The principle is to redistribute hair to the recipient area of the scalp where hair has been lost. Once moved, the transplanted hair behaves as if it were in its original location. This is possible because the donor hair is immune to the male-pattern baldness gene and therefore retains its genetic makeup regardless of location.
After roughly three months the new hair begins to grow, often in spurts over a 12-month period. A full result requires this length of time for the hair to mature and develop in its new environment.
Hair transplants have come a long way from the “plugs” of the past. Being able to move natural follicular units (FUs, or grafts) now allows a dense placement of FUs that mimics natural hair. The closer the slits are made, the greater care must be taken not to impair adjacent slits or hair groups. Technical skill is imperative in achieving results in “one pass” and not having to return to the area at a later stage, which can cause unnecessary trauma to the skin.
Slit placement and angles change depending on positioning on the scalp, especially in temple point reconstruction and crown rebuilding. Nature has to be respected when placing in a field of existing hair, but a little creativity can expand coverage while maintaining the appearance of thickness.
Donor areas are also important, but with technical improvements in tool size for FUE and closure techniques for FUT, scarring is becoming less detectable. FUE punch size has reduced scar visibility and in some cases made them indiscernible to the naked eye.
Follicular units are natural genetic groups of hair. Each unit contains anything from one to four hairs; in the donor area they average 2.2 hairs per FU. The original density of follicular units prior to hair loss can be anywhere from 70 and 110 groups per square centimetre, depending on genetics, ethnic background and natural hair characteristics. Better quality hair will naturally require less grafts.
Density, scalp pigmentation, hair colour and curliness are also important factors in achieving natural density, along with the calibre or diameter of the hairs. Some individuals have “home run” hair, essentially allowing them to treat any degree of hair loss, while others may not be able to treat the entire area of hair loss and will have to settle for less coverage.
Placement is also vital to the technical and cosmetic success of the procedure.
- FU size dictates single or multiple grafts. It is necessary to place grafts in a comparable slit size. Too small or too large may affect the growth yield of transplanted hair, influence the surrounding hair or compromise the laxity of skin tissue.
- Angle of placement is perhaps the most important factor in hair transplant. Hair naturally grows in certain directions, for example a spiral crown or natural parting, and these must be followed to preserve a natural look.
- Regarding design, the saying “We are older for much longer than we are younger,” tells us a lot about a hair transplant. The frontal hairline is arguably the most important feature of an entire head of hair. Why? It frames the face. Hairline planning is often a compromise between the patient and the surgeon. People have a tendency to want the hairline too high or too low. A middle-aged man seeking hair restoration may fear that a hairline that is not adequately receded at the temples may seem unnaturally low for his age while a hairline placed too high accentuates the balding.
It is therefore important to understand that hair transplant is not just a surgical procedure. In some respects, it is dependent on the artistic temperament of the doctor, which can make the difference between a good and a great transplant.
Strip is the traditional method of extraction and is still a good option for men with advanced thinning who want maximum coverage with minimum inconvenience. It involves removing a strip from the back and side of the head and leaving an almost invisible line that the surrounding hair then covers. The correct closure causes absolutely minimal tissue tension, is largely non-invasive and causes very little cosmetic change to the scalp.
FUE is a technique that only a handful of doctors worldwide can perform. The extraction is technically more difficult and special attention must be given to the surrounding hair in terms of laxity, skin texture and ethnicity of the patient. The procedure extracts follicular units individually from the back and sides of the head, thereby expanding the surface area that can be harvested. The process is also slow (approximately 2,000 FUs extracted and placed per day), so larger procedures are done over a series of days.
Body hair transplant (BHFUE) uses the same principles of extraction as FUE, however hair is extracted from the body instead of the scalp. The procedure is recommended when there is insufficient scalp donor hair. The doctor who performs BHFUE must already be able to competently perform FUT/FUE surgery before performing BHFUE.
Testing by Dr. Christian Bisanga – Progressive Research to Improve the Standards of Hair Transplantation.
Platelet-rich plasma has been used for years now to heal wounds in a variety of medical fields and Dr. Bisanga believes it may have significant benefits in hair transplantation, including healing in donor and recipient areas as well as improving post-op skin and hair physiology.