Hair Transplantation

How is a hair transplantation procedure performed?

The various methods involved in hair replacement or transplantation depend on the area that is balding or thinning and what kind of look you are trying to achieve. In all cases, hair follicles are moved from one area of your body and grafted, or transferred, to the area that is lacking. The donor site is usually on the head.Usually your surgeon will use local anesthesia in both the donor and recipient areas. On occasion, oral or IV sedation is added. Rarely is general anesthesia recommended. The donor area will be surgically removed, and the scar will be hidden by existing hair. The surgeon will usually divide the removed scalp into hundreds or perhaps even thousands of tiny segments, each containing a single or several hairs. These tiny pieces of your scalp will then be transplanted into the bald or thinning areas on your head.A less common hair transplant surgery involves moving hair as a flap of scalp skin that includes hundreds of hair follicles. The flap is repositioned into the area of hair loss replacing the balding scalp.Maintaining the integrity of the scalp and minimizing trauma is integral to this procedure and is quite tedious. The entire process takes anywhere from two to eight hours depending on how much hair is being transplanted or being transferred as a flap.

What are my options?

The quality and type of hair you have and where you are losing hair will factor into your aesthetic surgeon’s decision on how much hair to transplant and from where to take the hair grafts.Strip HarvestingStrip harvesting in the follicular unit transplantation (FUT) method removes a strip of hair, generally from the back of the head, and is dissected into smaller groups to implant into the recipient sites. Also called follicular unit strip surgery, this is a common method that is faster than harvesting from many different locations. Although there is a strip removed, the scar is easily covered by new and surrounding hair.Follicular Unit Extraction (FUE)Small groups of hair are harvested in a larger area around the head and then implanted into the desired site. Because the grafts come from all around the scalp, there is less bleeding, less postoperative discomfort, and no sutures necessary. The scars from FUE are scattered and not concentrated in one area; however, a much larger area of hair needs to be clipped short.Flap SurgeryFlap surgery removes a section of bald scalp and is replaced with a section of skin that contains hair follicles. This covers a large area of baldness and because the skin is intact, hair grows immediately from the area and will not need months to regrow.Scalp ReductionIn some cases, scalp reduction or advancement flap surgery is performed as an alternative or in addition to hair transplantation. This procedure involves removing a section of the bald scalp and pulling the hairline forward to fill in a bald spot. If more hair is needed, hair transplantation or flap surgery can be used to cover the remaining area.

What will my hair transplantation incisions and scars be like?

Your aesthetic plastic surgeon will determine where to remove the hair follicles for transplantation after assessing your hair. He or she will choose a location that is discreet and surrounded by other hair so that the scar will be unnoticeable. Strip harvesting will leave a long linear scar in the back of the head. Otherwise, there will be multiple graft sites and many more pencil-point scars that can be easily hidden by hair.Flap surgery and scalp reduction will produce larger scars that may become more prominent if further hair loss is experienced. Your plastic surgeon can give you a better indication of the likelihood of that occurring.

Select a surgeon you can trust

It’s important to choose your surgeon based on:

• Education, training and certification
• Experience with hair transplantation
• Your comfort level with him or her

 After finding a board-certified plastic surgeon in your area who is experienced in performing hair transplantation, you will need to make an office appointment for your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit, which is sometimes deducted from the price of the procedure.

Your initial consultation appointment

During your initial consultation, your plastic surgeon will review the details of hair transplantation. This will also be an opportunity for you to ask any questions you may have and explain your frustrations to your surgeon. He or she will examine your scalp and hair to assess the best place to remove hair, as well as find locations that need to be fuller.You should come to the consultation prepared to discuss your complete medical history. This will include information about:

• Previous surgeries
• Past and present medical conditions
• Allergies and current medications

Your treatment plan

Based on your goals, physical characteristics and the surgeon’s years of training and experience, your surgeon will share recommendations and information with you, including:

• An approach to your surgery, including the type of procedure or combination of procedures.
• The outcomes that you can anticipate.
• Your financial investment in the procedure.
• Associated risks and complications.
• Options for anesthesia and surgery location.
• What is needed to prepare for the surgery.
• What you can expect to experience after surgery.
• The doctor will also share before-and -after photos of cases similar to yours and answer any questions.

Questions to ask your aesthetic plastic surgeon

We developed these questions to help you:

• Make the most informed and intelligent decision about your procedure.
• Confirm that you have the right surgeon for your procedure.
• Make your initial consultation as rewarding as possible.
• Understand your options, potential outcomes and risks.

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.

• Am I a good candidate for hair transplantation?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for the procedure I am undergoing?
• Will my scars be visible? Where will my scars be located?
• How much does a hair transplant cost?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?

How do I prepare for a hair transplantation procedure?

Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history, and perform a physical exam to determine your fitness for surgery.In advance of your procedure, your surgeon will ask you to:

• Stop smoking at least six weeks before undergoing surgery to promote better healing.
• Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
• You may be asked to take a shower and wash your hair with regular or antibacterial soap.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.

Hair transplantation surgery is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.What can I expect on the day of hair transplantation surgery?Hair transplantation is usually performed with local anesthetic and is performed in an accredited facility. This may be a hospital, freestanding ambulatory facility or office-based surgical suite. Hair transplantation procedures take two to eight hours to complete. Your surgeon will give you an estimate of how long your surgery will last based on the details of your surgical plan. You will receive instructions on how to prepare and what to expect. This is what you can anticipate:

• The donor area(s) will be trimmed so that the surgeon can access and remove the hair grafts.
• The entire head will be shampooed and cleaned to prevent infection.
• Oral or IV anesthesia may be administered to help you relax during the surgery.
• A local anesthetic will be injected into the scalp.
• The method that you have decided on will dictate what techniques the surgeon will use to remove the hair follicles and transplant them into the skin.
• Usually, the surgeon will space out the grafts to achieve maximum retention.
• Afterwards, the scalp will be cleaned and covered with gauze.
• You may have to wear a pressure bandage to aid healing.

You will probably be permitted to go home after a short observation period unless you and your plastic surgeon have made other plans for your immediate postoperative recovery.

Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:

• Drains, if they have been placed
• Normal symptoms you will experience
• Potential signs of complication

Immediately after surgeryYou may be given dressings for your scalp, which will likely need to be worn for at least two days. Your scalp will be very sensitive, so your surgeon may prescribe pain medication to be taken in the week following your surgery. He or she may also give you antibiotic medicine to reduce the chance of infection.If you experience extreme or long-lasting pain or notice redness and swelling after the surgery, contact your surgeon to find out if your pain, redness and swelling are normal or a sign of a problem.Recovery time frameIt is vitally important that you follow all patient care instructions provided by your surgeon. Typically, you can return to work after hair transplantation within one to two days after surgery, although some patients choose to be off work longer. This will depend on the type of work you do. After a short amount of time (sometimes right after surgery), the hair grafts will fall out and will not regrow for approximately three months. This is a completely normal process and will allow new hair to grow in its place. The new hair should look fuller and more natural. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

Hair transplantation results last for a lifetime; however, some patients may find that after the procedure, they continue to lose some of their original hair or their new head of hair may not look as full as they would like. In these cases, it’s not uncommon for patients to schedule a second surgery.Maintain a relationship with your aesthetic plastic surgeonFor safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you have any questions about your hair transplantation healing and results. Do not hesitate to contact your surgeon when you have any questions or concerns.

The cost of hair transplantation varies from doctor to doctor, from one geographic area to another and based on the technique that is performed.These numbers only reflect the physician/surgeon fees last year and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or other miscellaneous costs related to this procedure.Because hair transplantation is elective surgery, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.Choose your surgeon based on quality, training and experience—not cost.See why ASAPS members are widely recognized for upholding the highest standards in the area of aesthetic plastic surgery by viewing their basic credentials, training, and certifications.

Fortunately, significant complications from hair transplantation are infrequent. Every year, thousands of people undergo successful restoration and are pleased with the results. Your specific risks will be discussed during your consultation.All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

Other risks specific to hair transplantation are outlined below:

• The hair follicles themselves may become inflamed or infected.
• Some patients experience what’s known as “shock loss,” which causes all of the transplanted hair to fall out at once. However, it’s very unlikely that this hair loss is permanent and typically new hair will grow in its place.

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your hair transplantation.