The most commonly performed definitive treatment for hair loss is hair transplantation, a minimally invasive procedure in which the patient’s own hair is transplanted into areas of hair thinning or hair loss. Once transplanted, these hairs will grow essentially for a lifetime, because they come from that part of the scalp (the “donor area”) where the hair is considered permanent. Hair transplantation does not stop the hair from continuing to fall out, so in cases of androgenetic hair loss, it must be combined with other therapies that help to slow down the progression of hair loss.
Mistakenly considered as a procedure reserved only for men, today more women are considering it and undergoing hair transplantation to restore their hair. In fact, women are the fastest growing group of patients undergoing this procedure. The most common indication for the procedure in women is the treatment of androgenetic alopecia, but hair transplantation can also be tremendously effective for the treatment of hair loss due to scarring from prior plastic surgery or traction alopecia or trichotillomania, to lower overly high hairlines, to restore eyebrows and eyelashes, and a variety of other indications.
Cases in which hair transplantation may not be the best approach to treatment include diffuse hair thinning, certain scarring alopecias, alopecia areata or totalis, and other etiologies that are best determined in consultation with the physician. Particularly in these cases of diffuse female pattern hair loss, not only is there a relative lack of sufficiently dense donor hairs to cover what can be large areas of thinning, but also there can be an increased risk of shock loss. Therefore, patient selection is critical prior to deciding on hair restoration surgery.
Please note that there are other hair procedures that have particular indications. These include the surgical hairline advancement/forehead reduction surgery, and balloon tissue expansion for the treatment of large areas of scalp scarring. Our doctors are uniquely trained to provide all of these different surgical techniques, along with their expertise in hair transplantation using both the follicular unit grafting (FUG) and follicular unit extraction (FUE) methods.
In order to achieve long lasting results, the hairs that are to be transplanted are harvested from the so-called “safe zone” donor area located on the back and sometimes the sides of the head. There are two techniques for harvesting these hairs- the strip procedure or FUG (follicular unit grafting) and FUE (follicular unit extraction) method. With the strip procedure, a single donor strip, ranging in length from 5 to 25 cm of hair-bearing scalp, is removed and then the area is sutured closed, healing as a fine line scar usually 2mm or less in width. From this single strip, hundreds to as many as 2000 or more hair “grafts” are dissected out under a microscope by specially trained hair technicians. A graft, whether the FUG or FUE technique is utilized, consists of a tiny grouping of one to three, even four hairs, which is the natural way that hair grows in the scalp, and thus is capable of creating natural appearing results under an aesthetic surgeon’s expertise.
The more contemporary (but not always superior technique, determined on a case-by-case basis) technique than FUG is follicular unit extraction (FUE), in which each graft is removed one at a time. FUE has grown tremendously in popularity due to its main advantage- it leaves no linear donor site incision. To harvest the grafts, a drill custom-designed by Drs. Kuka and Epstein is used. This eDrill allows for the efficient harvesting of the most viable grafts, using a punch 9mm or less in diameter. These tiny holes that are left behind then typically heal to such a small size that they are undetectable even with the head shaved.
FUE is a technically more challenging and time-consuming procedure, and requires that at least a narrow area of the back and/or sides of the head to be shaved, an area that can easily be concealed by surrounding longer hair until the shaved hair regrows. In general, men are a larger “consumer” of the FUE technique, but those women who wish to avoid having any incision in their scalp will also choose FUE.
The harvested grafts, whether obtained by FUG or FUE, are then implanted into tiny (0.6 to 0.8 or 0.9mm) slit incisions in the area(s) of missing or thinning hair. The making of these “recipient” sites is the key aesthetic step in the hair transplant procedure, as it determines the density, angle, distribution, and pattern of growth of the newly added hairs. With over 11,000 hair procedures performed by our doctors, they have made well over 15 million of these recipient sites- each one made one at a time.
These hair transplant procedures are usually performed using just local anesthesia with, if desired, oral sedation to help with relaxation and even sleeping during the procedure. The time from start to finish ranges from typically three to as many as eight hours, depending on the number of grafts transplanted and the work involved. For example, curly African hair tends to take longer to transplant, while smaller cases such as filling in some sideburn scarring from a prior facelift can be a relatively short case. The post-procedure recovery is usually quite easy. Antibiotics and a mild pain pill are provided for the first few days, and most patients are able to return to work and be in the public within three to seven days, with exercise permitted at five days. Tiny crusts that develop at the site of each graft usually fall off within a week, then the transplanted hairs typically fall out at three weeks. Four to six months later, these transplanted hairs start to regrow, gradually assuming a fuller and fuller look that occurs so slowly that it is typically undetectable. These hairs are permanent and will continue to grow for a lifetime.
The best technique – whether FUE or FUG for a hair transplant, or hairline advancement or hair transplantation- will be determined in consultation with your doctor, who will take into account: your goals, the pattern and degree of hair loss, and what is seen on examination including scalp laxity and hair density. You will be provided nothing but realistic expectations. When performed properly, your procedure will provide you with truly aesthetic natural appearing results.
Before and after one procedure of 1400 grafts