Hair Replacement

Hair loss, particularly in men, occurs as a result of aging, the effect of hormones on hair follicles, and a family history of baldness. How vulnerable we are to hair loss is largely preprogrammed into our genes before birth. Even though there is no cure for hair loss, there are means to halt the process. These include medications, hair restoration procedures, or reconstructive surgery. In general, hair loss at a younger age results in more severe baldness. Traumatic injuries to the head and burns can also cause hair loss and these can be treated with reconstructive procedures.

The truth about hair loss, dispelling the myths

The following myths are very commonly believed, but are usually illogical and almost always wrong.

  • Stress?
    Probably not, unless you've undergone extreme physical or mental torture for months.

  • Bad Circulation?
    No. Male pattern baldness is not caused by a lack of circulation or nutrients to the follicle, whether it be by hats, ponytails, or anything else. There are conditions where trauma to the scalp has caused damage, but it wouldn't happen without you knowing it.

  • Sweat & Dirt?
    No. Beware of any treatment that claims it is "cleaning" the follicles of excess sebum, dirt, or sweat. You sweat in high school, and you never lost a hair from it.

  • Hats?
    No. The high school baseball team was never known to be the baldest team in school. Hat's do not cause hair loss.

Hair loss in women

The discomfort and social factors surrounding a woman who is losing her hair can make the experience 10 times more difficult than for a man, and the complete lack of information on the topic out there only compounds the problem. some degree of hair loss usually caused by aging, illness, or hormonal changes. Women tend to experience a subtle thinning all over the scalp rather than losing hair in patches as is common in men. To correct the problem, some women choose to wear a wig or hair extensions. Others have had some success using a topical prescriptive drug. These drugs simply prevent further hair loss without stimulating any new growth. Hair replacement surgery may be the answer for those who feel uncomfortable with either of these options.

Because mini-grafts are usually the surgical treatment of choice for filling-in thinning areas, good candidates for this procedure should have dense hair growth at the back of the head. Mini-grafts are harvested from this dense area and replanted in thinning areas to create a fuller look. Occasionally flap and tissue expansion procedures may be used if the individual is judged to be a good candidate.

If you're considering a hair replacement procedure, it's important to understand that you will never have the coverage you had prior to your hair loss, but surgery may camouflage the thin areas and give you more fullness.

The best candidates for hair replacement

Hair replacement surgery can enhance your appearance and your self-confidence, but the results won't necessarily match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

You should understand that all hair replacement techniques use your existing hair. Hair replacement candidates must have healthy hair growth at the back and sides of the head to serve as donor areas. Donor areas are the places on the head from which grafts and flaps are taken. Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result. There are a number of techniques used in hair replacement surgery. Sometimes, two or more techniques are used to achieve the best results.

Transplant techniques that result in a more modest change in hair fullness include punch grafts, mini-grafts, micro-grafts, slit grafts, and strip grafts. Flaps, tissue-expansion and scalp-reduction are procedures that are usually more appropriate for patients who desire a more dramatic change.

Remember, there are limits to what can be accomplished. An individual with very little hair might not be advised to undergo hair replacement surgery.

The surgery

Hair transplantation involves removing small pieces of hair-bearing scalp grafts from a donor site and relocating them to a bald or thinning area. Grafts differ by size and shape. You may need several surgical sessions to achieve satisfactory fullness-and a healing interval of several months is recommended between each session. It can take up to two years before you see the final result. The amount of coverage you'll need is partly dependent upon the color and texture of your hair. Coarse, gray or light-colored hair affords better coverage than fine, dark-colored hair.

To maintain healthy circulation in the scalp, the grafts are placed about one-eighth of an inch apart. In later sessions, the spaces between the plugs will be filled in with additional grafts. Your doctor should take be careful removing and placing grafts to ensure that the transplanted hair will grow in a natural direction and that hair growth at the donor site is not adversely affected.

After the grafting is complete, you may have to wear a pressure bandage for a day or two. Some doctors allow their patients to recover bandage-free.

Tissue Expansion

Plastic surgeons are the leaders in tissue expansion, a procedure commonly used in reconstructive surgery to repair burn wounds and injuries with significant skin loss. In this technique, a balloon-like device called a tissue expander is inserted beneath hair-bearing scalp that lies next to a bald area. The device is gradually inflated with salt water over a period of weeks, causing the skin to expand and grow new skin cells. This causes a bulge beneath the hair-bearing scalp, especially after several weeks.

When the skin beneath the hair is stretched enough-usually about two months after the first operation-another procedure is performed to bring the expanded skin over to cover the adjacent bald area.

Flap surgery

Flap surgery on the scalp has been performed successfully for more than 20 years. This procedure is used to cover large areas of baldness. One flap can do the work of 350 or more punch grafts.

A section of bald scalp is cut out and a flap of skin that contains hair is lifted off the surface while still attached at one end. This flap is brought into its new position and sewn into place. As you heal, you'll notice that the scar is covered by relocated hair, which grows to the edge of the incision.

Advances in flap surgery include scalp reduction. This technique is sometimes referred to as advancement flap surgery because sections of hair bearing scalp are brought forward, or "advanced" to fill in a bald crown. It is used best for coverage of bald areas at the top and back of the head. It's not beneficial for coverage of the frontal hairline.

Non-surgical options for hair loss

  1. DHT Inhibitors
    - Work to inhibit the binding of Testosterone and 5-Alpha Reductase, which in turn keeps DHT levels close to normal, which in turn helps keep hair growth and loss regulation at its normal healthy state. These treatments truly deal with hair loss at the "root" of the problem.

  2. Growth Stimulators
    - Artificially stimulate growth, without actually dealing with hair loss at the cause of the problem. While this may sound like an ineffective method, growth stimulators are actually a very successful way to halt the balding process.

  3. SOD's
    - Also known as Super Oxide Dismutase. When cells sense a foreign body, they release Super Oxide, which typically help defend the body against invading viruses, cells, and foreign tissues. SOD's reduce the presence of this Super Oxide, thus reducing the body's desire to reject the follicle. It's yet another way that proven to work in fighting hair loss.

  4. Anti-Inflammatory's
    - These treatments work to reduce inflammation, itching, redness, and flaking which is caused as a result of the immune response, and which can make hair loss even worse if not controlled.

What are the risks?

Hair replacement surgery is normally safe when performed by a qualified, experienced physician. Still, individuals vary greatly in their physical reactions and healing abilities, and the outcome is never completely predictable.

As in any surgical procedure; infection, excessive bleeding, and/or scars may result. In transplant procedures, there is a risk that some of the grafts won't "take." Although it is normal for the hair contained within the plugs to fall out before establishing regrowth in its new location, sometimes the skin plug dies and surgery must be repeated.

Medical conditions that could cause problems during or after surgery, include uncontrolled high blood pressure, blood-clotting problems, or the tendency to form excessive scars, Also, be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.

Types of anesthesia

Hair replacement surgery, no matter what technique is used, is usually performed using a local anesthetic along with sedation to make you relaxed and comfortable. Your scalp will be insensitive to pain, but you may be aware of some tugging or pressure. General anesthesia may be used for more complex cases involving tissue expansion or flaps.

What will my recovery be like?

How you feel after surgery depends on the extent and complexity of the procedure. Any aching, excessive tightness, or throbbing can be controlled with pain medication prescribed by your physician. If bandages are used, they will usually be removed one day later. Any stitches will be removed in a week to 10 days.

Because strenuous activity increases blood flow to the scalp and may cause your transplants or incisions to bleed, you may be instructed to avoid vigorous exercise and contact sports for at least three weeks. Some doctors also advise that sexual activity be avoided for at least 10 days after surgery.

To make sure that your incisions are healing properly, your doctor will probably want to see you several times during the first month after surgery. It's important that you carefully follow any advice you receive at these follow-up visits.

Getting back to normal

How soon you resume your normal routine depends on the length, complexity and type of surgery you've had. You may feel well enough to go back to work and resume normal, light activity after several days.

Some patients who have had transplants (plugs or other grafts) are concerned to find that their "new" hair falls out within six weeks after surgery. Remember, this condition is normal and almost always temporary. After hair falls out, it will take another five to six weeks before hair growth resumes. You can expect about a half-inch of growth per month.

This information is intended only as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor does it guarantee results of your elective surgery. Further details regarding surgical standards and procedures should be discussed with your physician.

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