be healthy

Medical reviewer:

Medically Reviewed On: February 13, 2004

Published on: February 13, 2004

Most hair transplants are performed in men and women who have lost their hair because of age-related pattern baldness. But sometimes hair transplant surgeons restore hair that has been lost due to surgery or an accident. These hair transplant procedures, which are often more complex than standard hair transplants, are known as corrective hair transplants.

Women who have facial cosmetic surgery make up the bulk of corrective hair transplantation, says Edwin S. Epstein, MD, a hair transplant surgeon in private practice in Richmond, Virginia and Virginia Beach.

During a facelift, incisions are usually made near the hairline at the temple and run down to the front of the ear and behind the earlobe to the lower scalp. After removing fat and tightening muscle, the surgeon pulls the skin back, trims the excess and stitches the tissue together. The hairline is therefore pulled back on the head and hair loss may occur due to scarring. In men, the sideburns are often lost and women can lose their bangs. The hair loss may be especially problematic for women who like to wear their hair off their face in a ponytail.

Likewise, a forehead lift, also known as an eyebrow lift, can lead to hair loss because incisions are usually made at or behind the hairline and the skin is then pulled back. In men who are bald, the incision may be made at mid-scalp. Newer brow lift techniques leave less of a scar and cause less hair loss, but some people may still require a hair transplant.

"The goal of hair transplantation in these situations is to recreate and dense up the hairline," explains Bob Leonard, DO, founder and chief surgeon of the Leonard Hair Transplantation Association in Massachusetts and Rhode Island.

People may also seek corrective hair transplantation if hair loss has occurred as a result of trauma such as an accident or burn. The surgeon may perform hair transplants in the upper lips of men who had cleft palates repaired as babies, so that they can grow a mustache. They also do a lot of corrective procedures in people who had hair transplants performed with outdated plug techniques. These less precise procedures left wide spaces around each plug as well as scarring in the donor area in the back of the head.

Corrective procedures are more challenging procedures than standard transplants. Dr. Leonard says that's why it's particularly important that people find a hair transplant surgeon who has a great deal of experience performing transplants on a variety of patients.

When transplanting in a scarred area, surgeons have to be extra cautious about how close together they place the tiny grafts of hair to ensure that the hair is properly nourished. Hair growth in or near scarring may also be slower than it is healthy tissue, but Dr. Epstein says, "transplanted grafts often attract a blood supply, and that makes subsequent transplants work better."

People having this kind of transplantation may therefore require one or two additional procedures. In most cases, surgeons say, people who are patient and have enough donor hair are very satisfied with their new look.

"In people who have had a disfiguring scar, it doesn't always take a lot to make a dramatic improvement," Dr. Epstein says. "For them, a hair transplant offers a huge change in what they see in the mirror."

Michael Reed, MD

Assistant Professor of Clinical Dermatol

Medical reviewer:

Medically Reviewed On: December 04, 2001

Published on: December 04, 2001

Why have a hair transplant?
Men get hair transplants to achieve a more or less permanent correction of hair loss in order to restore a more youthful self-image and improve self-esteem.

Who can get a transplant?
Any person with noticeable hair loss-including thinning hair and bald areas-and whose remaining hair is capable of growing in a transplanted location (called a donor-dominant condition), is a candidate for hair transplantation. A donor-dominant condition is one in which transplanted hairs are able to survive at a new location, and will live and produce hairs as they would have in their previous location.

The most common condition treated is so-called male-and female-pattern androgenic alopecia (hereditary hair loss). However, other conditions such as scarring disorders resulting from injury, diseases, or previous surgery of the scalp, can also be treated with hair transplantation.

When should a hair transplant be done?
A hair transplant can be done any time after there is sufficient hair loss in a particular area-such as the front, middle, or top of the scalp-so that noticeable thinning is present on casual examination. Hair loss actually begins long before it is noticeable; Approximately 50 percent of the hairs in a given area are lost before noticeable thinning becomes apparent.

How is a hair transplant done?
A variable sized section of living scalp containing live hair follicles is removed from the back of the head (donor area) and subsequently microdissected into small follicular unit grafts that are implanted into small surgically prepared recipient sites in the balding area (recipient area). The surgical sites heal in 7 to 14 days, and after a delay of 8 to 12 weeks, the transplanted hairs begin to produce new hair shafts.

Where is a hair transplant done?
Hair transplants are done in an outpatient setting. Patients walk in and walk out the same day. They are given oral, or in some cases inhalant or intravenous sedation, followed by local anesthesia to the donor and recipient sites.

What are the main difficulties experienced by a patient before, during, and after a hair transplant?
The main problems encountered by patients before hair transplantation are usually concern about the cosmetic down time in the postoperative period, and varying degrees of anxiety about potential discomfort during and after the procedure. During the procedure, the patients often become restless due to the prolonged time required to achieve the results and because of this, sometimes have difficulty refraining from talking and moving, which makes the procedure more difficult for the surgeon and the assistants. Finally, after the procedure, the patients experience variable degrees of discomfort at the donor site and variable degrees of swelling of the forehead that resolve in a few days. Also, patients often experience self-consciousness caused by the tiny scabs that are present in the recipient sites.

Which regions of the scalp are best suited for hair transplantation?
The frontal scalp and the midscalp are the areas best suited for microsurgical hair restoration. The so-called bald spot (vertex) can also be corrected, but is somewhat less desirable.

Can a completely bald head be completely restored by hair transplant surgery?
The answer is no, but this is a trick question. Obviously, a completely bald head cannot be transplanted, because it has no donor hair to transplant! Even a very bald scalp cannot be completely transplanted since the size of the donor area and the number of hairs present are smaller than the potentially bald area on the top of the head. However, if the potential donor site is sufficiently large and reasonably dense, a surprisingly large number of hair follicles are available for transplantation to the top of the head, and fairly large areas of balding scalp can be covered adequately with hair that is both natural and reasonably dense in appearance.

Medical reviewer:

Medically Reviewed On: October 15, 2003

Published on: October 15, 2003

It's not hard to spot a man with a bad hair transplant. The transplanted hair looks unnatural, as if it were plugged into the head. What few people realize, however, is that it's likely they've also seen a man or woman with a good hair transplant. The trick is that a good hair transplant is virtually undetectable.

Hair transplantation has changed dramatically over the last decade. "It's almost unfair to call it the same the same thing, it's so different," says Robert Haber, MD, president of the International Society of Hair Restoration Surgery, an educational organization, and an assistant professor of dermatology at Case Western Reserve School of Medicine in Pittsburgh. "There have been huge improvements in every aspect of transplantation."

New techniques

In the transplant procedure, hair is taken from a donor area, usually at the back or sides of the head, and moved to the area where there is hair loss. While donor hair used to be harvested and transplanted in large bunches of 10 to 20 hairs, surgeons now transplant tiny bundles of three or four hairs that grow together in what are called follicular units.

"Surgeons used to use instruments called punches, which looked like cookie cutters, to make circular incisions in the head, and it gave the appearance of a doll's head," says Dr. Ivan Cohen, an associated clinical professor of dermatology at Yale University School of Medicine and a hair transplant surgeon in private practice in Fairfield, Conn. "With new techniques, we take hair from the back of the head in tiny strips and then separate it into follicular unit. We then use tiny needles to plant the hairs back into the scalp."

This technique, known as follicular unit transplantation, is most widely used transplant approach. Some surgeons, however, use a technique called follicular unit extraction in which hair is removed and transplanted with a 1-mm punch that can grab the follicular unit. Follicular unit extraction is considered most appropriate for people with limited hair loss, athletes who need to resume activity right after surgery, and those whose scars widen over time.

With the new techniques, experts say most people with pattern baldness who have a sufficient amount of donor hair are good candidates for hair transplantation. This includes people with any kind of hair type, and women, who are having more and more transplants.

Surgeons note that a large part of their practices is devoted to corrective work, which usually involves repairing old transplants by dividing the transplanted hair into follicular units and re-transplanting it.

Realistic Expectations

In order for patients to be truly satisfied with surgery results, it's essential that they have realistic expectations of what can be accomplished. "The amount of coverage will be determined by how extensive their balding pattern is," says Bernard Nusbaum, MD, a board-certified dermatologist and hair transplant surgeon in Coral Gables, Fla. "An extremely bald individual may only be able to achieve coverage of the front area, while someone with a more limited balding area can achieve total coverage."

The surgeon and patient should discuss the patients' expectations prior to the procedure. As Dr. Haber explains, "If they give me a photo of themselves at 16, I can't help them. But I can help those who are interested in turning the clock back a little and creating a better frame for their face."

Recovery

Hair transplantation is an outpatient surgery, which usually requires two or more sessions. With follicular unit transplantation, patients should expect a thin scar in the harvest area, but even three-quarters of an inch of hair should hide the scar. Potential side effects such as bleeding and infection are rare. Patients should abstain from strenuous activity for the first 48 hours, however, and avoid exposure to prolonged sunlight for the first month.

According to Dr. Nusbaum, patients initially develop scabbing over the transplanted area that can last for up to 14 days. Within four weeks, the transplanted hair, which has been shaven before harvesting, falls out, and new hair begins to grow within four months.

It's generally recommended that patients use FDA-approved medication after surgery to prevent further hair loss. These include Propecia, for men, and Rogaine, which is available to men and women. People who continue to lose hair, however, may want more transplants over time.

Choosing the Right Surgeon

Hair transplant surgeons come from a wide variety of medical backgrounds. While many are dermatologists, others are former family practioners, plastic surgeons or even urologists. Experts say the important thing is that hair transplant surgeons are open about their backgrounds.

To check the credentials of the surgeon they are considering, patients can look for membership in professional organizations such as the International Society of Hair Restoration Surgery, board certification in hair restoration surgery or another specialty, journal publications, and hospital and academic affiliations.

It's also suggested that patients view photos of other people whose hair the surgeon has transplanted, and possibly meet with other patients of that doctor. A good comfort level with the surgeon is also important.

Getting recommendations is also a good idea, though it might be hard to know who to ask. "People ask me why more people aren't having transplants," says Dr. Cohen. "But unless someone shares that information, you just don't know if they've had one."