Hair transplantation procedure involves movement of hair, individually, from a donor part of the body to the areas having the lack of hair. It can be very effective in the management of male type baldness. In this, grafts having hair follicles are transplanted on bald regions of scalp. The grafts selected for the procedure should be genetically resistant to hair fall.The procedure can also be used for restoration of eyebrows, eyelashes, beard hair, pubic hair and chest hair. The procedure can be helpful for hiding the scars caused by surgical procedures or accidents by transplanting hair over the areas. Hair transplantation is different for skin grafting in the sense that grafts used in hair transplantation contain all layers of skin like dermis, epidermis and also hair follicles. The results of the procedure are better if many small grafts are used for transplantation rather than using a single big sized graft.
Natural growth of hair occurs in follicles containing a cluster of 1 – 4 hair strands. Most of the advanced techniques used nowadays for hair transplantation use these follicles, also called follicular units. This way, the procedure can be helpful in giving natural appearance to the hairs that are transplanted. This procedure is known as Follicular Unit Transplantation. There are 2 different mechanisms for harvesting donor hair for hair transplantation that are described below:
Follicular Unit Extraction: The procedure can be done in 1 long session or in several smaller sessions. This procedure is quite time consuming and the outcome of the procedure depends highly upon the skills and experience of the doctor. The procedure is more costly compared to other ones. Also, the procedure can not be performed on all patients. However, it also has few advantages. It does not leave a scar, which is common after other surgical procedures. Patients do not suffer from much pain and discomfort after this procedure. In this procedure, individual hair follicles are removed using small punches having sizes ranging from 0.6 to 1.25 mm diameter. These follicles are then inserted over the scalp regions having loss of hair, with the help of microblades.
Strip Harvesting: It is the commonest technique used for removing hair follicles from donor site. The commonest sites used for it are sides and back of scalp. A scalpel having single, double or triple blades can be used for the purpose. Each incision made by the blades should be planned well so as to avoid cutting of the shaft from the hair. The procedure uses a small strip of scalp that is removed and cut into smaller pieces of grafts. These grafts are then transplanted on the areas of scalp having loss or thinning of hair. A linear scar may be left over the donor area after the procedure. The procedure needs a recovery period of 2 weeks.
Both the above-mentioned procedures are performed under local anesthesia. Proper and complete extraction of hair follicles is essential for getting optimum results regardless of the procedure used for harvesting. Care should be taken to avoid a transection of hair follicles during their removal.
These hair transplantation procedures are performed on an outpatient basis. Patients are given local anesthesia while some may need mild sedation along with it. The scalp is shampooed well initially, followed by application of antibacterial agents over the surface. This can help in minimizing incidences of infection. For Follicular Unit Transplantation, a strip of skin from the posterior part of scalp is removed gently and the wound caused by it is sutured. The size of the strip should be 1-1.5 X 15-30 cm and the part should have good growth of hair.
Smaller follicular unit graft are then prepared from his strip. Then, with the help of binocular stereo-microscope, excess fatty and fibrous tissues are removed from the strip. Care should be taken to avoid damage to follicular units while doing so. These individual follicular units are then carefully transplanted on the recipient area having thinning or loss of hair. Trichophytic closure, a latest procedure for closure of wound, can help in finer scars that are not easily visible. The density and pattern of grafting the hair follicles should be determined before the start of procedure.
Use of semi-permeable dressing can help in seepage of tissue fluid and blood. The dressings need to be changed on daily basis. Patients should take care to protect the vulnerable recipient area from hazardous effects of UV radiation in the sun. Shampooing of scalp and hair can be done 2 days after the procedure. Proper shampooing can help in prevention of occurrence of scabs around the shafts. These scabs can increase risk of loss of transplanted hair for 7-10 days after procedure by strongly adhering themselves to the shaft.
Patients can notice fall of all transplanted hair within the first 10 days of treatment. This occurs because of damage or traumatization of hair follicles during their relocation. However, growth of hair from the transplanted regions starts naturally after this and continues for almost 6-9 months thereafter. Patients should be informed about these events happening after the procedure, so as to avoid unnecessary worries caused by the initial falling of hair. Patients may suffer from hair loss after the procedure; but it should be noted that this hair loss is usually from the parts that are untreated.
Side Effects of the Process
Patients may experience itching over the recipient area after the procedure. However, scratching should be avoided as it can cause damage to the graft and can also lead to the formation of scabs. Using a moisturizer or shampooing hair can help patients in relieving the itching. Also, scaring of the donor and recipient part may occur after the procedure. Hence, precautions need to be taken so that these scars are not visible. Some patients may suffer from hyperpigmentation of scars that is aggravated after excessive exposure to sun. Pimples and cysts are also common at the recipient part of the procedure. These cysts and pimples can be treated easily with the help of medications. Slight swelling and pain is common after the procedure and can be alleviated with the help of mild analgesic and anti-inflammatory drugs.