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Who are good candidates for hair restoration surgery?

The ideal candidate for hair restoration surgery has healthy, dense hair on the sides and back of the head. These are the sites that are used as donor areas - the areas from which flaps and grafts are taken. Patients with well-defined baldness, thinning hair, and those with limited hair loss due to scalp injury or burns are generally good candidates for hair replacement surgery. However, hair replacement surgery may not be appropriate for those with little remaining hair.

Who is qualified to perform hair restoration surgery?
In order to achieve maximum safety and the best-looking results, choose a board-certified dermatologic surgeon who is an expert in the causes and treatment of hair loss. Dermatologic surgeons invented hair transplant procedures in the 1950s, and the major textbooks in hair replacement have been authored by dermatologic surgeons. Since the success of the procedure greatly relies on the physician's skill and artistry, it's important to see a dermatologic surgeon with training and experience. Dermatologic surgeons continue to pioneer the latest advances in the field, such as the use of much smaller and more flexible grafts, innovative tools and high-tech procedures, novel pain-reduction methods, and new surgical approaches that make hair restoration treatment a successful solution to hair loss.

What surgical treatments are being used today?
It is not uncommon for a surgeon to use a combination of techniques to produce the best results. The type of hair replacement surgery chosen depends on the extent and pattern of hair loss, along with the patient's individual situation, lifestyle, and desires.

Hair Transplants Hair transplant surgery is based on the principle of donor dominance, which means that hair from healthy donor sites will take root and grow normally when transplanted into balding, recipient sites. The basic technique is very similar to transplanting trees from one area to another. Hair transplantation first involves removing small strips of hair bearing scalp from the back and sides of the head. This "donor region" contains hair which will grow throughout a lifetime. The area from which the strips are taken are carefully repaired, usually resulting in a very narrow scar easily hidden amongst the hair.

The harvested strips of hair bearing scalp are then divided into grafts for placement in the balding areas. These grafts may be processed into a variety of different sizes depending on each patient's specific needs and condition. In recent years, the use of very small grafts, particularly at the hair line, has become very popular. These grafted hairs grow out much like normal hair and are virtually undetectable. Larger grafts containing more hairs may be used in some situations to obtain more density behind the hair line. Grafts containing one to two hairs are known as micro-grafts.

Grafts containing three to five hairs are known as mini-grafts. Larger grafts are referred to as standard grafts. The grafts are inserted into small holes or slits which are made in the balding scalp. The grafts can literally be inserted between existing hairs to increase the density and thicken the area. The number of grafts required and the length of a treatment session depend on each person's particular problem and degree of baldness. Other Surgical Options Scalp reduction offers a special benefit to patients with extensive balding. It is sometimes used for areas of hair loss at the top and back of the head. In this procedure, bald areas are reduced or even eliminated by removing several inches of the bald skin, then pulling upward and lifting the hair bearing skin together.

Scalp extenders or tissue expanders are sometimes used to increase the effectiveness of scalp reductions. The extender, which acts alike a large rubber band, or the expander, which acts like a balloon, is inserted under the scalp for about three to four weeks to stretch hair-bearing areas. This allows for an even greater reduction in the balding area. Scalp reduction surgery can be performed alone or in tandem with a hair transplant. Scalp lifts and scalp flaps are other surgical procedures that may be considered in certain cases. These involve larger rotations of hair bearing scalp to cover bald areas.

Where is treatment usually performed?
Treatment is performed using local anesthesia in the dermatologic surgeon's office where an operation theatre exists. This translates into added convenience and cost-effectiveness for the patient.

What can be expected after surgery?
Bandages are usually removed after 24 hours. Patients can resume their normal activities, unless this entails strenuous physical exercise. There may be some swelling and bruising around the eyes after two or three days, which can be minimized by ice compresses and sleeping in a semi-reclined position. Some crusting or small scabs may be present for a week to 10 days, along with some itching at the treatment sites. Any numbness at the donor and recipient sites usually disappears within three months.

What results can be expected?
The amount of coverage varies depending on the extent of baldness and the specific procedure performed. Within about one month, much of the transplanted hair is shed. About two months later, hair starts to grow and continues to grow at a normal rate. About six months after a hair transplant session, the transplanted hairs begin to take on a natural appearance. The donor site from which the hair was taken shrinks to a very small, barely noticeable scar that is well hidden by the surrounding hair.

How many treatments are needed?
How many treatment sessions are necessary depend on the procedure, the surgeon, the individual patient's physical characteristics, requirements and expectations. Multiple sessions at various intervals are usually required, and the entire process can take anywhere from months to years to complete.

Are there any complications from surgery?
As with all surgical procedures, there is always some risk. however, complications from the surgical treatment of hair loss are rare and generally minimal. Bleeding and infection are infrequent and minor. it's a good idea to check with your physician about avoiding aspirin-containing products or other drugs before surgery. If you have specific concerns, please consult your dermatologic surgeon.