Hair transplantation is a procedure that involves removal of hair from one part of the body, called the ‘donor site’, to a bald or balding part of the body known as the ‘recipient site’. In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding (like the back of the head) are transplanted to the bald scalp.
Hair transplantation can also be used to restore eyelashes, eyebrows, beard hair, and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants.
Hair naturally grows in groupings of 1 to 4 hair which are called Grafts. This procedure involves taking these natural group of hair & achieve a natural appearance by mimicking original hair orientation. From the donor hair can be taken in two different ways: follicular unit transplantation (FUT) or strip harvesting, and follicular unit extraction (FUE).
Pre-operative assessment and planning
At an initial consultation, the surgeon analyzes the patient’s scalp, actual existing density of hair , discusses their preferences and expectations, and advises them on the best approach (e.g. single vs. multiple sessions) and what results might reasonably be expected. The grade of baldness helps is making an assessment of how many grafts are needed & what results one can expect.
Some patients may benefit with preoperative topical minoxidil application and vitamins. For several days prior to surgery the patient refrains from using any medicines which might result in intraoperative bleeding and resultant poor grafting. Alcohol and smoking can contribute to poor graft survival. Post operative antibiotics are commonly prescribed to prevent wound or graft infections.
Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injection local anesthesia.
There are several different techniques for harvesting hair follicles. Regardless of the harvesting technique, proper extraction of the hair follicle is paramount to ensure the viability of the
transplanted hair and avoid transection, the cutting of the hair shaft from the hair follicle. Hair follicles grow at a slight angle to the skin’s surface, so transplanted tissue must be removed at a corresponding angle.
There are two main ways in which donor grafts are extracted today: strip excision harvesting, and follicular unit extraction.
Strip harvesting (also known as follicular unit transplantation or FUT) is the traditional method for removing follicles from a donor site. The surgeon harvests a strip of skin from the back part of scalp with an area of good hair growth. The individual follicular unit grafts, which are small, naturally formed groupings of hair follicles are dissected from the strip under microscope
The surgeon then uses very fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density, pattern, and angle & finally inserting the individual grafts in place.
This thin linear scar in the donor area, which is typically covered by a patient’s hair. The recovery period is around 2 weeks and will require the stitches/staples to be removed after 7-10 days.
Follicular unit extraction (FUE)
With Follicular Unit Extraction or FUE technique, individual follicular units containing 1 to 4 hairs are removed under local anesthesia; this micro removal typically uses tiny punches of between 0.6mm and 1.0mm in diameter. The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density, pattern, and angle to promote a realistic hair pattern. The final part of the procedure involves inserting the individual grafts in place at the recipient site.
FUE takes place in a single long session or multiple small sessions. The FUE procedure is more time-consuming than strip surgery. An FUE surgery time varies according to the surgeons experience, speed in harvesting and patient characteristics. The procedure can take anywhere from a couple hours to extract 200 grafts for a scar correction to a surgery over two consecutive days for a megasession of 2,500 to 3,000 grafts.
Advantages Of FUE over FUT
- FUE negates the need for large areas of scalp tissue to be harvested, so there is no scar on the back of the head.
- Post-surgical pain and discomfort is minimized.
- Recovery period is less than 7 days.
Other Uses of Hair Transplant Surgery
Other than restoring the hair on scalp, facial hair transplant treatment is quite commonly done, which restores hair to areas where facial hair growth is thin or missing. This procedure is most commonly performed on eyebrows, moustache, beard & sideburns. Facial hair transplants can be used to give a more mature, masculine looking appearance and can also be used to conceal acne scars and other types of scars.
Body hair transplantation (BHT)
If donor hair numbers from the back of the head are insufficient, it is possible to perform body hair transplantation (BHT) on appropriate candidates who have available donor hair on the chest, back, shoulders, torso and/or legs. Body hair transplant surgery can only be performed by the FUE harvesting method and, so, requires the skills of an experienced FUE surgeon. However, there are several factors for a potential BHT candidate to consider prior to surgery. These include understanding the natural difference in textural characteristics between body hair and scalp hair, growth rates, and having realistic expectations about the results of BHT surgery.
Side effects from a hair transplant are usually minor and clear up within a few weeks.
They can include:
- swelling of the scalp
- bruising around the eyes
- a crust that forms on the areas of the scalp where hair was removed or implanted
- numbness or lack of sensation on the treated areas of the scalp
- inflammation or infection of the hair follicles, which is known as folliculitis
- shock loss, or sudden but typically temporary loss of the transplanted hair
Robotic hair restoration
Robotic hair restoration devices utilize cameras and robotic arms to assist the surgeon with the FUE procedure. Robotic hair transplant has a number of advantages and often enhance and extend human capabilities. Their accuracy and repeatability may reach the sub-millimetre level. The extracting punch is mounted on an automatic arm of Robot and machine is programmed and patient is given proper position. The scalp donor area is selected by surgeon and a skin tensioner is fixed & then the robotic machine automatically extracts the graft. The implantation of follicles are done by surgeons and or his technicians. This technique is still under many changes and upgradation.