Hair Replacement

It is important to understand that all hair replacement techniques use your existing hair. Hair replacement candidates must have healthy, dense hair growth at the back and sides of the head to serve as donor areas. Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result. There are a number of techniques used in hair replacement surgery. Sometimes, two or more techniques are used to achieve the best results.

Transplant 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. There are limits to what can be accomplished. An individual with very little hair might not be advised to undergo hair replacement surgery.

 HAIR LOSS IN WOMEN

One in five women will experience some degree of hair loss usually caused by aging, illness, or hormonal changes after menopause. Women tend to experience a subtle thinning all over the scalp rather than losing hair in patches as is common in men. To correct the problem, some women choose to wear a wig or hair extensions. Others have had some success using a topical prescriptive drug. The effectiveness of such drugs varies in some patients and simply prevents further hair loss without stimulating any appreciable new growth. Hair replacement surgery may be the answer for those who feel uncomfortable with either of these options.

THE PROCEDURE

Hair replacement surgery, no matter what technique is used, is usually performed using local anesthesia along with sedation to make you relaxed and comfortable. General anesthesia may be used for more complex cases involving tissue expansion or flaps.

Hair 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 to 10 hairs each; strip grafts are long and thin and contain 30-40 hairs.

Generally, several surgical sessions may be needed to achieve satisfactory fullness with a healing interval of several weeks is usually recommended between each session. It may take 12-15 months 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 100. For mini-grafts or micro-grafts, the number can be up to 1000 per session.

To 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. Great care is taken 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.

OTHER TECHNIQUES IN HAIR RESTORATION

In recent years, plastic surgeons have made significant advances in hair restoration using a variety of other techniques which may provide better coverage of the crown and hairline as well as more natural hair distribution.

Tissue Expansion: Plastic 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.

Flap surgery: Flap 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.

A 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 supply. As 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 incision.

Scalp reduction: This 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. Scalp 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. The skin surrounding the cut-out 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.

WHAT WILL MY RECOVERY BE LIKE?

How 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. If 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. You may be instructed to avoid vigorous exercise and contact sports for at least three weeks. You may feel well enough to go back to work and resume normal, light activity after several days. How soon you resume your normal routine depends on the length, complexity and type of surgery you've had.

Many 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.

 FOLLOW-UP PROCEDURES

You 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.