Hair Transplantation

What Is Hair Transplantation?

In hair transplantation, the patient's hair roots are redistributed to cover or compress bald areas on the head. The surgeon removes hair roots from a densely hairy part of the head, usually the head's back, for this purpose. They can be taken either with a strip of skin at the back of the head or as individual dot-shaped small groups of hair roots. Afterward, the small hair root groups are carefully isolated and re-inserted in the designated areas, where the hair roots grow and form new hairs permanently.

For Whom Is Hair Transplantation an Option?

Hair transplantation can be carried out for certain forms of hair loss. In all cases, there has to be enough donor hair available. For men and women with congenital hair loss (androgenetic hair loss), the process can be stopped with medication in the early stages. Hair transplantation is suitable for advanced stages of hair loss when there are already large areas of baldness. In men, this is typically in the front of the head and at the parting area. In women, hair loss is most evident in the parting. Hair transplantation can also be considered in cases of hereditary hairlessness and hair loss through scars, such as after an accident or a burn. New hair can be transplanted not only on the head; eyebrow transplantation and beard transplantation are also possible.

How Advisable Is Hair Transplantation?

Hair transplantation is an accepted, effective method for the treatment of hair loss. It is useful if the hair loss is advanced and there are already large bald areas if sufficient donor hair is available. However, the patient should be aware that the hair will not look as thick and full as it did before the hair loss with a hair transplant. The result depends on the extent of the bald areas and the ratio between the donor area and the bald area. If extensive spots are bald, the result may look patchy, and a second surgery may become necessary.

Which Methods Are Available?

There are two methods: strip removal (FUI, FUT, Strip) and single hair group removal (FUE).

Strip Removal (FUI, FUT, Strip)

For strip removal, the surgeon shaves the removal area at the back of the head briefly. He cuts out a 1 - 1.5cm wide and 10 - 35cm long skin strip with hair roots. The resulting wound is sutured. Single groups of hair roots are carefully prepared from the skin strip under a magnifying glass or microscope. In this way, 60 to 120 hair root groups (follicular units) can be obtained per square centimeter of skin. A hair root group consists of 1 to 4 single hairs. The surgeon creates small openings in the recipient area's skin through small incisions or with the help of a laser. The surgeon distributes the small incisions regularly and at certain distances throughout the region, where the previously removed hair roots are inserted. A large number of hair root groups can be obtained by this method. Removal of up to 2500 hair root groups and more is possible. The growth rate is very high. 90 to 98 percent of the transplanted hair grows. The disadvantage is that a visible scar remains, but this is not noticeable in longer hair. Therefore, this method is suitable for women and men who do not want to wear their hair very short.

What Is the FUE Method?

In single hair group removal, a larger area is shaved, usually at the head's back, where the surgeon removes single hair groups with hollow needles or hollow drills. After removal, the hair groups are carefully removed from the donor skin. The further steps are similar to the method of strip removal. Only 12 to 15 hair root groups (follicular units) can be obtained per square centimeter of skin with this method. However, there is no more massive scar. The small point-shaped removal spots close by themselves. Little scab forms and falls off after a few days. The slight scars are hardly visible later. Fewer single hair groups, approximately 700 to 1500, can be extracted one day using this method. The removal takes longer and requires the surgeon’s high concentration. Due to the removal technique, the single grafts with the hair root groups are smaller, i.e., there is less hair than strip removal. The advantage is that no large incision is necessary, and no large scar is created. If only a few hair roots have to be removed, the areas will hardly be noticeable, and a short hairstyle is possible. If many groups of hair roots are taken close together, the hair at the removal site appears less dense, and the spots are noticeable when wearing a short hairstyle. The more hair roots per square centimeter are transplanted, the thicker the hair looks with both methods. At a density of more than 25 hair root groups per square centimeter, the optical results are excellent; they are still good at 10 to 25.

The Procedure of Hair Transplantation

First of all, a preliminary consultation takes place, which should be carried out by the treating surgeon! He discusses whether hair transplantation is possible and informs the patient in detail about the expected result and risks. He advises the patient on a suitable method. The treatment is carried out under local anesthesia. If necessary, the patient will be slightly sedated. The surgery takes 2 to 5 hours. Immediately after the surgery, patients can go home, and after 2 to 3 days, they can rewash their hair. For 10 to 14 days, a little scab is formed, which falls off by itself. If an incision was sutured, the stitches could be removed after 14 days. In the initial 3 weeks after the surgery, the patient should refrain from sports, sauna, saltwater, and protect the scalp from strong sunlight.

Prices and Costs: How Expensive Is a Hair Transplant?

Hair transplantation takes a long time and is very costly. It can only be carried out by an experienced surgeon. A sizeable surgical team is also necessary, which has its price. The patient has to pay about 3000 euros for minimal areas in Germany. A large-area transplant can cost more than 10,000 euros.

Are There Any Risks or Dangers Connected to a Hair Transplant?

Complications are infrequent. It is possible that bleeding may occur during the surgery, for example, due to an incision that is too deep. However, these can be stopped during the surgery. Infections are sporadic. During surgeries in the front part of the head, the upper half of the patient's face often swells up; especially the eyelids are affected. Numbness of the scalp after the surgery can last 2 to 4 weeks. Occasionally, feelings of numbness and tension can persist for up to a year. Major surgery for diabetics and smokers over 45 years of age must be carefully considered, as these patients may experience wound healing disorders. As a result, transplanted tissue can die. If the transplant is very dense, with more than 25 to 30 hair root groups per square centimeter, the grafts will grow less well. Even if a very large number (over 2500) of hair roots are transplanted, the complication rate increases and the growth rate may decrease.

How Long-Lasting Is the Result?

A hair transplant is permanent. In congenital, common hair loss, the hair roots are hypersensitive to androgens (male sex hormones), and the hair falls out. The surgeon removes the donor hair from a place that is not affected by hair loss. The hair roots are insensitive to androgens there. They stay insensitive even after their transplantation. Due to the transplantation stress, the hair falls out initially, but 12 weeks later, it grows back regularly, naturally for life.

Which Doctors Are Specialists in Hair Transplantation?

Hair transplantation is neither taught in university education, nor surgical training, nor in plastic surgery training. Therefore, the doctor must acquire the appropriate knowledge. The prerequisite should be a completed specialist training in general surgery, plastic surgery, dermatology, neurosurgery, MKG, ENT, or gynecology, or at least 15 years of experience in hair transplantation. Besides, the surgeon must learn the methods of hair transplantation through courses, training, or observation. Therefore, the patient should choose a specialist who has the appropriate qualifications, experience in hair transplantation and carrying out these surgeries regularly.

Sources:

Verband Deutscher Haarchirurgen e.V. (2016). VDHC-Leitlinie zur Haartransplantation. Link:https://www.vdhc.de/downloads/VDHC-Leitlinie_HT.pdf (16.11.2020)

Verband Deutscher Haarchirurgen e.V. Verfahren der Haartransplantation. Link: https://www.vdhc.de(16.11.2020)