Baldness or loss of scalp hair is a very common condition. There are many reasons for hair loss the commonest being male pattern baldness that is associated with a genetic predisposition and ageing. Hormonal changes may also result in hair loss and it can also occur as a consequence of disease or its treatment. Hair loss may be associated with scarring due to injury or burns.
Hair loss can affect a person’s self-image and self-esteem sometimes leading to depression and anxiety.
Hair transplant surgery involves removing small pieces of hair-bearing scalp grafts from a donor site and relocating them to a bald or thinning area. It restores the hair permanently. This technique primarily helps to treat male pattern baldness and hair loss due to scars from injury or burns.
Who is the right candidate for hair transplant surgery?
The candidate must have healthy hair growth at the back and sides of the head to serve as donor areas. Donor areas are the places on the head from which grafts are taken.
The final result is affected by the hair texture and colour as well as the waviness or curliness.
The patient should be physically healthy.
There should be no contraindications to the procedure such as diabetes, poor wound healing or coagulation disorders.
The patient should have realistic expectations.
Types of hair transplantation
Hair transplantation involves removing small pieces of hair-bearing scalp grafts from a donor site and relocating them to a bald or thinning area.
Round-shaped punch grafts usually contain about 10-15 hairs. Mini-grafts contain about two to four hairs; and the micro-graft, one to two hairs. Slit grafts are inserted into slits created in the scalp and contain about 4 to 10 hairs each; strip grafts are long and thin and contain 30-40 hairs.
More than one session may be needed to achieve the required coverage. It is recommended to keep an interval of several months between each session. The final effect may therefore take up to two years to be evident.
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.
Before surgery, the "donor area" will be trimmed short so that the grafts can be easily accessed and removed.
For punch grafts, a special tube-like instrument punches the round graft out of the donor site so it can be replaced in the area to be covered.
For other types of grafts, a scalpel is used 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.
The donor site holes may be closed with stitches. The stitches are usually concealed with the surrounding hair.
The grafts are placed about one-eighth of an inch apart for healthy circulation. The gaps will be filled at later sessions with additional grafts.
At each session, the scalp will be cleansed and covered with gauze. You may have to wear a pressure bandage for a day or two. However, your doctor may allow you to recover without a bandage.
Preparing for hair transplant surgery
You will be given instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking and avoiding certain vitamins and medications. If you smoke, it's especially important to stop at least a week or two before surgery; smoking reduces the blood flow to the skin, and can interfere with healing.
Arrange for someone to take you home after your surgery because, although the procedure will be done under local anaesthesia, you may be given a sedative, the effects of which take a few hours to wear off. During the procedure your scalp will be insensitive to pain, but you may be aware of some pressure or pulling sensations.
Hair replacement surgery is usually performed in a day care setting and rarely requires a hospital stay.
How you recover depends on the extent of the procedure. Any aching, tightness, or throbbing can be controlled with pain medication prescribed by your surgeon.
Most patients return to work about two to three days after the procedure.
You should be very careful with your transplanted hair for the first 2 weeks after your procedure. The newly transplanted grafts will not be secure in their new place.
You may gently wash your hair within two days following surgery. Any stitches will be removed in a week to ten days.
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.
You should follow up regularly as advised, so that your surgeon can check that the incisions are healing properly.
After a few weeks the transplanted hair will often fall out, and later start to grow back, Within six months new hair will normally start to appear. The full results should be seen in 12-18 months.
Risks of the procedure:
Hair replacement surgery is normally safe when performed by a qualified surgeon.
However, the outcome is never completely predictable as individuals vary in their healing abilities. As in any surgical procedure, infection may occur.
There is a risk that some of the grafts won't "take." The hair contained within the plugs may fall out and this is normal, but sometimes the skin plug dies and surgery must be repeated.
When hair loss progresses after surgery, an unnatural look may result if the newly-placed hair lies next to patches of hair that continue to thin out. If this happens, additional surgery may be required.