Hair Replacement surgery - transplantation - surgical procedure

Hair Replacement is a surgical procedure, also called hair transplantation, to relocate viable HAIR follicles from sites on the scalp where they are abundant to sites where there has been permanent hair loss. The most common reason for hair replacement is androgenic ALOPECIA (male pattern hair loss). Hair replacement is nearly always a cosmetic procedure, though may be restorative to correct damage resulting from injuries or BIRTH DEFECTS.

Hair Replacement - Surgical Procedure

Hair replacement procedures may involve tissue grafts, flaps, expansion, or combinations of these methods. The surgeon will plan the appropriate approach for each individual’s situation and hair loss circumstances. The OPERATION is an AMBULATORY SURGERY, performed with local ANESTHESIA and a sedative for comfort. Most people require several operations to establish satisfactory results. Mild to moderate PAIN is common for several days following a hair replacement procedure.

Tissue grafts

SKIN grafts were the original hair transplantation method. The surgeon removes a plug or slice of skin from the back or side of the head and transplants it to a hair loss site. The graft may contain from one or two to several hundred hair follicles, depending on the technique and size. With the first replacement procedure the surgeon places the grafts fairly widely apart (about one eighth inch) to allow generous BLOOD circulation. Subsequent grafts fill in the spaces. Generally, a pressure bandage holds the grafts in place for 24 to 48 hours following surgery to help the transplanted skin attach to the new site, and fine sutures (stitches) close the donor sites.

Tissue flaps

A tissue flap relocates a substantial amount of hair-bearing skin to a single recipient site. The surgeon loosens a flap of skin near the area of hair loss, and removes a similarly sized and shaped segment of skin from the hairless scalp. The surgeon leaves one end of the flap attached and pulls the remainder of the flap over the recipient site, suturing it in place. The surgeon also sutures the edges of the donor location, which heals beneath the hair with no visible SCAR. A common variation of tissue flap hair replacement is scalp reduction, in which the surgeon removes more hairless scalp than the replacement flap covers, drawing the edges tight to pull additional hair from the sides of the head higher onto the crown of the head. Tissue flaps generally heal with less chance of rejection than grafts because they remain anchored to their original blood supply.

Tissue expansion

Plastic surgeons developed TISSUE EXPANSION techniques to reconstruct major skin damage following trauma such as BURNS or major surgery, then discovered tissue expansion allows natural expansion of hair-bearing scalp for hair replacement. The surgeon loosens a segment of hair-bearing skin adjacent to an area of hairless skin to create a pouch, and inserts a special silicone balloon called a tissue expander.

Over a period of months the surgeon injects saline (sterile saltwater) into the expander, gradually increasing its size. As the expander stretches, the skin grows to accommodate it. When the area produces the desired amount of growth, the surgeon removes the expander, surgically removes a similarly sized and shaped segment of hairless scalp, and pulls the new skin over the area. Tissue expansion can relocate the greatest surface area of hair-bearing skin in a single procedure and produces the most natural-appearing frontal hairline.

Hair Replacement Risks and Complications

Risks and complications are slight for hair replacement methods, and include excessive bleeding, INFECTION, and reaction to the anesthetic. The recipient site on the scalp also may reject the replacement tissue. Because relocation traumatizes hair follicles, they immediately enter a resting phase and shed their hair about five to six weeks following relocation. Though this is normal, many people find it alarming and worry that it signals rejection of the new hair. However, with rejection the entire segment of relocated skin fails to grow and eventually sloughs off. The surgeon can generally replace the rejected replacement tissue during the next session of surgery. When they reestablish themselves in their new sites, the follicles return to a growth phase and produce about an inch of new hair within six to eight weeks after the old hair falls out.

Hair Replacement Outlook and Lifestyle Modifications

For the first few weeks following surgery the scalp is swollen and tender, and the replacement sites may bleed with strenuous physical activity. Surgeons recommend refraining from intense exercise or activity and contact sports for two or three weeks after the procedure. The scalp remains tender (though the swelling subsides within a few weeks) for up to three or four months, depending on the replacement method. Transplanted hair growth does not look exactly the same as the hair that previously grew from the transplant site, though most people experience satisfactory results when a qualified and experienced cosmetic surgeon performs the surgery. It generally takes a year or two from the final hair replacement procedure to see the full effects.

There must be abundant healthy hair on the back and sides of the head to serve as donor hair. Men in whom male pattern hair loss begins early in life are more likely to experience severe or total hair loss as they age. Satisfactory results from hair replacement surgery are less certain when this is the case, as the transplanted follicles may also experience hair loss. Hair loss from follicles native to the site generally continues, particularly in male pattern hair loss, which can result in irregular growth patterns and the need for further hair replacement.

See also ANALGESIC MEDICATIONS; PLASTIC SURGERY; SURGERY BENEFIT AND RISK ASSESSMENT.

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