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Hair Replacement

Surgical hair transplantation techniques help solve the problem of male and, sometimes, female, hair loss by removing small pieces of hair-bearing scalp grafts from a donor site and relocating them to a bald or thinning area. Most men lose their hair on the front or the crown of the head; areas affected by hormonal changes whereas they have healthy hair growth at the back of their head that serves as a donor area, genetically resistant to androgenetic alopecia. The follicular units in this area are, then, removed and repositioned in those affected by baldness and, once transplanted, there will be no more hair loss.

 

Preparing for hair replacement

During the preoperative evaluation, the surgeon carries out the medical history of the patient for a proper diagnosis. The specialist will then analyse the scalp, assessing its status and degree of baldness, more or less severe, in order to decide which areas submit to the transplant. Prerequisite to perform hair replacement is a good amount of hair follicles in the occipital area (donor area) to be transplanted into the impaired areas of the scalp (receiving areas) in order to carry out a redistribution of the bulbs. Depending on the width of the area to be thickened, the surgeon plans the amount of follicular units to remove from the nape and transplant in the receiving area, as well as the most suitable techniques to use.

 

Hair replacement procedure

This type of procedure is performed under local anaesthesia; it lasts several hours (depending on the extent of the areas to treat), it is painless and does not require any dressing. The width of the area affected by baldness and the features of the donor area are the variables that mostly affect the dimension of the intervention and the consistency of the follicular units to be implanted. Donor area can have different levels of thickness and, in some cases, surgery may require more than one session to achieve the best result. It is important, therefore, that patients have realistic expectations about the final results. Currently, there are two techniques for transplanting hair follicles: STRIP HARVESTING and FUE (Follicular Unit Extraction).

 

Strip harvesting procedure

With strip harvesting, the surgeon harvests a strip of skin from the posterior scalp, area of good hair growth. The removal of the strips of hair-bearing tissue from the donor site lasts about 30 min without problematic scarring. Every single follicular unit extracted from the donor area contains from 1 to 4 hair that allows getting thousands of hair from one strip scalp graft, a feature that makes this method very effective. It is essential that experienced surgeons carry out the extraction since a proper healing depends on the quality of the suture performed. Once the harvesting is accomplished, the wound is closed with stitches specifically designed for this type of intervention. Meanwhile, the assistants carry out the separation and collection of follicular units. Through customized magnifiers, the process is a lot easier than in the past, influencing also the reduction of transection of follicular units that, obtained from a single strip scalp graft, may increase up to 30%. Depending on the needs of the patient and the health of the donor area, the surgeon can get a large number of follicular units to transplant. With the presence of a thick donor area and a receiving area poor of ​​hair, there can be mega sessions, getting up to 6000 follicular units. The surgeon, then, will perform microscopic incisions in the receiving area, whose thickness will depend on its extent and the number of follicular units obtained. During the first phase of the procedure, the patient is half-seated on a recliner bed. For the creation of receiving sites it is performed the lateral-slit technique, a surgical technique that mimics the natural alignment and distribution of the hair. The follicular units containing a single hair will be, therefore, included in the first line, to create a natural effect and then backward with the transplanting of one- to two- hair grafts and three- to four- hair grafts to increase coverage. As soon as the procedure is accomplished, the patient will be provided with all the necessary postoperative care instructions to follow. Strip harvesting procedure can last from 3 to 7 hours, depending on the extent of the area to treat.

 

FUE procedure

Follicular unit extraction allows extracting the follicular units individually with the help of circular microblades by the maximum diameter of 0.9 mm. FUE procedure differs from the technique described above because, in strip harvesting, a strip of skin is removed from the donor area and dissected into many individual follicular units. This technique, on the contrary, does not require any suture and is recommended for patients willing to shave the hair of the donor area to the length of 0.2 mm. Since the extraction process is slower than strip harvesting, during a single session can be extracted at most 1500 follicular units. The patient may agree to return the next day and, if necessary, proceeds to further extraction of 1500 FU. The follicular units extracted do not need to be dissected since they are already set for being grafted and are kept in a special solution at 4 ° C till the transplantation (as for the units of the strip). 50 UF/cm2 is the optimal density for the distribution of the hair. Beyond this threshold, in fact, blood circulation could not be sufficient for all the grafts; that would reduce the success rate of the intervention, disappointing the expectations of the patient. Compared to strip harvesting technique, the postoperative course differs only in the absence of the sutures.

 

Postoperative care instructions

Immediately after the operation, the surgeon may prescribe some medications: antibiotics, painkillers and, if necessary, oral supplements; you can restart your normal activities within 48 hours after surgery.  The first results will be noticed after about three months and a half after surgery since, initially, hair cannot immediately grow from transplanted bulbs. The hair, then, grow to about 1 cm per month and may be cut as normal hair. Particularly visible results can be appreciated about 6 months after surgery, with an extra margin of hair growth until the tenth month. The aesthetic result achieved with hair transplantation is, therefore, natural, durable and repeatable. In the case of severe baldness, patients will need to perform more than one operation to achieve an aesthetically pleasing outcome.

 

Scars in hair replacement

The intervention does not produce scarring in receiving areas because these sites are created taking into account the extent of the follicular units provided by donor areas. The outcome is perfectly natural and consistent with the rest of the hair, making it difficult to recognize transplanted hair from pre-existing ones. In the case of thickening frontotemporal angles or frontotemporal recessions, the surgeon will use the most innovative reconstruction techniques providing also an advancement of the frontotemporal hair line, restoring a more natural and youthful appearance.

 

FAQ

Who undergoes hair replacement procedures?

These interventions are requested mostly by men who want to regain a more youthful appearance through the implantation of hair follicles especially on the frontal area and on the crown of the head. Women, on the other hand, can experience some hair thinning at the frontal hairline and may need to be treated surgically.

Is there any age limit to undergo this type of surgery?

There is no age limit to undergo hair replacement but most of the requests come from patients aged 30 to 50 years.

Strip harvesting or FUE harvesting: which one?

Both techniques have advantages and disadvantages that should be discussed during the preoperative evaluation to offer the patient the best suitable method to use.

Is it possible to combine hair replacement with other cosmetic procedures?

Hair replacement could be performed alone or in conjunction with other procedures such as otoplasty, rhinoplasty and so on.

Are there risks and / or complications for this type of plastic surgery?

If hair replacement is performed by specialists in accredited surgery facilities there are no particular risks associated with this surgery.

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