HAIR REPLACEMENT SURGERY - HAIR TRANSPLANTS
Hair transplantation is a surgical technique in which a physician redistributes hairs from an area of thick growth to areas that have balded.
Most hair transplants are performed in an office setting under local
anesthesia. Only minimal pain should be experienced. After thoroughly
cleaning the scalp, small needles are used to numb an area of normal
hair growth on the back of the scalp. A portion of the hairy scalp is
then removed with a scalpel and set aside while the surgeon sews the
cut scalp closed. After the scalp is sewn closed, small groups of hairs, or individual
hairs, are separated out from the removed scalp using a magnifying lens
and sharp blade. The area that will receive these healthy hairs,
usually the front of the scalp, is then cleaned and numbed with
additional small needles. Finally, tiny holes are made in the front of
the scalp and healthy hairs are delicately placed in the holes. During
a single treatment session, many hundreds or even thousands of hairs
may be transplanted.
In patients who are concerned about their balding, hair transplantation can significantly improve their appearance and self confidence. Realistic expectations are important, however. It is important to remember that hair still cannot be created; it can only be redistributed from the back of the scalp to the front.
Most patients undergoing hair transplantation have traditional male or female pattern baldness, with hair loss on the front or top of the scalp. Patients must still have thick hair on the back or sides of the scalp, or there may not be enough hair follicles to move. In some cases, patients with hair loss from lupus, injuries, or other medical problems may be treated with hair transplantation.
Patients undergoing hair transplantation should be otherwise relatively healthy, or surgery is less likely to be safe and successful. Always discuss your risks and options with your physician before undergoing any elective surgery.
As with any surgical procedure, risks exist. The most common complications of hair transplantation are bleeding, infection, and scarring.
Though less dangerous, it is also possible that the transplanted hair won't look as good as you had desired. Older techniques often resulted in unnatural appearing tufts of new hair growth. With modern techniques, this complication is infrequent.
Most modern hair transplants result in excellent hair growth within several months after the procedure. Often, however, more than one treatment session is needed to create the best-looking results. The replaced hairs are usually permanent, and no long-term care is necessary.
During the recovery period after surgery, the scalp is often very tender. Strong pain medications taken by mouth may be necessary for several days. A bulky surgical dressing, or sometimes a smaller dressing protected by a baseball cap, must be worn for at least a day or two. Some surgeons may also recommend several days of antibiotics or anti-inflammatory drugs following surgery. After this very brief recovery period, no special treatment is needed.
Twenty years ago, many people felt they risked looking like a Cabbage Patch doll if they chose surgery to eliminate baldness. Now, says Carlos Puig, D.O., director of Puig Medical Group, which is headquartered in Houston, better surgical techniques--used by increasingly skilled surgeons--are getting more eye-pleasing results.
"When I started in 1973 ... it was like the Stone Age," the cosmetic surgeon says, referring to the equipment and techniques in use. Now, he says, surgeons have learned to create a much more natural-looking hair line, using scalpels to cut either small slits or holes in the scalp to receive transplanted hair.
While there are numerous types of surgery, they can be sifted into two main categories: transplantation and scalp reduction.
Transplantation involves moving hair from densely covered sites on the sides or back of the head to bald areas of the scalp.
The key to success, explains Anthony Santangelo, president of the American Hair Loss Council, is to have good sites on the sides or back of the head from which to move hairs. Otherwise, patients can't expect ample coverage. Because their hair loss is diffuse, women generally lack good donor sites, making transplantation impractical for them.
The biggest improvement in transplants is with "micro" or "mini" grafts. "You're looking at one to two hairs shot into the head with a needle," Santangelo says. "It achieves a very, very fine, natural-looking hair line. The significant difference there is you need a lot of hair to do that."
Surgeons also use larger round plugs of seven to 10 hairs. Line grafts, the shifting of strips of nine to 12 hairs, are common, too.
One thing to keep in mind is that prosthetic hair fibers for transplantation are banned by FDA. Implanting them, according to Stephen Rhodes, acting chief of FDA's plastic and reconstructive surgery devices branch, caused a high incidence of adverse reactions, including infection.
If male-pattern baldness has left you with too much balding area to cover, you may benefit from scalp reduction: the surgical removal of large sections of a bald scalp. Extenders and expanders, elastic devices placed under the skin to stretch the hair-bearing scalp regions on the side of the head, have been used as a complement to reduction surgery.
Another surgical method is the flap technique, which rotates hair-bearing scalp areas from the sides or moves those areas from the back forward. The flap technique has the highest complication rate, though, Puig says. Bleeding, scarring and infection can occur from surgery. But advances, such as knowing what size flap to use and how to enhance blood supply to the region, have cut down on the visibility of scars.
by Larry Hanover, FDA Consumer Magazine