> Hair Restoration Surgery






Surgical hair transplant techniques include punch grafts, mini-grafts, micro-grafts, slit grafts, and strip grafts for a more modest change in hair fullness.

Flaps, tissue-expansion and scalp-reduction are procedures are best for patients who desire a more dramatic change.

Hair loss can start with a few extra hairs in the sink or in your comb. Later, it can progress to a bare scalp. Baldness typically refers to excessive hair loss from your scalp and can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss.

Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications and surgical procedures that are available to treat hair loss.

Types of Hair Loss
The medical term for hair loss is alopecia. Pattern baldness (androgenetic alopecia), the most common type of alopecia, affects roughly one-third of men and women. It's typically permanent. Other types of alopecia are temporary, including alopecia areata. It can involve hair loss on your scalp or other parts of your body. Plastic Surgeons typically treat permanent Alopecia.

Permanent hair loss

  • Male-pattern baldness (androgenetic alopecia). For men, pattern baldness can begin early, even in the teens or early 20s. It's typically characterized by a receding hairline at the temples and balding at the top of the head. The end result may be partial or complete baldness.

  • Female-pattern baldness (androgenetic alopecia). Women with permanent hair loss usually have hair loss limited to thinning at the front, sides or crown.

  • Cicatricial (scarring) alopecia. This rare condition occurs when inflammation damages and scars hair follicles, causing permanent hair loss. Sometimes the patchy hair loss is associated with itching or pain.

Temporary hair loss

  • Alopecia areata. Hair loss can be patchy or involve the entire scalp (alopecia totalis) or  involve the entire body (alopecia universalis).

  • Telogen effluvium. This type occurs suddenly, most often after a significant illness or major life stress. This type of hair loss usually causes overall hair thinning and not bald patches.

  • Traction alopecia. Bald patches can occur if you regularly wear certain hairstyles,

Anagen effluvium. In this type of hair loss, actively growing hairs in the anagen state are affected most often by chemotherapeutic drugs given to fight cancer or lymphoma

Hair Physiology

An understanding of hair physiology  is essential to understanding the process of hair loss. The initial growth phase of hair is called the anagen phase (2-7 years). In an adult, approximately 80 percent of scalp hair is in anagen phase. At this stage, the hair are in active growth and are sensitive to chemical and nutritional changes. Hence the importance of a balanced diet.

The next is the catagen phase (2 to 3 weeks) which is of shorter duration. Hair growth stops and the deepest part of the hair follicle becomes shorter, getting close to the surface of the scalp.

Finally, the hair enters the telogen phase (2-4 months), where it stops growing. An average adult has about 20% of scalp hair at this stage that culminates with hair fall. But before that happens, a new hair in the anagen phase usually begins to grow.

Male pattern baldness (Androgenetic Alopecia) affects approximately 50% of men during their lives. They have inherited sensitivity to DHT (dihydrotestosterone). High levels of DHT contribute to hair loss by interrupting the life cycle of the hair follicle in sensitive areas of the scalp. The front line is often the first area to be affected.

DHT has been associated with the shortening of the anagen or growth phase of hair. As a result, the hair does not reach full maturity and men appear in many areas completely bald scalp. Even today it is not clear exactly how the tendency to male pattern baldness is inherited. However, it seems that the old theories about the predisposition to male pattern baldness be motivated by a single dominant gene in men are incorrect and it is likely that multiple genes are involved.

Types of Baldness

Hair loss is classified according to the Norwood classification system ranging from Type I to VII.
Baldness Type I  : Type I has a hairline above normal or with a minimal loss in fronto-temporal region.

Baldness Type II : In the Type II loss in the hairline is already higher before as well as fronto-temporal region.

Baldness Baldness Type III and Type III Vertex : A of type III has two divisions: first, it shows a more pronounced loss in fronto temporal region and the  second is called a Type III Vertex , where there is a loss in fronto temporal as well as in the vertex region which is the most top of the head.

From there to the level VII hair loss will be accentuated further back, until the last degree when only hair on the back of the scalp are remaining.

Pre operative Preparation
Choosing to undergo Hair restoration surgery is a very personal decision. Your surgeon will present the information, explain the surgical strategy and answer all questions clearly. Pre operative photographs are taken from several angles. Photographs are high-quality, with close-ups so that the patient may see the frontal hairline.

Hair Restoration Surgery is performed in a clinic or a hospital setup under local anesthesia and sedation. Patients are asked to repost by 7:00 a.m.. The procedure can last from 4- 8 hours depending on the extent of transplant required. By 6 p.m. patients are discharged from the clinic. Patients are advised to fast the night before, because an empty stomach is a requirement. The anesthesiologist will meet with you in your room, and will ask specific questions. Photographs are taken for medical record keeping and, when all is set, the patient takes a sedative which causes a relaxed and comfortable feeling.
The FUT Procedure

In the surgical suite, an intravenous sedation is given. This is the safest and most controllable type of sedation, because the experienced anesthesiologist will know exactly what amount of medication to administer, to assure a light but safe sleep.

At the start of the procedure the patient is administered local anaesthesia (1% Xylocaine with adrenaline) at the proposed donor site with a very fine 26 guage needle. This aids in making the procedure bloodless and painfree for the patient.

The Operation
Recent research on the biology of the hair follicle has permitted the development of the "follicular unit transplantation" technique, where a single unit of hair is transplanted, avoiding the transfer of excess skin, which causes unnecessary fibrosis (scars and the "cobble-stone effect") in the recipient area. The transplanted hair will maintain its genetic characteristics, which means that this is a permanent procedure, with no risk of hair loss or rejection. It has been estimated that this technique
assures that follicular survival is over 90%.

Donor Strip Harvest - Under local anesthesia, a strip of hair-bearing scalp is removed from the back of the head (the donor area). Tricophytic closure is almost always done so as to leave a single, thin scar, which will be hidden inside the hair. These stitches are taken off after one week. The three commonly chosen sites are the midocciput over the protuberance, the supra-auricular point above the external auditory meatus, and a spot halfway between over the mastoid.

Graft preparation - The important step is the correct preparation of the grafts. The team of technicians, with the use of magnifying lenses and microscopes, separates the follicles into units containing one to three hair per graft.


Follicular unit Transplantation

The surgeon prepares the recipient area, where tiny holes are made with the help of 18-20 G needles so as to insert the individual grafts. Tumescent anaesthesia is used for pain relief as well as keeping the procedure relatively bloodless. This is a very dynamic procedure, requiring a large and well trained team. In this manner, it is possible to transplant over 1,500 grafts in a single session.

FUT surgical technique for hair transplantation should take into account the fact that follicles are very delicate, and therefore should be perfectly prepared and transplanted, so as to guarantee survival and, consequently, hair growth.

Post-op. recovery
Duration of surgery is variable, but a large session takes upto 5-7 hours. As surgery winds down, the sedation wears off, and the patient becomes awake, talking with the team.

A head bandage will be applied to protect the operated area and for comfort during the night. He or she will remain in the recovery room, a light lunch is offered, and 1-2 hours later patient is discharged. Ideally, there should be someone to accompany him or her home.

Follow up period
The patient returns the next day, when the bandage is taken off and his  head cleaned. Some swelling may occur on the 4th - 5th day; this is simply the infiltrated saline solution that was used for anesthesia. There is usually no post-operative pain. Patients must realize that an incision is placed in the back of the head, so some discomfort is to be expected. The sutures are removed after one week.

Permanent hair begins to grow after 3 - 6 months, and the patient will be able to appreciate the final result by one year post-operatively.

Currently, hair restoration surgery can achieve a high degree of natural result. The American Society of Aesthetic Plastic Surgery considered this procedure "the surgery of the decade", as it showed the most progress in the 1990's. It is one of the most frequently performed operations of an aesthetic nature. People are becoming aware that they no longer have to fear an artificial result, with the corn-row / doll's hair appearance.

Second Procedures

Some patients may need to undergo a second session. As long as there is donor area, a second session may be considered. This should not be done earlier than 9 months, allowing for complete healing from the first session. This 2nd stage will be either to cover areas that were not transplanted, or to increase density where hair has already been transplanted.

Factors affecting Density
The size of the donor site along with the hair density (hair/cm2) and diameter (microns) are the key factors in deciding whether or not the patient is a good candidate, as well as what kind of results should be anticipated. Hair diameter is the other major factor in determining the coverage achievable with a transplant. Besides density (hairs/cm2), hair volume plays a critical role. Hair volume (hv) is defined in the following formula:
hv = π(r)2 (h) (d) (a)

In this equation, r is the radius of the hair shaft, h is the hair length, d is the hair density (hairs/cm2), and a is the total area  covered (cm2). It is key to note that a doubling of the radius results in a quadrupling of hair volume, making hair diameter the most important single variable in the coverage achievable in a transplant.

Other factors that affect the final coverage include hair texture and hair/scalp colour contrast. Wavy, curly, helical, and spiral hairs improve coverage. A lesser contrast between hair color and scalp color improves the illusion of density. Gray hair on fair skin looks considerably denser than dark hair.

1. What Causes Baldness?
The most common cause is hereditary and men are more affected because the male hormone testosterone to DHT produces degraded being that acts by decreasing the presence of hair follicles.

2.Does the surgery really work?
Yes, the transplanted hair is removed from an area of the body (the donor) and transferred to another (receiving area). The transplanted follicles are not "rejected" because it is not foreign to the body.

3. How will my scalp be after surgery?
Small crusts form in the recepient area and disappear within 4 to 7 days. The washing of the scalp begins 48 hours after surgery, the crust points are removed from the donor area 10 to 12 days after surgery and are not visible, because the remaining hair will cover them.

4. I will be presenting a "doll's hair"?
No, because the technique is follicular unit hair transplantation,where single follicular unit are transplanted. “Dolls hair" happens when the technique of punch grafting is used when several (10-20) follicles are transplanted per hole.

5. Is the surgery painful?
Most patients are surprised how little this procedure is painful. Some discomfort is controlled with the use of common painkillers.

6. When can I return to work?
Depending on the extent of the procedure and the type of work involved you can return back to work 24 -48 hours after surgery. This will be discussed in the consultation.

7. Is surgery is expensive?
The hair transplant follicular units is more expensive than alternative treatments or a hair prosthesis. However considering the final outcome, most patients consider it a good  investment in your satisfaction.

8. How many sessions are needed?
The number of sessions depends on the area to be covered. In milder cases one session is enough. This  will be discussed during the consultation.