If you're considering Hair Replacement...
Hair loss is primarily caused by
a combination of aging, a change in hormones, and
a family history of baldness. As a rule, the earlier
hair loss begins, the more severe the baldness will
become. Hair loss can also be caused by burns or trauma,
in which case hair replacement surgery is considered
a reconstructive treatment, and may be covered by
health insurance. If you're considering hair replacement
surgery, the following information will give you a basic understanding
of the variety of procedures involved. It can't answer
all of your questions, since a lot depends on your
The Truth about Hair Loss
Baldness is often blamed on poor
circulation to the scalp, vitamin deficiencies, dandruff,
and even excessive hat-wearing. All of these theories
have been disproved. It's also untrue that hair loss
can be determined by looking at your maternal grandfather,
or that 40-year-old men who haven't lost their hair
will never lose it.
The Best Candidates For Hair Replacement
Hair replacement surgery can enhance
your appearance and your self-confidence, but the
results won't necessarily match your ideal. Before
you decide to have surgery, think carefully about
your expectations and discuss them.
It's important to understand that all hair replacement
techniques use your existing hair. The goal of surgery
is to find the most efficient uses for existing hair.
Hair replacement candidates must
have healthy hair growth at the back and sides of
the head to serve as donor areas. Donor areas are
the places on the head from which grafts and flaps
are taken. Other factors, such as hair color, texture
and waviness or curliness may also affect the cosmetic
result. There are a number of techniques used in hair
replacement surgery. Sometimes, two or more techniques
are used to achieve the best results.
Transplant techniques, such as punch
grafts, mini-grafts, micro-grafts, slit grafts, and
strip grafts are generally performed on patients who
desire a more modest change in hair fullness. Flaps,
tissue-expansion and scalp-reduction are procedures
that are usually more appropriate for patients who
desire a more dramatic change.
Remember, there are limits to what can be accomplished.
An individual with very little hair might not be advised
to undergo hair replacement surgery.
Hair Loss in Women
Some doctors estimate that one in
five women will experience some degree of hair loss
usually caused by aging, illness, or hormonal changes
after menopause. Women tend to experience a subtle
thinning all over the scalp rather than losing hair
in patches as is common in men. To correct the problem,
some women choose to wear a wig or hair extensions.
Others have had some success using a topical prescriptive
drug. The effectiveness of such drugs varies in some
patients and simply prevents further hair loss without
stimulating any appreciable new growth. Hair replacement
surgery may be the answer for those who feel uncomfortable
with either of these options.
Because mini-grafts are usually the surgical treatment
of choice for filling-in thinning areas, good candidates
for this procedure should have dense hair growth at
the back of the head. Mini-grafts are harvested from
this dense area and replanted in thinning areas to
create a fuller look. Occasionally flap and tissue
expansion procedures may be used if the individual
is judged to be a good candidate.
If you're considering a hair replacement procedure,
it's important to understand that you will never have
the coverage you had prior to your hair loss, but
surgery may camouflage the thin areas and give you
All Surgery Carries Some Uncertainty
Hair replacement surgery is normally safe when performed
by a qualified, experienced physician. Still, individuals
vary greatly in their physical reactions and healing
abilities, and the outcome is never completely predictable.
As in any surgical procedure, infection may occur.
Excessive bleeding and/or wide scars, sometimes called
"stretch-back" scars caused by tension may
result from some scalp-reduction procedures.
In transplant procedures, there
is a risk that some of the grafts won't "take."
Although it is normal for the hair contained within
the plugs to fall out before establishing regrowth
in its new location, sometimes the skin plug dies
and surgery must be repeated. At times, patients with
plug grafts will notice small bumps on the scalp that
form at the transplant sites. These areas can usually
be camouflaged with surrounding hair.
When hair loss progresses after
surgery, an unnatural, "patchy" look may
result-especially if the newly-placed hair lies next
to patches of hair that continue to thin out. If this
happens, additional surgery may be required.
Planning Your Surgery
Hair replacement surgery is an individualized treatment.
In your initial consultation, I will evaluate your
hair growth and loss, review your family history of
hair loss, and find out if you've had any previous
hair replacement surgery. I will also ask you about
your lifestyle and discuss your expectations and goals
Medical conditions that could cause problems during
or after surgery, such as uncontrolled high blood
pressure, blood-clotting problems, or the tendency
to form excessive scars, will also be checked . Be
sure to tell me if you smoke or are taking any drugs
or medications, especially aspirin or other drugs
that affect clotting.
Preparing For Your Surgery
I will give you specific instructions on how to prepare
for surgery, including guidelines on eating and drinking,
smoking, and taking and avoiding certain vitamins
and medications. Carefully following these instructions
will help your surgery go more smoothly. If you smoke,
it's especially important to stop at least a week
or two before surgery; smoking inhibits blood flow
to the skin, and can interfere with healing.
You should arrange for someone to drive you home
after your surgery. Plan to take it easy for a day
or two after the procedure and arrange for assistance
if you think you'll need it.
Types Of Anethesia
Hair replacement surgery, no matter
what technique is used, is usually performed using
a local anesthesia along with sedation to make you
relaxed and comfortable. Your scalp will be insensitive
to pain, but you may be aware of some tugging or pressure.
Hair transplantation involves removing
small pieces of hair-bearing scalp grafts from a donor
site and relocating them to a bald or thinning area.
Grafts differ by size and shape. Generally, several
surgical sessions may be needed to achieve satisfactory
fullness-and a healing interval of several months
is usually recommended between each session. It may
take up to two years before you see the final result
with a full transplant series. The amount of coverage
you'll need is partly dependent upon the color and
texture of your hair. Coarse, gray or light-colored
hair affords better coverage than fine, dark-colored
Just before surgery, the "donor
area" will be trimmed short so that the grafts
can be easily accessed and removed. A scalpel will
be used to remove small sections of hair-bearing scalp,
which will be divided into tiny sections and transplanted
into tiny holes or slits within the scalp.
To maintain healthy circulation in the scalp, the
grafts are placed about one-eighth of an inch apart.
In later sessions, the spaces between the plugs will
be filled in with additional grafts. I will take great
care in removing and placement of grafts to ensure
that the transplanted hair will grow in a natural
direction and that hair growth at the donor site is
not adversely affected.
After the grafting session is complete,
the scalp will be cleansed and covered with gauze.
You may have to wear a pressure bandage for a day
This technique is sometimes referred
to as advancement flap surgery because sections of
hair-bearing scalp are pulled forward or "advanced"
to fill in a bald crown.
Scalp reduction is for coverage of bald areas at the
top and back of the head. It's not beneficial for
coverage of the frontal hairline. After the scalp
is injected with a local anesthetic, a segment of
bald scalp is removed. The pattern of the section
of removed scalp varies widely, depending on the patient's
The skin surrounding the cut-out area is loosened
and pulled, so that the sections of hair-bearing scalp
can be brought together and closed with stitches.
It's likely that you'll feel a strong tugging at this
point, and occasional pain.
After Your Surgery
How you feel after surgery depends
on the extent and complexity of the procedure. Any
aching, excessive tightness, or throbbing can be controlled
with pain medication prescribed by your physician.
If bandages are used, they will usually be removed
one day later. You may gently wash your hair within
two days following surgery. Any stitches will be removed
in a week to 10 days. Be sure to discuss the possibility
of swelling, bruising, and drainage.
Because strenuous activity increases blood flow to
the scalp and may cause your transplants or incisions
to bleed, you may be instructed to avoid vigorous
exercise and contact sports for at least three weeks.
Getting Back to Normal
How soon you resume your normal
routine depends on the length, complexity and type
of surgery you've had. You may feel well enough to
go back to work and resume normal, light activity
after several days.
Many patients who have had transplants (plugs or
other grafts) are dismayed to find that their "new"
hair falls out within six weeks after surgery. Remember,
this condition is normal and almost always temporary.
After hair falls out, it will take another five to
six weeks before hair growth resumes. You can expect
about a half-inch of growth per month.
You may need a surgical "touch-up"
procedure to create more natural-looking results after
your incisions have healed. Sometimes, this involves
blending, a filling-in of the hairline using a combination
of mini-grafts or micro-grafts. In general, it's best
to anticipate that you will need a touch-up procedure.