The procedure consists of resurfacing bald areas of the scalp with hair. We remove plugs of bald scalp and then fill them with plugs of scalp containing several hair roots taken from hair-bearing areas. Thеse grafts root themselves into their new locations and hair follicles start to grow eventually.
The degree of baldness determines the number of grafts and the length of treatment. Several operations may be necessary. The technique may leave many small scars on the donor sites, but are usually not noticeable.
Follicular Unit Extraction (FUE) Hair Transplant
Follicular unit extraction (FUE) is a hair transplant technique in which we use a small round punch to extract follicular units from a patient's bald resistant donor areas. We then transplant hese hair follicular unit grafts into patient's balding areas.
Given the time consuming and tedious nature of this procedure, we are often cannot transplant more than 500 to 600 follicular unit grafts in one day. The cost per graft of FUE is also typically twice the cost of the standard follicular unit hair transplant procedure, in which we remove a strip of donor tissue from the back of the head and trim it under magnification into individual follicular unit grafts.
Comparing Follicular Unit Extraction (FUE) to the Standard Strip Procedure
While the FUE procedure has grown in popularity, largely due to the minimally invasive way in which follicular unit grafts are removed, the standard strip excision method is still the most popular hair transplant procedure. It involves surgically removing a strip of scalp from the bald resistant donor area of the patient. The physician the sutures the donor area together.
These sutures (either stitches or staples) stay for about ten days after surgery. Some physicians use absorbable sutures, so that their removal is not necessary. When the linear incision has fully healed, the patient is left with a thin scar in the back of the head. This scar is typically hard to see once the surrounding hair grows out and conceals it.
Scalp Flap Transfer
This is done when the sides of the scalp (above the ears) and the back of the scalp are hair-bearing. A long, thin "flap" of scalp that is hair-bearing is removed and placed across a bald section to create a band of normal hair growth. As part of the treatment, we may remove parts of the bald scalp. The surgeon closes the donor site by stretching the opposite side of the scalp. This procedure replaces hair across a large area of bald scalp. The hair growth looks normal, and the narrow scars are hidden between the hair follicles.
Scalp Reduction (Serial Excision)
This is the removal of as much of the bald section as possible and done in the first operation. The adjacent hair bearing areas of scalp are pulled in close to the bald section, with the understanding that some bald areas will remain. We repeat this technique one or more times at a later date to eventually reconstruct the bald area.
The surgeon places a device called "tissue expander" under a hair growth area, adjacent to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Then, another operation is necessary to place the newly expanded skin over the ajoining bald area.
Almost everyone believes that follicular units are the best size grafts for hair transplantation, but reality is a bit different. In our clinic, we use 3 sizes of grafts: single hair follicular units, follicular units, and modified follicular units. We use single hair follicular units mostly for the hairline, while follicular units could be the basic size for the rest of the grafts.
Ideal candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will be the donor sites, from where we will surgically remove the flaps and grafts.
To achieve the desired fullness, several surgical sessions are needed. There is a healing period of several months recommended between each session. The final result with a full transplant series may take up to 2 years.
A month or 2 after surgery, the grafted hair falls out (which is normal and temporary). It takes another month or more before hair growth starts. To create more natural-looking results, a surgical touch-up procedure may be necessary. This may consist of using a combination of mini grafts or slit grafts to fill and blend in the hairline.