Hair Transplant | Hair Restoration | Hair Replacement | Grafts, Scalp Reduction / Expansion, Flap Surgery

Hair Transplantation

Hair transplantation is a cosmetic procedure performed on men and women who have significant hair loss, thinning hair, or bald spots where hair no longer grows. A hair transplant can help you look better and get confidence, but you need to get the facts about hair growth surgery first.

Hair transplants can be done to replace hair loss due to genetic reasons, male pattern baldness (where hair typically grows only in a horseshoe shape around the head), or female pattern baldness, and hormonal reasons. Hair replacement surgery can also be done to replace hair loss due to burns, injury or disease of the scalp.

Hair Transplant Techniques

The cost of hair restoration can range from $4000 to $20,000, depending on the type of transplant procedure you use and how much of an area needs coverage. The American Society of Plastic Surgeons (ASPS) lists several hair transplant techniques. Some common ones are listed here.

Hair grafts

Hair graft transplants can be used to restore hair, with the graft taken from an area where hair is growing. There are different types of grafts:

• punch grafts - this type of graft is a cluster of about ten to fifteen hairs
• mini-grafts - this graft is a smaller cluster of two to four hairs
• micro-grafts - each micro graft consists of just one or two hairs
• round or square grafts - these traditional grafts can contain up to twenty hairs
• slit grafts - this type of graft can contain up to ten hairs
• strip grafts - this graft can contain up to forty hairs

You may also hear the term follicular unit hair transplantation. This refers to a hair transplant method in which the size of the grafts varies from a single hair, to two hairs, and three or four hairs Follicular Unit Hair Transplantation mimics the way our natural hair grows. The result, say proponents, is a more natural look. Because the grafts are so small, they fit into very small incisions. This can mean less trauma to the scalp. It also means that grafts can be placed closer together. As a result, follicular unit grafting can ead to a fuller look.

Each of these depends on the amount of hair being transplanted at a time and the quality of the hair at the area that is being moved. Doctors can move areas as large as two millimeters or more down to single strands of hair. The price of a hair graft can range from $3 per graft to $10 per graft.

Hair transplantation with grafts simply relocates existing hair follicles from one area to other. Good hair replacement candidates must have healthy hair growth on the back and sides of the head. These areas serve as "donor" areas. Hair is taken from these donor areas and moved to bald spots or thinning areas. The removed hair follicles are divided into individual grafts (consisting of hair and its roots). The numbers and types of grafts are made according to the patient's hair type, color, hair quality, and the area to be transplanted

Hair transplant surgery is performed by a doctor, and can be done in an office, clinic, or hospital. It is done under local anesthesia. First, the doctor removes or harvests the hair and follicles, and these are divided into the grafts. Then small incisions are made in the part of the scalp lacking hair and a graft is implanted into each of these slits. According to ASPS, several sessions may be needed to get the results you want. There should also be several months between each surgery so it may take up to two years before the final result.

Flap Surgery, Scalp Reduction and Scalp Expansion

Flap surgery and scalp reduction surgery are other types of procedures to restore hair. In flap surgery, a section of bald scalp is removed, with a flap of skin that still has hair attached at one end. This is then moved to cover the bald section. The flap is sewn in place, but because it wasn't totally detached, it still has its original blood supply.

In scalp reduction, sections of the scalp which still have hair follicles are pulled forward to cover the bald area. This can work for areas at the top and back of the head, but isn't very good for hair loss at the front of the head. Scalp reduction surgery is sometimes known as advanced flap surgery.

In tissue expansion, a devise is inserted beneath an area of scalp with hair that lies next to a bald portion. The device is inflated like a balloon with saline during the next few weeks. The skin basically grows, and after several months has expanded enough that it can be stretched over the bald area.

During the recovery period after surgery, the scalp may be tender and swollen. The American Society for Dermatologic Surgery (ASDS) suggests using mild pain medications for a few days after the surgery. Some people see the new hair falling out a few weeks after surgery. ASPS reports this condition is normal and almost always temporary. A patient may also need a "touch-up" procedure to create a more natural looking result. Major complications as a result of hair transplantation are very rare according to ASDS. Occasionally a patient may have problems with delayed healing, infection, scarring or rejection of the graft. The ASDS says at least 90 to 100 percent of the transplanted hair should survive unless the surgery or grafts are not handled properly, too many are transferred in a single session, or if the grafts are planted too densely.

Hair Transplant Concerns

• Health insurance may not pay for hair transplants that are done for cosmetic reasons.
• It is important to be realistic about what a hair transplant will finally look like. This procedure does not create new hair, it simply redistributes the hair that a person already has.
• Hair surgery requires both medical and technical expertise. The ASDS suggests finding an experienced doctor and discussing the expected results prior to surgery. It is important to completely understand the procedure and the expected outcome.

There is no simple answer about the best way to proceed with hair transplants. Patients should discuss all the options with their doctor.

In addition to hair transplant and hair replacement, there are also hair loss medications such as minoxidil (Rogaine) and finasteride (Propecia). You generally have to keep using these hair loss medications for life, or the hair will fall out again. Hair pieces and hair weaves are another option for hair problems.

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Updated May 2008

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