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The first written account of a successful hair transplant dates back to 1822 in Wurzburg, Germany. A medical student by the name of Diffenbach performed and documented hair transplant procedures performed on humans and animals done by him and his mentor.

What is a Hair Transplant?

Diffenbach and Unger successfully transplanted hair from one area of the scalp to another, and Professor Unger firmly believed transplanting hair would make baldness obsolete.

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Gone are the days of having artificial looking hair plugs.  The hair transplants procedures of the past have been replaced by more natural-looking, living and growing substitutes which are virtually undetectable.  With the advent of microsurgical techniques and instrumentation, combined with a better understanding of how hair naturally grows has resulted in considerable strides and new innovations made in the world of hair transplants. 

A hair transplant is a surgical procedure that involves moving skin containing hair follicles from one part of the body to the balding area.  Primarily used as a treatment for male pattern baldness, it can also be done to restore eye lashes, beard hair, eye brows or to fill in scarred areas.  A hair transplant procedure can also be done on women who experience female pattern baldness.

What are the Techniques?

After making an initial assessment, a surgeon will analyze a patient’s scalp; discuss the procedure and address the patient’s expectations and preferences.  A surgeon will also advise the patient on the best approach to use and what results may be yielded.  For several days prior to the transplant procedure, the patient will be required to abstain from medication and alcohol, both of which could result in postoperative bleeding and result in the grafts not adhering and healing properly.

Three different types of hair grafts used

  1. Single hair follicular units:  used around the hairline primarily to create a softer, more natural appearance.
  2. Follicular units:  generally consist of 2 hairs, used behind the hairline to create a thicker appearance.
  3. Modified follicular units:  consist of 3-4 hairs and used to add density to the recipient area.

A transplant procedure is generally performed on an outpatient basis under mild sedation.  The person is then given a topical anesthesia which typically lasts for 3-4 hours; the scalp is shampooed and treated with an antimicrobial solution prior the scalp being harvested. 

The surgeon will then harvest a strip of skin from the posterior scalp, which is typically an area with optimal hair growth.  The excised strip of hair is generally 1-1.5 x 15-35 cm in size.  When closing the area, the surgeon will begin to dissect follicular grafts from the strip.  Working with a small microscope, fibrous and fatty tissues are removed without damaging the follicle cells to be used for grafting.

The surgeon will then use a small micro-blade or fine needles to make punctures into the site to be grafted.  The follicles are placed into areas using a predetermined density and pattern, angled in properly to achieve the best results.  The surgical assistants generally perform the final portion of the transplant procedure by inserting the individual grafts into the appropriate area.

Once the hair transplant is completed, the area is thoroughly cleaned and covered in sterile gauze.  The patient might have to wear a pressure bandage for the first few days, though some surgeons allow a patient to recover without having to wear a bandage. 

There are two different hair transplant procedures which a surgeon may use, depending upon certain criteria:

Flap surgery:  this type of procedure has been performed for more than 20 years.  The procedure can cover a substantial bald area and is customized to suit the needs of each patient.  The size and placement of the flap depend upon the goals and desires of the patient and one flap can work with more than 350 grafts.  
 
Scalp reduction:  the technique is sometimes called “advancement flap surgery,” because sections of scalp are pulled forward to fill in a balding crown.  Scalp reduction is used for balding areas at the top and back of the head and is not used for covering a frontal hairline.

What are the Results of hair transplantation and who are perfect candidates?

Some people may wonder if a hair transplant will yield results and be an effective solution for baldness.  The transplanted hair is taken from one part of the body and transferred to another part.  The transplanted hair has its own characteristics, color, growth pattern, curl and re-growth and the vitality is provided by the rich blood supply from the scalp.  Results differ from person to person, but generally a hair transplants works as a solution to combat baldness in certain patients.

Who are Perfect Candidates?

The perfect candidate for a hair transplant would be anyone who has experienced hair loss and has sufficient donor hair on the scalp which can be transplanted into the balding area.  In the past, hair transplants were not recommended for balding patients, but with the revelation of advances made in the field now almost anyone can enjoy the benefits of a hair transplant. 

The following is a list of criteria used to determine whether or not someone would make a good candidate for a hair transplant:
  • Above 18 years of age
  • Stabilized hair loss
  • Tried medical treatments and had no success
  • No presence of a scalp infection
  • Adequate hair within the donor sites
  • Does not smoke or ready to quit two weeks before surgery
  • Reasonable expectations
  • No presence of diabetes, hypertension, hyperthyroidism, bleeding disorders, keloid tendency or any type of systemic disorder
  • No alcohol abuse or ready to discontinue alcohol use within two weeks of surgery

Hair Transplants for Men and Women

Because 90% of the people in the country make ideal hair transplant candidates, women tend to believe they too will be a good candidate.  However, few women have the particular type of hair loss that will make them an ideal candidate for a hair transplant.  Women tend to have hair loss dispersed all over the head including the sides and back, which are the places that serve as donor sites for hair transplants in men.

In men, the donor sites are referred to as “stable sites,” which means the hair and follicles found in these areas are not affected by dihydrotestosterone, which is responsible for male pattern baldness.  With female pattern baldness, these particular areas are not stable and thinning like other areas of the head.  Which means if a hair transplant is performed on a woman using unstable donor areas, the resulting transplanted hair will fall out.

The main difference between male and female pattern baldness is the frontal hairline.  Women tend to lose hair from other areas, while men predominantly lose it from the frontal area.  Women need a hair transplant to frame the face and are less concerned with the loss of volume and hair from the back and top of the head.  Hair transplants do not increase volume of the hair, but rather moves hair from one area to another.

Pros and Cons of Hair Transplant Surgery and its side effects

Depending upon a number of extenuating circumstances and factors, a hair transplant can either be a great decision or possibly less than ideal.  Before committing to a hair transplant a person should be aware of certain benefits and risks associated with the procedure.  The following is a list of considerations for a person considering a hair transplant:

Pros:

Improved appearance:  the most evident benefit of a hair transplant is giving the patient a more youthful appearance, which can have a direct impact on self-esteem. 
  
Improved self-esteem:  along with an improved appearance, hair transplant patients report a marked increase in self-esteem.
 
As with any type of surgical procedure, there are certain risks associated with hair transplants, most of which occur during the healing process.  Such risks include:
  • Infection 
  • Reaction to anesthesia
  • Possible hair transplant problem

Side Effects of Hair Transplantation

There are some minor, often temporary side effects which can be directly associated with a hair transplant, which include the following:
 
Bleeding:  some bleeding is completely normal and will cease with the application of light pressure.  Persistent bleeding is rare, occurring in about one of one-hundred cases, the use of additional stitches may be required
 
Pain:  pain is minimal and lasts for a few days; most patients only require acetaminophen for moderate pain relief.
 
Numbness:  some transient numbness has been reported and is an inevitable side effect which can last for 3-12 weeks post-operative.
 
Hiccups:   can occur after surgery and the exact cause is not known.  Hiccups seem to be more frequent after a hair transplant than with a scalp reduction.  The condition is not serious and can be treated with medication from a physician.
 
Itching:  some itching during healing is normal and can usually be alleviated with daily shampooing.
 
Swelling:  swelling occurs in nearly all patients.  Usually the swelling occurs around the eyes and forehead, lasting for period of 3-5 days, being most prevalent on the fourth day.  The swelling is not harmful and will generally subside within a period of 7-days.
 
Infection:  occurs in one in a thousand cases and is easily cured by using antibiotics.
 
Scarring:  keloid scarring occurs only in those people who have a predisposition.  Some of the scarring is a result of hypertrophy to the point of “ridging.”
 
Cysts:  one or more cysts can occur in the donor area when the grafts are inserted.  The cysts usually disappear and require no medical treatment.
 
Neuralgia:  if one of the nerves in the facial area is damaged during surgery, the result can be numbness, tingling or a “pins and needles” sensation.  Rarely have patients had the condition last more than 1-4 weeks, prolonged or severe cases are extremely rare and usually completely disappear within a period of months.

Approximate Cost of a Hair Transplant

Increased competition and shopping online have dramatically reduced the once-high costs associated with hair transplant surgery.  Today, most traditional hair replacement clinics offer no obligation consultations and surgical sessions which are priced per-graft or by the session.  Hair transplant procedures generally range in between $3,000-$8,000 per graft, with a cost of $5-8 per graft being the average amount.  The cost of grafting can also drop as the number of surgical sessions required increases. 
 
(It is also important to keep in mind the costs of a hair transplant can also increase due to other factors such as extra medication, blood tests, and anesthesia and individual facility fees.)

Overview

Hair loss is a condition that is not a new phenomena, the condition has affected both men and women for centuries.  Innovative technology in the field of hair transplantation has helped countless numbers of people restore their natural hairline and improve overall quality of life by increasing self-esteem.