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The Basics of Hair Transplant Surgery

Clinical Methods for Hair Transplantation

Hair transplantation or hair surgery as it is more fondly called, is the medical procedure that extracts individual hair follicles from a particular area of the body. The extracted follicles are then surgically planted on the affected area, more particularly, an area on the scalp that is no longer able to propagate and produce healthy hair growth. Hair surgery is a last course of action in a solution treatment of male pattern baldness. The concept of hair surgery lies on the concept of transferring healthy hair follicles that are not genetically prone to male pattern baldness, this minor surgical procedure involves extracting the hair follicles, not necessarily coming from the head but other parts of the body that has healthy hair growth.

Since the scalp is also a part of our skin, other hair growing in our body can also grow on our scalp. The only difference is that other hairs on our body are not genetically prone to male pattern baldness unlike those that are growing on our head. Therefore, it was conceded that male pattern baldness was not a matter of the scalp being genetically prone to male pattern baldness but that of the hair follicles that grow on our head. Hair surgery is not limited to the hair on top of our heads, it can also be applied to restore eyebrows, eyelashes, chest hairs, beard hairs and even pubic hair as a result of any unfortunate accident.

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The concept of hair transplant is quite different from that of skin grafting as the later involves an extraction of the epidermis and dermis. Hair usually grows by 1 to 4 groups of follicles on a single area, by this arrangement, a hair surgeon can mimic the almost natural condition that hair should look like on a normal, healthy scalp and is called by hair surgeons as Follicular Unit Tranplantation (FUT). There are two kinds of common procedures that hair surgeons use when performing FUT.

Strip Harvesting:

Strip harvesting involves a procedure that necessitates the removal of a strip of hair growth tissue from the scalp which is no affected by male pattern baldness. These strips of tissue with healthy hair growth are then planted on the recipient side of the head, which is of course, the balding part of the head. The extracted tissue of healthy hair growth can be described as a row of corn in a corn field. The area in which the healthy hair growth tissue were extracted will be sewn together that will eventually leave a pencil line like scar. The donor area in which the tissues were extracted, which are located on the back part of the head, would heal naturally and will be unnoticeable due to hair growth. Recovery period from this kind of hair transplantation surgery usually takes about 2 weeks.

Follicular Unit Extraction:

FUE harvesting as commonly addressed by hair transplant surgeons, this procedure involves the individual extraction of follicle groups of between 1 to 4 groups of hairs, under localized anesthetics. It is a microscopic removal procedure that requires surgeons to use binocular type microscope. These microscopic patches of hair follicles measure to about 0.6 mm to 1.0 mm in diameter, no bigger than that of a pin head. The extracted follicles also include the surrounding scalp tissues, and are inserted by the surgeon on tiny sites on the affected scalp by the use of a placement tool. Puncture woulds are usually the result after this surgery and pain and inflammation is reduced to a minimal after post operation procedure, recovery period could be as long as a week (7 days). Some surgeons however disclose that the chances of Follicular Unit Extraction to be successful is very low, and that a number of sessions would be needed to arrive at a satisfactory result.

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The History of Hair Transplantation

During the 19th century, the first crude attempt to cover a balding man’s head was done by using the scalp band, which was a particularly large amount of scalp tissue that contained the original veins and blood supply. This procedure meant literally exposing the top part of the cranial plate, hence exposing the skull itself. In the early 1930′s, in Japan, modern surgical techniques were incorporated when surgeons used small tissue grafts even to the point of follicular grafts, to repair some portions of a damaged eyebrow and it was not originally for the purpose of male pattern baldness. Unfortunately, their efforts were not received with enthusiasm during those time and the onset of World War II further delayed their pursue of advancing their methods for another 20 years.

The arrival of modern post war technologies and advancement in science and medicine, had paved the way for the western world in the later part of the 1950′s. In the United States of America, particularly in New York, a dermatologist named Norman Orentreich, started to work on the principles of donor grafting of follicular growth and transplanting them to affected areas, that would later be used as the standard procedure of hair transplantation. During the early years of the conceptualization of hair graft transplantation, it was thought that hairs that were taken out from a healthier area on the head would survive and propagate as normally as it would from the area that it was taken from.

The principle of donor transplant was further supported by Dr. Walter P. Unger, who defined the principle that extraction of healthy hair follicles for transplantation on the recipient site, said that from the most potential part of the area of the head, a donor healthy donor follicle would survive and thrive just as well and just as long as it would in it’s original place. Even as today, these are the same principles used by hair transplant surgeons and dermatologist. For the following 20 years, work continued to improve a refined and effective method of propagating and implanting follicular tissues. In the 1980′s, an American doctor named William Rassman was successful in using “micro grafts”.

Since the introduction of microscopic procedures continued to improve, doctors were having trouble in effectively performing these surgical operations. It was not until the late 1980′s that Dr. Limmer, created a specialized binocular type of microscope that can be worn on the face as an attachment to the spectacles or eye glass. Further improvements of the methods of follicular hair transplant became more refined as improvements on both the methods and equipments also gave practicing surgeons a chance to refine their approach on the proper procedure. The sizes of the surgical tools became smaller that allowed a faster and more precise surgical incision that left very little post surgical scars. So refined was the improvement in surgical tools and procedure, that it enabled the implantation of over 50 grafts in a single square centimeter area.

Improvements in the procedure concerning the angle and orientation of implants provided a natural way on how the newly planted follicles would grow out to create a seemingly natural growth pattern. Veering away from the traditional direct downward implantation plane of trajectory, surgeons were now adopting a lateral slit implantation technique since the early years of 2000. This enabled surgeons to create a brushed effect when the follicles grew out after fully recovering from the surgery, providing an angle that covers an ample amount on the area of the affected scalp region. Of course, even in the advent of modern techniques and procedures, there are always disadvantages that come out of any surgical procedures. Lateral incisions tend to destroy the veins on the scalp, causing less blood irrigation to the newly planted follicles.

Procedures of Hair Transplantation Surgery

Her is a simplified method on how the basics of hair transplant surgery works, as to give a simple point of view on how the procedure takes place from beginning to post surgical recovery. The primary concept of hair transplant surgery was originally for follicular restoration of damaged hair that covers portions of the body particularly the eyebrows and head, and was not meant for male pattern baldness to begin with. It all starts with initial consultation with a hair surgeon to evaluate the affected span of the damaged area. The doctor will make the proper diagnosis to the patients scalp to make valid decisions on the proper procedures that will not compromise the end result. The doctor will give the patient his honest opinion on the expected result in view of the procedures that will be made.

Even days before actual surgery, the patient is strictly refrained from engaging in the use of alcohol, smoking and any counter indicated prescription medicines that may induce hemorrhage during the surgical proceedings.

Surgical Proceedings

Usually, hair transplantation is considered as minor surgery and that it is considered an outpatient procedure that only involved mild sedatives, which is optional, to relax the patient and localized anesthesia, as such surgery can last up to as long as 6 hours. The scalp is washed clean with an antibacterial shampoo. After the administration of a mild sedative, the scalp is then subjected localized anesthetic prior to follicular extraction. The surgeon then proceeds to to harvest a portion of the scalp tissue from the posterior area which is composed mostly of good hair growth. The strip of follicular tissue usually measures about 1 to 1.5 by 15 to 30 centimeters. After the extraction, the surgeon will close up the wound where the follicular tissues were taken, while this is being done, the extracted tissue will then be cut up into strips, prior to implantation.

The extracted strips will then be cleaned from any excess of fibrous fatty tissues while avoiding to incur any unnecessary damage to the follicular area. The latest surgical method called “trichophytic closure” ensures surgical recovery that will only result to pencil line scars. As compared to the olden days of the procedure, today’s modern methods disregards the use of large areas of the scalp nor the need to initiate bigger surgical incisions. The modern use of micro blades and ultra fine surgical needles to make puncture wounds for surgical implantation, the surgeon does all the proceedings from start up to the point of making the final puncture points in where to plant the donor follicular tissues, while implantation technicians are the ones that put the follicular tissues in their final places.

Post Operative Care

Semi-permeable dressings are finally applied to the area, which allow the seepage of excess blood and albumin. Daily change of clean dressings are needed in order to maintain a good hygienic state as to ensure that there will be no post operative onset of infection. The affected area must be shielded from direct contact from sunlight as it may cause unnecessary growth of bacteria that may infect the fresh wound. The application of bacteriostatic shampoo is needed in order to keep bacteria from causing any chances of growth and maintain a favorable scalp pH balance that will stave down any possibilities of irritations. During the process of healing, scabs will naturally adhere to the hair follicles that may make the newly implanted follicles to fall off, and this is during the first 7 to 10 days after the operation.

The newly recovering scalp will experience post operative trauma or shock that eventually fall off, fortunately, after two to three months after the operation, hair will begin to grow and as expected, it will grow normally and will continue to improve on it’s growth for the next six to nine months after the surgical procedure. The first two to three months will evaluate on the chances of the surgery to succeed or not as some cases would imply, failed to produce adequate or positive results, requiring them to undergo subsequent surgical proceedings for the second time. Nowadays, DNA test are first made to ensure that the patient’s follicle compatibility is viable for follicular tissue transplantation in order to make a predictive outcome of the surgery. Guess work is usually decreased as to know the possibilities of a favorable outcome in order for the surgeon to recommend any alternative procedures that will be of favor to the patient.

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Josh Matthews

My name is Josh Matthews and I am 53 years old and live in Miami. I have two kids, one boy and one girl with my wife Linda. My son Jon is now 19 years old and in College. My daughter Jennifer is 14 and still in High-School. We also have a dog. When I don't work in the marketing department of a health company, I like to spend time outdoors with my family and friends. I don't do as much sport as I should but my family and me go on a skiing vacation at least once a year.

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About the author

I am 53 years old and live in Miami. I have two kids, one boy and one girl with my wife Linda. My son Jon is now 19 years old and in College. My daughter Jennifer is 14 and still in High-School. We also have a dog. When I don’t work in the marketing department of a health company, I like to spend time outdoors with my family and friends. I don’t do as much sport as I should but my family and me go on a skiing vacation at least once a year.

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