Hair transplantation has acquired the position of most popular and widely accepted technique of hair restoration. It is a widely practiced aesthetic surgery across the globe driven by steady improvement in technology which is reflected in the results. With recent advancements in equipment and development of techniques such as follicular unit extraction, the procedure has gained a new height in terms of acceptance and popularity. The ability of procedure to provide nearly natural-looking and naturally growing hair has encouraged larger number of balding men and women to opt for this solution.
Hair transplant has established the field of hair restoration as a most exciting, innovative and popular aesthetic procedure in contemporary world.
A precise anatomy of hair around its root allows the use of its follicular unit for hair restoration. With better methods of harvesting, implantation and obligation to give an appearance of nearly natural hair, hair transplantation has evolved as an amalgamation of art and science.
The scientific principle that works behind hair transplantation surgery is that when a graft is taken from baldness resistant area (donor area) like side hair and at back of head and implanted to bald area it will grow in new area naturally after initial period of effluvium. Usually, hair the back of head is selected as donor hair as grafts here are more densely packed and are genetically stubborn to resist the effect of male pattern baldness. After an initial period where some hair might fall out, rest will continue to grow as it normally would have.
There are two techniques that are popular worldwide. The first is the Follicular Unit Transplant abbreviated as FUT and also called as strip technique and second is Follicular Unit Extraction abbreviated as FUE. There are also some modified techniques that are also practiced by clinics world over but the main and base techniques are FUT and FUE.
The follicular unit called graft contains 1–4 hair follicles, terminal hair follicles, one (or rarely two) vellus follicles (smaller, less developed), related sebaceous lobules (oil-producing glands), insertion of erector pili muscle (muscles that make hair stand up), perifollicular neurovascular network and other components make up the follicular unit known as a graft. Follicular unit is a collection of hair shafts that comes out from the scalp. Follicular units are collections of hair shafts that emerge from the scalp and have a closer spacing between them than the nearest collection of hairs. While harvesting, dissecting, and transplanting hair to ensure maximum efficiency and to give a natural appearance to the patient’s hair.
Grafts that are taken from body parts other than from head are termed as body grafts. Body grafts is majorly consist of terminal hair. Terminal hair is androgen-dependent, male-type hair on the face (mustache, beard, and sideburns) and on the body (chest, axilla, linea alba, pubic area, arms, inner thigh and legs). These grafts are used when the patient don’t have enough grafts at head to fulfill the requirement.
Planning of hair transplant is the most crucial phase among the different steps of the procedure. In the first step, the reason behind the hair loss is determined. A detailed family history of hair loss is examined to understand the cause and plan the procedure accordingly. After a complete investigation, the plan is prepared along with the hairline design as per the baldness pattern and requirement. The planning of the hairline is one of the most important steps that should be plotted according to requirements to match a natural hairline. The shape of the hairline varies from person to person according to the shape of the face as some people have round, oval, or triangular shape faces. Sometimes the patient’s desire and constraint also influence the shape of the hairline. After considering all these factors the hairline is drawn on the head.
A hair transplant is an aesthetic procedure so the result of the procedure should enhance the look of the person as the foremost requirement. Every graft is planned meticulously. The single hair grafts are used to create a frontal hairline to give a natural appearance. The frontal hairline is the most exposed to visibility; its appearance reflects the quality of work of the team.
To design an ideal hairline for the patient, it is required to divide the face into three parts. In the midline, the hairline is drawn at a distance that should be at least 8 cm from the glabella. Due to the top head's oval form, a curve extends from the center to the lateral side of the forehead. The sides of the hairline should be lined up with the bend at point. The lateral hairlines are made generally 8–10 cm above the lower part of a well-shaped eyebrow or 9.5 to 11.5 cm from lateral canthus in vertical measurement. At temple the hairline is given a right angle or acute angle to match with natural temporal angle in case of men where as in case of women these angles are made more circular. Typically 450–900 single follicle grafts are required to create a new hairline in any individual. These single follicle grafts in the hairline are placed in zig zag pattern of small and big uneven pattern to give a natural look. Behind the hairline, two-hair grafts are used to provide further line of hair. Three or four hair grafts are used just further behind. To give good density and natural hair growth to bald recipient areas punch of 0.7 to 1.2 mm in diameter are used. The use of smaller punch is especially important when the quality of the hair and skin is less ideal. Punches with a circular point hollow needle benefits in removing a circular tissue of bald area where the grafts will be placed.
Removal of the tissues using punches for the purpose of insertion of the grafts is a very focused and skilled process. The punches be used in the bald area, and should be stay away from the areas where hair is already present as punching can destroy the roots of existing hair that may result in adverse result.
Before the procedure the patient are advised to discuss all the preoperative precautions and preparation in detail so that everything go smoothly during and after the procedure. Some of the instructions that one must follow are summarized as:-
There are a few medical tests that are needs to be done before the procedure. There are particularly two reasons that these tests are advised. It is obvious that some blood tests are needed before every surgery to know the general well-being of the patient and also to see whether the bleeding and clotting profiles are normal.
Some routine blood tests are needed, including:-
These normal tests are performed to rule out any unwanted medical condition that could appear during or after the surgery. It is not necessary that everyone to get these tests done. The number of tests they should go through depends on the advice of the doctor.
The second category of blood tests is to investigate the cause of hair loss which may include Serum iron/ferritin profile, Thyroid profile, some tests regarding hormones, and some blood tests that may be required for auto-immune diseases.
Donor area is first prepared to carry out the procedure under the effects of local anaesthesia, a specific type of numbing medication, to make the entire treatment painless. 1mL of adrenaline (1:1000) is mixed to 30 mL of 2% lignocaine and 100 mL of normal saline to create a local anaesthesia solution.
Once the hair at back of the head (donor area or occipital region) is trim to a length of 2-4 mm, the local anaesthesia solution is administered slightly below the donor area. After that, tumescent is injected across the donor area to cause tumescence. The donor area is turgid at the end of process because this gives great anaesthetic and minimizes bleeding after 10 to 20 minutes for complete haemostatic action. Overall, by using local anesthesia and injecting the tumescent solution, the procedure becomes painless and reduces bleeding.
The preparation of recipient area includes the making the hair line followed by the applying the local anesthesia at the recipient area.
Anesthetization at the recipient area is planned and executed first at supratrochlear and supraorbital nerve block, followed by a ring block in the frontal area outside the zone of hair transplantation and infiltration in following ways:-
Once the local anesthesia numbed the recipient site the process of slits or holes creation begins. To minimize bleeding and pain, it's important to make sure the area where the hair is going to be transplanted is turgid before creating the slits or holes. For giving a natural appearance to the transplanted hair it's crucial to follow the direction of the existing hair while making the slits or holes. The hairline too should have a natural appearance. Hairline is designed unevenly with zig-zak style. The holes are made using a specific type of needle, and around 350-700 small grafts are needed to create a normal hairline. Behind the hairline, slits can be made using specially designed needles, a knife, etc.
It is very important for the doctor to know the history of hair loss treatment or hair transplant done by the patient in the past.
It has been observed that patients who have had previous hair transplant procedures or have been using minoxidil lotion or a like medicine may experience increased bleeding in the area under transplantation. Using a good amount of fluid and waiting for 10-15 minutes before creating holes can help reduce this bleeding. In secondary procedures, creating holes in the recipient area may be more difficult due to scar tissue from previous surgeries.
It is imperative for the doctor to confirm through pre-surgery medical tests whether the patient is allergic to local anesthesia or not.
It is the first, a well-established and effective method for addressing hair loss concerns in both men and women. It is pioneer technique that became popular world over and still widely practiced.
Grafts Harvesting in FUT : At very first step of graft harvesting a strip of skin having required grafts from the donor area is surgically removed. This region is carefully selected because it typically contains genetically resistant hair follicles that are not prone to balding. The procedure is performed under local anesthesia to ensure the patient's comfort.
The surgeon uses a scalpel to remove a thin strip of the donor scalp. The size of the strip may vary depending on the patient's specific needs and the surgeon's expertise. Special attention is paid to minimize damage to the surrounding hair follicles. Once the strip is removed, the wound is carefully sutured, leaving a linear scar that is well hidden by the surrounding hair. The sutures used are typically absorbable, so there's no need for suture removal later.
Graft Separation and Preparation: After harvesting the strip, the next step is to separate and prepare individual hair follicular units from the strip. This is an important and delicate process that requires precision and skill.
The strip is divided into small sections under the microscope. Each section contains one or more hair follicular units, which may include one to four follicles. Careful dissection of these follicular units results in high graft survival rates.
The grafts are then sorted according to their size, number of hairs, and overall quality. This sorting helps in planning the placement of grafts according to their size and suitability for placement.
Graft Insertion: After the graft is prepared and sequenced, it is now time for the final step which is graft insertion into the recipient area. The surgeon makes small incisions in the recipient area, carefully considering the direction and angle of existing hair growth for a natural-looking result. The grafts are then placed delicately one by one in these incisions.
The placement of grafts requires a keen eye for aesthetic detail, as well as an understanding of hair growth patterns. The surgeon strategically places single-hair grafts in the front hairline for a soft and natural appearance and uses multiple-hair grafts for density in other areas.
FUE (Follicular Unit Extraction) is an innovative technique that was developed after FUT. It has transformed the field of hair transplant. It offers a minimally invasive and highly efficient way of hair restoration. Unlike the conventional FUT method, FUE involve the extraction of individual hair follicular units directly from the donor area. Let us find out the two primary steps involved in the FUE technique which are graft harvesting or extraction and graft insertion. Entire procedure is done under local anesthesia.
Graft Harvesting or Extraction: At the very first step graft harvesting, also known as extraction is done. To ensure the survival and viability of the hair follicular units, the procedure needs to be executed with accuracy and careful attention to detail. First, the donor area is shaved to allow easy access to the hair follicles. An extremely small hand-held tool known as a microneedle or punch tool is used by the surgeon to remove each individual hair follicular unit one by one. Depending on the qualities of the hair and the surgeon's discretion, the size of these punches varies; normally, they have a diameter between 0.6 mm and 1 mm. The extraction process involves carefully working around each hair follicle to avoid damaging the surrounding tissue. Extracted follicular units are preserved in specific solution. FUE grafts are kept healthy and alive, until the transplantation process begins.
Graft Insertion: After the grafts are extracted, the next step is the insertion into the recipient area. The surgeon creates tiny incisions in the recipient area using fine needles or blades. The size, angle, and direction of these incisions are made to mimic the natural hair growth pattern. Once the incisions are crated, One by one, the surgeon delicately places the harvested hair follicular units into these incisions. The process requires an artistic eye and an understanding of hairline design which is crucial for a successful hair transplant. The meticulous attention to detail ensures that the transplanted hair will grow harmoniously with the patients existing hair.
After the completion of the procedure, the patient is discharged on the same day and can positively go back home.
A simple bandage is applied over the donor site which is removed after 2-3 days or during dressing as required. The bandage must also be removed with great care as the unhealed donor area and recipient area may be inadvertently damaged, causing injury.
Once the hair transplant is done, the process of hair growth starts in sequence. Within few days scabs appears on the transplanted area. The scabs are result of drying of the epidermis, dermis, shaft outside the skin and dead skin layer surrounding transplanted grafts. Scabs fall within the 2 to 3 weeks. Only the follicles remain inside the skin and go into a resting phase. It takes nearly 3 months to new hair appears growing after hair transplant. It generally takes 6 to 9 months for the hair transplant results to be fully visible. If a second sitting is planned, it should take place at least 3 to 6 months after the first sitting.
One may get less dense hair after the growth of transplanted hair in complete bald area and second sitting may be planned for improving the density. It is often seen that using 5% minoxidil in men and 2% in minoxidil in women after the procedure helps in growing hair early and fast.
There is very few and rare chances that a patient develops any kind of severe complication like any infection after the procedure. Some patients who have had the procedure performed with the FUT technique may experience hypoaesthesia of the scalp in the donor area. It is usually temporary, but in some cases, the patient may experience it comparatively for a longer period of time.
Infections in the recipient areas are rarely severe. Around the sutures, there may be a mild infection, but it often goes away quickly when the sutures are removed. Epidermal cysts are occasionally visible and require draining. It's crucial to avoid over-harvesting the donor area because strain on the suture line can result in dehiscence and a noticeable scar.
There are no doubt that hair transplant is most viable option for hair restoration when this technique is utilized prudently. It is a team work because it involves many steps and each step needs special skill to be performed. Entire process cannot be performed by individual. To obtain optimal result from the surgery, each step must be performed with accuracy and mimic the natural style of hair growth. The doctor, the team and the patient should be in comfortable situation at physical as well as mental level at the time of the procedure. There must be proper lighting in the operating room as well as team should use latest and high quality instruments. The comfortable environment in the operating room is beneficial for both the patient and the procedure team.
Availability of visual entertainment, music and magazines of interest break the monotony of the room.
It's crucial to keep in mind that if the procedure go erroneously, the patient's life could get worse. Transplantation can be immensely gratifying for both the patient and the clinician if done carefully.
Hair transplant procedure is also quite effective in re-growing hair on many different parts of the body. Let's explore the realm of these techniques and see how they can effectively alter one's appearance and self-confidence. These sites are:-
Hair transplants is not confined to restore hair at scalp only but also used for restoring hair at variety of body parts like eyebrows, eyelashes, beards, scars, and mustaches, in addition to restoring the scalp. Numerous people have gained new confidence and the ability to embrace their ideal appearance.
If you are considering any of these procedures, we would recommend you to consult our panelist doctors. Our doctors analyze your specific needs, consider potential results, and guide you through the process.