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The state of the art in Hair Restoration surgery involved the transplantation of minigrafts and micrografts from the donor scalp to the recipient area. This technique ensures a natural appearing hairline that is apparent from 6-12 months after the procedure. Each session can be approached as if this is the only session that the patient will ever have. By starting with the proper hairline design, usually one that frames the face, there is no specific requirement for future sessions.
The major advantage that hair transplantation has over other ways of dealing with hair loss, is the permanent restoration of one’s own natural growing hair to areas of balding. It is important to note that the first hair transplants done in 1960 are still growing today! Even though hair transplants require brief investments of time, money and effort, the benefits are reaped over the years to come. Natural hair will continue to grow in previously bald areas.
Hair transplants are used in three different ways to correct various types of hair loss: First, when total hair loss has occurred, transplants can restore hair to the affected areas. Secondly, if only partial hair loss has occurred, transplants can add additional hair. This method is particularly useful in the earlier stages of hair loss. The third application is to re-create an entirely new hairline. This new method makes it possible to obtain a natural appearing hairline that is essentially undetectable as a transplant.
A Hair Transplant is the relocation of growing hair follicles to places on the scalp that are thinning or balding. The success of the transplant is based on the fact that these hair follicles will behave as they did in their original site. Even in the most advanced cases of male pattern baldness, there is a fringed area of hair (known as the “donor site”) that remains unaffected by the balding process. This area of hair is horseshoe-shaped and persists behind the ears and across the lower portion of the back of the scalp. Hair follicles are moved from this donor site and transplanted to areas of thinning and balding (known as the “recipient site”). The newly transplanted hairs will now grow indefinitely, and will no longer be affected by the balding process. This is called the “Donor Dominance Principle.”
Between 1960 and 1990, there was only one method of hair transplantation available. Large round “plugs” of hair were taken from the donor area and was transplanted to the frontal area. Each plug typically contained 12-15 hairs, and a series of plugs were placed in rows in the front of the scalp to recreate a hairline. Unfortunately, there were two significant problems with this approach: First, the transplanted plugs were large, and contained such great numbers of hairs, that they produced noticeable “tufts” of hair on the scalp. This tufted appearance resembled a“doll’s head.” Secondly, the arrangement of plugs in rows produced a contrived, grid-like pattern, similar to “rows of corn.” Since natural hair does not grow this way, the distribution of these plugs looked unnatural.
By 1990, hair replacement surgeons recognized the need for new techniques that would more closely create a natural hairline. Physicians worldwide began investigating alternative methods of hair transplantation that would eliminate the unattractive looking tufts and “corn rows” that were seen with larger plugs. Through this investigation, new techniques evolved. Today’s hair transplants emphasize the artful placement of smaller grafts called minigrafts and micrografts.
Minigrafts are similar to the older plugs used in the past except that they are much smaller. Rather than having 12-15 hairs, they contain only 2-4 hairs. Minigrafts are scattered throughout an area of hair loss in the frontal and crown regions and give an appearance of a diffuse addition of hair. Each minigraft is small enough that they blend into one another instead of standing out as a tuft of hair. Care is taken to place these hairs in random fashion in order to avoid visible rows, lines, or grid-like patterns that catch the eye. The rest is a more natural appearing addition of hair. Since minigrafts contain only 2-4 hairs, large numbers are transplanted to an area to create sufficient density. Typically, 300-600 minigrafts are transplanted in one session over several hours.
Micrografts, on the other hand are the smallest grafts of all and consist of a single hair.
They are used in a very specialized manner, especially along the hairline. On close inspection, an inborn hairline seems to consist of a few isolated hairs staggered along the frontal scalp. As one looks further back into a hairline, the hairs appear closer and closer together, creating some density. During a hair transplant, the density behind the hairline is typically reproduced by using minigrafts of 2-4 hairs, while the small micrografts are placed along the frontal hairline as isolated, single hairs. The usage of micrografts in combination creates the soft, feathered appearance of a natural hairline.
THE ROLE OF LASER IN HAIR TRANSPLANT SURGERY
Carbon Dioxide (CO2) lasers are currently being used in many areas of medicine and surgery. They permit vaporization of tissue with minimal adjacent tissue damage and virtually no bleeding. They are used frequently to treat skin growths and tumors, as well as to resurface skin that has been damaged by age, sun, and inflammation.
In Hair Transplant Surgery, lasers may play a role in creating the recipient sites (the tiny holes and slits where the minigrafts and micrografts are placed). This may result in less bleeding, less post-operative swelling and more efficient surgery. In 1996, the use of lasers in hair transplant surgery remain controversial. We are currently studying new techniques and methods of incorporating lasers into hair transplantation surgery.
Scalp Reductions involve the surgical removal of large areas of balding scalp. With this procedure, there is an increased chance of scarring and deformity, and multiple sessions are required (usually 5 or more) to camouflage the surgical scars. Experience shows that this technique also leads to a thinning of the remaining hairs on the outside rim of the scalp. Scalp reductions are not indicated for the majority of patients.
Minoxidil (Rogaine) therapy stimulates hair follicles to grow in many patients. We often prescibe topical minoxidil therapy in conjunction with hair transplants to help maintain regrowth of transplanted hairs. Its mechanism of action is unknown.
Hair weaves and wigs are appropriate for patients who are unable or unwilling to have a hair transplant. Unfortunately, this method limits one’s lifestyle (i.e., exercise, swimming), needs frequent maintenance and often looks unnatural. Also, the long term cost of a hair piece is significantly higher than that of a hair transplant.
Hair loss varies greatly from individual to individual. It is important to rule out medical causes of alopecia such as scalp diseases or metabolic defects. All patients with hair loss should be evaluated by a physician before having any surgical procedure. The amount of hair transplantation required to correct any given situation also varies. Persons with complete or substantial hair loss obviously require more intervention than individuals with partial or minimal hair loss. The best recommendation is to see a doctor that specializes in hair transplants. He will discuss your treatment options and give you the best advice for achieving a natural head of hair.