Introduction to Hair Transplant
Hair loss occurs both in men and women and almost everyone suffers a degree of hair loss in older age. However, when hair loss occurs in a younger age, resulting in areas of ‘alopecia’ or a bald patch, it can be very distressing.
The classical ‘male pattern baldness’, is known as ‘Andro-genetic alopecia” and abbreviated as AGA. As the very name suggests, to develop male pattern baldness or alopecia, both components must be present, which are, defective genes and testosterone. Testosterone is a normal hormone present in all men and by itself does not damage hair roots or follicles unless it is converted by an enzyme 5 alpha reductase II into dihydrotestosterone or DHT. DHT causes the root of genetically susceptible hair to shrink to the point that they are completely destroyed and hair cannot grow back in those areas unless they are transplanted. If you notice the head of people with male pattern baldness, even those with extensive hair loss, still retain a horseshoe shaped area of healthy hair starting just above each ear and going round to the back. These hairs are genetically programmed to resist the damaging effect of DHT, and it is these hair roots which when transplanted into the bald areas retain their original characteristics and hence are permanent.
Females can also develop male pattern baldness in rare cases but more often they suffer diffuse thinning of hair. Careful assessment of hair loss in females is essential as in most cases medical treatments may be quite helpful. In males the classical hair loss starts with a receding hairline, which can extend to large areas of complete baldness. In women this does not usually happen though some women have a naturally high hairline which they want to lower for cosmetic reasons and this can be combined with ‘texturising’ or filling in more hairs within areas of thinning.
In simple terms, hairs from genetically ‘safe zone’ from the back of the head are transplanted into the bald areas. The technique had been used for decades, and in old days large plugs of hair were removed from the safe zone on the back of the head to the bald patch on the frontal bald areas. But the results in early days were not satisfactory and looked very fake and ‘pluggy’. With modern technology, using a microscope, it is possible to isolate every single hair follicle and these single follicles are painstakingly transferred into the bald area as individual ‘micrografts’. The area from where the hair grafts are obtained is called the ‘donor area’ and the area where the hair follicles are transferred to is called as the ‘recipient site’. The slits in skin at recipient sites are carefully prepared keeping in mind the direction and angle of original hair in that specific area.
The grafts are obtained from the donor area under local anesthesia. The classical method, with proven safety and success record, is to ‘harvest’ or take a strip from the back of the head, in the safe zone, and a team of highly skilled technicians separate each hair follicle carefully under the microscope. While the technicians are doing that the surgeon closes the donor area with simple stitches. When the grafts are ready, they are inserted or ‘planted’ into the carefully created slits by the surgeon.
How many sessions will I need?
Depending on the extent of your hair loss and the density and laxity of the donor area, the surgeon can give you an estimate of the number of sessions that may be required to obtain the final result. It also depends on your expectations. While majority of patients are happy with just one session, most patients with significant baldness will need at least two or even three sessions. Be realistic about your expectations. You may never have the density and texture you used to have.
Results after hair transplantation are not visible straight away. The transplanted hair goes into the resting or ‘telogen’ phase and the transplanted hair shafts drop off. But, the follicle or root of the hair gets vascularized and develops a firm attachment to the new recipient site. The resting phase continues for 3 to 4 months after which the new hair shaft regrows. Some hair keep growing and shedding for a while and it can be up to 1 or sometimes up to 2 years before full growth is achieved. As a rough guide one can expect up to to 95% of transplanted hair to regrow but individual results may vary.
Apart from meticulous technique, a number of variables affect the quality of final outcome, including the extent of baldness against available safe zone or permanent hairs, their colour, caliber and density of donor area hairs. Generally speaking thick, wavy or curly hair gives a better impression of texture than straight fine hairs. In younger patients, adjuvant medical therapies can help reduce further hair loss and also promote regrowth of minuterised, but still intact follicles.
Return to work
There will be a phase of temporary swelling and discomfort, and about 3 days of rest at home is recommended. Most patients will be able to return to work in 1 week or even earlier.
After care following hair transplantation is relatively straightforward. A detailed instruction sheet of dos and don’ts will be given to you following your procedure. In general, you can start to rinse your hair (WITHOUT RUBBING) from the next day using a mild soapy solution or simply a baby shampoo. Its best to just pour water with a tumbler for the first week after which you can use a ‘soft’ spray. Remember that the hairs placed in the slits are not stitched or glued and may drop or pull out if you rub on the scalp before 1o days.
You can expect some swelling and slight discomfort for first 2 to 3 days. It is very rare to need strong painkillers, though some patients may use them once or twice. Antibiotics are taken for 3 days and the suture will need to be removed in 10 to 12 days.