HAIR TRANSPLANTATION

HISTORY OF HAIR TRANSPLANTATION

Hair transplantation has evolved a long, long way since it began in the early 1950’s. In 1939, a Japanese dermatologist, Dr. Okuda, published a revolutionary method in a Japanese medical journal of using small grafts that was similar to the way hair transplantation is performed today. In the late 50’s one physician in particular, Dr. Norman Orentreich, began to experiment with the idea of relocating or transplanting the hair on the back and sides of the head to the balding areas. “Donor Dominance”, established that hair could be transplanted from the bald resistant donor areas to the balding areas and continue to grow for a life time. This laid the foundation for modern hair transplantation. During the 60’s and 70’s hair transplants grew in popularity. However, the standard of care involved the use of larger grafts that were removed by round punches and often contained many hairs. The problem with this method was that there had to be a minimum of 4 procedures for the final results to be noticeable. These patients, that the doctors see at ProHAIR Transplant Clinic, that have this type of hair transplant, usually gave up by the second procedure, for obvious reasons. In the 80’s hair restoration surgery evolved dramatically, as the large punch grafts were gradually replaced with a more refined combination of mini and micrografts. This “combination mini micrografting” hair transplantation procedure no longer used the punch to extract the bald resistant grafts. Rather a strip of bald resistant hair was surgically removed from the back of the head and then trimmed into mini and micrografts. Typically the minigrafts (4-8 hairs) were used to create fullness and density, while the one, two, and three hair micrografts were normally used more grafts, several hundred grafts per session, rather than the approximately 50 to 200 large grafts of the original punch graft procedure. The 90’s saw the gradual use to create a refined and feathered hairline in front. This combination procedure also introduced to a very refined surgical procedure now known as “Follicular Unit hair Transplantation” or “FUT” by Dr. Bob LimmerDr. Bernstein and Dr. Rassman. This exacting and labor intensive procedure, transplants hairs in their naturally occurring 1, 2, 3, and 4 hair “follicular unit groupings” in which they grow naturally. “Follicular Unit Extraction” or “FUE” by Dr. Robert H. True is a hair transplant technique in which a small round punch is used to extract follicular units from a patient\’s bald resistant donor areas. These 1, 2, 3 and 4 hair follicular unit grafts are then transplanted into a patient\’s balding areas. Given the time consuming and tedious nature of this procedure a physician is often limited to transplanting 1000 follicular unit grafts in one day. The donated hair follicles, surrounding tissue and skin are called Follicular Units. Each follicular unit contains one or more hair follicles with accompanying hair, tissue, and skin. The art of hair transplantation is as important as the mechanics of this medical technique. It is important to remember that no two heads are alike, and each procedure should be looked at on an individual basis. Hair density is the number of hair follicles per squared centimeter of scalp. Scalp laxity constitutes the flexibility or looseness of the scalp, the more flexible your scalp, the easier it is to harvest donor follicles. Conversely, the tighter the scalp the more difficult it is not only to harvest donor hair, but also to close the donor area after excision. More hair can be transplanted if the scalp is loose and the density is high

What is Follicular Unit Transplantation?

microscopes„Follicular Unit Transplantation (FUT)” is a technique, in which hair is transplanted from the permanent zone in the back of the scalp into areas affected by genetic balding, using only the naturally occurring, individual follicular units. In order to remove follicular units from the back of the scalp without damaging them, the donor tissue is removed in one piece. This technique, called „Single Strip Harvesting”, is an essential component of follicular unit transplantation as it not only preserves the follicular units, but it prevents damage (transection) to the individual hair follicles. It differs dramatically from the „Mini-Micrografting” technique of using a multi-bladed knife that breaks up follicular units and causes unacceptable levels of transection of hair follicles. The other harvesting technique, „Follicular Unit Extraction (FUE)”, allows the surgeon to remove individual follicular units without a linear donor incision. The most essential component of Follicular Unit Transplantation is „Stereo-Microscopic Dissection”. In this technique all of the follicular units are removed from the donor tissue under microscopic control to avoid damage. Complete stereo-microscopic dissection has been shown to produce an increased yield of both the absolute number of follicular units, as well as the total amount of hair, (upwards of 25%). (This procedure differs from mini-micrografting in which the grafts are cut with no microscopical magnification.) A major advantage of follicular unit transplantation, (besides preserving follicular units and maximizing growth) is the ability to use small recipient sites. Grafts comprised of individual follicular units are small because follicular units are themselves small, but also because the surrounding non-hair bearing tissue is removed under the microscope and doesn\’t need to be transplanted. Follicular unit grafts can be inserted into tiny needle-sized sites in the recipient area, which heal in just a few days without leaving any marks. When performed by a skilled surgical team, Follicular Unit Transplantation can provide totally natural looking hair transplants that make the full use of the patient\’s donor supply to give the best possible cosmetic results in the fewest possible sessions.

HOW IS FOLLICULAR UNIT TRANSPLANTATION DIFFERENT FROM MINI-MICROGRAFTING?

This is one of the most commonly asked questions and it is a very important one for those deciding which hair restoration procedure to choose. In contrast to Follicular Unit Transplantation, where the follicular unit sizes are determined by nature, in Mini-Micrografting the graft sizes are arbitrarily determined by the assistants who cut the donor tissue into the size pieces that they need. Another name for this technique is Mini-Micrografts „cut to size”. In mini-micrografting, neither preserving follicular units nor even keeping hair follicles intact are felt to be that important. Rather, the speed and economics of the procedure are the deciding factors. Mini-micrografters use a multi-bladed knife or a single bladed knife to quickly generate thin strips or a strip of tissue and then use direct visualization or backlighting (rather than microscopic control) to cut the tissue. The resulting grafts are generally larger than follicular units and since the excess skin is not trimmed away the donor sites (wounds) are also larger or the follicular units are trimmed under backlighting but the hair shafts or the hair bulb of the follicular unit are transsected due to poor visualization and therefore the final results are poor. It should be readily apparent from the above comparison that Follicular Unit Transplantation is superior in producing a natural, undetectable result, in maximizing healing, and preserving precious donor hair.

Your Procedure

When you arrive for your hair transplant, the ProHAIR Transplant Clinic staff will begin by going over the activities for the surgery. Your ProHAIR Transplant Clinic doctor will review the goals that have been established and will answer any last minute question that you might have. The doctor will take the time to be sure that there are no outstanding issues, areas of confusion or concerns. The surgical consent form that is signed followed by the taking of pre-surgical photographs. Mild medication is given to relax you and to make you more comfortable. We also give routine antibiotics before and after the procedure.

Length of the Procedure

Your Follicular Unit Transplant may require many hours of work by a team of professionals. Some of the longest procedures (between 2000-2500+ follicular units) may take hours of surgery and during that time, many highly trained nurses will participate in the process. The work must be organized efficiently so that the total length of the procedure for the patient will be minimized. On average, a procedure of 1000 follicular units would last about 6 hours.

The Surgical Experience

The procedure may be long, but for the patient the time goes by quickly. You are lightly sedated so that you can sleep if you desire. Most patients choose to watch TV or movies for at least part of the time. We try to make your experience enjoyable so that the actual time the surgery takes is transparent. Some patients may choose to be fully awake the entire procedure.

Usually the patient sleeps for a few hours, watches a movie or two, chats with the doctor and nurses doing the work. A relaxed and informal atmosphere is encouraged so that the day stands out as one of the better, more pleasurable experiences ever encountered. The patient takes a series of breaks, to the bathroom, to eat lunch or to just stretch and move around. Not infrequently, patients tell us that the experience of being the center focus of the day\’s activities is wonderful, and they further report that watching all of those people working on them was like watching an orchestra playing beautiful music, while having people catering to their every need!

Local Anesthesia

After preparatory medication is given orally, the actual anesthesia begins. We use a combination of Lidocaine (Xylocaine) which you have probably been given by your dentist, and a longer acting local anesthetic called Marcaine. Injections around the perimeter of the scalp (called a ring block) will make your entire scalp numb. With this technique, there is no need to use anesthesia directly in the area that is being transplanted. Once anesthetization is complete, there is generally no pain or discomfort during the remainder of the procedure. If you do require more, it will be given before the first wears off.

The Surgical Team

workingThe procedures can be long, and during the initial period when the donor hair is removed, the surgical team must work without stopping. The team must prepare the grafts according to the surgeon\’s exacting specifications. The preparation of 2,000 or more follicular units and placing them into the recipient area may take a team hours of intensive, concentrated work. Care must be taken to keep the surgical team free of stress. Just as the patient needs a break, so do team members. AtProHAIR Transplant Clinic we focus on the needs of our staff as well as the patient to ensure that the best-trained staff in the world is always operating at peak performance.

Donor Scalp

heg-2After a strip of donor scalp is removed, it is temporarily placed into a container with chilled Lactated Ringer\’s, a solution that closely mimics the body\’s own natural fluids. The area from where the donor strip is removed is sutured closed. This usually leaves a very fine scar that heals in a week or two with the sutures being removed in that time frame. Ideally, the scar may heal well enough that it is almost undetectable even when the hair is combed back by a barber or hairdresser. After the tissue has been harvested, the individual follicular units (each containing from 1 to 4 hairs) are meticulously dissected out in their naturally occurring groups under strict stereo-microscopic control. The follicular units are trimmed of extraneous fatty tissue and the bald intervening skin between the groups is discarded. The isolation of individual, naturally occurring follicular units, that were obtained from the donor area as a single strip, and then carefully dissected under microscopic control, is an essential part of Follicular Unit Transplantation. If this step is not done correctly the follicles can be injured and growth impaired. It is important that these steps be carried out only by a highly experienced surgical team.

Length of Time the Grafts Are Away From Their Blood Supply

A number of hours may pass between the time the donor follicular units are removed from the back of the scalp to the time they are placed into the recipient area. Care must be taken to preserve the viability of the follicular units during this process. The procedure starts with the removal of a strip of scalp from the donor area. Once the strip is removed, it is immediately immersed into a cold bath of Lactated Ringer\’s saline to lower its temperature. Once the individual follicular units are prepared, they are cooled to 3.8-4.0C and kept at this temperature while awaiting placement.

Bleeding

Many people have the impression that hair transplantation is a “bloody procedure.” In our hands it is not. AtProHAIR Transplant Clinic, we have developed surgical techniques that greatly minimize the amount of bleeding in all aspects of the procedure.

The Surgical Suite

The surgical team wears masks, surgical gloves, and gowns and uses instruments that are sterile. The procedure is performed while the patient sits in a comfortable, adjustable reclining chair. For added comfort the Suites are equipped with music, TV, and an assortment of movies. After the anesthesia is administered, the patient should feel nothing other than pressure sensations. Many patients have long, friendly conversations with the doctor and assistants during the time it takes to complete the transplant. The atmosphere in the treatment area will make the patient feel secure and relaxed. Concern and compassion on the part of the doctor and medical staff make a tremendous difference and we will expend great effort to make sure that your experience is a pleasant one.

Making the Recipient Sites

The creating of the recipient sites determines much of the aesthetic look of the transplant. It determines the angle at which the new hair grows and determines the distribution and density of the follicular units. This is a very important part of the procedure and requires considerable artistic knowledge and surgical skill. It may be the one part of the procedure where your ProHAIR Transplant Clinic physician is silent as he concentrates on making these sites. Don\’t be concerned if he isn\’t chatty during this time. Your ProHAIR Transplant Clinic physician is accustomed to working in, and around, existing hair so you need not cut your hair short for the procedure. Your existing hair may help to cover any traces of the transplant.

Placement of New Grafts

Placing is the longest part of the procedure. The placement process is exacting and during this time you will be asked to keep your head relatively still. Watching TV, looking at movies or even sleeping will make the time go quickly. You can take breaks as needed, to eat and use the bathroom. When placing is complete, post-op instructions are given to you verbally and in writing. A baseball cap is placed around your head and is worn home.

After Your Procedure

The night of the surgery, and for the next few nights afterwards, you are encouraged to sleep with your head elevated on pillows. You will be given medication to help you sleep if needed. The next day after the surgery, you will come back for hair washing and you will be instructed how to shower and gently clean the transplanted area. The follicular unit grafts are made to fit snugly in the recipient site and will not be dislodged in the shower provided you follow the instruction given to you. If the post-operative instructions are followed carefully, in most patients the transplant is barely detectable after a few days and practically undetectable after the first week. We will give you medication for swelling, but in spite of this, some patients experience swelling of the forehead that settles around the bridge of the nose over the course of the next several days. If this occurs, it is almost always gone in the 5th day after the surgery and should not be a cause for concern. Frequently, the newly transplanted follicular units can be made less noticeable by minor changes in hair style to cover the area. Makeup consultants in large drug stores and department stores can help you choose the appropriate shade and type of makeup. Any problem of visibility can also be minimized by altering the appearance of your face. If you do not shave for a while, most people will focus upon your new beard, not on your head. If you have a mustache or a beard, consider taking it off for the first few weeks and then letting it grow back.