Hair Transplant (FUE)
Hair transplantation is a surgical technique that removes hair follicles from one part of the body, called the ‘donor site’, to a bald or balding part of the body known as the ‘recipient site’. The technique is primarily used to treat male pattern baldness. In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding (like the back of the head) are transplanted to the bald scalp. Hair transplantation can also be used to restore eyelashes, eyebrows, beard hair, chest hair, pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.
Procedure
Pre-operative assessment and planning
Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested. There are several different techniques for harvesting hair follicles, each with their own advantages and disadvantages. Regardless of the harvesting technique, proper extraction of the hair follicle is paramount to ensure the viability of the transplanted hair and avoid transection, the cutting of the hair shaft from the hair follicle. Hair follicles grow at a slight angle to the skin’s surface, so transplanted tissue must be removed at a corresponding angle. There are two main ways in which donor grafts are extracted today: strip excision harvesting, and follicular unit extraction.
Strip harvesting
Strip harvesting (also known as follicular unit transplantation or FUT) is the most common technique for removing hair and follicles from a donor site. The surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. A single-, double-, or triple-bladed scalpel is used to remove strips of hair-bearing tissue from the donor site. Each incision is planned so that intact hair follicles are removed. The excised strip is about 1–1.5 x 15–30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts, which are small, naturally formed groupings of hair follicles, from the strip. Working with binocular Stereo-microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting. The latest method of closure is called ‘Trichophytic closure’ which results in much finer scars at the donor area. The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place. Strip harvesting will leave a thin linear scar in the donor area, which is typically covered by a patient’s hair even at relatively short lengths. The recovery period is around 2 weeks and will require the stitches/staples to be removed by medical personnel or sub cuticular suturing can be done.
Follicular unit extraction (FUE)
With Follicular Unit Extraction or FUE harvesting, individual follicular units containing 1 to 4 hairs are removed under local anesthesia; this micro removal typically uses tiny punches of between 0.6mm and 1.0mm in diameter. The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The technicians generally do the final part of the procedure, inserting the individual grafts in place. FUE takes place in a single long session or multiple small sessions. The FUE procedure is more time consuming than strip surgery. An FUE surgery time varies according to the surgeons experience, speed in harvesting and patient characteristics. The procedue can take anywhere from a couple hours to extract 200 grafts for a scar correction to a surgery over two consecutive days for a megasession of 2,500 to 3,000 grafts.With the FUE Hair Transplant procedure there are restrictions on patient candidacy.Clients are selected for FUE based on a fox test, though there is some debate about the usefulness of this in screening clients for FUE. FUE can give very natural results. The advantage over strip harvesting is that FUE harvesting negates the need for large areas of scalp tissue to be harvested, so there is no linear incision on the back of the head and it doesn’t leave a linear scar. Because individual follicles are removed, only small, punctate scars remain which are virtually not visible and any post-surgical pain and discomfort is minimized. As no suture removal is required, recovery from Micro Grafting FUE is less than 7 days. Disadvantages include increased surgical times and higher cost to the patient.It is challenging for new surgeons because the procedure is physically demanding and the learning curve to acquire the skills necessary is lengthy and tough.Some surgeons note that FUE can lead to a lower ratio of successfully transplanted follicles as compared to strip harvesting.
FAQs
A patient of hair loss or patterned baldness comes with lot of confusion about which treatment would give him best results. There are lots of treatments available to control hair loss. But, Hair transplant is the best and permanent solution for the patients of baldness.
Hair transplant is a surgical procedure that removes hair follicles from one part of the body and then they are implanted on the bald or balding part of the body. Donor area used most commonly is the scalp. Other body areas like beard, chest, abdomen, back, pubic hair can also be utilized in case scalp area is not sufficient. Bust scalp donor hair gives best results. There are two techniques of hair transplant, FUT & FUE. FUE is the most commonly done technique now days, because scars are very minute and less visible in FUE technique.
Practically anyone above the age of 20 can undergo hair transplant surgery as it is a minimally invasive surgery done under local anesthesia with minimum risk. Ideal candidate for HT surgery should have a good donor area density. Also he should be fit for surgery for which we need to do some blood investigations prior to surgery. But the most important thing is patient should have realistic expectations about the results because we cannot achieve natural density by hair transplantation. We can only provide sufficient density to cover the bald area to provide the natural and fuller look.
Hair transplant is a day care procedure which takes around 6 to 7 hours after which patient can go home. He or she has to take care of the implanted area for next 5 to 7 days. Patient has to avoid touching the implanted area for 7 days. Patient needs to take some medications to avoid the complications such as surgical site infection, pain and swelling over the face. Such complications are transient and they are manageable by appropriate and timely treatment.Post-surgery patients are advised to take some hair supplement tablets and minoxidil solution to apply on the scalp to increase the blood circulation to newly implanted hair. Platelet Rich Plasma (PRP) therapy if done during surgery and post-surgery provides additional growth factors to the surgical hair as well as pre-existing natural hair,thus it improves the final outcome.
In the initial two months patient experiences shedding of all the implanted hair and after two months the actual growth phase will start. Results of hair transplant are visible within 4 to 6 months, but it takes around 10 to 12 months for maximum results.
Results are prolonged and sustained in young and healthy individuals.Someone can enjoy the freedom from baldness as long as they are fit and healthy. Transplanted hair may get thinner if they were extracted from the unsafe donor area. As the age progresses, hair thinning can occur due to environmental and nutritional factors. Such individuals need to continue some medications to maintain their hair growth. But some individuals may require repeat sessions of hair transplant in future to increase the density of transplanted area as well as to cover up the adjacent bald area.
