Hair has a great social significance for human beings. It can grow on almost every area of the human body except on the palms and soles. But hair is most noticeable in only a small number of areas which are also the ones that are most commonly trimmed, plucked or shaved. Hair is seen as an indicator of gender or aging. Facial hair is one of the most visible differences between the male and female body, while facial hair is a sign of puberty in men, white hair is an indicator of aging. Although in today’s society a shaved head is an acceptable hair style for men, healthy hair indicates vitality and youth, which may explain the reason why many people experiencing baldness seek hair restoration.
Baldness is the loss of hair from the head. In men, this condition can have its onset from a younger age (about 16 years). Conventionally, baldness is believed to be caused due to three main factors: age, hereditary factors, and effect of androgenic hormone. Adding to these, changes in life style have also contributed to this condition. Examples of such conditions are stress in the forms of smoking, late night jobs, long hours of work, irregular sleep cycles. These conditions have not only increased baldness in men, but also in women. Therefore, hair transplantation technique can also be beneficial to them.
Hair transplantation is a popular procedure for growing permanent natural hair on bald areas of head, eye brows and other areas. A successful hair transplant can change your life. Hair Grafting is a surgical technique that involves moving individual hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. However, it is also used to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants.
Hair naturally grows in follicles that contain 1 to 4 hairs. Today’s most advanced techniques transplant these natural 1–4 hair “follicular units” in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking natural hair. This hair transplant procedure is called Follicular Unit Transplantation (FUT).
Hair transplant operations are performed on an outpatient basis, under local anaesthesia with mild sedation (optional), which usually takes about six hours. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested.
At an initial consultation, Dr Goyal analyzes the extent of your baldness and quality of your hair. The doctor will estimate the approximate number of grafts available at your donor area and will discuss the plan (e.g. FUT Vs FUE, single vs. multiple sessions) to give you best result. The assessment includes the post surgery density & the hair transplant cost. During your consultation with Dr. Goyal, you will get answers of commonly asked questions about hair loss problem and about hair transplantation.
Cyclic medicine treatment for 2-3 months is usually recommended to improve the result of hair transplantation.
Design of the Hairline
It is important to project the definitive frontal hairline, especially in young patients. The frontal hairline is projected in an irregular manner, maintaining the temporal recesses .A non-straight line is vital to have a more natural and non-detectable result. Usually, the forehead middle point is 8 cm distant from the root of the nose, varying from 7 to 9 cm depending on the facial structure.
FUT Vs FUE
Follicular unit hair transplant (FUT) is the gold standard for hair transplant procedures. According to international data 91 percent of hair transplant processes all over the world are done using the FUT process. The basic steps in the process involve removal of a strip from the back portion of the head (where hair growth is permanent), separation of the hair follicles one by one, and then individual implantation in the area of baldness or thinning. Follicular unit extraction (FUE) a reliable hair transplant procedure that involves no scars. The hair graft is taken directly from the scalp using small punches of 0.8 mm to 1.5 mm. These grafts are then implanted into the region of baldness. Similar to head, other areas like back of the head, chest hair, hair of the temple region, beard region can also be used for transplantation. This procedure is more time consuming and is generally limited to 1800-2000 follicular units at a time. The procedure is exclusively meant for those who desperately do not want scars on their head.
In Hair Transplant by FUT more number (more then 2000, sometimes upto 4000) of follicles can be harvested in one sitting while this may not be possible in Hair Transplant by FUE. FUE is useful for small sessions. Examples include eyebrow, hairline, and other touch-up procedures.
In Hair Transplant by FUT strip harvesting follicle dissection is done under direct vision using magnification so chances of follicle damage are very negligible. While Hair Transplant by FUE is blind technique of harvesting follicles, so there are more chances of follicle damage.
In Hair Transplant by FUT you get a linear scar which is almost invisible (tricophytic closure) while there is no linear scar in Hair Transplant by FUE. But multiple small circular scars are given after extraction of follicles using circular punch.
In Hair Transplant by FUE we can harvest body hair follicles while it is not possible in Hair Transplant by FUT. This is greatest advantage of Hair Transplant by FUE.
Hair Transplant by FUE is good procedure for small number of follicles to be transplanted like for beard, moustaches and for successive stages of hair transplant.
Usually cost of Hair Transplant by FUE is much more then Hair Transplant by FUT because it involves more time and expensive disposables to be used in this technique.
Generally, both the techniques yield approximately the same final results. There is not much of a difference in parameters like density, distribution, and appearance.
In the usual follicular unit strip procedure, the surgeon harvests a strip of skin from the back of your scalp (a baldness resistant area). The excised strip is about 1–1.5 x 15–30 cm in size. The gap is closed by using a special technique which is known as trichophytic closure. This technique enables us to give a nearly invisible scar at donor site. The production of graftable follicular unit requires a two stage process of first slivering and then dissection of the follicular unit from these slivers. Both of these stages are accomplished with the help of most advanced dissecting microscopes by highly trained technicians at our centre. The follicles dissected are immediately preserved within special cooling solutions and are made ready for transplantation. The surgeon then uses very small micro blades or fine needles to make slits for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern by inserting the individual grafts in natural angle & sites.
The whole procedure can take 5-6 hours or more depends on the numbers of graft used. You can take break for lunch & for washroom. You are completely conscious & comfortable all the time. You can watch television or listen music of your choice.
Small dressing and head band is given after the procedure. Detailed post operative instructions will be provided in writing.
How Is Each Hair Transplant Step Different at Lavanya Clinic?
Planning & Hairline Design
It is important to project the definitive frontal hairline, especially in young patients. The frontal hairline is projected in an irregular manner, maintaining the temporal recesses. A non-straight line is vital to have a more natural and non-detectable result. Usually, the forehead middle point is 8 cm distant from the root of the nose, varying from 7 to 9 cm depending on the facial structure
Donor Area Trimming & Local Anesthesia
We identify the thinning areas (known as the “recipient” areas) that you are interested in restoring and work to personalize a plan to help you achieve the most natural-looking hairline possible.
Next, we prepare the hair from the back of your head (known as the “donor” area) by trimming the area and preserving the surrounding hair. After administering local anesthesia to numb the donor area so that you’re completely comfortable during the procedure, our physician removes a strip of tissue in the donor area containing your permanent, lifelong hair follicles. Once we’ve removed the donor’s hair, we suture the area and use the surrounding hair to conceal the sutured area.
Recipient Site Creation or Slit making
When performing a hair transplant, the surgeon creates hundreds to thousands of tiny incisions, called recipient sites, in the balding areas of the scalp where harvested follicular unit grafts are to be placed. The pattern of recipient sites, and how they are created, has a major impact on the outcome of the hair transplant.
To create the recipient sites, we use a variety of instruments depending on the clinical situation. In all hair transplants, the goal during the procedure is to create a snug fit between the follicular unit and the skin surrounding the graft. This will maximize oxygenation of the grafts, promote healing, and increase graft survival. Tiny recipient sites also ensure that there will be no visible scarring, pitting or other surface irregularities as a result of the hair restoration procedure.
We use fine hypodermic needles or a series of custom-made, ultra-fine blades to create the hair transplant recipient sites. The blades range in diameter from 0.6mm (for single-hair follicular unit grafts) to 0.9mm (for 4-hair follicular units). Before site creation begins, the different size follicular units are fitted to specific site sizes to determine exactly the best size instrument to use for each graft. By custom fitting the sites to the grafts, healing is facilitated and our patients are able to return to showering and gentle shampooing the day following the hair restoration.
At Lavanya Laser & Plastic Surgery, the recipient sites in all of our hair transplant procedures are made using lateral slits (also called coronal or horizontal slits). Recipient sites created using lateral slits give the hair transplant surgeon the highest degree of control over the direction and angle in which the transplanted hairs will ultimately grow.
Follicular units placed in lateral slits will provide more coverage than those placed in vertical slits, as the hair follicles tend to fan out over the surface of the scalp rather than lying on top of one another. Lateral slits also allow the hair transplant surgeon to angle the follicular unit grafts more acutely and follow the orientation of the patient’s original hair to match the way it grows in nature. This is particularly important at the temples, in the crown, sideburn areas, and in eyebrow restoration.
Controlling the depth of incision is also critical in making recipient sites, as limited depth incisions minimize injury to the deeper blood vessels in the scalp, allow grafts to be placed more closely together, decrease tissue swelling after hair transplant surgery, and facilitate healing.
Follicular Unit Extraction (FUE), as opposed to the FUT procedure, is a hair transplant method in which the doctor extracts the follicular units of hair, from the donor area of your head, one by one. The doctor uses a small microneedle, which punches a tiny incision around a hair follicle before extraction. Each unit contains one to four hairs. These ones to four hair groupings (called follicular unit grafts) are then transplanted into the balding areas of your head. In this method thus, there is no need for the surgeon to make a long incision in the donor area, as in the FUT procedure. This is an ideal method of surgery for patients who like to wear their hair short. This method is also recommended for patients who have a tight scalp or have previously undergone the ‘strip’ or FUT method but with little or no success
Graft Counting & Consent Form
You can’t differentiate between let’s say 2500 grafts and 3000 grafts by just looking at the scalp after the grafts are planted. However if you count the grafts after they are extracted (before they are taken for implantation), then you get at least know how much was extracted.
After implantation there is a problem with graft counting (From the patients point of view):
You cant count them on your own as it would be difficult to count even after taking pics. In FUE you can see the whitish circular epidermal part. A count of these epidermal circles might give you an approximation. But the count may be nowhere closer to the actual count. This is especially true with High-density hair transplants. Many grafts are implanted too close to each other, this makes them impossible to distinguish between 1 graft or 2 grafts. Sometimes the epidermal portion may not be present which makes it appear as if nothing is being planted in that area. Counting before they are waiting for implantation is easier said than done. It takes 2 hair transplant assistants to count 3000 grafts in about 1–2 hrs. or sometimes more. How a patient untrained in counting grafts are going to do it accurately? And just by looking at the stored grafts, you won’t know any difference between 2500 and 3000 grafts.
A hair transplant is a procedure in which a plastic or dermatological surgeon moves hair to a bald area of the head. The surgeon usually moves hair from the back or side of the head to the front or top of the head. Hair transplants typically occur in a medical office under local anesthesia. Pattern baldness is responsible for the majority of hair loss. This comes down to genetics. The remaining cases are due to a variety of factors, including:
- hormonal imbalance
Final Result & Recovery
During the first 10-20 days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out (“shock loss”). The implanted roots are intact and they start growing new hair after 3-4 months. After three or four months new hair will begin to grow from the moved follicles. Then the patient’s hair will grow normally, and continue to thicken through the next six to nine months. So the final result of hair grafting is visible after 8-12 months after surgery. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure.
Hair transplantation is actually about relocating or transplanting the bald-resistant hair follicles from the back of your head (donor area) to the balding areas on the top of the head.
Transplanted hairs are permanent. This process works for a lifetime because the hair follicles taken from the back of the head are genetically resistant to baldness, regardless of where they are relocated to.
The transplanted hair is your own hair. Hair transplantation when done right, appear absolutely natural, they grow naturally and can be cut, washed, combed, and styled. But the skill and technique of the surgeons do vary widely, as do their results. It is important to choose the right procedure and the right hair transplant surgeon to assure that you will get the best possible results.
It is safe. It is performed under local anesthesia in high standard operation theatre.
There are no visible scars. The donor area at the back is closed with the unique technique known as “Trichophytic closure”, which leads to a fine line-like scar that is covered by the hair without any baldness
Usually, 1 or 2 sittings are required depending on the extent of your baldness. If the bald area is small, it can be filled in one sitting only.
A typical session normally involves a full day of surgery on an outpatient basis. Most patients arrive in the morning and will have their procedure completed by late afternoon or evening.
We use the most advanced technique of local anesthesia that gives a painless experience. Most patients find that once anesthesia is given they feel no pain or discomfort during the whole length of surgery. Most patients are pleasantly surprised by how minimal the discomfort from the procedure is.
Ideal candidate for hair transplantation is one whose baldness is not progressive and has healthy and dense hair density at the back and sides of the head.
Yes, some women are good candidates for hair transplantation.
Though the transplanted hair is permanent, the original hair may continue to fall in some cases. This new bald area can be managed by another sitting of HT. Cyclic medicine helps to reduce further hair loss.
Some studies show that intake of certain vitamins, amino acids, and minerals at regular intervals along with local scalp care with Minoxidil and specific shampoos reduce hair fall, thickens existing miniaturized hair, and helps to grow new hair.
You can have head wash after three days with plain water .You shall not rub transplanted area with towel till 10 days. Avoid heavy exercise (workout) for two weeks.
Usually, no rest is required. If you are doing field work then you can take 2-3 days’ rest but if your work is confined to the office then on the very next day you can resume your job.
Small scabs in the recipient area are generally present for 1-2 weeks. Over the next few weeks, most of the hair shafts will fall out. New hair shafts will begin to grow over the next 3-4 months. The transplanted hair grows very thin initially and gradually grows thicker and fuller over time. The final result will be visible in 8 to 10 months.
After one year a patient’s transplanted hair will be fully mature and will continue to grow for a lifetime.