1. Who needs hair transplantation?
Baldness is a common problem these days. In males it is graded into seven stages (Hamilton-Norwood Scale) depending on the extent of hair loss and into three stages in females(Ludwig). Hair loss and baldness are caused by various factors such as hormonal changes, genetics and even environmental factors. People who suffer from hair loss or baldness look so much older and this can result in low self-esteem and depression. Also with hair transplantation, you can start to enjoy various hairstyles that show your forehead.
Male pattern Hair Loss- Seven Stages
Female Pattern Hair Loss- Three Stages
2. What are the options in hair transplantation?
There are two types of hair transplant surgeries: hair restoration surgery and hairline correction surgery. The former treats people who suffer from hair loss and the latter treats people who wish to reconfigure their hairline. Although the surgery procedure involves the same expertise, the design process is different.
3. What are the types of hair transplantation?
Hair transplantation is one of the commonly performed cosmetic procedures. Generally there are two well accepted methods of hair transplant, FUT (Strip) method and FUE (Follicular unit extraction). Both these methods have their pros and cons.
The choice of either procedure depends on various factors including hair density, scarring tendency and extent of baldness. Both the procedures are done on day care basis under local anaesthesia. The procedure can last up to 8-10hrs depending on the individual client.
FUT (Strip) or FUG method: Follicular Unit Transplantation Method
Follicular Unit Transplantation/Grafting is based upon the principle that hair does not grow individually but in naturally occurring groups of 1 to 4 hairs. These follicular units are obtained through microscopic dissection of tissue that is harvested in a single strip.
Using magnification loupes or microscopes it is possible to identify and extract these microscopic 1-4 hair units and transfer them to the areas of balding scalp. This method literally transfers the hairs in the same way that nature grows them and allows us to mimic a totally natural looking head of hair.
Here is a step by step explanation of the process involved:
One week prior
- Keep a record of any medications you take one week prior to surgery and advise your doctor on the day of surgery.
- Do not take aspirin or any other anti-inflammatory medication as this affects your bloods ability to clot and may increase bleeding.
- Restrict and if possible cease smoking as it decreases blood flow to the scalp and can result in poor healing.
- Do not drink alcohol three days prior to surgery as this can thin the blood.
- Do not engage in strenuous exercise three days prior to surgery as this can thin the blood.
- Do not drink coffee or any other caffeinated products the day prior.
The morning of your procedure
- Wash your hair as you normally would and do not apply any styling products.
- Wear upper body clothing that opens at the front and does not require it to be pulled over the head. i.e. button shirt and avoid round neck T-shirts.
- Eat breakfast as you normally would.
- You will begin with a review by your surgeon, during which he will explain the process, discuss any preferences you may have regarding hairline or graft placement and answer any questions you may have.
- Then you will get changed into a surgical gown escorted to theatre where you will be given some mild sedatives to help you relax.
- We will then attach some monitoring equipment to you to ensure that your are safe and comfortable during the procedure.
- Next we select a narrow strip of donor scalp from the permanent hair zone. The hair in this area is clipped to a 1-2mm.
- The donor scalp is then anesthetised (frozen) using a local anesthetic. This ensures that the procedure will be virtually pain free.
- Once the donor tissue is removed he two edges are closed with either dissolving sutures or surgical staples, and a thin bandage is placed around the donor area.
- The tissue is then placed under microscopes and dissected into their naturally occurring groups of 1, 2, 3 or 4 hairs. And then sorted and stored depending on how many hairs they contain.
- Once sufficient grafts are cut we will commence making the recipient sites with a very fine gauge needle and placing the grafts immediately after the hole is made. This is known as a “stick and plant” process and whilst it is more labour intensive it ensures that the smallest hole possible is made and reduces vascular damage to the scalp.
- If we are performing a large procedure that started in the morning we will take a break for lunch at which time you are free to get up and stretch your legs and you will be given a meal you pre ordered in the morning.
- Once all the grafts have been placed your surgeon will double check the position of all the grafts.
- You will then get changed back into your clothes and a technician will read your post operative instructions and give your medications for the next week.
- The night of your procedure we encourage you to sleep semi upright at a 30-45 degree angle to reduce blood pressure to the scalp.
- Your post op medication will assist with sleep and any pain you may experience.
- The following day we encourage you to return to our office so we may remove your bandage and check and wash your transplanted area and donor region.
- You may resume showering normally with a low temp and pressure applied directly to the scalp after 5 days.
- You should avoid alcohol for three days and abstain from smoking if possible.
- You should not engage in any strenuous activity or heavy lifting for two weeks after the procedure. Any activity that stretches or puts undue pressure on the back of the scalp should be avoided for one month.
- Most scabs in the recipient region should be gone after 7-10 days and the procedure should be virtually unnoticeable at this time.
- The newly transplanted hair will begin to grow through after 10-12 weeks.
- The final growing result is expected after 12 months.
Follicular Unit Extraction or FUE Method:
The No Scalpel, No Strip, Minimally Invasive Procedure
Follicular Unit extraction or FUE as it is known is a relatively new technique of extracting grafts individually from the scalp. In this type of procedure a small round punch generally 0.6 to 1 mm in diameter is used to make a small circular incision around the follicular unit. These follicular units are then individually plucked from the scalp. This new procedure negates the need for a linear incision at the back and sides of the scalp with the inevitable scar that is produced.
Follicular Unit Grafting and Follicular Unit Extraction are sometimes viewed as being two totally different procedures. Follicular Unit grafting involves surgically removing a strip of skin from the back and sides of the scalp, this strip is then microscopically dissected into follicular units and these are implanted back into the balding areas of scalp.
FUE individually harvests these 1, 2, 3 and 4 hair grafts from the back and sides of the scalp. Each follicle after being extracted is examined under magnification and further trimmed of non hair bearing skin if required. And then re-implanted into tiny incisions in the balding area. So effectively once these grafts are out of the scalp the implantation procedure is exactly the same as it is for FUT.
So in effect when a comparison is made between FUE vs. FUT what is really being compared is linear strip excision (FUT) vs. individual graft extraction (FUE). As FUE does net leave a linear scar it is of particular interest for those who wish to wear their hair very short at the back and sides or plan to fully shave their head in their future.
Step by Step explanation of the FUE procedure
- The donor region at the back and sides of the scalp is clipped down to 1-2 mm in length to allow the doctor to easily pinpoint which follicular units he will extract
- The donor area is aneasthetised to ensure a relatively pain free experience.
- The patient lies face down on a special operating chair that fully supports the head.
- The doctor using a powerful magnifier, extracts follicular units from the donor region one at a time using a small cylindrical punch and forceps.
- As each follicular unit is extracted, they are handed to the technicians who under the microscope will trim off any excess skin on the graft so they may be placed into the smallest incisions possible.
- The many small holes produced at the back of the scalp are then left to heal on their own.
- Once the doctor has extracted the required number of grafts the patient will change position and sit upright to allow the implantation to begin
- The follicular units are then implanted into the scalp one at a time into tiny needlepoint holes.
- Once all the grafts have been implanted the patient is free to go home.
Advantages and Disadvantages of follicular unit extraction
For many years clients have been concerned about the linear scar that is produced by the strip excision method that is an integral part of the FUG procedure. However FUE’s primary advantage of no linear scar does bring with it, its own unique set of disadvantages.
- No linear scar
- Minimally invasive so shorter healing time
- No bandage required after surgery
- Allows a larger portion of the donor area to be harvested(does not increase the yield from a given area though)
- Best used in procedures that require a limited number of grafts
- Possible to use body or beard hair for transplantation if required
- Almost twice as expensive to achieve the same result as FUG.
- Absolute yield from given area is not as great as with FUG.
- Graft survival rate not as high as with FUG, due to the transection of grafts as they are extracted from the scalp.
- Those with curly or fine hair are generally not good candidates for FUE.
- Due to the labour intensive nature of the extraction process there are limits on how much can be achieved in one session and therefore multiple sessions are required to equal just one FUG.
In summary the one disadvantage of FUG is the visible scar at the back of the scalp. However with the advanced surgical techniques in use at our centre, the reality is that over 90% of our patients have a scar that is 2mm in width or less and is easily camouflaged. This combined with the excellent and consistent growth rates of FUT mean that FUT is yield equally good and consistent results.
That said FUE is a fantastic new advance and gives prospective patients an additional treatment modality to choose from.
Before and After
Cost: Rs.45,000 onwards for 1500 to 2000 grafts (3000-5000 hair follicles)