- Best Candidates:
People who are seeking to improve their appearance by restoring a fuller head of hair
- Length of Procedure:
2 to 4 hours per session (hair transplantation)
Local with sedation or general
- Procedures in 2015:
15,610 (source: American Society of Plastic Surgeons)
More than half of men and women in the United States will eventually lose at least some of their hair. Advances in plastic surgery have led to several different surgical hair replacement techniques that are available for people who want to restore a fuller head of hair and a more youthful look. The majority of hair replacement patients successfully achieve an improved appearance and an increase in self-confidence.
The procedure information contained in this article will give you a good introduction to hair replacement techniques. Schedule a consultation with a Top Plastic Surgeon to receive a medical examination and discuss your hair replacement options.
Hair Replacement Overview
Hairs are shed and replaced by new hairs as part of the normal cycle of human hair growth. Excessive hair loss (also called alopecia), occurs when the body fails to replace hairs that are naturally shed. Alopecia can begin as early as the teenage years and affects 30% of people by age 30 and 50% of people by age 50.
Male pattern baldness (also called androgenic alopecia) is the most common type of hair loss, typically involving a receding hairline and thinning of hair on the top of the head. Most women who are affected experience a thinning of hair throughout the head while the hairline remains intact. Hair loss is usually hereditary, though it can have many other causes such as hormonal changes, medical treatments (such as chemotherapy or certain medications) disease, trauma, poor nutrition and incorrectly used hair treatments.
Options for people who want to do something about hair loss include wearing a wig or toupee, undergoing treatment with topical prescription drugs and surgical hair replacement. Topical drugs can delay hair loss and occasionally regrow new hair, but are a temporary solution that must be used daily. The results of hair transplants and other hair replacement surgeries are permanent and can give both men and women a fuller, natural-looking head of hair and a boost to their self-esteem.
How Hair Replacement is Performed
Several different techniques are used to perform hair replacement. The most common method is hair transplantation, during which small sections of skin containing one or more hairs are transplanted from a site of dense hair growth to the balding area. Tissue expansion, flap surgery and scalp reduction are other options that are available for a more dramatic change. Some hair replacement procedures involve a combination of these techniques.
During a hair transplant, plugs or strips of hair are grafted from a donor site and implanted into the bald or thinning areas of the scalp. Hair transplantation usually involves several treatment sessions, with intervals of several months between sessions to allow for healing. The final result from a series of hair transplants may not be apparent for up to 2 years.
The donor site is usually the back or side of the head, where hair growth tends to be the thickest. A significant amount of hair can be taken from this area without being noticeable.
The hair at the donor area is trimmed prior to surgery. The plastic surgeon then uses a small scalpel to remove patches or strips of skin (which are then divided into smaller pieces), or a tube-like instrument to remove the grafts as small round plugs. Stitches are used to close the incisions at the donor site. The grafts are then transplanted into small holes or slits created in the scalp. Mini-grafts contain two to four hairs and round-shaped punch grafts contain up to about 14 hairs. Micro-grafts only contain one to two hairs and are often used at the hairline to soften the transition from the forehead to the mini-grafts.
The grafts are initially spaced about 1/8 of an inch apart to maintain healthy blood circulation. These spaces are filled in with additional grafts during subsequent sessions. Once transplanted, the hair within the grafts temporarily falls out before regrowth occurs in 5 to 6 weeks.
Each hair transplanting session usually takes from 2 to 4 hours to complete and is performed under local anesthesia combined with a sedative to cause drowsiness. The procedure is generally performed as an outpatient procedure, allowing you to return to the comfort of home on the same day.
Tissue expansion is a plastic surgery technique commonly used for both reconstructive and cosmetic procedures, including hair replacement. In this two-stage procedure, also called scalp expansion, a balloon expander is inserted beneath the hair-bearing scalp adjacent to the bald area. The expander is gradually filled with saline solution, stretching the scalp and creating new skin. After the skin has stretched for 8 to 10 weeks, a subsequent surgery is performed during which the expander and the area of bald scalp are removed. The new skin is then positioned to replace the bald area, remaining attached its original blood supply. This technique is often used for people with scars on the top of the scalp or men with extensive balding at the front and top of the head.
Flap surgery is a plastic surgery technique that involves taking a section of living tissue from one section of the body and moving it to another. Hair replacement flap surgery is frequently used to cover large bald areas. During the surgery, a portion of bald scalp is removed and a flap of hair-bearing skin is lifted from the underlying tissues. The flap is then repositioned to replace the skin in the bald area, remaining connected to its original supply of blood. The size and placement of the flap are customized based on the individual needs of each patient.
Scalp reduction, also called advancement flap surgery, is frequently used to cover bald areas on the top and back of the head. During the surgery, a section of bald scalp is removed and the sections of hair-bearing scalp are pulled together. The pattern of the scalp that is removed varies depending on the patient's needs. To treat large bald areas, the pattern usually resembles an inverted Y-shape. Since the skin on the top of the head usually lacks the elasticity to remove the entire bald area at once, scalp reduction usually requires multiple procedures over several months.
The best candidates for hair replacement are people who are in good health and want to improve their appearance with a fuller, thicker, permanent head of hair.
In general, the best candidates for hair replacement:
- Are in good physical and psychological health.
- Are well-informed about treatment options and have realistic expectations.
- Want to improve their appearance by adding fullness and thickness to the hair.
- Have enough hair on the back and sides of the head to act as donor areas.
If you believe that you may be a good candidate for hair replacement, a qualified plastic surgeon can evaluate your circumstances, explain anything about the procedure you don't understand, answer all of your questions and help you decide if the procedure is right for you.
Hair Replacement Risks
Complications are rare and usually minor when hair replacement is performed by a qualified plastic surgeon. However, all surgeries carry risks. To minimize your risk, carefully follow all of your surgeon's instructions both before and after the procedure. Contact your surgeon's office immediately if you experience any symptoms you believe may indicate a complication.
The most common risks associated with hair replacement surgery include:
- Pain, swelling or bruising beyond normal levels
- Excessive bleeding
- Numbness (usually temporary)
- Adverse reaction to anesthesia
- Dissatisfaction with results
Some of the grafts used for a hair transplant may fail to establish a blood supply and die, though regrowth occurs in most cases. When plug grafts are used, small bumps on the scalp may form at the transplantation sites. Scars at the graft sites and at the donor areas are usually small and well-hidden by hair growth.
Hair Replacement Costs
According to the American Society of Plastic Surgeons, the national average surgeon/physician fee for a hair transplant in 2013 was $5,136. This figure does not include other costs, such as a facilities charge or anesthesia. Your plastic surgeon will provide you with complete information on costs and financing options at your consultation. The total fee for hair replacement can vary considerably depending on the procedure used, the region of the country and the patient's specific needs.
Health insurance will usually not cover the cost of cosmetic hair replacement. However, certain procedures may be covered if performed to treat burns, trauma or for other reconstructive purposes. Check with your insurance company to find out if nose surgery is covered and to determine the eligibility requirements.
Hair Replacement Consultation
If you decide that you might benefit from hair replacement, the first step is to locate a qualified plastic surgeon and schedule a consultation. At the consultation, the doctor will perform a physical examination to evaluate the extent of hair loss and the condition of your skin. He or she will also take a complete medical history, including your family history of hair loss, existing health conditions, medications (prescription and non-prescription) and vitamins. Be sure to tell the surgeon if you smoke, have any allergies or have had previous hair replacement surgery.
The surgeon should carefully listen to your goals for hair replacement, fully answer all of your questions and explain the different options that are available. He or she should give you the full details of the recommended procedure, including the benefits, risks, costs and recovery time. Be sure to ask for before and after photos of the surgeon's recent hair replacement patients.
As the consultation concludes, you may wish to schedule your procedure, take some time to think or seek a second opinion. If you decide to proceed with the procedure, your plastic surgeon will provide you with specific instructions on how to prepare for hair replacement surgery. These instructions will include guidelines for eating, drinking, and medications and vitamins to take or avoid before and after surgery.
Hair Replacement Recovery
After hair replacement, most patients experience some minor discomfort including throbbing, tightness and a mild headache. Any pain should subside quickly and be controlled with medication prescribed by your plastic surgeon. Temporary swelling, bruising and numbness is common at both the donor site and the area where the grafts are placed. Numbness usually goes away within 2 to 3 months.
For the first few days after your hair replacement, take it easy, get plenty of rest and follow all of your post-operative instructions. A pressure bandage may be worn overnight if the head was bandaged after surgery. Most patients can gently wash their hair after a couple of days. Any stitches are removed in 7 to 10 days.
How soon you can resume normal activities depends on the technique used and the extent of the procedure. Most patients can resume light activity and return to work after several days. Strenuous activity or any activity that involves contact should be avoided for at least 3 weeks.
The hair in the transplanted grafts normally falls out within about 6 weeks because the blood supply is reduced during the procedure. It may take 5 or 6 weeks for regrowth to occur. Once growth is resumed, the new hair should continue to grow throughout the patient's lifetime. Ensuing procedures may be used to fill the spaces between grafts or to touch-up certain areas for more natural-looking results.
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