What You Should Know and Why
When it comes to hair loss, heredity is the primary cause. Hereditary loss or patterned hair loss occurs in both men and women regardless of popular misconceptions. Medical science now reports that genes causing baldness are passed down from both sides of the family. Generations can be skipped and random in terms of which siblings are affected by hair loss. Depending on the severity of hair loss the impact on the individual is both unique and personal. Medical Science has determined that every single hair follicle is genetically coded prior to birth. Each follicle is programmed to be sensitive to the male hormones which begin to appear during puberty – causing the follicle to whither and die in time or not to become sensitive to these hormones and continue to grow throughout the life of the person.
Unfortunately once the process begins, it continues throughout a person’s life unless preventative measures are taken. As hair follicles shrink over time, they become thinner and thinner failing to grow to the normal length as in years past. Eventually, in the process of balding the shrinking hair follicles stop producing any hair at all.
Each year consumers spend millions of dollars on shampoos and specialized treatments claiming to restore or slow the pattern of hair loss only to mislead and cause false expectations on the part of the user. The fact is only two medications are approved by the FDA for hair loss, Rogaine and Propecia. Both medications require daily use, are costly, and are limited to their desirable results.
Hair restoration is the only proven method for restoring hair permanently. The medical process known as “hair restoration” involves transplanting hairs and follicles from one area of the head to another. Modern hair transplants have evolved over the years from scalp reduction procedures, hair plugs, strip grafts and hair pieces to a procedure known as micro-graft hair transplantation.
Micro-graft hair transplantation relies on the knowledge that hair in the scalp undergoes growth cycles. It also relies on the knowledge that hair taken from one area such as the back of the head will retain its growth cycle properties from that area despite being moved to another area. This phenomenon is termed “donor dominance.” In practical terms it means that the hair on the back of the head is usually not lost even in men destined to have significant hair loss. Virtually all men and women possess lifelong hair follicles in concentrated areas at the back and sides of the head.
During the hair transplant procedure hair follicles are removed from the donor region and relocated. One at a time, individual grafts are precisely placed in the thinning and balding areas of the patient. This process is performed under magnification. No hair is discarded.
The procedure takes place as an outpatient in our plastic surgery center. The procedure is performed under local anesthesia using regional blocks and tumescent technique which provide complete comfort. The patient remains awake throughout the surgery, free to move around at certain times and able to watch DVDs during the surgery. The procedure typically is completed in four hours.
The ability to create truly great hair transplants requires not only experience, surgical skill, but artistry to create that great looking, undetectable hairline. Now without having to travel a great distance from Central Florida, those interested in improving their appearance and looking younger again can do so by simply contacting the Aesthetic Center for Cosmetic and Reconstructive Surgery. Your consultation and evaluation are free. A consultation will review your medical history, family history, and history of hair loss. After an examination you will be counseled whether you’re a good candidate for micro graft transplantation or not. At this point, it’s up to you to make the right choice. Dr. Ahumada is a board certified plastic surgeon and will answer all your questions.
For individuals struggling with hair loss, the good news is there’s simply no reason to delay exploring the possibilities. Let Dr. Ahumada and the Aesthetic Center for Cosmetic and Reconstructive Surgery provide you with a real solution to your hair loss problem permanently. Whether you’re 18 or 75 years of age you’re a candidate for this outpatient procedure.
You never know but Hair Restoration by the Aesthetic Center might be one of the most important self improvement decisions you make in your adult life, both personally and professionally.
One thing for sure, family and friends will notice you in an intriguing way. You’ll look younger and be happier but they’ll be unable to detect the soft, natural, living hairlines that are virtually indistinguishable from the original hairlines on your head.
Questions & Answers
What is hair replacement surgery?
Hair transplantation involves removing small pieces of hair-bearing scalp grafts from a donor site and relocating them to a bald or thinning area.
If you and your doctor have determined that hair transplants are the best option for you, you can feel comfortable knowing that board-certified plastic surgeons have been successfully performing this type of procedure for more than thirty years.
The truth about hair loss
Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff, and even excessive hat-wearing. All of these theories have been disproved. It’s also untrue that hair loss can be determined by looking at your maternal grandfather, or that 40-year-old men who haven’t lost their hair will never lose it.
Hair loss is primarily caused by a combination of:
- a change in hormones
- and a family history of baldness
As a rule, the earlier hair loss begins, the more severe the baldness will become.
Hair loss can also be caused by burns or trauma, in which case hair replacement surgery is considered a reconstructive treatment, and may be covered by health insurance.
Hair replacement surgery candidates
Hair replacement candidates must have healthy hair growth at the back and sides of the head to serve as donor areas.
- Donor areas are the places on the head from which grafts and flaps are taken.
- Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result.
- There are a number of techniques used in hair replacement surgery. Sometimes, two or more techniques are used to achieve the best results.
Hair replacement surgery can enhance your appearance and your self-confidence, but the results won’t necessarily match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
It’s important to understand that all hair replacement techniques use your existing hair. The goal of surgery is to find the most efficient uses for existing hair.
Hair transplantation techniques, such as punch grafts, mini-grafts, micro-grafts, slit grafts and strip grafts are generally performed on patients who desire a more modest change in hair fullness. Flaps, tissue-expansion and scalp-reduction are procedures that are usually more appropriate for patients who desire a more dramatic change.
Remember, there are limits to what can be accomplished. An individual with very little hair might not be advised to undergo hair replacement surgery.
Hair replacement surgery recovery and follow up
How you feel after surgery depends on the extent and complexity of the procedure. Any aching, excessive tightness, or throbbing can be controlled with pain medication prescribed by your physician. If bandages are used, they will usually be removed one day later. You may gently wash your hair within two days following surgery. Any stitches will be removed in a week to 10 days. Be sure to discuss the possibility of swelling, bruising, and drainage with your surgeon.
Because strenuous activity increases blood flow to the scalp and may cause your transplants or incisions to bleed, you may be instructed to avoid vigorous exercise and contact sports for at least three weeks. Some doctors also advise that sexual activity be avoided for at least 10 days after surgery.
To make sure that your incisions are healing properly, your doctor will probably want to see you several times during the first month after surgery. It’s important that you carefully follow any advice you receive at these follow-up visits.
Getting Back to Normal
How soon you resume your normal routine depends on the length, complexity and type of surgery you’ve had. You may feel well enough to go back to work and resume normal, light activity after several days. Many patients who have had transplants (plugs or other grafts) are dismayed to find that their “new” hair falls out within six weeks after surgery. Remember, this condition is normal and almost always temporary. After hair falls out, it will take another five to six weeks before hair growth resumes. You can expect about a half-inch of growth per month.
You may need a surgical “touch-up” procedure to create more natural-looking results after your incisions have healed. Sometimes, this involves blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts, or slit grafts. Or, if you’ve had a flap procedure, a small bump called a “dog ear” may remain visible on the scalp. Your doctor can surgically remove this after complete healing has occurred.
In general, it’s best to anticipate that you will need a touch-up procedure. Your surgeon can usually predict how extensive your follow-up surgery is likely to be.
Hair replacement procedure steps
Hair transplantation involves removing small pieces of hair-bearing scalp grafts from a donor site and relocating them to a bald or thinning area. Grafts differ by size and shape. Round-shaped punch grafts usually contain about 10-15 hairs. The much smaller mini-graft contains about two to four hairs; and the micro-graft, one to two hairs. Slit grafts, which are inserted into slits created in the scalp, contain about four to10 hairs each; strip grafts are long and thin and contain 30-40 hairs.
Generally, several surgical sessions may be needed to achieve satisfactory fullness-and a healing interval of several months is usually recommended between each session. It may take up to two years before you see the final result with a full transplant series. The amount of coverage you’ll need is partly dependent upon the color and texture of your hair. Coarse, gray or light-colored hair affords better coverage than fine, dark-colored hair. The number of large plugs transplanted in the first session varies with each individual, but the average is about 50. For mini-grafts or micro-grafts, the number can be up to 700 per session.
Just before surgery, the “donor area” will be trimmed short so that the grafts can be easily accessed and removed. For punch grafts, your doctor may use a special tube-like instrument made of sharp carbon steel that punches the round graft out of the donor site so it can be replaced in the area to be covered-generally the frontal hairline. For other types of grafts, your doctor will use a scalpel to remove small sections of hair-bearing scalp, which will be divided into tiny sections and transplanted into tiny holes or slits within the scalp. When grafts are taken, your doctor may periodically inject small amounts of saline solution into the scalp to maintain proper skin strength. The donor site holes may be closed with stitches-for punch grafts, a single stitch may close each punch site; for other types of grafts, a small, straight-line scar will result. The stitches are usually concealed with the surrounding hair.
To maintain healthy circulation in the scalp, the grafts are placed about one-eighth of an inch apart. In later sessions, the spaces between the plugs will be filled in with additional grafts. Your doctor will take great care in removing and placement of grafts to ensure that the transplanted hair will grow in a natural direction and that hair growth at the donor site is not adversely affected.
After the grafting session is complete, the scalp will be cleansed and covered with gauze. You may have to wear a pressure bandage for a day or two. Some doctors allow their patients to recover bandage-free.
Plastic surgeons are the leaders in tissue expansion, a procedure commonly used in reconstructive surgery to repair burn wounds and injuries with significant skin loss. Its application in hair replacement surgery has yielded dramatic results-significant coverage in a relatively short amount of time.
In this technique, a balloon-like device called a tissue expander is inserted beneath hair-bearing scalp that lies next to a bald area. The device is gradually inflated with salt water over a period of weeks, causing the skin to expand and grow new skin cells. This causes a bulge beneath the hair-bearing scalp, especially after several weeks.
When the skin beneath the hair has stretched enough-usually about two months after the first operation-another procedure is performed to bring the expanded skin over to cover the adjacent bald area. For more information about tissue expansion, ask your plastic surgeon for the American Society of Plastic Surgeons, Inc. brochure entitled, Tissue Expansion: Creating New Skin from Old.
Flap surgery on the scalp has been performed successfully for more than 20 years. This procedure is capable of quickly covering large areas of baldness and is customized for each individual patient. The size of the flap and its placement are largely dependent upon the patient’s goals and needs. One flap can do the work of 350 or more punch grafts.
A section of bald scalp is cut out and a flap of hair-bearing skin is lifted off the surface while still attached at one end. The hair-bearing flap is brought into its new position and sewn into place, while remaining “tethered” to its original blood supply. As you heal, you’ll notice that the scar is camouflaged-or at least obscured-by relocated hair, which grows to the very edge of the incision.
In recent years, plastic surgeons have made significant advances in flap techniques, combining flap surgery and scalp reduction for better coverage of the crown; or with tissue expansion, to provide better frontal coverage and a more natural hairline.
This technique is sometimes referred to as advancement flap surgery because sections of hair-bearing scalp are pulled forward or “advanced” to fill in a bald crown.
Scalp reduction is for coverage of bald areas at the top and back of the head. It’s not beneficial for coverage of the frontal hairline. After the scalp is injected with a local anesthetic, a segment of bald scalp is removed. The pattern of the section of removed scalp varies widely, depending on the patient’s goals. If a large amount of coverage is needed, doctors commonly remove a segment of scalp in an inverted Y-shape. Excisions may also be shaped like a U, a pointed oval, or some other figure.
The skin surrounding the cut-out area is loosened and pulled, so that the sections of hair-bearing scalp can be brought together and closed with stitches. It’s likely that you’ll feel a strong tugging at this point, and occasional pain.
Before: Hair replacement candidates should have some noticeable hair loss with healthy hair growth at the back and sides of the head to serve as doner areas.
Step 1: A tube-like instrument punches round gafts from the donor site to be placed in the area where hair replacement is desired.
Step 2: A tube-like instrument punches round gafts from the donor site to be placed in the area where hair replacement is desired.
Step 3: When the skin beneath the hair has stretched enough, it is surgically placed over the bald area.
Step 4: During flap surgery, a section of bald scalp is cut out and a flap of hair-bearing skin is sewn into its place.
Step 5: The patterns used in scalp reduction vary widely, yet all meet the goal of bringing hair and scalp together to cover bald areas.
After: The results of hair replacement surgery can enhance your appearance and self-confidence.
Hair replacement surgery risks and safety information
Hair replacement surgery is normally safe when performed by a qualified, experienced physician. Still, individuals vary greatly in their physical reactions and healing abilities, and the outcome is never completely predictable.
As in any surgical procedure, infection may occur. Excessive bleeding and/or wide scars, sometimes called “stretch-back” scars caused by tension may result from some scalp-reduction procedures.
In transplant procedures, there is a risk that some of the grafts won’t “take.” Although it is normal for the hair contained within the plugs to fall out before establishing regrowth in its new location, sometimes the skin plug dies and surgery must be repeated. At times, patients with plug grafts will notice small bumps on the scalp that form at the transplant sites. These areas can usually be camouflaged with surrounding hair.
When hair loss progresses after surgery, an unnatural, “patchy” look may result-especially if the newly-placed hair lies next to patches of hair that continue to thin out. If this happens, additional surgery may be required.
What to expect during your consultation
Hair replacement surgery is an individualized treatment. To make sure that every surgical option is available to you, find a doctor who has experience performing all types of replacement techniques-flaps and tissue expansion as well as transplants. Look elsewhere if your doctor tells you that he or she has perfected one technique that can “do it all.”In your initial consultation, your surgeon will evaluate your hair growth and loss, review your family history of hair loss, and find out if you’ve had any previous hair replacement surgery. Your surgeon will also ask you about your lifestyle and discuss your expectations and goals for surgery.
Medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to form excessive scars, should also be checked by your doctor. Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.
If you decide to have hair replacement surgery, your surgeon will explain anesthesia, the type of facility where the surgery will be performed, and the risks and cost involved. Don’t hesitate to ask your doctor any questions.
Make sure you understand your surgeon’s plan-which procedures will be used and how long each will take. Ask your doctor to give you an idea of what you will look like after the procedure or, in the case of grafts, after each stage of treatment.
Preparing for hair replacement surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it’s especially important to stop at least a week or two before surgery; smoking inhibits blood flow to the skin, and can interfere with healing.
You should arrange for someone to drive you home after your surgery. Plan to take it easy for a day or two after the procedure and arrange for assistance if you think you’ll need it.
Where your surgery will be performed
Hair replacement surgery is usually performed in a physician’s office-based facility or in an outpatient surgery center. Rarely does it require a hospital stay.
Types of anesthesia
Hair replacement surgery, no matter what technique is used, is usually performed using a local anesthesia along with sedation to make you relaxed and comfortable. Your scalp will be insensitive to pain, but you may be aware of some tugging or pressure.General anesthesia may be used for more complex cases involving tissue expansion or flaps. If general anesthesia is used, you’ll sleep through the procedure.
Hair loss in women
Some doctors estimate that one in five women will experience some degree of hair loss usually caused by aging, illness, or hormonal changes after menopause. Women tend to experience a subtle thinning all over the scalp rather than losing hair in patches as is common in men. To correct the problem, some women choose to wear a wig or hair extensions. Others have had some success using a topical prescriptive drug. The effectiveness of such drugs varies in some patients and simply prevents further hair loss without stimulating any appreciable new growth. Hair replacement surgery may be the answer for those who feel uncomfortable with either of these options.
Because mini-grafts are usually the surgical treatment of choice for filling-in thinning areas, good candidates for this procedure should have dense hair growth at the back of the head. Mini-grafts are harvested from this dense area and replanted in thinning areas to create a fuller look. Occasionally flap and tissue expansion procedures may be used if the individual is judged to be a good candidate.
If you’re considering a hair replacement procedure, it’s important to understand that you will never have the coverage you had prior to your hair loss, but surgery may camouflage the thin areas and give you more fullness.
Questions to ask my plastic surgeon
Use this checklist as a guide during your consultation:
- Are you certified by the American Board of Plastic Surgery?
- Were you trained specifically in the field of plastic surgery?
- How many years of plastic surgery training have you had?
- Do you have hospital privileges to perform this procedure? If so, at which hospitals?
- Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
- How many procedures of this type have you performed?
- Am I a good candidate for this procedure?
- Where and how will you perform my procedure?
- What shape, size, surface texturing, incision site and placement site are recommended for me?
- How long of a recovery period can I expect, and what kind of help will I need during my recovery?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if I am dissatisfied with the cosmetic outcome of my facial implant surgery?
- Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?
Choose a surgeon you can trust
Hair replacement surgery involves many choices. The first and most important is selecting a American Society of Plastic Surgeons (ASPS) member you can trust. ASPS member surgeons meet rigorous standards:
- Board certification by the American Board of Plastic Surgery® (ABPS) or in Canada by The Royal College of Physicians and Surgeons of Canada®
- Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
- Pass comprehensive oral and written exams
- Graduate from an accredited medical school
- Complete continuing medical education, including patient safety each year
- Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities
Do not be confused by other official sounding boards and certifications.
The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name. By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly trained plastic surgeon who is board-certified by the ABPS or The Royal College of Physicians and Surgeons of Canada.
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