Hair transplantation
2902770
224848318
2008-07-10T18:10:05Z
64.50.9.27
/* History */
'''Hair transplantation''' involves relocating (transplanting) bald resistant [[hair follicles]] from the back and sides of the head (the donor areas) to a person’s bald or thinning areas. The transplanted hair follicles will typically grow hair for a lifetime because they are genetically resistant to going bald. In recent years hair transplantation techniques have evolved from using large plugs and mini grafts to exclusively using large numbers of small grafts that contain from between 1 to 4 hairs.
Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques [[Organ transplant|transplant]] these naturally occurring 1 – 4 hair "follicular units" in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This recent hair transplant procedure is called "[[Follicular Unit Transplantation]]."
Given the improved naturalness of hair transplantation surgery [[hair loss]] sufferers are increasingly selecting this hair loss treatment{{Fact|date=February 2007}}.
==History==
The use of both [[scalp]] flaps, in which a band of tissue with its original blood supply is [[medical grafting|shifted]] to the bald area, and free grafts dates back to the 19th century. Modern transplant techniques began in Japan in the [[1930s]], where surgeons used small grafts, and even "[[hair follicle|follicular unit grafts]]" to replace damaged areas of [[eyebrows]] or lashes. They did not attempt to treat [[baldness]] per se. Their efforts did not receive worldwide attention at the time, and the traumas of World War II kept their advances isolated for another two decades.
The modern era of hair transplantation in the western world was ushered in the late [[1950s]], when New York [[dermatologist]] Norman Orentreich began to experiment with free donor [[grafts]] to balding areas in patients with [[male pattern baldness]]. Previously it had been thought that transplanted hair would thrive no more than the original hair at the "recipient" site. Dr. Orentreich demonstrated that such grafts were "donor dominant", as the new hairs grew and lasted just as they would have at their original home. Today Dr. Orentreich's practice still performs hair transplants.
For the next twenty years, surgeons worked on transplanting smaller grafts, but results were only minimally successful, with 2-4 mm "plugs" leading to a doll's head-like appearance. In the 1980s, Uebel in Brazil popularized using large numbers of small grafts, while in the United States Rassman began using thousands of “micrografts” in a single session.
In the late 1980's, Limmer introduced the use of the stereo-microscope to dissect a single donor strip into small micrografts. In 1995, Bernstein and Rassman published the first paper on "[[Follicular Unit Transplantation]]." where hair is transplanted exclusively in naturally occurring groups of 1-4 hairs. With microscopic dissection of donor pieces from an excised portion of scalp, individual follicular units containing but 1-4 hairs could be prepared and individually relocated into needle punctures in the recipient areas. Since the transplanted hair mimics the way hair grows in nature, close to natural results were attainable.
The follicular unit hair transplant procedure has continued to evolve, becoming more refined and minimally invasive as the size of the graft incisions have become smaller. These smaller and less invasive incisions enable surgeons to place a larger number of follicular unit grafts into a given area. With the new "gold standard" of [[follicular unit transplantation|ultra refined follicular unit hair transplantation]], over 50 grafts can be placed per square centimeter, when appropriate for the patient.
Surgeons have also devoted more attention to the angle and orientation of the transplanted grafts. The adoption of the “lateral slit” technique in the early 2000s, enabled hair transplant surgeons to orient 2 to 4 hair follicular unit grafts so that they splay out across the scalp's surface. This enabled the transplanted hair to lie better on the scalp and provide better coverage to the bald areas. One disadvantage however, is that lateral incisions also tend to disrupt the scalps vascularity more than sagitals. Thus sagital incisions transect less hairs and blood vessels assuming the cutting instruments are of the same size. One of the big advantages of sagitals is that they do a much better job of sliding in and around existing hairs to avoid follicle transection. This certainly makes a strong case for physicians who do not require shaving of the recipient area. The lateral incisions bisect existing hairs perpendicular (horizontal) like a T while sagital incisions run parallel (vertical) along side and in between existing hairs. The use of perpendicular (lateral/coronal) slits verses paralel (sagital) slits however, has been heavily debated on patient based hair transplant communities. Many elite hair transplant surgeons typically adopt a combination of both methods depending on what is best for the patient.
===The procedure===
At an initial consultation, the surgeon analyzes the patient's scalp, discusses his preferences and expectations, and advises him/her on the best approach (e.g.,single vs. multiple sessions) and what results might reasonably be expected.
For several days prior to surgery the patient refrains from using any medicines, or alcohol, which might result in intraoperative bleeding and resultant poor "take" of the grafts. Pre-operative [[antibiotic]]s are commonly prescribed to prevent wound or graft [[infection]]s.
===Cost===
In recent years hair transplants have become less expensive. Prices typically range from $3.00 to $7.00 per graft, with $4 to $5 per graft being about average. Normally the price per graft also drops as the size of the surgical session increases. Depending on the needs of the patient a typical surgical session can range from 1,500 to over 4,000 grafts, resulting in a total cost of approximately $6000 to $15,000. A few clinics offer larger sessions of up to 6000 grafts in one sitting.
===Surgery===
Transplant operations are performed on an outpatient basis, with mild [[sedation]] (optional) and injected topical [[anesthesia]], and typically last about four hours. The scalp is shampooed and then treated with an antibacterial chemical prior to the donor scalp being harvested.
In the usual follicular unit procedure, the surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. The excised strip is about 1-1.5 x 15-30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts from the strip. Working with binocular [[microscope]]s, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting.
The surgeon then uses a fine needle to puncture the sites 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. The assistants generally do the final part of the procedure, inserting the individual grafts in place.
===Post-operative care===
Advances in wound care allow for semi-permeable dressings, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have you shampoo the day after surgery. Shampooing is important to prevent scabs from occurring around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.
During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out ("shock loss"). After two to three months new hair will begin to grow from the moved follicles. The patient's hair will grow normally, and continue to thicken through the next six to nine months. 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 to deal with this eventuality.
===Selecting a Quality Hair Transplant Surgeon===
Many elite hair restoration physicians have truly refined their techniques and met the "gold standard" of performing state of the art ultra refined follicular unit hair transplants on a daily basis with consistent and natural looking results. But not all hair transplant surgeons have met these high level of standards. It is highly important therefore for seeking patients to do spend time researching physicians who use these state of the art techniques. Below are a few important tips for seeking patients to select a physician using ultra refined follicular unit grafting as a standard part of their practice.
'''Make an Informed Decision Based on Research and Knowledge''': Make educated and informed decisions based on knowledge and experience rather than gut and emotion. The internet is a powerful tool and when used wisely, can be one of the best sources of information that you can find and use to your advantage.
'''Find Patient Driven Hair Loss and Hair Restoration Forum Communities''': Get past the fancy marketing hype and speak to and view real patient posted photos who have had hair transplant surgery. Ask your hair loss and hair transplant related questions on patient driven hair restoration forum communities. Discussing a particular topic will not only increase your knowledge but will facilitate learning to everyone who may be afraid to ask the same question. Visit and participate by asking your hair loss related questions on patient based hair loss forums. However, it is important to ensure that the forum you are using is impartial, so be very wary of any site that accepts paid advertisments from physicians. Such sites will remove any negative forum posts relating to their sponsors and thus the information provided will be biased. Further, do not assume that you will be able to find out everthing you need to know from search engines or from the internet. In fact more information will not be on the internet than will be. Lawsuits, for example, will very rarely be published on the internet, so try to use alternative means of finding out information about a physician and a type of surgery.
'''Look For Consistent Evidence of Quality Hair Transplant Patient Results''': Select a hair transplant surgeon that performs state of the art ultra refined follicular unit hair transplantation and produces consistent quality results. In order to be confident with a surgeon’s work, look at a number of patient posted online hair transplant photos on patient based hair restoration forums.
'''Meet with Real Hair Transplant Patients''': Hair transplant pictures are helpful, but meeting patients of a surgeon you are considering is even better. Consider asking a hair restoration pnysician for a referal list of patients in the area that you can call and meet up with. You may also find local patients of a physician you are considering on patient driven hair loss communities.
==Side effects==
Hair thinning, known as "shock loss", is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day.
Other side effects include swelling of areas such as the scalp and forehead. If this becomes uncomfortable, medication may ease the swelling. Additionally, the patient must be careful if his scalp starts itching, as scratching will make it worse and cause scabs to form. A moisturizer or massage shampoo may be used in order to relieve the itching.
== References ==
* Bernstein RM, Rassman WR, Seager D, Shapiro R, ''et al''. Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques. ''Dermatol Surg'' 1998; '''24''': 957-63.
* {{eMedicine|derm|559}}
{{Operations and other procedures of the integumentary system}}
[[Category:Hair loss]]
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