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Over the course of recent years, the technique of hair restoration surgery has developed enormously. Hair grafts have become increasingly smaller and refined, changing from 15 to 25 hair grafts to as small as one and two hair grafts. Modern transplant techniques performed by a skilled doctor can produce quite natural looking results, which are often indistinguishable from normal hair. The donor hair needs to be first taken from an appropriate area of your skin where the hairs are quite thick. Once collected, the individual grafts can be prepared by a team of trained technicians; these grafts can be as tiny as using only one or two hairs. The patients scalp is anaesthetised and the grafts are then placed into tiny incisions in the skin. The process of graft insertion can take many hours; and depending on the extent of original hair loss, degree of correction required and type of procedure, you may need to return for further procedures to obtain a good aesthetic result. Most successful transplants take from between 1 and 2 years to complete. Private costs for hair transplantation range from approximately £1,000 - £10,000 as they tend to be based on the number and type of grafts transplanted, along with the amount you require.
The first recorded hair transplant happened in the 1930s when a Japanese doctor named Okuda used transplanted hair to repair scarred eyelashes and eyebrows. However, it wasn't until after Dr Norman Orentreich published the first widely read report on hair transplant surgery in 1959 that the field of Hair Restoration Surgery (HRS) was born.
At first, doctors learned to transplant hair from the sides and back of the head and grow hair on top. Unfortunately, these early transplants did not look at all natural as the new hair grew in peculiar clumps on top of the head! These early attempts were often referred to as "doll's hair" and many people still associate hair restoration with this old technique, as that's the only transplantation work they had seen.
Over the course of recent years, the technique of hair restoration has developed enormously. Hair grafts have become increasingly smaller and refined, changing from 15 to 25 hair grafts to as small as one and two hair grafts. Modern transplant techniques performed by a skilled doctor can produce quite natural looking results, which are often indistinguishable from normal hair. Many doctors emphasise the artistic skill involved, as well as the technical expertise required, in obtaining a successful and natural looking head of hair for any individual.
Statistics from the American Society for Aesthetic Plastic Surgery (A.S.A.P.S.) indicate that there were over 18,000 hair transplant procedures performed in the U.S. in 2009, a decrease of 16.8% on 2008 statistics. (Note: there were no statistics for hair transplant procedures in the 2010 survey due to an insufficient sample of physicians).
Although there are no similar reliable statistics for the U.K. available at the moment, there is no doubt that there has been significant growth in the number of clinics offering hair restoration treatment.
If you are considering a hair transplant, the following information will give you a basic understanding of the procedure. It can't answer all your questions, since a lot depends on the individual patient and the practitioner. Please ask a practitioner about anything you don't understand.
How Does It Work
Every single follicle of hair on the human scalp is genetically programmed before birth to either become sensitive to the male hormones dihydrotestosterone - DHT (causing the follicle to wither and die in time) or not to become sensitive to these hormones and continue growing throughout your lifetime.
Lifelong hair follicles are found in good supply in virtually all men, and they are often concentrated in a horseshoe-shaped area at the very back of the head. This is why most men only lose their hair from the top of their head and not from round the back and sides.
Hair transplantation is literally taking hairs from the “horseshoe” shaped area and placing them in the areas of hair loss. Once transplanted, these hairs continue to grow normally.
Your first consultation with a practitioner should clearly set out your expectations of this treatment and whether your practitioner thinks he or she can achieve the results that you’d like.
As baldness is a condition, which continues throughout your life, it is important that the practitioner discusses this and takes into account future hair loss when he advises you.
A medical history should be taken to make sure that there are no reasons why you shouldn’t have this procedure. You would normally be asked to sign a consent form which means that you have understood the potential benefits and risks associated with hair transplantation.
Photographs may also be taken by the practitioner for a "before and after" comparison at a later date.
The transplantation procedure is split into three parts as described below.
Donor strip harvesting
The donor hair needs to be first taken from an appropriate area of skin (usually at the back of the head). These hairs need to be quite thick. Before surgery, your practitioner may give you a mild tranquilliser to reduce anxiety and discomfort. This will usually be in a tablet. Lignocaine (a local anaesthetic) and adrenaline (used to reduce bleeding) are then injected into the area of donor skin. Immediately before the skin is cut, a salt and water solution is injected into the donor area to help raise the skin so that a crescent-shaped strip around 20cm long by about 6mm in width can be removed with a scalpel. Staples or stitches are used to close the wound.
Once the donor tissue is collected in the process described above, the individual grafts can be prepared. A team of trained technicians sometimes does this. As we explained earlier, these grafts can be as tiny as using only one or two hairs.
Different terms are used by different clinics to describe the process of grafting and transplantation. Don’t be confused by this. Below is a list of all the language, which is commonly used, so you should be able to identify the technique which is to be used on your head.
Micro graft - 1 to 2 hair grafts into needle holes.
Small slit grafts - 3 to 4 hairs into a recipient slit.
Large slit grafts - 5 to 7 hairs into a recipient slit.
Small minigraft - 3 to 4 hairs into a small recipient site.
Large minigraft - 5 to 8 hairs into a small round recipient site.
Standard round or square grafting - approximately 9 to 18 hairs in a 3 - 4.5 mm size graft placed into a slightly smaller round recipient site.
How many grafts does it take to get adequate coverage?
If you cut a square of paper 3.3 inches long, you would need approximately 500 - 600 standard hair grafts in order to give the appearance of a natural head of hair in the same area on your head. This shows you the importance of careful planning and precise placement of grafts to give the impression of more hair.
Today most hair transplant surgeons use grafts that contain one to eight hairs, with 200 to 800 grafts transplanted in each session.
The "state of the art grafts" today are called "follicular unit grafts".
If you look closely under magnification at how hair naturally grows, you'll see that hair grows in clusters of one, two, three, and some times four hairs.
These naturally occurring groups of hair are called "follicular hair units".
Given how hair naturally grows, an excellent hair transplant imitates nature by relocating each of these naturally occurring "follicular hair units" from the donor area to the balding area to produce the ultimate in natural looking results.
The choice of graft type(s) depends on the area of baldness to be covered, the quality and extent of donor hair, and the skill and experience of the practitioner.
When the donor grafts have been prepared, the patient’s scalp is anaesthetised using either a nerve block, or a local injection of lignocaine. The grafts are then placed into tiny incisions in the skin. The process of graft insertion can take many hours, depending on the type and number of grafts used.
Following this, you are free to go home, occasionally with a turban like bandage that you may be required to wear for the first night to help secure the grafts.
Depending on the extent of original hair loss, degree of correction required and type of procedure, you may need to return for further procedures to obtain a good aesthetic result. Time between transplant sessions varies depending on the characteristics of each individual case.
Most successful transplants take from between 1 and 2 years to complete.
You would need to take a day off for the procedure. Some patients decide to take further days off during the healing process, especially if larger areas are transplanted that may result in more swelling.
Side Effects and Risks
Owing to the use of local anaesthetic, there tends to be no pain during the actual procedure.
Whilst there are risks with any form of surgery, hair transplantation is not a major procedure. Complications are minor and usually only involve mild swelling. This may occur 2 - 3 days after the procedure, along with some mild discomfort. In some cases where extensive areas are transplanted, swelling may be more severe, causing puffiness around the eyes.
Small scabs may develop over each graft. These may last for 7 - 14 days following the procedure before they fall off.
Rarely, an infection may develop at the site where any cuts have been made, but any scarring tends to be very slight.
Transplanted results vary according to every individual. It is not common for patients to see new hair growth from day one. Most people lose some hair immediately after the transplant, but then this stops for a while. The new hair follicles will not then grow for a few months, but they should grow normally after this period. Occasionally there may be some grafts that fail to grow.
It is important that you follow the advice of your practitioner carefully after a hair transplant to help to make the treatment successful and reduce the risk of complications.
Post-treatment advice may include:
There are few medical reasons why people should not undergo hair transplantation.
The main considerations are your expectations of the treatment and the extent of your balding and the density and quality of your donor hair.
If either your expectations of a final result are unrealistic, or if the potential donor hair is not suitable, the practitioner may recommend that this is not a suitable procedure for you.
If you are prone to keloid (red, angry, raised) scars, or have a history of problems with wound healing your practitioner may not recommend this procedure or may caution you that scars could be raised and very visible.
Who Can Do It
You should only consider being treated by doctors or surgeons who are specifically trained and experienced in hair transplantation.
For more information about practitioner training, qualifications and relevant medical organisations please view the information contained within the Legislation section of the Consulting Room.
It is highly unlikely that anyone considering a hair transplant would be able to access this free of charge on the National Health Service.
However certain regions do make special cases, and we would always recommend that you visit your General Practitioner before embarking upon a cosmetic procedure involving surgery.
As well as their advice and guidance they may also be able to refer you to a local NHS Hospital who can treat you.
The NHS has set out the following guidelines on how to get cosmetic surgery through the NHS:
"To qualify for surgery on the NHS you must meet specific criteria as set out by your local health authority. The NHS will not pay for surgery for cosmetic reasons alone. Reconstructive and cosmetic surgery to correct, or improve, congenital abnormalities and injuries will usually be carried out free of charge.
NHS reconstructive surgery is performed by plastic surgeons who have had extensive training and belong to the British Association of Plastic Reconstructive and Aesthetic Surgeons. Surgeons who carry out cosmetic surgery through the NHS also belong to the British Association of Aesthetic Plastic Surgeons.
To receive cosmetic surgery from the NHS, you will normally need a referral from your GP. You will have a consultation with a plastic surgeon and an assessment by a psychiatrist, or psychologist. It will then be decided whether there is enough social, psychological, or physical benefit to be gained to justify surgery.
Hair transplantation is not a cheap procedure, and it is very important that you look to the future and plan for additional loss of hair as you age when you decide, with your practitioner, where your new hairline will start. Remember, the lower the hairline, the more grafts that will eventually be required behind it.
Prices vary and tend to be based on the number and type of grafts transplanted, along with the amount you require. You can pay anything from £1,000 - £10,000 depending on the clinic and number of grafts and procedures that you require.
Hair transplantation really works. The great advances that have been made in the last 40 years, along with the skill of an experienced practitioner, can reproduce a relatively natural looking hairline. Your hair may not be as thick as it once was, but it takes away that exposed forehead and top of the head and allows you to wear your hair in virtually any style.
As long as you are realistic and carefully plan for the inevitable future loss of hair, this is a successful treatment for many people.
Before and After Pictures
Please note that results of hair transplantation surgery vary enormously, depending upon both the patient and the skill of the individual surgeon.
(All before and after photographs featured are real patients treated by highly experienced surgeons, your results may differ).
Male Pattern Baldness before surgery and following Follicular Unit Extraction (FUE) hair transplantation surgery
Male hair loss before treatment and 9 -12 months after hair transplantation
Male hair loss before and 1 year on from FUE hair transplant
Images provided courtesy of The Private Clinic.