may remain visible on the scalp. Your doctor can surgically
remove this after complete healing has occurred.
general, it's best to anticipate that you will need a touch-up
procedure. Your surgeon can usually predict how extensive your
follow-up surgery is likely to be.