Surgical procedure in which the hairs can be transplanted from one part of body or head to another part of body or head where the area is bald or hairline is regressed

Hair loss represents a distressing issue affecting a large portion of the population, including up to 85% of males and 40% of females, and its incidence increases with age for both sexes. Though many causes of hair loss exist, by far the most common etiology is androgenic alopecia (AGA), an androgen-sensitive pattern of hair loss that affects both men and women. Indeed, non-surgical modalities exist which may halt the progression of androgenic alopecia and even help grow new hairs (i.e., minoxidil, finasteride, dutasteride, low-level laser light therapy, platelet-rich plasma, adenosine, ketoconazole) Nevertheless, ¬recent advancements in surgical hair restoration have made hair transplantation (HT) an increasingly effective, safe, and reliable way for patients distressed by androgenic alopecia to regain a more youthful and natural appearance of their hair.

Androgenetic alopecia (AGA) – the most common etiology of hair loss where in androgenetic effects, namely testosterone and dihydrotestosterone (DHT), disrupt the growth cycle (the anagen to telogen ratio decreases). Hallmark characteristics of AGA include thinning and subsequent miniaturization of terminal hairs to vellus hair

Donor site

The non-alopecic areas (not influenced by androgenic alopecia) where donor terminal hairs can be harvested for implantation. The safe donor site of the scalp lies in the mid-occipital region between the upper and lower occipital protuberances. In general, there are 65 to 85 FUs per square centimeter (cm) in the occipital donor scalp. Of note, hairs are finer in the inferior portion of the donor area and coarsest at the superior margin. The donor site represents the primary limiting factor in hair transplantation, regardless of the technique employed. In general, harvesting more than 15 to 20 FU per squared cm is ill-advised, as this may cause donor site thinning. NOTE: If necessary, the parietal scalp, submental region, chest and other parts of the body may be used as donor sites, though data regarding efficacy is limited and the hair characteristics can be very different from scalp hairs.

Good candidate for Hair transplantation

Identifying appropriate candidates for hair transplantation includes an evaluation of the following

• Diagnosis: Fortunately, diagnosing androgenic alopecia is relatively straightforward and based upon the characteristic pattern of associated hair loss (Norwood for males, Ludwig for females), the miniaturization and depigmentation of hairs, and the lack of clinical inflammation. If these features are not present, further evaluation (i.e., laboratory, histopathology) may be warranted.
• Age : The HT surgeon should only operate on patients older than 25 years of age because future hair loss pattern is less predictable and expectations are generally more unrealistic in patients younger than 25 years old.
• Hair Caliber : Mathematically speaking, hairs with larger shaft diameter provide exponentially more surface area coverage; therefore, patients with thicker-caliber hair can expect to obtain much denser coverage (better aesthetic results) versus patients with thin-caliber hair (when controlled for the number of follicular units transplanted).
• Donor Hair Density : Patients whose scalp donor sites have greater than 80 FUs per squared cm are excellent candidates. Those with donor hair density less than 40 FUs per squared cm are considered poor candidates for HT, and the clinician needs to set patient expectations accordingly.
• Degree and Pattern of Baldness : Patients hoping to correct frontal baldness can expect the most dramatic results in appearance, and thus represent great candidates. Grafting only the scalp vertex should be avoided if possible, as this not only consumes potential future donor grafts but also may cause a “doughnut” appearance as hair loss progression continues. The surgeon must reiterate that concentrating grafts in the frontal scalp will provide the maximum long-term density and minimal aesthetic risk.
• Hair Color : In the light-skinned individual, patients with light-colored hair (i.e., blonde, red) are preferable to those with black hair since the color contrast between hair and skin is less noticeable.
  NOTE: Proper technique helps mitigate most problems with transplanting dark-haired patients.
• Patient expectations : Patients with realistic expectations and a history of compliance with hair loss medications/treatments (i.e., minoxidil, finasteride, platelet-rich plasma) represent ideal candidates. The patient must also understand the need for a conservative approach when recreating the anterior hairline so that it will have a natural appearance that lasts. Lastly, multiple hair transplantation sessions may be needed to achieve the desired results.

Types of hair transplantation techniques

Follicular unit transplantation (FUT)

Follicular unit extraction (FUE) techniques.

Currently, FUE represents the more common approach due to its potential advantages over FUT

Types of hair transplants

There are two types of transplant procedures - Slit grafts and Micrografts
Slit grafts contain 4 to 10 hairs per graft.
Micrografts contain 1 to 2 hairs per graft, depending on the coverage needed.

Who might undergo hair transplantation?

Receiving a hair transplant can improve your appearance and self-confidence. Good candidates for a hair transplant include:

• Men with male pattern baldness
• Women with thinning hair
• Anyone who has lost some hair from a burn or scalp injury

Hair replacement isn’t a good option for:

• Women with a widespread pattern of hair loss throughout the scalp
• People who don’t have enough “donor” hair sites from which to remove hair for transplant
• People who form keloid scars (thick, fibrous scars) after injury or surgery
• People whose hair loss is due to medication such as chemotherapy

What happens during a hair transplant?

After thoroughly cleaning your scalp, a surgeon uses a small needle to numb an area of your head with local anesthesia.
Two main techniques are used to obtain follicles for transplantation: FUT and FUE.
In follicular unit transplantation (FUT):

1. The surgeon will use a scalpel to cut out a strip of scalp skin from the back of the head. The incision is typically several inches long.
2. This is then closed with stitches.
3. The surgeon next separates the removed portion of scalp into small sections using a magnifying lens and sharp surgical knife. When implanted, these sections will help achieve natural-looking hair growth.

In follicular unit extraction (FUE), the hair follicles are cut out directly from the back of the head through hundreds to thousands of tiny punch incisions.

1. The surgeon makes tiny holes with a blade or needle in the area of your scalp that’s receiving the hair transplant. They gently place hairs in these holes.
2. During one treatment session, a surgeon may transplant hundreds or even thousands of hairs.
3. After, the graft, gauze, or bandages will cover your scalp for a few days.

A hair transplant session can take 4 hours or more. Your stitches will be removed about 10 days after surgery.

You may require up to three or four sessions to achieve the full head of hair you desire. Sessions occur several months apart to allow each transplant to fully heal.

What happens after a hair transplant?

Your scalp may be sore, and you may need to take medications following hair transplant surgery, such as:

• pain medication
• antibiotics to reduce your risk of infection
• anti-inflammatory medications to keep swelling down

Most people can return to work several days after surgery. It’s typical for the transplanted hair to fall out 2 to 3 weeks after the procedure. This makes way for new hair growth. Most people will see some new hair growth 8 to 12 months after surgery. Many doctors prescribe minoxidil (Rogaine) or the hair growth medication finasteride (Propecia) to improve hair regrowth. These medications also help slow or stop future hair loss.

Frequently asked questions about hair transplants

Is a hair transplant painful?

The good news is, no — a hair transplant is not painful. At the time of the procedure, the area of your scalp that the surgeon will be focusing on will be numbed with a local anesthetic, so while you may feel a little pressure or movement sensations during the procedure, it shouldn’t be painful.

But like with most postsurgery recovery, you may experience discomfort or pain at the incision points as your body starts to heal and recover. Your medical team will likely discuss the best ways to manage pain and other ways to minimize the risk of negative side effects or reactions.

Is it worth getting a hair transplant?

A hair transplant is a good option for people who can afford the high cost of the procedure and haven’t found success from treatments like minoxidil or Rogaine. Hair transplant surgery is relatively low risk compared with other surgeries, but it isn’t without risks. There is also always the possibility that your hair regrowth may be minimal

A hair transplant is a good option for people who can afford the high cost of the procedure and haven’t found success from treatments like minoxidil or Rogaine. Hair transplant surgery is relatively low risk compared with other surgeries, but it isn’t without risks. There is also always the possibility that your hair regrowth may be minimal