Hair Transplant: Procedure, Health Risk, Cost and More

As in good health and youth, the majority of us take our locks for granted – before they are lost. For certain patients, a hair transplant may eventually restore the appearance of a complete head of hair – or at the very least a fuller head of hair.

If thinning at the crown or going bald is a significant issue for you, the treatment could be one way to boost your trust in your appearance. However, you can first speak with your doctor about what to expect before and after surgery.

What is a Hair Transplant?

Hair transplantation is a surgical procedure that involves the removal of hair follicles from one area of the body, referred to as the ‘donor site,’ and transplanting them to a bald or balding area of the body, referred to as the ‘recipient site.’ Male-type baldness is the primary indication for this procedure.

This minimally invasive technique involves transplanting grafts comprising hair follicles from areas of the scalp that are genetically immune to balding (such as the back of the head) to the bald scalp. Hair transplantation may also be used to regenerate eyelashes, brows, beard hair, chest hair, and pubic hair, as well as to conceal injuries from accidents or prior hair transplants.

Hair transplantation is distinct from skin grafting in that grafts include nearly all of the epidermis and dermis covering the hair follicle, and several small grafts are used rather than a single strip of skin.

Due to the fact that hair develops normally in clusters of one to four hairs, modern procedures extract and implant hair “follicular groups” in their existing clusters.

Thus, modern hair transplantation will imitate the initial hair orientation to create a natural look. This operation is referred to as follicular unit transplantation (FUT). Strip harvesting and follicular unit extraction (FUE) are two methods for harvesting donor hair.

History of Hair Transplant

Scalp flaps, in which a band of tissue with its original blood supply is transferred to the remaining bald region, and free grafts have been used since the nineteenth century. Menahem Hodara effectively inserted hair from untouched regions of the scalp onto bald scars caused by favus in 1897.

Modern transplant procedures originated in Japan in the 1930s, where surgeons used tiny grafts and also “follicular device grafts” to cover injured brows or lashes, but not for baldness treatment. Their achievements were not immediately recognized on a global scale, and the traumas of World War II held their developments hidden for another two decades.

In the western world, the current age of hair transplantation started in the late 1950s, when New York dermatologist Norman Orentreich began experimenting with free donor grafts in patients with male trait baldness.

Previously, it was believed that transplanted hair would thrive in the same manner as natural hair on the “recipient” location. Orentreich established that such grafts were “donor dominant,” as the new hairs developed and lasted identically to their natural counterparts.

Hair Transplant Procedure

Pre-operative assessment and planning

During the initial appointment, the physician examines the patient’s scalp, addresses their needs and desires, and informs them on the correct procedure (e.g. single vs. various sessions) and reasonable expectations for outcomes.

A pre-operative follis duplicate can assist in determining the real current hair mass, allowing for a precise assessment of the postoperative outcomes of freshly transplanted hair grafts. Certain patients can gain from preoperative topical minoxidil and vitamin supplementation.

For several days prior to surgery, the patient is advised to abstain from all medications that can cause intraoperative bleeding and subsequent bad grafting. Alcohol and nicotine will also lead to graft failure. Antibiotics are often prescribed postoperatively to avoid wound or graft infection.

Harvesting methods

Outpatient transplant procedures are conducted under light sedation (optional) and injected local anesthesia. Prior to harvesting the donor’s hair, the scalp is shampooed and then washed with an antibacterial agent.

There are many methods for harvesting hair follicles, each with its own set of benefits and drawbacks. Regardless of the extracting procedure used, careful isolation of the hair follicle is critical to ensuring the transplanted hair’s longevity and avoiding transaction, or the cutting of the hair shaft from the hair follicle. Since hair follicles develop at an angle to the skin’s surface, transplanted tissue must also be extracted at an angle.

Today, donor grafts are harvested in two primary ways: strip excision harvesting and follicular device extraction.

Strip harvesting

Strip harvesting (an acronym for follicular unit transplantation, or FUT) is the most often used method for extracting hair and follicles from a donor site. A strip of skin is harvested from the posterior scalp, in a region of healthy hair development.

Strips of hair-bearing tissue are removed from the donor site using a single–, double-, or triple-bladed scalpel. Each incision is carefully designed to extract only intact hair follicles. The excised strip measures approximately 1–1.5 x 15–30 cm in length. When the wound is being closed, assistants begin dissecting individual follicular unit grafts from the strip.

Follicular unit grafts are thin, spontaneously shaped groupings of hair follicles. They gently scrape excess fibrous and fatty tissue using binocular stereomicroscopes, taking caution not to harm the follicular cells that would be used for grafting. The most recent form of closure is referred to as ‘Trichophytic closure,’ and it results in much clearer scars in the donor region.

The surgeon then punctures the locations for the grafts with extremely fine microblades or fine needles, inserting them in a fixed density and shape and angling the wounds consistently to promote a natural hair pattern. Generally, technicians perform the final stage of the operation, inserting the actual grafts.

Strip harvesting leaves a fine longitudinal scar in the donor region, which is usually concealed by the patient’s hair, except though it is cut short. The treatment time is about two weeks and would enable medical staff to extract the stitches/staples or sub-cuticular suturing will be performed.

Follicular unit extraction (FUE)

Specific follicular units comprising one to four hairs are removed under local anesthesia using tiny punches measuring between 0.6mm and 1.0mm in diameter. The surgeon then punctures the locations for the grafts with extremely fine micro blades or fine needles, inserting them in a fixed density and shape and angling the wounds consistently to promote a natural hair pattern. Generally, technicians perform the final stage of the operation, inserting the actual grafts.

FUE may be performed in a single lengthy session or in a series of brief sessions. FUE is a more time-consuming operation than strip surgery. The time required for FUE surgery differs according to the surgeon’s expertise, harvesting pace, and patient characteristics.

The operation will take anything from a few hours to remove 200 grafts for a scar correction to two days to perform a super session of 2,500 to 3,000 grafts. Candidacy for the FUE Hair Transplant treatment is restricted. Clients are chosen for FUE based on the results of a fox exam, but there is some controversy regarding its utility in screening clients for FUE.

FUE can produce extremely natural-looking effects. The benefit of FUE over strip harvesting is that it eliminates the need to remove vast areas of scalp tissue, resulting in no longitudinal incision on the back of the head and no linear scar. Due to the removal of individual follicles, only thin, punctate wounds are left, which are nearly undetectable, and postoperative pain and irritation are reduced. Due to the absence of suture replacement, the healing time for Micro Grafting FUE is less than 7 days.

The disadvantages include prolonged surgery periods and increased patient costs. It’s difficult for novice surgeons since the operation is physically exhausting and the learning curve for acquiring the requisite expertise is long and difficult. According to certain surgeons, FUE may result in a lower percentage of successfully transplanted follicles as opposed to strip harvesting.

Follicular unit transplantation (FUT)

Follicular unit transplantation (FUT) is the standard hair transplant procedure that involves extracting a linear strip of hair-carrying skin from the back or the side of the scalp. The strip is then dissected to remove actual grafts.

Robotic hair restoration

Robotic hair repair robots use sensors and robotic arms to support the surgeon with the FUE operation. In 2009, NeoGraft became the first robotic surgical unit FDA certified for hair reconstruction. The ARTAS System was FDA certified in 2011 for use in extracting follicular units from brown-haired and black-haired males.

Types of Surgery

There are a variety of applications for hair transplant surgery, including:

Androgenetic alopecia
Eyebrow transplant
Frontal hairline lowering or restoration (naturally elevated hairlines without an underlying hair loss condition)

If donor hair numbers from the back of the head are inadequate, it is necessary to conduct body hair transplantation (BHT) on suitable applicants who have usable donor hair on the chest, back, shoulders, torso, and/or legs.

Body hair transplant operation may only be done using the FUE harvesting process and, thus, involves the expertise of an experienced FUE surgeon. However, there are many considerations for a prospective BHT applicant to weigh prior to surgery.

This involves recognizing the natural variation in textural features between body hair and scalp hair, growth rates, and having reasonable assumptions regarding the outcome of BHT surgery.

Post-operative treatment

Advances in wound treatment provide for semi-permeable dressing, which allows seepage of blood and tissue fluid, to be added and modified at least regularly. The delicate recipient region must be protected from the heat, and shampooing begins two days after the surgery.

Any surgeons will make the patient shampoo the day following the operation. Shampooing is necessary to prevent scabs from developing around the hair shaft. Scabs bind to the hair shaft which raises the chance of losing freshly transplanted hair follicles within the first 7 to 10 days post-op.

During the first ten days, some of the transplanted hairs, inevitably traumatized by their transfer, may fall out. This is referred to as “shock failure”. After two to three months new hair will begin to emerge from the transferred follicles.

The patient’s hair will develop naturally, and then begin to thicken over the next six to nine months. Any associated hair loss is likely to be mostly from uncontrolled regions. Some people elect to use drugs to retard such withdrawal, whilst others schedule a concurrent transplant operation to cope with this eventuality.

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What occurs during a hair transplant procedure?

After properly cleansing your scalp, a surgeon can numb a region of your head with local anaesthesia using a tiny needle.

Follicular unit harvesting (FUT) and follicular unit extraction (FUE) are the two primary methods used to harvest follicles for transplantation.

Under the context of follicular unit transplantation (FUT):

The surgeon will remove a strip of scalp skin from the back of the head using a scalpel. Usually, the incision is several inches deep.
This is then stitched shut.
Using a magnifying glass and a sharp surgical knife, the surgeon then divides the extracted scalp into tiny parts. As inserted, these parts can aid in the development of natural-looking hair.

Hair follicles are extracted directly from the back of the head using hundreds to thousands of tiny punch incisions during follicular unit extraction (FUE).

The surgeon creates tiny holes in the region of the scalp that will receive the hair transplant through a razor or a needle. They carefully insert hairs into these gaps.
A surgeon can implant hundreds or even thousands of hairs during a single treatment session.
After that, the scalp will be covered for a few days by a graft, gauze, or bandages.

A hair transplantation session will last up to four hours. Your stitches will be pulled about ten days after surgery.

Three or four sessions might be enough to obtain the maximum head of hair you crave. Sessions are spaced many months apart to allow for the complete healing of each transplant.

What occurs after a hair transplant?

Your scalp can be tender, and you may need treatment after hair transplant surgery, including:

antibiotics to prevent infection;
anti-inflammatory drugs to control swelling

The majority of patients can return to function many days after surgery.

Two or three weeks after the surgery, it is common for the transplanted hair to fall out. This allows for the development of fresh hair. The majority of people will see any fresh hair growth between 8 and 12 months following surgery.

Numerous physicians recommend minoxidil (Rogaine) or the hair growth drug finasteride (Propecia) to aid in hair regrowth. Additionally, these drugs aid in slowing or halting potential hair loss.

What are the possible risks of a hair transplant?

Hair transplant side effects are usually mild and resolve within a few weeks.

They can involve the following:
bleeding;
infection; swelling of the scalp;
bruises around the eyes
a layer that grows on the scalp areas where hair was lost or inserted
a layer that grows on the scalp areas where hair was lost or inserted
itching;
irritation or illness of the hair follicles referred to as folliculitis;
itching;

What is the forecast for the long term?

Generally, individuals who have undergone a hair transplant begin to develop hair in the transplanted regions of the scalp.

The new hair can look more or less thick based on the following factors:

scalp laxity, or how loose the skin on your scalp is;
follicle density in the transplanted zone;
hair calibre or quality; and
hair curl.

Without medicine (such as minoxidil or finasteride) or low-level laser treatment, you can begin to lose hair in untreated areas of your scalp.

It is important to negotiate the anticipated result with your surgeon and to establish reasonable standards.

How much does the hair transplant cost?

Hair transplantation costs vary considerably and usually range from $4,000 and $15,000. Sometimes, both of these expenses are borne by the person. The majority of insurance providers classify hair transplantation as a cosmetic treatment.

The expense of hair transplantation is determined by a variety of variables. This involves the following:

Your place of residence: The area’s relative cost of living and the number of surgeons doing the operation can have an impact on the fee charged by a surgeon.

The method you select: Hair transplantation is classified into two procedures: follicular unit transplantation (FUT) and follicular unit extraction (FUE) (FUE). Each has a distinct price.

Your surgeon’s skill: This is an often occurring correlation: If your surgeon is regarded as one of the finest, he or she can charge a premium. At the same time, higher rates do not necessarily imply superior capacity, so conduct thorough testing.

The amount of hair you desire to be transplanted: Adding a few patches is much less expensive than the hair coverage around the whole scalp.

Costs of travel: While your doctor would not bill you for this, it is an expense you should remember. Occasionally, you would need to fly to locate the right doctors, and you can factor these expenses into your decision on whether you can handle the treatment.

Alternatives of hair transplants

If you’re unable to afford a hair transplant or are awaiting one, there are some nonsurgical options you may use in the meantime. While these remedies are not as successful, they may be beneficial.

Hair transplant alternatives include the following:

Minoxidil (Rogaine), is distributed without a prescription. It is suitable for both men and women.
Finasteride (Propecia) capsules, may be effective in managing male and female trait baldness when used consistently for three to six months.
Low-level laser treatment stimulates cellular activity to cure hair loss of both sexes. It aids in hair retention and may help repair brittle hair.

Some Frequently Asked Questions (FAQ) about Hair Transplant

What is the success rate of hair transplants?

Clinical trials have shown that approximately 85-95 per cent of all implanted grafts develop readily in the transplanted field. This high rate suggests that hair transplants are very effective in general. Certain patients believe that, as in other transplants, a condition known as graft failure will occur.

How long does transplanted hair last?

1) Transplanted hair performs similarly to natural hair and sheds about two to four weeks after transplantation. Following that, the roots spontaneously begin sprouting hair and proceed to do so for the remainder of one’s existence.

2) Since local anaesthesia is used, the treatment is painless, and the patient will return home the same day.

Is hair transplant permanent?

Hair transplantation — alternatively referred to as hair regeneration — is an outpatient treatment that utilizes micrograft technology to transplant your own hair follicles to thinning regions of your scalp. Hair transplantation effects are visibly long-lasting and are deemed irreversible.

What is a good age to get a hair transplant?

To maintain a realistic appearance, the grafting procedure is tailored to the degree of hair loss and the patient’s facial characteristics. Nothing is fully determined with younger patients, whether it is the pattern of hair loss or its magnitude. As a result, the optimal age for a hair transplant is 25+.

What is the best time to get a hair transplant?

This is not to say that you cannot get a hair transplant sooner. However, it is prudent to wait before the rapid hair loss subsides so that the hair specialist or hair restoration specialist may ascertain your hair loss trend. Skin transplantation is accomplished by using donor hair from the back of the head.

Are hair transplants natural-looking?

Hair transplants may seem perfectly normal — if performed by an experienced surgeon. Candidates for hair transplantation might be worried about their outcomes becoming noticeable, but with a skilled and trained surgeon, “the scalp would not look like a doll’s head.”

What are the disadvantages of hair transplants?

If a person’s hair loss is hereditary and he or she undergoes a hair transplant at a young age, such as 20 to 30 years, hair loss will occur after surgery and will need therapy.

Is a hair transplant painful?

Due to the fragile nature of the operation, it is very labour intensive and can leave you looking a little raw afterwards. However, the real FUE operation should be painless, since most doctors numb the scalp with a local anesthetic. While it can be mildly sore at first, until the region is completely numb, there would be no discomfort.

How many hairs do I need to be transplanted?

To ensure the accuracy of your transplant, we assume that the maximum amount of grafts that can be transplanted in a single day is approximately 4,000 via FUT or 2,000 via FUE. This equates to approximately 8,000 hairs while performing FUT or approximately 4,000 hairs when performing FUE.

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