Hair Transplant

Hair transplants represent methods of permanent hair restoration for patients suffering from hair loss that can be reversed in a number of ways. Male and female pattern hair loss can be treated using hair transplantation procedures that transplant hair follicles from strips of scalp or individual hair bulbs into balding areas. Some procedures manually extract hair grafts and cut them into micro-grafts while others extract several or individual hair follicles using robotic technology.

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Medically Reviewed by Dr. William A. Kennedy III, MDLast Reviewed 02.04.2019

Summary

Hair transplant procedures have come a long way since decades ago, when hair transplant surgery left some patients with big "hair plugs" in their scalps. They were large and obvious pockets of hair, like those seen on a doll's head. However, in modern times, a partially bald scalp can be covered in more natural ways, with the use of advanced robotic techniques that encourage the growth of new hair, using the patient's existing hair.

Types of Advanced Hair Transplant Procedures

Hair loss can have an effect upon both sexes. Male and female pattern baldness can be attributable to heredity or other conditions. Age and traction alopecia - which is hair loss from tight hairstyles - is another cause for thinning or balding areas. Whatever the causes of the lessening of the thickness and density of a person's original hair, the popularity of hair transplant procedures is growing.

Medgadget reports that younger and older people alike are experiencing hair loss and seeking solutions. Advanced popular forms of hair transplants that are being used, according to the American Society for Dermatologic Surgery, include follicular unit strip surgery (FUSS) and follicular unit extraction (FUE).

Let's examine four main methods of surgical hair restoration that hair transplant surgeons use:

#1 - Strip Harvesting via Follicular Unit Strip Surgery (FUSS) or Follicular Unit Transplantation (FUT) According to the American Academy of Dermatology and Harvard Health, a large portion of hair-transplant surgeons use follicular unit transplantation, which was first used circa 1995. When FDA-approved over-the-counter topical treatments and prescribed solutions for androgenetic alopecia do not provide patients with desirable results, they can turn to options like FUSS or FUT, which transforms a strip of scalp from the rear of the head into tiny grafts with a few hairs in each of the hair grafts. Those grafts are then "transplanted" into bald or thinning areas of the scalp using needle injections or blade incisions.

The FUSS or FUT Procedure Also called follicular unit strip surgery (FUSS), follicular unit transplantation strip harvesting is named as such because a strip of scalp and hair is removed from the patient, usually taken from the back of the head. First the surgeon determines the size of scalp to be excised, which can be six to 10 inches long, according to WebMD. Then the hair in the donor site area is cut very low, about two to three millimeters, and the donor site is injected with local anesthesia.

Hair transplant surgeons must envision the hair follicles when removing the strip, and stay parallel to existing hair shafts during the procedure, to avoid damage to existing hair follicles via transection. Existing hair covers the strip where the hair was removed after the incision is sutured closed by the surgeon.

Once the strip is removed from the scalp, it will be separated into 500 to 2,000 tiny grafts that may contain an individual hair or several hairs, based upon the hair type and hair transplant size. Brands such as Max Density Advanced Hair Transplants represent this method of hair loss grafting, with the tiny grafts viewed under a microscope as they are separated into grafts that contain either one, two, three, or four pieces of hair. There are also grafts made of groups of five to eight hairs.

Transplanting the New Hair Follicles The micrografts of newly transplanted hair follicles are placed inside incisions or needle points in a random pattern in the balding area in order to copy the natural appearance of original hair. The front hairline portion of the head usually receives the tiny grafts of singular hairs and follicles, while hair grafts comprised of several hairs are placed farther back.

The same procedure can be performed on the eyebrows, however, an even tinier graft from the scalp is extracted, approximately three to six centimeters in length and 10 to 15 millimeters in width. Then individual hair grafts are transplanted in the same direction of eyebrow hair growth that remains flattened against the patient's skin.

#2 - Follicular Unit Extraction (FUE) hair transplant Follicular unit extraction (FUE) is similar to other methods of hair transplant surgery, except the transplanted hair isn't taken from a strip of scalp and hair - but from areas all over the scalp, usually the rear.

What to Expect During FUE Hair Transplantation The FUE procedure means that the patient must sport a short buzz cut (at least in the back of the head) during the harvesting process. In the case of a person receiving FUE who doesn't want to sport a bald scalp over his or her entire head, “layer shaving" of the donor area may be performed. Those who suffer from male pattern baldness, where hair is typically lost in the front, at the temples, and atop the crown, might benefit greatly from follicular unit extraction.

The surgeon will shave the back of the head during the FUE procedure, and singular hair follicles will be removed. Unlike strip surgery that requires the area to be sutured, the scalp will heal with small circles, which should be hidden by existing hair. Just like FUSS or FUT, FUE then involves the new hair and follicles being placed in the balding area, which may take anywhere from four to eight hours to complete as a physician and assistant may work together during the process.

During FUE, manual or motorized and sharp or blunt dissection can be used to control the depth of the extraction and to avoid destroying follicles.

FUE for Women FUE works for women as well as men, although the process generally involves differing concerns. Women may desire that their donor area hair be shaved in layers, since it may take up to two years for the original hair to reach its previous length prior to shaving.

Avoiding Bad FUE Results According to Dr. Kenneth L. Williams of Orange County Hair Restoration, the FUE technique refines the old method of punch extraction to allow an individual hair to be removed via a hair transplantation process that creates tiny circular punches that are one millimeter in size. Typically removing hair circles from the back of the head, FUE is a process that Dr. Williams writes has been disparaged by some who promote the strip surgery method instead.

However, Dr. Williams advises patients to select the best hair transplant surgeons available who are experienced in FUE - and not merely those who have the lowest rates. A photo of a patient whose FUE procedure featured over-harvested areas from his donor site is shown on Dr. Williams' website as a warning of what to avoid.

#3 - The NeoGraft Semi-Automated Hair Transplant System The NeoGraft semi-automated hair transplant system practices follicular unit extraction, but does so using a pneumatic pressure-powered machine wand instead of manual methods to extract donor hair. The wand moves quickly and without pain to remove hair and follicles, typically from the back of the head for males, and from additional areas for women.

NeoGraft is more accurate and faster than other methods of manual FUE. The process extracts, stores, and transplants the hair without it being touched. Brands such as AccuGraft Hair Transplant use the NeoGraft FUE technology.

Patients tend to experience little to no pain during the outpatient procedure that uses local anesthesia and takes one day to receive. The procedure can be so comfortable that certain individuals sleep during the transplant, or watch TV as they have their individual follicles harvested from the best positions and transplanted into optimal thinning areas or balding areas.

#4 - ARTAS Fully-Automated Hair Transplantation The ARTAS System uses a robot for hair transplantation, as the advanced robotic technology harvests individual follicles from the donor area. It begins with a custom three-dimensional model of your head that the surgeon creates with the ARTAS Hair Studio® Technology. Then the doctor will be able to show you how much fuller your results may appear after your hair transplant, based on how many hair grafts are required.

ARTAS employs algorithms to choose random hairs that are the best for harvesting, with the system not requiring any scars or sutures like strip harvesting. A device provides tension on the scalp to stabilize the skin and analyze hair density and angles in the donor area. The ARTAS robot contains a small needle, which means there are no linear scars created for the patient during the process. Afterward, patients can cut their hair as short as they would like without evidence of scarring.

After the surgeon enters important data, such as the dissection depth and the hair angle, the ARTAS camera keeps track of hair follicles, recalculating every 20 milliseconds. Adjustments are made as necessary during the two-step hair restoration procedure. The skin depth may be approximately one to two millimeters, while the punch depth may run about four millimeters deep to extract follicles from the skin. Less damage to existing healthy hair is the attraction of this procedure, which can last from five to seven hours.

ARTAS Hair Restoration for Women? According to Anil R. Shah, MD, of Chicago Hair Surgeon, "use of the ARTAS does suggest that women who are experiencing androgenic alopecia may be good candidates." Dr. Shah advises women to have their specific hair loss source identified via trichoscopy hair evaluation and extensive medical history with blood laboratory results included. ARTAS and PRP treatments may greatly help women suffering from hair loss.

The Bernstein Medical Center for Hair Restoration in New York announced that they were the first to use the upgraded ARTAS Robotic System 9x, which provides more precise and faster treatments.

Hair Transplant Cost

The cost of hair transplant procedures can vary, based upon the individual's donor hair area and the amount of hair grafts desired to be transplanted to balding areas. Several medical institutions may offer a variety of methods for hair transplantation with differing prices.

Certain facilities, such as MAXIM Hair Restoration in New York City, list prices per graft, such as $3.25 per graft. Therefore, their "mega hair transplant" including up to 4,000 grafts, would cost at least $13,000 for the maximum amount of grafts. Their consultations are free with the board-certified hair transplant surgeons.

Hair Restoration of New York also lists free consultations, with prices beginning at $4,000. Overall, hair transplant procedures may cost an average of $7,075, estimated by more than 2,086 RealSelf reviews under the general term of hair transplant.

Follicular unit extraction generally costs more than follicular unit transplantation (FUT) strip surgery, according to Ann Arbor Plastic Surgery. However, the firm notes that women getting hair transplants usually have fewer amounts of grafts transplanted, and typically pay between $4,000 and $8,000 for 500 to 1,500 grafts.

FUE hair transplant is listed on RealSelf as having a wide range of costs from $25 to $12,850 - but the average cost listed for more than 1,100 patients is $4,775. FUE can typically range from $4,000 to $15,000.

The ARTAS Robotic hair transplant method may cost as little as $6,900 and up to $18,000, with the average price of the treatment listed at $11,850 for more than 80 patients on RealSelf.

NeoGraft may range in cost from $3,500 to $15,000. The average cost of NeoGraft is listed at $9,775.

Recovering from a Hair Transplant Procedure

The type of hair transplant surgery undergone will dictate the recovery time and process.

The Chuback Medical Group notes that strip surgery harvesting involves an incision, therefore recovery from strip methods of hair transplantation may take longer than FUE recovery. Pain from the incision can be another result of strip surgery, which can be managed with medication.

Several considerations are shared among hair transplant recovery procedures, which include treating the scalp gently and with great care after surgery. The newly grafted hair and follicles will likely jut out from various places as stubble when the bulbs take root and begin to grow over the following 2.5 to 3 months, growing at the rate of normal hair of up to one inch monthly.

When to Get Haircuts, the First Shampoo After Hair Transplantation The Wimpole Clinic advises patients to treat their heads gently and wait until 10 days following hair loss surgery to wash and brush their hair like normal. While avoiding actions that may stress the scalp and cause new grafts to fall out, patients can still obtain a haircut after 10 days if they so desire, and wait until four weeks post-surgery to use hair color.

Immediately after the procedure, patients might experience itching, but they are advised not to scratch, touch, or comb the grafts during the first 10 days. Staying away from alcohol or activities that produce sweat - such as exercising, saunas, and steam rooms - are recommended during that period. Lifting heavy weights that strain the head or neck should also be temporarily avoided as the grafts settle in and get stronger during the first 10 days.

Hair Transplant Procedures Involve the Hair Growth Cycle During the recovery period, the transplanted hairs may not spring forth with new hair growth until several months have elapsed, because hair grows in cycles. The transplanted hair rests, but people often see the biggest growth of hair after approximately five months up to one year following their procedure, progressing in fullness and texture after that point.

When to See Your Doctor After Hair Transplant Surgery Crusty scalps, bleeding, swelling, infection, numbness, and eye bruising are possible side effects of hair transplantation procedures, and should be brought to the attention of your physician.

According to The Hair Transplant Institute of Miami, shock loss can occur after hair transplant surgery, but should be temporary. Shock loss happens when hair near the donor area or nearby natural hair is lost for several day or months in the wake of the procedure. As time progresses, the shock loss should heal and hair should return.

Before & After Hair Transplant Care

Prior to hair restoration surgery, discover the best hair transplant surgeons via the American Board of Hair Restoration Surgery, or select experts with patients who have had long-term success as proven by the physician's real before-and-after photo galleries.

In your consultation or before your hair transplant procedure, you should receive instructions on stopping the use of products such as Rogaine and Minoxidil approximately two weeks prior to your procedure's appointment day - a day that you won't wash your hair. Coloring gray hair should occur three days before hair transplant surgery to help your doctor see the hairs - but don't dye the hair again until two weeks following the procedure.

Blood-thinning medications such as aspirin should be avoided directly prior to and after the procedure. Patients should stop smoking one week prior to their hair transplant surgery.

After Hair Transplant Surgery Expect to sleep in an elevated position for 72 hours after the procedure to help reduce swelling. In the case of strip surgery, bandages can be removed 48 hours after surgery, and infection-preventing ointment received from your doctor should be applied for one week.

Scabs and short hairs may fall away during this time, which is a natural process, and doesn't likely contain the hair bulb. Whereas hair can be lightly rinsed after 48 hours, you should not rub your head nor shampoo it for at least 10 days.

Discuss with your doctor the long-term plan for success after your initial treatment. Based on the objectives, you may only need one visit to your physician for the procedure. However, in order to maintain your hairline, it might require that you resume topical Minoxidil solutions or a DHT blocker, as long as there are no negative indications for such treatments. The truly successful hair restoration surgery is one that lasts a long time and prevents future hair loss.

Ideal Candidates for Hair Transplant Procedures

New hair growth after suffering from baldness or thinning hair can provide a youthful look for patients. The thought of not having to wear a wig or hairpiece is attractive to patients willing to wait for the time it can take for natural hair to restore itself via hair restoration.

Any healthy person who doesn't like their thinning hair, balding areas, and receding hairline might be a good candidate for hair restoration. However, those patients must possess enough hair follicles in the donor area in order to have it transplanted to other areas on the scalp.

Based on the type of hair transplantation procedure used, varying candidates may be ideal for the surgery. For example, the ARTAS system is great for males who have straight black or brown hair - but could be FDA-approved for females in the future.

The best candidates for FUT and FUE hair restoration might be individuals who want to wear their hair short, without worrying about hiding the scar from a strip surgery incision. Whether you select ARTAS or NeoGraft as the method of extracting follicles for hair restoration, it's most important to determine the cause of your hair loss in the first place.

If the hair loss is attributable to stress, certain medications being consumed, or similar factors, they should be addressed and reversed if possible, prior to seeking hair restoration. Any individual who lacks enough natural hair follicles in their donor sites or is experiencing hair loss due to reasons other than male pattern baldness and the like, should determine if they are truly a good candidate for a surgical hair procedure.

In your search for excellent hair transplant surgeons, make sure to seek out those who are experienced in all types of hair restoration, and not merely an FUE or FUT specialist.

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