HAIR TRANSPLANTS OVERVIEW
Hair transplantation is almost always the preferred way to restore a balding scalp (see Best Approaches for Male pattern Baldness). In a man losing his hair in a typical balding pattern (one that starts in the front and on the top of the scalp), the problem is due to the effects of a hormone called DHT (dihydrotestosterone). DHT will only cause thinning of hair if the man has a genetic tendency for this condition handed down by his parents or ancestors. With the exception of extreme cases of baldness, DHT’s tendency of causing inherited baldness at the front or top of the scalp only rarely involves the hairs at the back and sides of the scalp. In other words, for the vast majority of men, they are protected from the effects of DHT at the back or sides of the scalp and will never go bald in these areas.
Why Hair Transplants Work and Results Last a Lifetime
The procedure is successful because hairs removed from the backs and sides of the scalp (donor areas) will keep their genetic protection from the balding process for a lifetime even after they are moved to the front or top of the scalp (recipient areas)
Patients are encouraged to bring their favorite CD’s or DVD’s to enjoy throughout the procedure. For further relaxation and to prevent undue discomfort, pain pills and tranquilizers are given prior to and during the procedure. A strip of hair about 1″ wide and 4 to 8″ long is shaved on the back and sides of scalp where the donor hairs will be harvested. This shaved area and the balding areas on top of the scalp are anesthetized with Lidocaine injected through a small needle. Then, depending on which of two types of hair transplant is desired, the donor hairs are removed either in small bundles (called follicular unit extraction) or the entire area is surgically removed as a strip (strip graft extraction) and closed with staples (usually removed 7-10 days later).
In either method, the harvested hairs are then handed over to a team of technicians who meticulously use small instruments and magnifying scopes to trim the hairs down to a perfect size and grouping (1-2 hairs are called “micro-grafts” and 3-4 hairs are called “follicular units”) for placement into tiny holes made in the balding areas. It is imperative that the physician make the recipient sites for hair implantation in an artistic fashion for a more natural eventual outcome. After all the hairs have been planted in their recipient sites, a protective bandage is placed.
What to Expect After the Procedure
As per the request of most of our patients, we usually perform transplants on Fridays to afford some rest and the fewest number of days lost from work.
There will be some soreness of the scalp for about a week that is easily controlled with pain pills such as Tylenol or Vicodin. During this time it is also common to have some swelling of the forehead that is the result of scalp swelling that has migrated downwards (this can also be prevented and lessened by medications such as Prednisone).
Tiny areas of redness and crusty scabs surround the transplanted hairs for about a week. Most of the transplanted hairs fall out between the 2nd and 8th week. While a few transplanted hairs will immediately start growing, most do not start making their appearance for 2-3 months. They will then grow as fast as normal hair at a rate of about 1″ per month and they usually grow in with increasing shaft density over about a one year period.
Occasionally, some of the pre-existing hair on the top of the scalp will also fall out after the procedure, but this is temporary and the original hair will start to re-grow at the same time the transplanted hair re-grows. Sometimes there is decreased skin sensitivity of the scalp, but this usually resolves in less than a year.
Number of Procedures Required
On the other hand, most men find it desirable to get their first hair transplant performed when there is still enough natural surrounding hair existing in a balding area to camouflage any temporary evidence of new healing grafts. Overall, the number of procedures and the time to start should be addressed on a case-by-case basis. The limiting factor is the amount of donor hair predicted to be available over a lifetime.
A scalp reduction is a procedure that involves surgically removing large areas of bald scalp prior to hair transplantation. Dr. Degnan does not perform scalp reductions due to certain risks and associated subsequent problems with eventual hair growth and alterations of future donor hair sites.
Mega-sessions refer to procedures where 2,000-3,000 grafts are transplanted (remember, each graft can contain 1 to 4 hairs). Dr. Degnan has found such procedures cause undue fatigue to the patient and the surgical team. Sometimes the recipient areas become “over-stuffed” with swelling before the planned number of grafts are inserted and the surgery can not be completed in a maximally artistic fashion.
The high number of grafts can also become dried out and render them useless. Similarly, some men don’t have enough blood supply to allow the high number of grafts to heal and subsequently grow properly.
Newer techniques of both harvesting donor hair as well as placement into the balding areas have elevated the results of hair transplantation surgery from conspicuous to natural.
These improvements are also less invasive lending to a more rapid healing time. Responsible hair transplant surgeons have all learned these rather simple new techniques and there is no longer any reason for a patient to pay the extra costs of going to a “franchised” center for their procedure.
Essential to the experience are: a clean and relaxing facility, patient comfort, state-of the art magnifying scopes ,and as many good technicians working as possible to shorten the duration of each procedure.