Hair Transplantation

Hair Transplantation, Scalp Reduction and Flap Surgery

Baldness and thinning of scalp hair are conditions that affect almost one-third of all men in this country and, though fewer in number, some women as well. There are many causes for hair loss including high fever as a result of severe infection, thyroid disease, inadequate protein in the diet, certain medications, cancer treatments, childbirth and birth control pills. Many of these are reversible; however, other types of baldness may be permanent, including those which are a result of accidents, operations and inflammatory or infectious diseases of the scalp. One of the most common types of permanent hair loss is male pattern baldness. This condition, inherited from either side of the family, starts when a person is in his or her teens, twenties or thirties. While women with this inherited tendency do not become bald, they can develop considerable thinning of the hair. Although many people are unconcerned about hair loss, others are distressed and look for ways to remedy the condition. Hair pieces are a satisfactory solution for some, while others find them unnatural looking or difficult to maintain. New products on the market that claim to restore hair growth have had limited success. Toda y however, several surgical procedures can provide a permanent solution for those who are bald or have thinning hair. Hair transplantation or grafting, sometimes done in conjunction with scalp reduction, is a procedure which produces very favorable, permanent results for many people. Flap surgery is another technique that has had good results.


Before Surgery

Hair transplantation or hair grafting is a surgical procedure in which strips of hair bearing skin are taken from the sides or back of the scalp, dissected into smaller sections and transferred to the bald area on the head. The physician carefully examines both the area from which the grafts are to be taken (donor site) and the area to receive the grafts (recipient site) to see if they are compatible. The patient’s type and pattern of hair loss are evaluated. The physician and patient discuss how the hair should look in order to produce a pleasing, natural appearance. Blood tests may be taken to determine whether there are medical conditions such as bleeding or clotting defects that might make surgery inadvisable. Pre-operative instructions may include the elimination of drugs containing aspirin in order to minimize the possibility of excess bleeding.


The Procedure

Immediately before surgery, the donor hair may be cut very short and cleansed with a special solution. A local anesthetic is applied to the donor site and a strip of skin containing hair and hair follicles is removed. This strip is then cut into minigrafts, (5-7 hairs) micrografts (3-4 hairs) or single hair grafts which are used to refine the hair line. The recipient site is similarly treated and the donor grafts are carefully placed in a pattern that matches the direction of the original hair. The grafts are placed in such a way as to allow each graft to receive an adequate blood supply during the healing process. Sutures and/or bandages which are removed within a few days may be used.


Following Surgery

Following the procedure, the patient is required to wear a protective bandage overnight. Patients may experience a moderate amount of discomfort which is controlled with oral medication. Risks and complications are rare because only the outer layer of the skin is involved. Some swelling and bruising around the eyes may occur two to three days after surgery. Using eye compresses and sleeping in a semi-reclining position can minimize these problems. Numbness around the donor and recipient sites is common and will diminish within two to three months. Scabs may be present on the grafts for seven to ten days. Small scars remain but are hidden within the hair line.

About six weeks after the transplant, the hair begins to fall out. Approximately three months later, new hair appears and grows at about the same rate as it did in its original location, about one-quarter to one-half inch a month. One to three months later, the spaces between the new implants are filled in with new grafts. Several treatment sessions may be necessary and patients who want to achieve greater density or refinement of the hairline often return for additional transplants. The end result is a hairline similar to the patient’s original one.


Scalp Reduction

Another surgical procedure designed to reduce the amount of bald skin on the head is scalp reduction, often done in conjunction with hair transplantation. Scalp reduction is a procedure which involves the removal of bald skin from the top of the head and is particularly well suited for those with extensive hair loss. This procedure may reduce significantly the number of donor grafts needed to cover the area. As with hair transplantation, a local anesthetic is given and an incision is made, usually on the top center of the head, from the front to the back. Skin is loosened from the underlying tissue and excess skin is removed.


Flap Surgery

Flap surgery is done less frequently than hair transplantation and scalp reduction, often in conjunction with one or both of these procedures. There are several different flap operations. One of the most common involves the partial removal of wide strips of hair-bearing scalp several inches long, from the sides or back of the head. Bald skin from an adjacent area is completely removed and the hair-bearing flap is rotated and sutured in place area is completely removed and the hair-bearing flap is rotated and sutured in place. The edges of the donor site are also sutured. An additional technique using tissue expansion of the scalp has been developed. Plastic balloons are placed under the hair-bearing scalp and expanded by injecting fluid. This is done at intervals of one to two weeks. This allows more hair-bearing tissue to be available for flap transfer. After expansion, the balloons are removed and the extra tissue is used to create a new hairline.

As with all surgical procedures, there are possible risks and complications connected with flap surgery which should be thoroughly discussed with the physician. Flaps of hair which are rotated from another part of the head may result in hair growing in a different direction than the surrounding hair. For this reason very curly, kinky or wavy hair may look more natural than straight, wiry hair. Bacterial infection following this surgery is rare because the blood supply in the scalp is excellent; however, a secondary infection can occur which can be controlled with medication. Patients can minimize complications by carefully following directions given by the physician.