Techniques of Hair Transplantation

Hair transplantation surgery has improved in leaps and bounds over the past decade. Reconstructing a new hairline is an art requiring surgical as well as artistic skills. It is critically important to get it right the first time and thus requires considerable forethought and planning.

History

Hair transplantation is an operation that takes hair from the back of the head and moves it to the area of hair loss. The fringe (back and sides) of hair on a balding scalp is known as donor dominant hair which is the hair that will continue to grow throughout the life of most men. This hair retains its characteristics of growth after it is transplanted to the bald area. Donor dominance (of hair from the back and sides of the head, which continues to grow throughout life) is the scientific basis for the success of hair transplantation. Dr. Okuda of Japan first described the use of transplanted hair to repair scarred eyelashes and eyebrows. Dr. Norman Orentreich published the first widely read report on hair transplantation surgery in 1959 and the field of hair transplant surgery was born.

Candidates for hair transplant surgery

Those individuals with hair loss that have sufficient donor hair from the back and sides of the scalp to transplant to the balding area are eminent candidates for hair transplantation. In the past, many bald patients were not suitable candidates for hair transplant surgery but modern techniques have advanced the art of hair transplant surgery so that many more men are candidates.

Techniques of Hair Transplantation

There is different terminology for techniques used by many hair restoration surgeons of AHRS-India and those around the world.

The techniques in short are:

• Punch grafting – The days of the "paddy" or “toothbrush” appearance, which were a consequence of punch grafting of some years back are gone. (Beware!! since some physicians still have not done away with the old and ugly technique of punch grafting. Therefore the importance of asking the doctor in detail about the procedure as advised by our website)
• Single hair-grafts have the finest and softest appearance. Although they do not provide much density, they do provide the critical soft hairline that is the transition to thicker hair.
• Mini- grafting/Micro-grafting - Examining the hairline of a nonbalding person will show the presence of numerous single hairs in the very frontal hairline. Micrografts are small grafts containing 2-3 hairs that are placed behind the hairline to provide a gradually increasing hair density.
• FUT Follicular Unit Transplantation by Strip Graft or FUE - With each passing day, international consensus is shifting from single hair transplants to “Follicular Unit” Hair Transplants due to better results. The natural follicular units having 1,2 or 3 hair are preserved and implanted as they occur in nature. Through the use of natural hair units along with new and improved instrumentation, the accomplished hair transplantation surgeons can create a natural hair appearance that is appropriate for each individual patient.
  The commonest state-of-the-art procedure today can be done by the strip method or by FUE or Follicular Unit Extraction. The strip method utilizes a strip of skin from the back of the head from which grafts are dissected out under high magnification and the donor area is closed by a ‘stitchless technique’. Upto 3000-5000 grafts can be placed in a one day session of 5-6 hours utilizing this technique. The technique is more affordable and is meant for people requiring large areas to be covered. FUE, which is costlier, can be used for those who need 500-700 grafts in one sitting. FUE demands the skill to follow the direction of the follicular unit and the hair roots below the skin. Diverging hair roots in follicles having 2 or 3 hair may get transected at various angles. Weak roots may break while being pulled off after coring out the skin. Thus now there is a FUE test to decide the usefulness of the procedure. After first 10 extractions if four or more are incomplete.
  the candidate is termed as FUE negative and better offered a strip method which will preserve follicles and increase the yield. Also large number of FUE grafts harvested tend to transgress out of the zone of non sensitive or permanent hair and end up being taken from the sensitive or temporary hair area. These follicles extracted from outside the permanent zone are sensitive and can fall off in the next few years. Each site of extraction leaves a 2 – 4mm scar. When large numbers of FUE are harvested the scars can be seen through short hair. The scars may hypertrophy or stretch over time and look larger and raised making them obvious to people around. Otherwise, essentially, both the techniques are the same as both use intact natural follicular units for transplant
• Tissue Expansion & Flap Surgery- In cases with burns where good quality skin is not available, surrounding skin can be recruited by the technique of “Tissue Expansion” or by “Flap surgery”. However, these techniques may be used by some surgeons but do not give results superior to “Follicular Unit Hair Transplantation” in Hair Loss other than in burns.
• Megatransplants - Hair loss, however, is a life long process, most men will develop male pattern baldness (due to male hormones) until approximately 40-45 years of age. After that, the ageing process thins the entire head of hair. Progressive hair loss or the desire for more density, will require more transplant procedures. Modern techniques, however, allow hair transplant surgery specialists to transplant larger number of grafts, greatly reducing the number of procedures needed to complete the result.

Side Effects of Hair Transplantation:

The side-effects of hair transplantation surgery are relatively minor consisting of mild pain and discomfort after the operation, swelling which may move down to the eyes, and the formation of scabs over the grafts which take approximately one week to resolve. Serious problems of bleeding, scarring, and infection are rare. Modern hair transplantation surgery is comfortable, predictable, and the results are pleasing to most patients.