It has been known for over fifty years that genetically strong hair around the sides and the back of the scalp and now the body (donor area,) can be moved to a new area of the scalp (recipient area) where it will behave as if it were still in its original state. The reason being is this hair is genetically healthy and under normal circumstances not affected by the baldness gene.
Past Surgical Procedures
Scalp Reduction –
This is considered to be an aggressive form of hair transplant surgery. Removing the bald skin from the top of the scalp and pulling the sides and back up. Thus reducing the size of the bald area. Scalp reductions were never a popular form of hair replacement. They were performed mainly in the 1990s. But due to the potential complications in performing a scalp reduction, it never became mainstream. There is the potential for the skin to stretch back. Leaving a visible large scarring. As well as an unnatural pattern of hair loss. The donor area can be pulled into unnatural directions. Causing the hair density to be reduced and impairing future procedures.
Flap Surgery –
The cutting out of a bald area of skin. Along the hairline normally. Then the same cut but of a hair-bearing area from the sides. This “flap” remains attached to the skin. It is then twisted to sit in the area removed. Then sutured. The flap procedure is aggressive. Can be very painful with a high potential for the hair not to grow. Flap procedures invariably will leave severe scarring. In the donor and recipient areas. As well as an unnatural orientation of hair growth along the hairline.
Minigrafting Hair Transplants –
This technique evolved from the first “plug grafting” techniques. Was popular in the 1990s. Minigrafting involved the use of small groups of hairs. By today’s standards large. But, an improvement of the 30-40 hair groups once used.
The technique was a significant improvement. In performing a more natural looking hairline. Although it did leave larger spacing between each group of hairs. Minigrafting was the first real step to the techniques of today.
Hair Transplants Today
Refined Follicular Unit Grafting. A major evolution in creating a natural look. Improved donor management it is possible to harvest natural growing groups of hairs. Known as Follicular Units or “FU´s”. FU´s can contain one to four hairs. They are placed strategically in the recipient area to recreate the natural appearance of hair growth.
There needs to be the careful alignment of each hair follicle. That follows the natural direction of the native hair. Placing them to ensure they do not overlap. Placing them in an asymmetrical pattern. This achieves natural hairlines, maximum coverage and natural looking density. From a relatively small amount of hairs. Especially compared to the surface area that needs to be covered. Considering the limitations of the finite donor resource.
Follicular Unit Hair Transplant Surgery is now the most refined form of hair transplantation. Greater skills have to be applied as well as time to excise the natural groups of FU intact.
Regardless of the actual harvesting technique used today. The graft management and care must be focussed on the follicular unit use. Also, hair placement to mimic natural hair growth. Although the extraction of the follicular units differs between the Follicular Unit Transplant – FUT and Follicular Unit Extraction – FUE techniques. The basic principles remain the same.
It´s all about the illusion of hair
Typically, around 30% of scalp hair follicles have one hair, 40% have two hairs and 30% of follicles have three to four hairs. This varies slightly from person to person and ethnic background.
The areas of hair loss can be divided into three regions: the front, the mid-scalp, and the crown or vertex.
The total area of hair loss may vary from 5 to 250 square centimetres. The scalp is not flat but contoured and measured in volume. The potential size of the crown can create an insatiable demand for donor hair. Which, as we know, is limited.
When designing a hair transplant it is important for a varied mix of each hair grouping. For example, single hair units for the hairline and larger groupings to add the thickness behind. So it is important when harvesting the follicular units they are removed intact.
It all starts with your hairline
The front hairline is generally considered to be the most important aspect of the entire head of hair. This is because it frames the face. As a result, will change the appearance most dramatically.
It is impossible to place like for like hair density when the man had a full head of hair. The effects of trying to reach the same density can result in trauma to the skin. Poor yield from the placed grafts. As well as, by placing two hair units in the frontal line will create a “pluggy” look.
Therefore some of the art is to give the cosmetic effect that the density is the same, this is most obvious when the hair is longer because it blocks the reflection of light on to the scalp. But when the hair is short or shaved this effect is lessened because there appears to be less density; although this is obviously not true.
With good planning, the Doctor has to assess where a prospective patient is in terms of physical hair loss. Their areas of greatest concern. What treatments may have already been tried. How hair loss impacts the individual on an emotional level.
Studying such characteristics as facial features and aspects such as the existing hairline. What other areas may need to be addressed. At this stage, the doctor is already planning how they will place different groupings of hairs. To best fit that individual. Taking the time to analyse these details enhances the doctor´s ability to form an initial idea of their assessment and plan for your case.
From a patient‟s perspective, the consultation is your time to learn as much as you can about the doctor, the practice and your hair restoration.