Hair Restoration Surgery

Hair Restoration Surgery

Hair loss has many possible causes, including genetics, an underactive thyroid, cancer treatments, or medications for other health conditions. For many people, hair loss (alopecia) or thinning hair can result in a loss of self-esteem and cause depression, anxiety, and other emotional issues. Hair loss is devastating to both men and women. Almost every society in the world associates luxurious hair with youth, beauty, and good health. For centuries, humans have adorned themselves in a variety of ways tattooing, nail cosmetics, and most universally, hairstyles of all sorts. For many people, their hair is what makes them feel beautiful and when they lose your hair it can be truly distressing.Women associate their hair with their sexuality, sensuality, and beauty whereas for men its almost like losing their masculinity.

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Hair loss can start with a few extra hairs in the sink or in your comb. Later, it can progress to a bare scalp. Anyone men, women and children can experience hair loss.

Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications and surgical procedures that are available to treat hair loss.

Hair Physiology

An understanding of hair physiology is essential to understanding the process of hair loss. The initial growth phase of hair is called the anagen phase (2-7 years). In an adult, approximately 80 percent of scalp hair is in anagen phase. At this stage, the hair are in active growth and are sensitive to chemical and nutritional changes. Hence the importance of a balanced diet.

The next is the catagen phase(2 to 3 weeks) which is of shorter duration. Hair growth stops and the deepest part of the hair follicle becomes shorter, getting close to the surface of the scalp.

Finally, the hair enters the telogen phase (2-4 months), where it stops growing. An average adult has about 20% of scalp hair at this stage that culminates with hair fall. But before that happens, a new hair in the anagen phase usually begins to grow.

Male pattern baldness (Androgenetic Alopecia) affects approximately 50% of men during their lives. They have inherited sensitivity to DHT (dihydrotestosterone). High levels of DHT contribute to hair loss by interrupting the life cycle of the hair follicle in sensitive areas of the scalp. The front line is often the first area to be affected.DHT has been associated with the shortening of the anagen or growth phase of hair. As a result, the hair does not reach full maturity and men appear in many areas completely bald scalp. Even today it is not clear exactly how the tendency to male pattern baldness is inherited. However, it seems that the old theories about the predisposition to male pattern baldness be motivated by a single dominant gene in men are incorrect and it is likely that multiple genes are involved.

Norwood Hair lossClassification

Hair loss is classified according to the Norwood classification system ranging from Type I to VII.

  • Baldness Type I : Type I has a hairline above normal or with a minimal loss in fronto-temporal region.
  • Baldness Type II : In the Type II loss in the hairline is already higher before as well as fronto-temporal region.
  • Baldness Baldness Type III and Type III Vertex : A of type III has two divisions: first, it shows a more pronounced loss in fronto temporal region and the second is called a Type III Vertex , where there is a loss in fronto temporal as well as in the vertex region which is the most top of the head.
  • From there to the level VII hair loss will be accentuated further back, until the last degree when only hair on the back of the scalp are remaining.

Preparing for Hair Restoration Surgery

Choosing to undergo Hair restoration surgery is a very personal decision. At the first consultation your surgeon will understand your particular concerns about your hair loss, discuss your needs and goals requirements, and discuss with you in depth the various surgical options available and the one which would best suit your needs. It is important for you to provide complete information about your past medical history, any medical illness, drug allergies, previous surgeries including breast biopsies, and medications that you currently take. It is recommended that you stabilize your weight prior to surgery.

General Guidelines prior to surgery for Mastopexy

  • An initial Scalp examination and detailed measurements will be taken
  • Pre operative photographs of scalp are taken from several angles including closeup of the frontal hairline.
  • Pre-operative Anaesthetic assessment for fitness for surgery
  • Agreement to proceed with the surgery by signing an informed Consent form
  • Stop smoking 2-3 weeks prior to surgery
  • Avoid taking anti inflammatory medicines 2 weeks prior to surgery
  • Stop taking the oral contraceptive pills 6 weeks prior to surgery and use alternative means of contraception.

Hair Restoration Procedure

Hair Restoration is performed in a clinic or hospital set up under local anaesthesia and or intravenous sedation under an anaesthetists observation in order to assure a comfortable procedure. Patients are advised to fast the night before and to arrive at the facility by 7:00 a.m.. The procedure can last from 4- 8 hours depending on the extent of transplant required. Most patients are discharged from the clinic around evening.

At the start of the procedure the patient is administered local anaesthesia (1% Xylocaine with adrenaline) at the proposed donor site with a very fine 26 guage needle. This aids in making the procedure bloodless and painfree for the patient.

Follicular Unit Transplant with Strip method

Under local anesthesia, a strip of hair-bearing scalp is removed from the back of the head (the donor area). Tricophytic closure of donor site is almost always done so as to leave a single, thin scar, which will be hidden inside the hair. These stitches are taken off after one week. The three commonly chosen sites are the midocciput over the protuberance, the supra-auricular point above the external auditory meatus, and a spot halfway between over the mastoid. The maximum recommended width of the strip is not more than 2 cm.

Graft preparation

The important step is the correct preparation of the grafts. The team of technicians, with the use of magnifying lenses and microscopes, separates the follicles into units containing one to three hair per graft.

Graft Insertion

Before the grafts are harvested, tiny “recipient sites” are made in the balding area of the scalp using a fine needlepoint instrumentThe creation of recipient sites and the placing of follicular unit grafts are essentially the same in both FUE and FUT procedures. The difference lies in the appearance of the donor area and in the quality and quantity of grafts obtained with each technique.

The surgeon prepares the recipient area, where tiny holes are made with the help of 18-20 G needles or a specialized knife, so as to insert the individual grafts. The follicular units are then placed into the recipient sites where they will grow into healthy hair-producing follicles. Tumescent anaesthesia is used for pain relief as well as keeping the procedure relatively bloodless. This is a very dynamic procedure, requiring a large and well trained team. In this manner, it is possible to transplant over 1,500 grafts in a single session.

FUT surgical technique for hair transplantation should take into account the fact that follicles are very delicate, and therefore should be perfectly prepared and transplanted, so as to guarantee survival and, consequently, hair growth.

The Recovery Period

Duration of surgery is variable, but a large session takes upto 5-7 hours. As surgery winds down, the sedation wears off, and the patient becomes awake, talking with the team.

A head bandage will be applied to protect the operated area and for comfort during the night. He or she will remain in the recovery room, a light snack is offered, and 1-2 hours later patient is discharged. Ideally, there should be someone to accompany him or her home.

The patient returns after 24 hours, when the bandage is taken off and his head cleaned. Some swelling may occur in the scalp and forehead areas on the 2nd-4th day; this is simply the infiltrated saline solution that was used for anesthesia. There is usually no post-operative pain. Patients must realize that an incision is placed in the back of the head, so some discomfort is to be expected. The sutures are removed after one week.

Permanent hair begins to grow after 3 – 6 months, and the patient will be able to appreciate the final result by one year post-operatively.

Follicular Unit Extraction (FUE)

Follicular Unit Extraction (FUE) is a method of extracting, or “harvesting,” donor hair in a follicular unit hair transplant procedure. In FUE hair transplants, an instrument is used to make a small, circular incision in the skin around a follicular unit, separating it from the surrounding tissue. The unit is then extracted (pulled) directly from the scalp, leaving a small open hole.

This process is repeated until the hair transplant surgeon has harvested enough follicular units for the planned hair restoration. This process can take from a few hours upto 2 consecutive days in large sessions,. The donor wounds, approximately 1-mm in size, completely heal over the course of seven to ten days, leaving tiny white scars buried in the hair in the back and sides of the scalp.

This method of donor harvesting, removing follicular units one-by-one directly from the scalp, is what differentiates the FUE hair transplant from a traditional Follicular Unit Transplant (FUT), where the donor hair is removed from the scalp in one thin, long strip and then subsequently dissected into individual follicular units using a stereo-microscope.

Before the grafts are harvested, tiny “recipient sites” are made in the balding area of the scalp using a fine needlepoint instrument. The follicular units are then placed into the recipient sites where they will grow into healthy hair-producing follicles. The creation of recipient sites and the placing of follicular unit grafts are essentially the same in both FUE and FUT procedures. The difference lies in the appearance of the donor area and in the quality and quantity of grafts obtained with each technique.

Robotics FUE Hair Transplant

Follicular Unit Extraction is an instrument dependent procedure; therefore, the type of tool used for this procedure significantly affects its outcome. In fact, the development of increasingly better extraction instruments has closely paralleled advances in the procedure.

Almost all of FUE transplant procedures are now being done using this technology.

Different Robotics FUE Machines are : SAFE System, 3-step FUE, RotoCore, NeoGraft, and ARTAS Robotics.

The Origin of FUE

The use of direct extraction to harvest follicular units was initially conceived by Dr. Woods in Australia as the “Woods Technique,” but he did not disclose the details of his procedure. The technique was first described in the medical literature by Drs. Rassman and Bernstein in their 2002 publication “Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation.” This paper provided the anatomic basis for the procedure, gave it its current name, and described the FOX test used to identify patient variability in harvesting, an issue which continues to be a significant challenge for doctors today.

A major refinement in the procedure was advanced by Dr. Jim Harris by adding an additional step of blunt dissection to the technique, as this substantially reduced transection (damage) to follicles. FUE hair transplantation continues to evolve as more physicians learn about this procedure, gain experience with it in their practices and offer improvements to the technique.

Indications for FUE Hair Transplants

Because FUE does not leave a linear scar, it may be appropriate for patients who want to wear their hair very short. It is also an advantage for those involved in very strenuous activities, such as professional athletes, who must resume these activities very soon after their procedure.

The technique is also useful for those who have healed poorly from traditional strip harvesting or who have a very tight scalp. FUE transplants also allow the surgeon to potentially remove hair from parts of the body other than the donor scalp, such as the beard or trunk, although there are many limitations with this process.

Possibly the most straightforward application of this technique is to camouflage a linear donor scar from a prior hair transplant procedure. In this technique, a small amount of hair is extracted from the area around a linear donor scar and then placed directly into it.

Some patients desire Follicular Unit Extraction simply because they heard that it is less invasive than FUT or is non-surgical. The reality is that both procedures involve surgery and in both cases, the depth of the incisions (i.e. into the fat layer right below the hair follicles) is the same. The difference is in the type of incision made. In FUE there are multiple round incisions scattered diffusely through the donor area and in FUT there is one single, long incision in the middle of the donor area. FUE should be chosen if the multiple round incisions are preferred and not because the technique is “non-surgical.”

Since FUE harvesting requires a much larger area compared to strip harvesting (approximately 5x the area for the same number of grafts) in order to perform large sessions of FUE, the entire donor area must be shaved. This can present a significant short-term cosmetic problem for many patients. In contrast, with FUT using strip harvesting, the donor incision can be covered with hair – even with very large sessions.

On the other hand, because there is no linear incision with FUE, patients can resume strenuous activities and contact sports much sooner after the procedure.

Currently, hair restoration surgery can achieve a high degree of natural result. The American Society of Aesthetic Plastic Surgery considered this procedure “the surgery of the decade”, as it showed the most progress in the 1990’s. It is one of the most frequently performed operations of an aesthetic nature. People are becoming aware that they no longer have to fear an artificial result, with the corn-row / doll’s hair appearance

Some patients may need to undergo a second session of hair transplantation. As long as there is donor area, a second session may be considered. This should not be done earlier than 9 months, allowing for complete healing from the first session. This 2nd stage will be either to cover areas that were not transplanted, or to increase density where hair has already been transplanted
The size of the donor site along with the hair density (hair/cm2) and diameter (microns) are the key factors in deciding whether or not the patient is a good candidate, as well as what kind of results should be anticipated. Hair diameter is the other major factor in determining the coverage achievable with a transplant. Besides density (hairs/cm2), hair volume plays a critical role. Hair volume (hv) is defined in the following formula:
hv = π(r)2 (h) (d) (a)

In this equation, r is the radius of the hair shaft, h is the hair length, d is the hair density (hairs/cm2), and a is the total area covered (cm2). It is key to note that a doubling of the radius results in a quadrupling of hair volume, making hair diameter the most important single variable in the coverage achievable in a transplant.

Other factors that affect the final coverage include hair texture and hair/scalp colour contrast. Wavy, curly, helical, and spiral hairs improve coverage. A lesser contrast between hair color and scalp color improves the illusion of density. Gray hair on fair skin looks considerably denser than dark hair.

Schedule a Consultation

If you would like to schedule a consultation for Hair Restoration, please contact online or by phone today. Dr. Biraj will be happy to answer your questions and talk with you about all aspects of the procedure

Common Questions

The most common cause is hereditary and men are more affected because the male hormone testosterone to DHT produces degraded being that acts by decreasing the presence of hair follicles.

Yes, the transplanted hair is removed from an area of the body (the donor) and transferred to another (receiving area). The transplanted follicles are not “rejected” because it is not foreign to the body.

Small crusts form in the recepient area and disappear within 4 to 7 days. The washing of the scalp begins 48 hours after surgery, the crust points are removed from the donor area 10 to 12 days after surgery and are not visible, because the remaining hair will cover them.

No, because the technique is follicular unit hair transplantation,where single follicular unit are transplanted. “Dolls hair” happens when the technique of punch grafting is used when several (10-20) follicles are transplanted per hole.

Most patients are surprised how little this procedure is painful. Some discomfort is controlled with the use of common painkillers.

Depending on the extent of the procedure and the type of work involved you can return back to work 24 -48 hours after surgery. This will be discussed in the consultation.

The hair transplant follicular units is more expensive than alternative treatments or a hair prosthesis. However considering the final outcome, most patients consider it a good investment in your satisfaction.

The number of sessions depends on the area to be covered. In milder cases one session is enough. This will be discussed during the consultation.

Risks and Potential Complications

Possible complications include bleeding and collection of blood under the skin (hematoma), fluid accumulation(seroma), infection or poor healing at the incision site. These risks are common to many operations and can be dealt with easily. Blood clots in the deep veins of the leg is a problem associated with lying still for too long for which adequate prophylaxis is taken prior to surgery. Rarely pulmonary and Fat embolism are risks associated with any major prolonged surgery. Any surgery carries risks associated with anaesthesia. These risks will be fully discussed with you prior to your consent for surgery. It is important that you understand these aspects of your surgery and that you seek clarification from your surgeon.

During the Operation: Reactions to Drugs, Bleeding
Later: Painful Scars, Abnormal Scars, Persistent Lower Abdomen Numbness and Swelling and Umbilical Deformity