Today’s hair restoration surgeries usually entail hair grafts being taken from the back of the head, which are then transplanted to the parts of the head which have experienced hair loss. This type of surgery is mostly for vanity purposes, more than for reconstructive reasons. Scalp reductions and larger flaps are usually performed on people who have lost hair resulting from illnesses such as cancer, and injuries and accidents involving trauma.
The idea of hair restoration is largely based on the theory of ‘Donor Dominance’ by Norman Orentreich. This theory states that the hair taken from the back of the head, and subsequently moved to the front of the head, will not be later lost because they retain the characteristics and genes that they had before they were transplanted. Unfortunately, there are pros and cons to this. The transplanted hair will not be lost by falling out. However, the non-transplanted hair surrounding the transplanted hair can still fall out, resulting in the thinner appearance of the general hair. This may make the transplanted hair look unnatural, and may require further hair transplant procedures in the future.
The scalp does not decrease in size, but the amount of hair that can be transplanted does. This is a problem to be addressed before any transplant procedure can occur. Hair transplant patients who are still young (twenties) are not ideal candidates for hair transplant procedures because their available donor hair can run out over time. It will also lead to an unnatural appearance as the non-donor hair continues to fall out, leaving only the donor hair. Older patients (sixties and up) are good candidates for hair transplant procedures because they will not need as many procedures over time, and they are not vulnerable to still experience the loss of significant amounts of non-donor hair. Most patients wanting the procedure are between these two polar opposite ages.
In essence, a balding scalp is a growing canvas for hair, as it is constantly balding. Before the procedure the surgeon has to carefully inspect the part of the scalp that will provide the transplant hair, to determine how much is available, and what it is like. Thick hair is probably one of the most important requirements for the surgeon to be able to determine if the procedure will lead good results. It is also important as it will be determine how much more hair will be available for future hair transplant procedures. The best hair for hair transplant procedures is thick and curly. This type of hair will greatly improve the thickness of the hair in the balding spot.
The traditional hair restoration procedure entails taking hair from a donor strip that is removed from back of the head (called the Occipital scalp). This hair transplant surgery is performed while the patient is under a light anesthetic to reduce pain and discomfort. If the procedure is done well, the incision marks (hair transplant scars) will not be easily visible if the hair is kept at least one inch long. A good hair transplant surgeon will explain how he does the donor closure to the patient. It is also important that the procedure is done well in order to enable future hair transplant procedures.
Once the donor strip is removed from the scalp, a strip is slivered from it. This means that it is cut into a thin slice (like bread) on one row of hair follicles. Each follicle is removed and turned into individual grafts. It is very important that the surgeon is gentle with these grafts so that they are not affected, which could result in them not growing properly, or growing out kinky. The grafts also have to be properly hydrated in order for them to grow correctly.
While the team of assistants dissects the donor strip, the surgeon creates the recipient sites for the grafts. Skilled assistants and surgeons will be able to create small grafts and recipient sites. This reduces swelling, improves graft growth and results in the better arrangement of transplanted hair. Many factors affect the final result, such as the angle, direction, pattern of distribution and tilt. These are all determined by the surgeon’s experience and skills. The aim of the surgeon should be to perform a hair transplant that yields natural looking results with as much hair density as possible with the available hair grafts.
The final step in a hair transplant procedure involves the graft placement. This is usually done by the same people who did the graft dissection. The grafts are placed into the incisions that the surgeon made during dissection. If placed well, the grafts will grow properly. As stated previously, if the grafts are affected, they may not grow out correctly. If they are placed too deeply into the skin, they will have a pitted result. If they are placed too high in the layer of the skin, they will either grow too poorly, or they will have a cobblestoned appearance. Other things that may grow include; if a four-hair graft is placed into an incision for two-hairs, the hair can grow out as a tuft or result in pitting. And, if the curl of the hair is changed, e.g. backwards instead of forwards, then the final result will be tangled hair that is not thick enough.
All of these things, and other mistakes, can affect the quality and the final result of the hair transplant. These should all be discussed with a potential patient. A hair transplant is a team procedure that needs skilled and expert people in order to have the desired result.
