There are two basic procedures that can be used in hair replacement, although a variety of techniques may be used with each procedure. Existing hair is used in all hair replacement techniques. The surgeon will look for the most effective way to use these “donor sites.” Because of this, one cannot expect to achieve the same coverage as before the hair loss, but surgery can camouflage thinning, and create more fullness.
One procedure is called grafting, which involves removing areas of hair-bearing scalp, and placing it in areas where there is no hair (called the “recipient” site). Another is scalp reduction, which involves removing the bald spot to cause the remaining skin to stretch into place, causing the hairs to move closer together.
During grafting, the surgeon may use a variety of transplant techniques to achieve hair replacement goals. Punch grafts, slit grafts, strip grafts, mini- and micro-grafts are used with patients desiring more fullness. Graft sizes vary in shape and size – from two to four hairs to grafts containing 30 – 40 hairs. The surgeon will determine the size and location to place the grafts to achieve the most natural look.
Hair replacement usually just involves a local anesthesia and is performed as an outpatient surgery. Several sessions may be needed to replace extensive hair loss, and it could take up to two years to complete the entire replacement. The average number of hairs replaced during one session is 50 for large plugs and up to 700 for the mini- or micro-grafts. It is also wise to expect a touch-up – the surgeon can advise how extensive this may be.
On the day of surgery, the patient will need someone available to drive them home. After checking in, the patient is prepped with anesthesia and trimming of the donor site hair to be moved. The amount and type of anesthesia will depend on the type of replacement being done – a more extensive replacement may require general anesthesia, instead of just a local, causing the patient to sleep through the entire procedure. Stitches will be used with most of the procedures; the surgeon will remove those in 10 days. After the procedure, the area is cleaned and covered with either gauze or a bandage.
As with any surgery, a patient can experience side effects. Most common with hair replacement are swelling, bruising around the eyes, crusting and/or numbing around the donor and recipient sites, itching at the donor site. Infection, excessive bleeding, and scarring may also occur.
After the surgery, the patient may experience throbbing or tightness in the area, and should avoid strenuous exercise for several weeks. The doctor may schedule to see the patient several times over the first month to be certain the incisions are healing correctly.
One side effect that often surprises patients: soon after surgery, the new hair tends to fall out! This is normal and usually only temporary. “Roots” will then take hold and new hair will begin to grow within 2 months. One-half inch of growth per month is the norm. Patients will be advised by the surgeon that some grafts may not take hold. Sometimes, the grafted areas die and surgery has to be repeated.
Hair replacement, like any surgery, is performed for the individual. There is no one technique that can accomplish “all”. The patient needs to understand the surgeon’s exact procedure and follow-up care, so questions are encouraged and advance research is advised.
