Surgical Management of Hair Loss - Hair Loss & Hair Transplant Surgery Guide

Hair Transplant Surgery

Hair transplant surgery involves taking small pieces of skin from areas with actively growing hair follicles and implanting those pieces of skin on areas of the scalp with hair loss. This treatment works because those follicles that are transplanted will continue to grow even when they are transferred to another part of the scalp.

Previously, the procedure involved “plug grafts”where small plugs of skin, each containing about 100 hair follicles, were transplanted. However, this resulted in a tufted appearance with sprouts of hair, much like the appearance of doll’s hair.

Surgeons can now transplant much smaller grafts, and this enables a much more natural appearance. Depending on how much coverage is needed, and whereabouts on the scalp it is needed, these grafts range from 3-4 hairs/graft (minigrafts) to grafts containing a single hair (unigrafts). Sometimes, a surgeon will combine the different types of grafts to give widespread coverage with a natural appearance.

The surgery is usually carried out using a local anaesthetic, and the hair grafts are taken from an area where there is plenty of hair growth. The area is also selected to help ensure that it will not be obvious that the surgery has been performed, and so the back of the scalp, at the top of the neck, is a common site. The small pieces of scalp are cut out and then placed into small incisions that the surgeon makes in the bald area. These incisions can be made using a scalpel, a laser or a needle. The scalp has a very good blood supply, so the clotting action holds the grafts in place. The good blood supply means that no stitches are required and the scalp also heals very quickly.

Depending on the extent of the hair loss, an individual usually requires between 300 and 700 of the grafts. This means that the surgery is normally split over a course of sessions. About 100 grafts can be transplanted in a session, and this will usually take around three hours. The day following surgery the hair can be washed as normal, and within a few months it is difficult to distinguish between the transplanted areas and the natural hair.

The procedure is carried out by cosmetic surgeons, and so it is important to research the reputation of the practitioner you use, and also to ensure that you are being charged a reasonable amount. It is important to establish from the beginning how many sessions you will require, how long the process will take, and what the overall cost will be. Men are sometimes dissatisfied with the result of the surgery so it is important to discuss your expectations with the surgeon beforehand so that you have a realistic idea of what the outcome will be.

Side Effects

As this is a surgical procedure there are potential side effects. These can include infection of the scalp, failure of the grafts to grow (this cannot be treated), variation in colour between transplanted hair and surrounding hair and scarring or uneven skin appearance. It is important to discuss with the practitioner all of the risks involved before beginning the procedure.

Artificial Transplant Surgery

Some clinics will offer a procedure where artificial hair is inserted into the bald areas. The hair is chosen to be the same strength, thickness and colour of the natural hair and each hair is individually implanted using a needle. However, the use of artificial hair causes a lot of problems, and it is common for the scalp to reject the implants because they are treated as “foreign bodies”. This can lead to infection and inflammation, and although the initial results may be promising, the hairs tend to break over time. Artificial hair transplantation is now banned in most European countries because it is not felt to be safe or successful in the long-term.

Scalp Excision (Reduction) Surgery

In this surgery the scalp area that is bald is operated on to remove excess skin. The edges are then stitched together and therefore the bald area is reduced. In older men the skin on the scalp is looser and so the operation is more appropriate. The surgery only needs to be performed once, and therefore the process is shorter than with hair transplants. Depending on the distribution of hair loss, however, the surgery may pull the surrounding hair into an unnatural shape, and therefore the results may be unsatisfactory.

Occasionally, a surgeon may perform scalp expansion surgery first. During this surgery a balloon is placed under the skin and then inflated. This stretches the skin and makes it looser so that it can be removed, as in a scalp excision procedure.

Both types of procedure are usually performed under local anaesthetic.

Side Effects

Again, the side effects of this surgery include infection, bleeding, swelling and scarring. It is important to discuss with your surgeon the risks associated with your individual procedure.