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Hair Transplant Surgery

Hair-transplantThough hair restoration can be done medically (finasteride for men and minoxidil for men and women), surgical restoration in the form of hair transplant is the only permanent technique where hair follicles are removed from the individual’s permanent zone and transplanted in balding area or area of hair loss.

Hair loss & growth

As the hair follicles present in outer skin surface produce new hair cells made of protein called keratin, old cells are pushed out of the skin in the form of thin hair strands, made dead keratin cells (6 inches a year which can vary as people age). With hundred to hundred and fifty thousand hairs per average adult head, hair loss of 100 to 150 per day is normal and 90% of person’s scalp hair is always growing at any given point in time.

This hair growth is divided into three phases- Anagen (active growth phase lasting for 2-6 years), Catagen (transitional growth phase lasting for 2-3 weeks) and Telogen (resting phase for 2-3 months after which hair fall and is replaced by new hair).

Hair loss (alopecia) in male or female can be of many types: Involutional alopecia gradual thinning with age), androgenic alopecia (genetic condition affecting men and women), alopecia areata (starts suddenly, can cause complete baldness but 90% hair will return in few years), alopecia universalis (all body hair fall), trichotillomania (a psychological problem most common in children pull and eat own hair) and telogen effluvium (temporary thinning because of changes in growth cycle).

Non-hereditary causes of alopecia can be from poor nutrition or from medical conditions like thyroid, scalp infections and other skin disorders or from side effects of medicines used for cancer, arthritis, depression, high blood pressure and heart problems. It can also result from physical or emotional shock or hair pulling. Hereditary hair loss can result in ineffective hair growth resulting in shortening of growth cycle until no growth at all.

Male pattern baldness:

Male balding pattern baldness (MBPB) also called as common baldness, is the most common cause of alopecia in men and mostly due to inherited or genetic trait. Extent of the baldness depends on the age at which the balding pattern started, resulting in extensive baldness with early onset of age.

When hair is exposed to Dihydro testosterone (DHT) for longer periods, the hair dies resulting in premature hair loss. When hair loss gene gets activated early in life, at 20’s, the concentration of DHT is higher resulting in faster hair loss compared to the gene activation in 50’s when the hair loss is gradual due to low concentrations of DHT.

Female Pattern baldness:

Female hair loss can happen at the age of 50 or later and generally occur in more than one pattern. It is important to recognize if it is temporary or a permanent loss and a self-diagnosis is more effective. 

What can you expect from Hair Transplantation?

The recipient (transplanted) of hair behaves in a similar manner to the donor hair which means, it can be cut, shaved, shampooed and do not need any medicines to grow back. While the normal scalp contains more than 80 follicular units per square centimetre area, the implanted area, for a natural look, should contain at least more than 40 follicular units per square centimetre and this can be attained by dense packing technique.

If the area to be covered is large, multiple sessions are required. Based on the number of grafts in a single session, the session can be called as a Mega Session (transplanting >2000 follicular units) or Super Mega Session (transplanting >2800 follicular units) or a Giga Session (>5000 follicular units transplanted) which need high well trained surgical assistants in centres with latest equipment.

These can be achieved by two techniques: Follicular Unit Transplantation (F.U.T) or Strip Method where, as much as >5000 follicular units can be transplanted and stitch less Follicular Unit Extraction (F.U.E) that is good for covering smaller areas. The recent revolutionary method is the Long Hair Transplantation (L.H.T) where the qualified person need not wait for 8-12 months to see the results. Although the F.U.T method can leave a scar in donor area, the latest closure techniques like trichophytic closure minimizes the scar.

Surgical candidates

To prevent further progression of baldness and also to promote hair growth, the younger patients in early stages of baldness can be generally treated medically to some extent. Even though there is no cut-off age limit for hair transplantation surgery, based on the psycho-social obligations like marriage, depression, etc, medically fit younger patients are sometimes recommended for the same.

Outcome is measured by the donor area size and quality, which further depends on follicular unit density (> 80 units per sq. cm), hair shaft thickness, nature of hair (curly is better) and scalp laxity. Surgical candidates must be devoid of any medical contraindications, bleeding disorders or abnormal keloidal tendency.

Post Procedure

Done under local anesthesia, you are conscious and can talk to your doctor during the procedure and go home the same day. You can shampoo the hair immediately next day and it takes one or two months for full growth. The hair transplantation is mostly painless now-a-days. Pain killers are needed for 5-6 days in strip method, while the stitch less FUE technique is a painless technique without any resultant pain after the procedure. 

Transplanted hair is generally lost in  2-6 weeks after the procedure, and then in 3-8 months, the hair starts to sprout from the transplanted roots. Within 10-12 months after the procedure hair growth is full. Keratin treatments begin 2-3 weeks before the procedure and one week after the procedure, hair loss is reduced and thereafter the re-growth of transplanted hair happens.

After the full re-growth, quality of hair transplant surgery can be easily assessed by looking at the natural appearance of the transplanted grafts, hair density, hairline design and un-detectability of the post-operative scar. The orientation of the fully grown transplanted hair mimicking the original hair, will decide the quality of the surgery. A pluck test will assess the start of post-surgical hair loss. Normally, when 50 hairs are plucked with rubber tip surgical clamp, 90% pulled hair bulbs depth average 4mm and the rest 2mm. But if > 20% hair bulbs are 2mm depth, it the beginning of hair loss.