Hair restoration surgery is a permanent solution for hair loss. It is commonly used in the treatment of male pattern baldness. It can also be useful in restoring eyebrows, eyelashes, pubic hair, and chest hair; and to fill in scars caused by trauma such as accidents or previous hair transplants.
Surgical hair restoration involves removal of hair from the hair-bearing areas on the back of the head (donor sites) and transplanting them in those areas on the scalp that are deficient in hair (recipient sites). There are several techniques used in performing this kind of hair restoration surgery. This surgery can be expensive, and also may take several surgeries to obtain the coverage desired by you. The outcome of the surgery is dependent on the skills, experience and talent of the operating surgeon.
Most of the hair transplantation techniques are performed in the physician’s chamber under local anesthesia. The duration of transplant shall be based on the pattern and extend of hair loss area to be covered.
Potential Candidate for Surgical Hair Restoration
Surgical hair restoration drastically enhances the appearance and general well being of an appropriate candidate. Though, every person is not a perfect contender for surgical hair transplant. Every person should be assessed individually.
Perfect candidates for hair transplantation are as follows:-
- Males are the best candidates for surgical hair transplant as they have localized areas of thinning as compared to females.
- Young persons are generally not considered as ideal candidates.
- In persons with availability of good amount of donor hair.
- People with good scalp laxity.
- Males having dense hairs for surgical hair restoration.
- Hair loss in males due to trauma; burns; scarring; scalp injuries or other cosmetic procedures such as face-lifts are good entities for hair restoration surgery.
- People with thick, coarse and wavy hair.
- Best outcome of surgical hair restoration is observed in males with coarser, denser hair and whose skin color is alike their hair color.
During the initial consultation, the surgeon evaluates the scalp and assesses the density of hair and intensity of hair loss. After that the surgeon discusses the best procedure suitable for the patient. The outcome of the procedure too, is discussed with the patient so that the patient is very clear regarding his expectations from the procedure.
Preparation for the Surgery
Once you have decided to restore your youth and appearance by undergoing surgical hair restoration technique. To ensure that the surgical hair transplant is successful and without any complications, one needs to follow certain instructions preparing for the hair transplant surgery. Though, the instructions to be followed shall vary based on the type of procedure.
Few of the guidelines to be followed prior to the surgery are as follows:-
- Restrict smoking minimum two weeks before surgery and for a month after the surgery.
- Intake of alcohol is to be stopped, minimum three days prior to the surgery.
- Avoid intake of caffeine on the day of the surgery.
- Avoid eating or drinking anything 12 hours prior to the surgery.
- Use of styling products such as hair gel, hair spray, etc on the day of surgery should be avoided.
- Avoid cutting scalp hair for minimum one month before the surgery, so that maximum donor hair can be available for the procedure.
- To ensure softening of the scalp skin, massage the scalp for a minimum of ten minutes and maximum of thirty minutes daily, for approximately fifteen days to a month prior to the surgery.
- Use of multivitamins, Vitamin E, mineral supplements or herbal supplements should be stopped, minimum fifteen days prior.
- Intake of aspirin; anti-inflammatory drugs; anti depressants; blood thinning drugs; beta blockers should be limited, two weeks prior to the surgery.
- Based on the degree of hair loss, certain medications such as minoxidil shall be suggested prior to the surgery.
- Vitamin C is recommended, one week before the surgical procedure.
- Minimum three days before the hair restoration surgery and five days after the surgery, exposure to sun is avoided.
- Avoid any form of exercise, minimum three days prior to your restoration procedure.
- Wear loose and comfortable clothes during the surgery.
There are different techniques available for harvesting of hair follicles. Presently, there are two ways in which the donor grafts are extracted: strip excision harvesting, and follicular unit extraction.
Strip harvesting or Follicular Unit Transplantation
To conduct the hair restoration surgery, initially the scalp is cleaned by the surgeon and then, anesthesia is administered to the patient on the scalp from where a strip of hair from the donor site is removed. After removing the strip of hair, the scalp is sutured. The surgeon then divides the strip of hair into around 500 to 2,000 micro grafts containing individual hair follicles. Stereo-microscopes are used to eliminate extra fibrous and fatty tissue while avoiding the damage to the follicular cells that shall be used for grafting. The number and type of grafts is dependent on the color, type and quality of hair and also the size of bald spot to be covered. Later, the surgeon cleans and numbs that area where the hair is to be implanted. Small micro blades or fine needles are used to puncture the sites receiving the grafts. Then, the surgeon carefully places the individual grafts in these areas. It takes around two weeks for recovery.
Follicular unit extraction (FUE)
In this procedure, the surgeon removes each follicular unit separately, from the donor site using a micro punch. Hence, there is no linear scar but multiple punchy scars visible. These individual follicular units are then placed into the recipient site where there is deficient of hair growth. Compared to the strip method, FUE procedure is more time consuming.
FUE procedure is different from Strip procedure or FUT (Follicular Unit Transplantation) as in FUT a strip of scalp is surgically removed from the donor area and the follicular units are prepared outside the body by using microscopy. The closure of the scalp leads to linear scar in the donor area.
Advantage of FUE over strip harvesting is that in the procedure of FUE there is no need for large areas of scalp tissue to be harvested hence, there is no linear incision on the back of the head leading to a linear scar. As in this FUE procedure, only individual follicles are eliminated hence, leading to small, invisible punctate scars.
Robotic Hair Restoration
Robotic Hair Restoration is another novel instrument in the field of hair restoration. Robot detects the follicular units and its topography through numerous cameras. Images from the cameras detect the location, distribution, and the angulations of the follicular grafts. Robotic arm is used to increase the speed of graft extraction and to reduce the exertion of the surgeon during an FUE procedure.
Procedures to Avoid in Surgical Hair Restoration
In spite of the development of several advanced hair restoration techniques, there are numerous hair transplant surgeons who still conduct outdated and harmful hair restoration techniques.
Some of the outdated and harmful procedures that should be avoided in surgical hair restoration are as follows:-
Round or Square Grafts
Linear or Line Grafts
Hence, when you choose to undergo a hair transplant surgery ensure that the technique used for your surgical hair restoration is not any of the old technique. As old techniques give rise to numerous complications and the appearance of the surgery is also unsightly. Therefore, the techniques mentioned above should be avoided in surgical hair restoration.
Every operative procedure involves some amount of side effects. Hair transplant surgery too, involves certain side effects. Most of the side effects experienced because of hair transplant surgery are temporary and disappear within a few days. At times, these side effects are observed immediately after the surgery while some times it is observed few days after the surgery.
Some of the commonly experienced side effects, post hair transplantation are as follows:-
- Temporary thinning of hair
- Excessive bleeding
- Small size harmless cysts developing at the recipient site
- Death of hair follicles after transplantation leading to no growth of new hair
- Unnatural look with patchy hair pattern
Healing of Transplant Scars
Scars are one of the commonest side effects of surgical hair restoration procedure. They are an inevitable outcome of hair transplant surgery. Scarring can cause a cosmetic issue especially when old techniques are used or when current procedures are not performed properly or in cases when the patient is a poor healer. Few scars are small and can be easily hidden while few scars may require the need of scar repair. The appearance or size of scars is dependent on the type of hair restoration technique used, amount of tissue eliminated and the experience of the surgeon.
Some of the most beneficial methods to heal scars are –
- Scar revision surgery
- Placement of follicular unit extraction into scars
- Scalp Micropigmentation treatment
- Laser skin resurfacing treatment
Procedure to Fix A Bad Hair Transplant
Hair restoration techniques prove to be a blessing to bald patients but then, this blessing at times can turn into a nightmare when the hair transplant may not be fixed appropriately. The old hair transplant techniques occasionally results in pluggy, unnatural appearing hairlines, circular scars, poor hair growth or incoherent growth of hair.
In few cases, bad hair transplant results are not the outcome of older procedures but then they can be the resultant of lack of experience on the surgeon’s part. To repair a bad hair transplant, you must search for an experienced surgeon who is not only skilled in performing the hair restoration procedure but also has experience in repairing bad hair transplant.
Some of the procedures which can be used to fix a bad transplant are as follows:-
- Individual Follicular Unit Extraction.
- Follicular Unit Hair Transplantation technique.
- Carpet Tacking Punch Excision.
- Small grafts can be camouflaged.
- Elevated scars can be treated with cortisone injections.
- Excess scar tissue can be excised and eliminated.
Post Surgery Instructions & Expectations
To avoid complications and for quicker recovery, you shall require to follow a set of instructions, post hair restoration surgery.
Some of the instructions to be followed are as follows:-
- It is advisable not to drive back home alone as the procedure is generally performed under local anesthesia and sedation.
- You should take it easy for a few days post surgery and take at least a week off from work; as your head shall be swollen and sore and there shall also be some amount of pain which shall take some time to recover and time shall also be required for the donor site to heal.
- Antibiotic and/or anti-inflammatory drugs shall be prescribed to prevent infections.
- Pain relievers shall be prescribed as your scalp may be very tender, post operation.
- You need to wear a surgical dressing over the scalp for minimum a day or two.
- The transplanted hair falls out within two to three weeks post surgery and you shall notice new hair growth within a few months.
- In case the coverage area is large then, you may require to undergo several sessions of surgical hair restoration.
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