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Hair
Replacement Surgery For patients looking for alternatives to hair transplants, many doctors now offer scalp flaps and scalp reductions to produce a new, natural-looking head of hair. Of all hair restoration procedures, scalp flaps move the greatest amount of hair in the shortest amount of time. As with hair transplants, scalp flap surgery involves removing hair from a section of the scalp where hair follicles are abundant and transferring some of those to the balding area. However, instead of cutting the section of hair into smaller grafts and then inserting them into thinning areas, scalp flap surgery is performed by moving the entire strip to a completely bald section of the head. The hair then continues to grow, in its new location, at the same rate of growth as the previous location. It will not thin or die unless hair in the area it came from also thins or dies. Scalp flaps are sometimes performed in combination with hair transplants for a more natural look, or with scalp reduction, to more effectively cover a large bald area. Because of significant surgical advances with improved results, interest in hair replacement has increased significantly during the past decade. Hair loss affects both men and women of all ages. Some people begin to lose hair in their twenties. Frequent shampooing, poor circulation, wearing hats or any other personal habits are not factors that cause hair loss. For men, heredity is the major factor in hair loss. For women, hormonal changes, including those that occur in menopause, are mainly responsible for female "pattern changes," which include thinning and loss. Accidents, burns, and disease can also trigger hair loss. It is 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. Hair replacement surgery can enhance your appearance and your self-confidence.
How is hair replacement surgery performed? 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. Transplant 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. 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. 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 cutout 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. How long does a hair replacement procedure take? Most doctors perform more than one session of transplanting to achieve the best results. Each transplanting session takes between two and four hours, depending on the extent of the treatment. What type of anesthesia is used? Hair replacement surgery, regardless of the 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. Where is the procedure 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. A hair transplant can be done in an outpatient surgery center or in an office surgical suite. Most hair transplants are performed under local anesthesia (like that used by dentists) combined with a sedative to make you drowsy. You'll be awake but relaxed, and although you may feel some tugging and mild discomfort, you won't feel any pain. When can I return home and resume normal activities? 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. How do I prepare for hair replacement surgery? During your initial consultation, your surgeon will discuss the changes that you would like to make to your appearance. Since the appearance of your hair is a matter of personal perception and preference, you will need to discuss your concerns in detail so your surgeon can determine the appropriate alternatives. You also should make arrangements ahead of time for someone to drive you to and from your procedure and to assist you with your daily activities during your recovery period. Prior to your surgical procedure, the surgeon will perform a complete health history and physical. Knowledge of your allergies, medications and previous surgeries should be brought to your surgeon's attention at this time. Specific instructions to assist you in preparing for this procedure will be given to you after the health history and physical is complete. Depending on your individual health status, the instructions may include guidelines regarding your diet, alcohol intake, smoking and which medications to take or avoid. Your experience will be much smoother if you remain compliant with your surgeon's instructions. What precautions are necessary during recovery? 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. What are the possible complications after hair replacement surgery? 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 re-growth 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. It is always important to be informed about the possible complications before any surgery. Be sure to discuss any concerns you may have with your surgeon. What results can I expect after hair replacement surgery? 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. To obtain further information regarding hair replacement surgery, we advise you to consult with a qualified and experienced board-certified plastic surgeon. Regardless of the type of procedure you are considering, it is crucial to choose the right surgeon for your individual goals. To receive a complimentary consultation with a specialist in your area, simply fill out our Online Referral Form or call Toll Free 800.434.6760.
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