Hair transplant surgery

Hair transplant surgery treats hair loss. Various techniques are available, but they all involve taking hair-bearing skin from one part of the scalp and grafting it onto bald or thinning areas. Hair loss may be due to common male pattern baldness (also known as androgenetic alopecia), certain inflammatory conditions, scalp inflammation, or injury to the scalp. Injuries from burns, scalds, surgery or accidents can leave permanent bald areas that may be concealed with a transplant. Most hair transplants are performed to treat male pattern baldness.

If you are concerned about the way you look, or are thinking about cosmetic treatments to boost your confidence, there are alternatives. These include prescription medication, over-the-counter minoxidil lotion, or simply accepting yourself the way you are.

A transplant is not a cure for male pattern baldness. It will cover bald scalp, but it will not stop further hair loss. Because male pattern baldness is progressive for most men, it may be worth combining surgery with medical treatments to slow the balding process.

Things to consider before surgery#

Discuss your plans with your doctor first. Some important points to keep in mind:

• Have realistic expectations. If you start with very little hair, a transplant will not give you a full head of hair.
• The thicker and denser your remaining hair, the better the results. Generally, thick hair that is light coloured or grey gives better results than hair that is thin and dark.
• It takes time. It can take up to nine months for transplanted hair to take root and begin to fill in.
• Think about the cost. Cosmetic surgery is not usually covered by health insurance. If the hair loss was caused by burns or trauma, the surgery may be considered reconstructive and could be covered. Ask your medical practitioner about any out-of-pocket costs.
• Smokers are at increased risk of complications. If you are serious about surgery, try to quit smoking first.
• You may need ongoing treatment after the surgery.

Finding a practitioner#

Ask your doctor to recommend a suitable and reputable doctor or hospital where hair transplants are performed. At your first consultation, ask the practitioner about their training and experience. It is best to have the procedure done by a reputable professional who is specially trained in hair transplant surgery and who performs this type of operation often.

Before the operation, discuss the following with your practitioner:

• Physical health – an examination helps your practitioner decide if the treatment is appropriate, including the type of anaesthetic used. Some pre-existing conditions and past surgery may influence these decisions.
• Hair evaluation – including your hair growth pattern, the extent of your hair loss, your family history of hair loss, and any prior treatments.
• Risks and possible complications – make sure you understand these so you can weigh up whether a transplant is right for you.
• Medication – tell your practitioner about anything you take regularly or have recently taken, including over-the-counter preparations such as fish oils and vitamin supplements.
• Past reactions – tell your practitioner if you have ever had a bad reaction or side effect from any medication, including anaesthesia.
• Preparation for surgery – your practitioner will give you detailed instructions on how to prepare at home. For example, you may be advised to take a particular medication or change the dose of one you already take. Follow all instructions carefully.

How the surgery is done#

Your practitioner will choose the most appropriate method for your circumstances. Hair transplant grafts are usually done under local anaesthetic. Each session can last from two to eight hours, depending on the number of hairs transplanted.

It is common to transplant between 1,000 and 2,000 hair follicles in one session, although larger areas may need up to 4,000 follicles per session. Many people choose to have two or three separate sessions.

Hair transplant graft#

• The hair on the donor area is trimmed short to make it easier to handle.
• The practitioner anaesthetises the part of the head where hair grows thickly.
• Small sections of hair-bearing scalp are taken and transplanted to the desired area, usually the front of the scalp above the forehead.
• Various instruments may be used to harvest the donor skin, such as a round tube (punch) or a scalpel. A single punch graft may harvest 2 to 15 hairs depending on the size of the tube. A slit graft may contain 4 to 10 hairs, and the much longer strip graft up to 40 hairs.

Flap surgery#

Flap surgery is used when the transplant is extensive and requires large tissue flaps rather than small grafts. You may need to stay in hospital, and general anaesthesia is required.

• The practitioner implants balloon-like devices (tissue expanders) under the skin of a hair-bearing section of scalp.
• The expanders are inflated with more and more saline over several weeks, which encourages the area to grow more skin cells.
• After about two months, the scalp has grown enough extra skin for the transplant.
• The bald section of scalp is cut and removed. The newly grown hair-bearing skin is partly cut away, moved to its new location and stitched into place. Because the flap is never fully severed, it should keep a good blood supply.

Scalp reduction surgery#

Scalp reduction is suitable for bald areas on the back and top of the scalp, not towards the front.

• Local anaesthesia is given to the scalp.
• The practitioner cuts out a strip of bald skin in a U or Y shape.
• The scalp is loosened, and the incisions are brought together and stitched.

After the operation#

How you feel afterwards depends on the extent of the surgery. You can expect bruising and swelling, possible numbness, pain, throbbing and discomfort, a tight feeling in the scalp, and small scabs across the treated areas. You may need to wear dressings or bandages, and a pressure bandage may be worn for a day or two.

Complications#

All surgery carries some degree of risk. Possible complications include:

• risks of general anaesthesia, including allergic reaction, which may rarely be fatal
• surgical risks such as bleeding or infection
• scars that may be severe, raised, reddened and itchy
• nerve damage, including permanent loss of sensation
• death of the skin grafts or tissue death along the wound
• further surgery to treat complications

This is not a complete list. Your medical history or lifestyle may put you at increased risk of certain complications, so speak to your practitioner for more information.

Self-care at home#

Be guided by your practitioner. General suggestions include:

• Follow all instructions on caring for your wounds.
• Avoid exercise or strenuous activity that could raise your blood pressure, as this can make your wounds bleed.
• Your practitioner may advise you to avoid sex for about 10 days.
• Report any bleeding, severe pain or unusual symptoms.

Long-term outlook#

Most hair transplants are successful, although it can take up to nine months for the hair to take root and fill in. It is not unusual for transplanted hair to fall out after several months and then regrow. Once it regrows, it should look natural, because the hair is transplanted in the direction it would normally grow in that location. Most scars are covered by hair and hard to see. Any visible scarring is permanent but should fade over time, and improvements may take a year or so. You will almost certainly need touch-up surgery to refine the result.

Alternatives to surgery#

Non-surgical alternatives include prescription medications such as creams, over-the-counter minoxidil lotion, and wigs, hairpieces or hair extensions. You may also decide to accept that hair loss is a natural part of ageing. Talking to a counsellor or psychologist may help you work through concerns about your appearance, and you may decide that you like yourself the way you are.

Key points#

• The thicker and denser your remaining hair, the better the results will be.
• Smokers are at increased risk of complications from surgery.
• There may be a need for continuing medical treatment after surgery.
• Each session can last from two to eight hours, depending on the number of hairs transplanted.
• All surgery carries some degree of risk.

Where to get help#