Hair Loss Replacement Surgery

For many men hairpieces for one reason or another is just not an option.  Many of these individuals turn to hair transplants.  According to the American Academy of Cosmetic Surgery, some 244,500 hair transplants were performed in the U.S. last year. The popularity of hair transplants combined with frustration of managed care has pushed all types of physicians into the field, which has historically consisted of dermatologist and plastic surgeons.  The influx of new hair-transplant physicians has subsequently brought transplant prices down significantly from as high as $30.00 to as low as $4.00 per graft.  This reduction in price is not necessarily favorable news for all patients.  Some of the more reputable hair transplant centers have suggested that a third or more of their clientele result from patients looking for someone to repair the inadequacies of previous transplants.

During recent years, physicians have developed and refined new transplant techniques that represent the way hair grows naturally.  Physicians now transplant hair using the mini/micro-graft procedure.  Rather than creating rows or clumps of conspicuous hair the mini-graft transplant consist of much smaller grafts containing 3-6 hairs, approximately the size of a pinhead.  Micro-grafts contain only 1-2 hairs and are used on the periphery to create a soft and natural hairline. 

Donor sites are usually obtained from the posterior aspect of an individual's head.  Usually a ½ to 1 x 3 to 5 inch donor strip of hair is surgically removed. The scalp is very elastic so the incision is simply pulled together and closed with sutures.  The small suture line remains concealed by the existing hair.                  

The surgery team then delicately divides the donor graft into mini/micro grafts for transplant. The grafts are then implanted into the appropriate donor sites. The correct selection, placement and angle of the grafts remain the critical element in obtaining a positive result.  Physicians must posses a unique artistic flare combined with surgical skill to create a natural appearance of the hair.  Hair transplants have evolved to the point where they are done on an outpatient basis.  Most surgeries last 3-4 hours and patients may return home a couple of hours following the procedure.  A bandage is usually applied to keep the area clean and free from infection, patients are usually asked to return the next day for a follow-up appointment.  Many patients return to work within 24 hours although strenuous activity is discouraged.

Fortunately the scalp is very vascular, so the healing process is relatively short.  However, as with any surgery there is always risk of infection.  Individuals may also experience some swelling of the forehead in the week following the surgery, some areas may also scab over. Patients should also realize that transplanted hair shaft often go into a resting phase shedding the existing hair.  Usually within 3-6 months  the transplanted hair follicles will begin to produce noticeable hair. There is a new FDA approved product developed by ProCyte called GraftCyte that helps prevent transplanted follicles from going into the resting phase so the transplanted hair does not shed as often.

The number of procedures required is dependent on the surface area that needs to be covered and the expectations of the patient.  The human scalp averages one follicular unit per 1mm and each unit represents approximately 2.2 hairs.  So a section of healthy scalp measuring 1cm by 10 cm would represent some 1000 follicular units or around 2,200 hairs. Normally two or three sessions are sufficient to get a natural appearance. Natural appearance does not necessarily dictate natural density.  Hair loss remains a dynamic process and donor sites are limited, therefore, individuals are encouraged to be realistic about the density of their transplants. 

For those individuals who desire more expedient or dramatic results there are several other surgical procedures:

• Scalp reductions involve surgically excising a section of bald scalp from the vertex of the head.  Then the adjacent skin is extensively undermined so the surgeon can close the incision. Following a recover period, mini/micro grafts are later transplanted into the appropriate regions.  Scalp reductions can cost between $2,000-$3,500 depending on the extent of the surgery.                                                 

• Transpositional flaps involve a series of procedures were a surgeon partially dissects a horseshoe section of skin containing healthy hair from the donor area.  The free end is positioned over the follicular challenged area where a section of skin has been excised.  The surgeon then closes the donor and recipient sites with sutures. Transplanted micro-grafts are then inserted to promote a natural look.  Transpositional flaps can cost between $3,000-$9,000 depending upon the extent of the surgery.                                                         

• Free flaps represent an extensive surgery, first all or a portion of the bald area is excised.  A section of micro vascular surgery, the blood vessels that supply nourishment to the donor flap are connected to the vessels in the new area. Sutures are then used to close both donor and recipient areas and transplanted micro-grafts are inserted to promote a natural look. There are some disadvantages to the flap procedures.  Sometimes the resulting frontal hair does not appear natural and a scar along the hairline can be detected.  Additionally, the hair of the flap may grow in a direction different from the natural hairs, giving an artificial look. Free flaps also cost between $3,000-$9,000 depending on the extent of the surgery.

• Tissue expanders are procedures involving two surgical sessions spaced approximately 8-12 weeks apart. Expanders are balloon-like devices, which are surgically inserted under the scalp during the first surgery.  The expanders are then gradually filled with saline solution over a period of weeks.  As the balloons expand, the skin supporting the healthy follicles is stretched. During the second surgery the expanders are removed, all or a portion of the bald area is excised and then the adjacent sections of healthy scalp are sutured together.  The major disadvantage to this procedure is that individuals have to tolerate the strange appearance of balloons underneath their scalp for several weeks.  Though men can find ways to camouflage this, most find it embarrassing.  Average cost between $4,000-$6,000.

                                

• Extender procedures involve two surgical sessions approximately four weeks apart.  Extenders are elastic straps with small hooks attached at both ends.  Initially, an extender is stretched and placed under the scalp with the hooks protruding up into the underside of the scalp.  Over a period of weeks the extender draws together the healthy scalp from the periphery and extends the skin to the area where the bald spot was.  During the second surgery, the extender is removed, all or part of the bald spot is excised, and then the adjacent sections of healthy scalp are sutured together. The disadvantages of this procedure are quite similar to the flap procedures.  Average cost is between $4,000-$6,000.  

The above mentioned procedures may be performed using local or general anesthesia depending upon the extent of the surgery.  Surgical risk is similar to the mini/micro transplant procedures, there is always a risk of infection.  In the US any licensed physician may perform hair surgery, many individuals end up with unsatisfactory results i.e. excessive scarring, patches of thin transplanted hair partially covering areas that continue to lose hair, loss of hair leaves the scars from previous surgeries visible, etc. Carefully and cautiously select a surgeon, beware of seductive marketing brochures showing after photos of men thick, full heads of hair.  Ask for referrals, actually talk with individuals who the surgeon has treated.  Check the credentials of the surgeon, individuals may contact The American Hair Loss Council phone 1-312-321-5128).