what are hair restoration procedures?
Patients who are ideal candidates for hair restoration surgery usually have androgenic alopecia and are otherwise in good health. The areas of hair loss should be limited to the frontal and crown region. The donor area should also be relatively dense with little to no previous scars from prior hair restoration procedures. Women may also be good surgical candidates if the area of alopecia is localized versus diffuse and resembles the pattern of loss in men. Patients considering hair restoration surgery must have realistic expectations as for any elective cosmetic procedure. We lose nearly 50% of our hair before noticing baldness. Hair restoration surgery may create or restore a frontal hairline and add density to the crown area but will not usually return a patient’s hairline to the density and shape it once had as a teenager. This is simply due to the limited supply of donor follicles which are available along the back of the head. However, most patients who are good candidates for hair transplantation procedures are very pleased with the final results which appear natural with today’s technology.
Hair restoration technology has improved drastically since its inception in the 1960’s. Early hair restoration involved excising a large portion of the scalp with its hair follicles from the back of the head with a scalpel and electrocautery. This was called the FUT (follicular unit transplant) method which involved excising a strip of scalp was divided into smaller and smaller transplant units which were ultimately transplanted into balding areas of the scalp in the frontal and crown region. The defect created in the back of the head was closed with sutures or staples, often under tension. This often resulted in a wide scar with surrounding hair loss and permanent numbness in the scalp. Patients often complained of significant pain and swelling during the recovery process which could take several weeks.
Current techniques involve the use of the FUE (follicular unit extraction) method using advanced semi-automatic devices which extract the hair follicles as individual units using a small punch often less than one millimeter in diameter. The procedure is much less invasive than the older FUT method and avoids the need for sutures. The scalp heals and no linear scar is created in the back of the head. Hair loss is minimized because there is no tension on the scalp. Patients do not experience significant discomfort, prolonged swelling, nor permanent scalp numbness as this procedure is much less invasive. There is also minimal manipulation of the hair follicles so graft survival is maximized. The three most common devices which are used for this procedure are the Neograft, Smart Graft and Artas. The Neograft device has been in use for the longest time period of these three devices. Results appear similar regardless of which device is employed and are more dependent upon the experience of the team versus the device.
Hair restoration is generally performed in an office setting under local anesthesia with oral sedation in some cases. If the frontal hairline is to undergo hair transplantation, great care is taken to design this hairline in a natural and age-appropriate manner. It is often helpful for patients to bring photos of their faces from earlier years to evaluate the shape and position of their hairline so that the final result is completely natural and undetectable. The hair along the back of the head is shaved down with hair clippers and local anesthesia is injected into the scalp. The FUE device is employed to harvest the hair follicles which are stored prior to transplantation. After the grafts have been harvested, local anesthesia is applied to the balding scalp where the grafts will be implanted. Small slits will be made in the scalp with either a needle or scalpel in preparation for placement of hair follicles. The hair follicles are individually placed in the scalp by hand with small forceps. The use of a needle or scalpel to create these recipient sites for placement of hair grafts avoids any noticeable scars.
At the end of the hair restoration procedure, a light dressing is applied overnight and the patient is seen the following day in the office to remove it and inspect the scalp and grafts. No other dressing is usually needed. There is usually minimal discomfort and swelling of the scalp following FUE hair restoration and most patients will take oral pain medication for a few days after the procedure. Most patients take off one week from work. They can return to light physical exercise within two weeks and all physical activities within a month. There are often small crusts at the base of the hair transplants which will fall off within seven to ten days after the procedure.
What results should patients expect after hair restoration?
The small hairs associated with each hair graft will usually fall out within a few weeks following transplantation and begin to grow at about three months. The final results will be seen within 12-18 months after the procedure. Patients who are candidates for further hair restoration to increase density should wait at least 1-2 years following the initial procedure to avoid damage to existing hair follicles. It is also recommended that most hair transplant patients begin on maintenance therapy of Rogaine and Finasteride as studies indicate 70-80% of patients will stabilize their hair loss if these medications are continued on a daily basis.
Who is a good candidate for hair restoration?
Hair loss patients who are suitable candidates for hair restoration are generally very pleased with the aesthetic outcome of this procedure. Unlike some other aesthetic procedures, the results of successful hair transplantation are permanent as the transplanted hair follicles will continue to grow throughout the patient’s lifetime. The results should appear very natural and not detectable to others.
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On the other hand we denounce with righteous indignation and dislike men who are so beguiled.