Hair Restoration: A Modern Solution to Hair Loss

Hair loss is part of the human condition. It affects an estimated 40 percent of males and 20 percent of females in the United States, regardless of race, ethnicity, age, and gender. It has long been an extremely personal and sensitive topic of concern. It is only in recent years, however, that effective and realistic solutions to hair loss have become available. In fact, it was only a few decades ago that hair transplantation began to move from cosmetic experimentation into refined surgical artistry. As the most reliable, effective, and permanent solution to androgenetic alopecia, hair transplantation has come to represent an ideal option for many patients looking to regain not only their hair, but more importantly, their confidence. Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) are the two foundational techniques of hair restoration in Richmond VA. The success of both techniques relies on the biologic principle of donor dominance.

Hair restoration: donor dominance

Hair transplants work through a principle in hair biology called donor dominance. This is a genetic programming of hair follicles in the donor area of the scalp, typically the occipital and temporal regions at the back and sides of the scalp, to be resistant to the effects of dihydrotestosterone (DHT), a hormone that leads to the effects of pattern hair loss in susceptible men and women. This DHT-resistant follicle is harvested from the donor region and meticulously transplanted to a recipient site of the scalp. The graft, now in its new environment, retains its original genetic programming and will continue to grow throughout its life span for the life of the patient. This is why hair transplants are a permanent solution for hair loss, as opposed to topical or oral medications which must be used indefinitely to maintain results.

Hair Restoration: History

Hair transplantation is one of the few fields of surgery that has seen such an exponential increase in both technical and methodological development. The first procedures, created in the 1950s and 1960s, typically used skin plugs of five to six hairs and often resulted in a harvest of unnatural, “doll’s hair”. The first major evolution in hair transplant surgery came in the form of Follicular Unit Transplantation, also known as the strip method. FUT offers a much more natural appearance due to the utilization of smaller grafts containing one to four hairs, mimicking the size of a naturally-occurring group of hairs on the scalp. The procedure itself consists of the removal of a thin, ellipsoid strip of tissue with local anesthesia from the donor area, which is then carefully dissected into individual follicular units by a team of technicians in a sterile lab using high-powered microscopes.

The implantation of these grafts into thousands of micro-incisions in the recipient area that have been created by the surgical team can take several hours. It is the surgeon’s duty to recreate an individual patient’s natural hairline and recreate the natural angles of the hair, both in terms of angle and direction of individual follicular units when implanting. A well-designed, soft, irregular hairline which is also age-appropriate is critical in the transplant, as this will make the difference between an average result and a truly undetectable one. FUT often leaves behind a linear scar where the strip of skin was taken from, which will need to heal over several months and does not permit the wearing of very short hairstyles due to visible scarring.

In recent years, the development of FUE has revolutionized the field of hair restoration in Richmond VA. For some patients, the desirability of a procedure without a linear scar led to the development of FUE, which is considered a completely different approach to FUT. The procedure itself consists of removing individual follicular units directly from the scalp, which are then extracted one at a time and prepared for implantation. This is in stark contrast to FUT, in which a linear strip of tissue is removed and then dissected by a team of technicians in the lab.

FUE avoids the creation of a linear scar and thus leaves behind small, punctate scars which are evenly distributed throughout the donor area, which are mostly undetectable by the naked eye even when wearing very short hairstyles. FUE is a much more time-consuming and labor-intensive process and is also most effective when the surgeon uses a handheld punch less than one millimeter in diameter. It also requires the shaving of the donor area, which is necessary for visualization. After follicular units are harvested and prepared, both FUT and FUE proceed in the same manner, with the creation of recipient sites by the surgeon and implantation of grafts by both the surgeon and technicians in most cases.

Hair Restoration: The Process

The first step in any hair transplant surgery is a comprehensive consultation with a qualified, board-certified surgeon to ensure candidacy. This process involves the patient’s full medical and social history, as well as a physical examination of the scalp, analysis of hair loss pattern and stage, hair density and quality, donor hair caliber, skin contrast, age, and considerations for future loss. The most important aspect of the consultation, however, is the setting of realistic expectations. A hair transplant does not create hair where there is none, but rather redistributes existing hair to its new location. The surgeon must work with the patient’s donor supply to not only create a result which is both aesthetically pleasing and effective, but also sustainable for the future, given their present and future state of loss.

A common example of such is patients with more advanced stages of hair loss. In many of these cases, creating a full head of hair with the density of a younger patient is simply not possible, and the surgeon must work with the patient to develop a more attainable goal, for example the creation of a natural-looking frame around the face, where the maximum amount of natural-looking coverage can be achieved with the patient’s existing donor supply.

Hair Restoration: Surgery Day

On the day of surgery, hair transplantation is performed under local anesthesia, with the patient awake, but in a very comfortable state. The average session for a moderate number of grafts can range from six to ten hours, a number which includes not only the surgical time, but also the preparation of the patient’s scalp and harvesting and preparation of the grafts. In short, it is a tedious process which requires the absolute focus of the entire surgical team. The surgeon, in charge of the procedure, plays a critical role in the creation of a good hairline, as well as the creation of recipient sites on the scalp which the technician will later implant the grafts. The technique used to prepare the grafts for implantation requires an incredible amount of care and patience by the technician, as the viability of these grafts outside of the body is critical in ensuring high survival rates and proper growth once implanted.

Hair Restoration: Post-op

Post-operative care is a waiting process and requires the careful following of instructions and guidance from the surgical team. There will be scabs that will form on the recipient site around each graft, which will usually fall off in one to two weeks. Grafts are to be washed gently according to the surgeon’s instructions, and patient should avoid direct contact with the area to not dislodge the grafts. The period after surgery in which a patient will experience some degree of shock loss is typically the most difficult for patients. A certain amount of shedding of transplanted grafts which have now entered a resting telogen phase of growth is to be expected and is considered completely normal, and yet it can be quite demoralizing for a patient who may feel they have “lost the hair they just got”. It is important to remember that the follicles are still alive and exist underneath the surface.

Hair Restoration: After The Fall

Hair growth does not start immediately after surgery but rather a few months in when the follicles which have not been lost shed their telogen phase and enter a growth phase. As a result, the newly transplanted hair will first appear thin and fine, and it is not unusual for patients to be concerned about the early results in this regard. For many patients, by about six months, a significant result is noted, but full maturation of the transplant will not occur for about 12-18 months. The result is a head of hair which can be cut, washed, and styled like any other and will be permanently resistant to the effects of balding.

Hair Restoration: Final Thoughts

Hair transplantation has come a long way from its roots in the mid-20th century, to an innovative and successful branch of surgical science today. The field is made up of two major pillars in terms of technique, FUT and FUE, which require extensive technical and medical knowledge, as well as an artistic hand and eye, to deliver an exceptional result. Hair transplant surgery is at its very core a unique combination of scientific and artistic merit, and understanding both is critical to not only the harvesting of hair follicles from one region of the scalp, but the way in which they are transplanted and how they will grow and perform over the next decades for the patient. It is for this reason that FUT and FUE can be performed by different surgeons and produce very different results, even in the hands of a surgeon with years of experience and a veritable army of harvested grafts. If you are considering hair transplantation as a viable option to address your hair loss, do your research, know your options, and have realistic expectations. It is a journey, and the path, for those who choose to take it, leads not only to hair, but to confidence and a renewed sense of self.