A hair transplant is a surgical procedure that treats baldness or hair loss by moving hair follicles from a donor site on the body to the balding area of the scalp. The hair transplant process is also known as hair restoration as it restores hair to parts of the body where it was lacking for a variety of reasons.
By far, the most common reason for hair loss in men and women is male and female pattern loss. Another term for this is androgenetic alopecia. There might be other causes such as scarring or trauma to the scalp like skin cancer surgery or an accident. Anything damaging to the skin can result in hair loss and can often be treated with a hair transplant.
There are some less common medical conditions like autoimmune types of hair loss or inflammation in the scalp resulting in hair loss. As long as the condition is under control and not active, the surgeon can transplant hair in order to thicken the affected areas.
The patient has to think about hair loss as a lifelong problem. Male and female pattern hair loss is genetic and something that progresses over time. If a 22-year-old guy is panicking because his hairline is receding, steps need to be taken to stop the hair loss. If steps are not taken to stop the progressive hair loss and he has extensive balding and a permanent hairline in place, the look may become unnatural if he has a transplant to restore his teenage hairline at such an early age.
Another example would be a 28-year-old guy with a bald spot on the back of his head. He gets the transplant and fills in an area the size of a fairly small circle on the back of his scalp. If he goes on to have hair loss around that area, there can be a problem where there is permanent hair and balding around it to create an unnatural appearance.
In the old days, plugs looked unnatural and there was balding around it. Thankfully, grafts are more natural looking these days.
There are two main techniques used for transplants:
1. Follicular Unit Extraction (FUT) – Hair naturally grows on the scalp in little clusters of one, two, three, and sometimes four hairs and that is a graft. The surgeon makes follicular units that are created exactly the way they grow in the scalp. The grafts are cut out of a strip of scalp from the back of the scalp and sutured or stapled shut.
2. Follicular Unit Technique (FUE) – In this case, rather than cutting everything out of the strip and then dissecting it down, each follicular unit is extracted one by one.
These are the two main types of procedures and one is not better than the other. The procedure used depends on a patient’s individual situation.
Since hair loss is progressive, many patients would benefit from a medical program to stop or slow their genetic hair loss. This primarily means one of two things:
1. Finasteride, which is an oral medication approved by the FDA for male pattern hair loss. It lowers the hormone called DHT which is responsible for shrinking the hair as people age. Most men stop losing hair and lot of men enjoy a little thickening.
2. The other option approved by the FDA is minoxidil solution. This is a topical treatment that does not work as uniformly as the finasteride. For many patients, it will have a thickening effect. The best approach is to use both of them in order to get better results than using either one alone.
No medical treatment is perfect and a small percentage of patients who take the finasteride pill may have side effects. Some of the patients who use the topical minoxidil get a topical allergy or irritation. These are not perfect but they generally work well for most patients.
There are other things that can be done as well such as PRP to get a thickening effect that is not permanent, but does extend the life of the balding hair. There is also low-level laser which some patients might benefit from using.
The number one limitation of hair transplantation is the limited supply of hair that can be transplanted. In other words, the demand may outstrip the supply of hair. This is why surgeons have to be very smart and strategic about planning hair transplants. Patient should first ask their doctor how many grafts they have available and the level of their donor supply.
It is possible to use body hair for transplants if the supply of hair on the scalp is running low. Some patients are a good match between their beard hair and their scalp hair so that opens up an additional source of grafts. There is also the possibility of using chest hair, leg hair, and back hair.
Using hair from other parts of the body is very specialized. Except for beard hair, the hair from the body has an unpredictable success rate. It appears that beard and scalp hair is very robust and spends most of its time in the growing phase. A lot of hair elsewhere in the body spends a lot of time in the resting phase so that could be a reason why its success rate is not as high. Anyone thinking about using body hair for a transplant needs to do research to find someone who really specializes in that area.
Scientists are working on research to actually clone hair. Over the last decade, it has been tried but the first generation basically failed when it went into human clinical studies. The work is great on mice but the first generation of cloning research did not work in humans.
There might be a treatment in the future that clones or multiplies hair. Ideally, a patient comes in and the doctor takes a small sample from their scalp and sends it to the lab. They grow the cells and get them to multiply. The lab then mails back syringes to be injected as needed. However, it is not available now and cannot really be incorporated into hair restoration planning.
There is a possibility of donor scarring. Any type of surgery will cause patients to scar. Normally it is very unnoticeable or undetectable, but everyone heals differently. The strip technique has a risk of a thin scar through the scalp that sometimes stretches depending on the patient. Even with the FUE or individual extraction approach, some patients heal with little white dots where the hair was extracted. If they wear their hair short, it might actually be noticeable. FUE is not without a scar. It basically makes little fine dots that are usually unnoticeable but, depending on the patient, they can be seen.
If the transplant is done in an area of thinning, as opposed to baldness where there is no hair, there is a risk of shock loss or the surrounding non-transplanted hair may shed. Some of it may shed in the weeks after the procedure as a result of the trauma in the scalp. Modern approaches with very small follicular unit grafts make this uncommon. They may look a little thinner but that hair will generally grow back when the grafts grow back.
One other risk is the growth of the grafts. Doctors try to get close to 100% of the grafts to take root and grow. It is a technical challenge in terms of not damaging these very tiny grafts so not everyone gets 100% growth. Little steps along the way can affect the survival and the take rate of the grafts.
With the strip technique, the incision with the stitches is generally completely hidden by the surrounding hair so the hair combs right over it.
Because of the need to shave, the FUE technique causes little scabs for a few days that will eventually turn pink. About a week later, the patient will see some scattered pink spots throughout the scalp but they heal quickly. On the top, it may look a little sunburned for a few days and then the redness fades away. The tiny little scabs are gone within a week.
Most patients take a week off of work and then feel comfortable being out and about without being very noticeable at that point. With both techniques, patients can wear a bald cap to hide things during the first week after surgery.
For the most part, transplanted hairs are permanent and not susceptible to genetic balding. However, as people get older, they have aging of the hair that is not related to pattern hair loss or genetic balding. Some people can see hair volume loss as early as their 40s or well into their 60s. Many women who go through menopause notice that their hair volume begins to thin.
When it comes to hair transplant and restoration, the surgeon needs to create a plan for the patient and their situation that involves medical strategies to stop hair loss and create something realistic that will look good for a lifetime.
Written by Cosmetic Town Editorial Team- MA
Based on an exclusive interview with Jerry Cooley, MD in Charlotte, North Carolina