WHAT IS HAIR TRANSPLANT?
Hair transplantation is the most frequently performed plastic surgical operation on men. Several thousand hair transplantations are made every year in Greece, and the interest towards this procedure is ever increasing.
The essential idea of this procedure is to harvest hair follicles from the back of the head, where the hair is thicker, and transplant them in the frontal area, where it is thinner or completely lost.
Hair transplantation is aimed at dealing with male pattern baldness only, wherein there is fairly thick hair at the back of the head and extensive thinning or complete loss, at the front and top. The follicles of the hair are simply moved to a new position, similar to a plant being dug up from one spot and replanted somewhere else. The follicles will continue to produce hairs in their new position in exactly the same way as they did in their old position.
Precisely because the hairs will continue to behave in the same way, maintaining all their properties from their older position, they also maintain their tendency not to fall out when transferred to their new position. As such, the results of transplantation are permanent. The hairs will grow normally, as they did in their previous position. Many patients may wonder how it can be guaranteed that the newly placed hairs will not fall out, like the original hair in that area. The answer is that hair loss is not caused by a property of the area, but by properties of the hair follicle itself. Hair in the frontal area of the head is more sensitive to hormonal triggers, whereas the hair on the back of the head isn’t. As such, by transplanting hair follicles from the back of the head, we are also transplanting their endurance against hormonal influences.
The patient’s consultation should be done by the same surgeon who will be performing the transplantation. It is the norm in most hair transplant clinics for others to conduct the briefing, rather than the surgeon themselves. Each medical practice must begin with thorough consultation, before moving onto the correct application of the treatment and finishing with close follow up.
Only the plastic surgeon is qualified to evaluate the particularities of each procedure, and, most importantly, to decide which cases are eligible to undergo a hair transplant and which are not. Not all patients are suitable for this procedure.
The surgeon must analytically explain each detail of the procedure to patient, so that they may together select the method that will be applied, as well as the areas wherein the transplants will be placed.
The patient will have to be informed of each method’s pros and cons. A thorough briefing is fifty percent of a successful operation; the remaining fifty percent is the operation itself.
HAIR TRANSPLANTATION: THE PROCEDURE
As we have mentioned before, the procedure entails the collection of hair follicles and its implantation in areas suffering from hair loss. The collection is performed on the back of the head, where the hair is thicker. There are two main methods of transplanting hair, as far as the method of collection is concerned.
• THE STRIP METHOD: This method requires the collection of an intact graft, i.e. an entire section of hairy tissue from the back of the head, which is then splint into smaller micrografts. There will be no gaps left in the area, as what gap does appear will be sutured.
• THE FUE METHOD: In this method, the smaller micrografts are obtained individually from the back of the head. These are then briefly processed, and implanted in the frontal area of the head.
Neither method can be considered better or worse. The doctor, along with the patient, will simply have to determine which is the most recommendable method for their case.
THE NATURALISM OF THE RESULT
There are two main parameters which determine the success of a hair transplant. The first is the naturalism of the result, and the second is thickness.
In many cases, the two can contradict each other. The methods that achieve the most natural-looking result yield hair with less thickness, and vice versa. Our aim is to achieve both. The naturalism of the result depends on a number of factors, such as how thin the implants are, the angle in which they are placed, the design of the frontal hairline, etc.
In particular, the frontal hairline should be drawn in such a way as to be identical with a natural, male hairline. In addition, the implants should not be arrayed in a straight line; the progression from clear forehead to the hairy area should be gradual. Results that feature hairlines conforming to a straight line appear most unnatural.
The angle of the hair follicle in relation to the skin is also quite important. Careful observation of a regular head of hair will reveal that this angle differs from area to area. This must be replicated when transplanting hair.
As far as the size of the implants is concerned, we must consider that the human eye is not accustomed to seeing hair grow in clusters, but rather individually. For this reason, in particular around the hairline, each implant must be very thin, containing only one or two hairs at most. Thicker implants create an appearance similar to ‘doll hair’, which of course appears completely unnatural
The more we progress further back from the hairline, however, the size of the implants should increase, in order to balance naturalism with density. In this way we can satisfy both parameters, balancing a natural-looking result with thicker hair.
The procedure is performed with a local anaesthesia, similar to the one administered by a dentist. Once this has been done, the patients will feel absolutely no pain in their scalp. The operation, i.e. the collection of the transplants from the back of the scalp and their placement in the frontal area, can then be performed. The duration may depend on the extent of the hair loss problem the surgeon is attempting to correct; the operation usually lasts between 2 and 5 hours. The patient will be fully conscious during the operation, though they will experience no pain.
After the operation is complete, the patient can immediately return home.
Once the patient has returned home, they should restrict themselves to more relaxed activities, i.e. should not engage in heavy work or vigorous exercise. There is usually no pain, but when it does appear it can be dealt with using painkillers. Particular care must be exercised upon the area where the implants have been placed; the patient should, for example, avoid rubbing it. Over the next few days there may be some edema (swelling) in the area of the forehead, but this is not accompanied by pain.
The period of time required before a patient can return to work depends on their occupation, the location of the transplants and their own organism’s reactions. Some patients may not need to take leave from work at all; others may need to request up to 15 days of absence.
Your doctor will be able to determine the precise length of your recovery period.
The result will begin to make itself apparent gradually after 3 months, and be fully in place after approximately 8 months.
After this period has passed, the patient may, if they wish, repeat the procedure in order to achieve even greater thickness. Patients always ask “What can I expect from the result?” This can depend on several factors, such as the quality of the hairs the surgeon can collect from the donating area, their quantity, the size of the area where they will need to be implanted, the width of each hair, and various others.
A surgeon can usually, based on experience, calculate and attempt to describe the result you can expect. Unfortunately, in many cases a surgeon may make exaggerated promises, causing patients to be disappointed at the actual result and lose their trust.
Ask your surgeon to show you photographs of the results he has achieved, and ask if your own results are likely to be better or worse than what you are being shown. Always remember that it is best to communicate with your plastic surgeon from the very beginning and throughout the procedure, i.e. from the first briefing session up until the end of the observation period.