Q. What is hair transplantation (HT)? How safe is it?
Hair transplantation (HT) an increasingly effective, safe, and reliable way for hair restoration. The ability to provide very natural-looking results has encouraged larger number of balding men and women to opt for this surgical solution.
HT involves removing hair follicles from the back portion of scalp called the ‘donor site’ and transplanting them to a bald area known as the ‘recipient site’. The basic principle of hair transplantation is that of ‘donor dominance’ – that the occipital area consists of androgen-resistant hairs and are therefore permanent – and they retain this property when transplanted to other areas. Hence, these hairs are retained even after being transplanted and do not fall off.
Q. A lot of hair transplant centres have mushroomed up in the valley. Who is really qualified to perform hair transplantation?
According to National Medical Commission guidelines (2022), the hair transplant should preferably be undertaken only by those who have surgical grooming like formal surgical training such as MCh/DNB Plastic surgery, MD/DNB Dermatology with adequate grooming in dermatological surgical procedures. It is also noted that these specialities have Hair transplantation as a core topic in their curriculum and are trained to perform such surgeries.
Patients are therefore advised to check about the qualifications of the concerned doctor and not to go by advertisements in the media.
Q. What the various techniques of Hair transplantation? Please elaborate?
Two types of hair transplantation techniques predominate, including the follicular unit transplantation (FUT) and follicular unit extraction (FUE) techniques. Currently, FUE represents the more common approach due to its potential advantages over FUT, which include:
(a) Less post operative pain
(b) Less post operative healing time
(c) More number of grafts are harvestable
(d) Non- scalp Follicular units can be also be harvested (eg from chest, submental area etc)
On the contrary, FUT may be preferable to FUE given FUT’s reported advantages, which include shorter operative period and lesser chances of graft transection. Still, controversy remains as to which hair transplantation procedure is superior, however the astute hair transplantation surgeon should be knowledgeable of the nuances of each.
Direct hair implant (DHI): This hair transplantation technique is a further development of FUE hair transplant. It is carried out with special ‘pen implanters’ which provide better control over the graft placement (angles and depth of the planted grafts) and highest graft survival rates than other techniques.
Q. Who are the ideal candidates for Hair transplant? Which type of patients can get good results?
Identifying appropriate candidates for hair transplantation includes an evaluation of the following:
- Diagnosis: Diagnosing androgenic alopecia is relatively straightforward and based upon the characteristic pattern of associated hair loss (Norwood for males, Ludwig for females), the miniaturization and depigmentation of hairs, and the lack of clinical inflammation.
- Age: The HT surgeon should only operate on patients older than 25 years of age because future hair loss pattern is less predictable and expectations are generally more unrealistic in patients younger than 25 years old.
- Hair Caliber: Patients with thicker hair diameter in donor area can be expected to obtain much denser coverage (better aesthetic results) versus patients with thin-caliber hair.
- Donor Hair Density: Patients whose scalp donor sites have greater than 80 follicular units (FUs) per squared cm are excellent candidates. Those with donor hair density less than 40 FUs per squared cm are considered poor candidates for HT, and the clinician needs to set patient expectations accordingly.
- Degree and Pattern of Baldness: Patients hoping to correct frontal baldness can expect the most dramatic results in appearance, and thus represent great candidates. Grafting only the scalp vertex should be avoided, if possible, as this not only consumes potential future donor grafts but also may cause a “doughnut” appearance as hair loss progression continues. The surgeon must reiterate that concentrating grafts in the frontal scalp will provide the maximum long-term density and minimal aesthetic risk.
- Patient expectations: Patients with realistic expectations and a history of compliance with hair loss medications/treatments (i.e., minoxidil, finasteride, platelet-rich plasma) represent ideal candidates.
- Hair & skin colour: The contrast between the hair and the skin colour, is also an important factor that affect the result. The lesser the contrast between the donor hair and the skin, the better is the result.
Q. Is Hair transplant painful?
It is a painless procedure barring the first few minutes when local anaesthesia is given. Once the effect of anaesthesia sets in, the patient does not feel any pain.
Q. How long does the procedure take?
The hair transplant procedure takes 6-8 hours. Patient can go home the same day and resume normal work after a week.
Q. What is the sequel of a hair transplant surgery? When can a patient expect to see full results?
The transplanted hair shafts start to shed off two to three weeks after the surgery, but the hair roots remain and go into a resting phase. New hair start growing about three months after the procedure. It usually takes eight to twelve months to appreciate the full result of a hair transplant surgery.
Q. What are the potential complications of a Hair transplant surgery?
In general, complications after hair transplantation are rare, given the vigorous blood-supply to the scalp, which allows for quick healing and low rates of infection. Nevertheless, potential complications include edema (5%), bleeding (0.5%), folliculitis, numbness of the scalp (mostly temporary).
Apart from these, an uncommon but concerning complication is Telogen Effluvium which is characterized by shedding of native hairs at the donor or recipient site. This “shock”loss, likely a result of stress and microtrauma sustained during HT, is transient. Patients should receive reassurance that the majority of the hairs shed will return at 3 to 4 months.
Q. Some say results of hair transplant are temporary? How far is it true?
This myth revolves a lot around hair transplant aspirants. However, this is not true. Hair transplant results are near-permanent and visibly long-lasting if one commits to medications and these are taken religiously.
Q. Do the hair follicles regrow at the site from which they are taken during the transplantation?
The hair follicles taken out from the donor site do not regrow because they are transplanted elsewhere along with their roots. Therefore, it is important to consult a doctor before the procedure and assess from where and how much hair will be transferred to the new area, because hair follicles in the donor area also have their limit.
Q. Does a person need further treatment for hair loss even after getting a Hair transplant done?
One of the many facts about hair transplants that people need to understand is that hair transplant alone cannot eliminate hair fall on its own. To minimise hair loss over time, it needs to work in conjunction with many post-operative medications and treatments, including topical lotions (minoxidil, procapil etc), oral tablets, and PRP injections.
Q. What is your take on Robotic Hair Transplant?
There is a new trend for false marketing using the term ‘Robotic Hair Transplant. This term sounds impressive, and many patients are drawn to it. However, this is misleading!!
There is only one robot capable of doing hair transplant which is the ARTAS robot. This robot does the first step of FUE by making holes around the grafts. It DOES NOT extract the grafts or implant them. Those steps are done by humans. So, experienced and skilled surgeons can easily out-perform robot assisted hair transplant surgeries.
Q. Can women opt for Hair transplant?
HT in women is considered when the conventional measures such as nutrition, lifestyle change, correction of the underlying cause, and medicines such as minoxidil and PRP do not yield good results and when hair loss is significant enough to be visible cosmetically.
Q. How costly is a Hair transplant Surgery?
The cost varies depending on the number of grafts required, the area to be covered, the quality of instruments and the technique used. In European and western countries, it might be costly, but in Asian countries, it is very much affordable. However, one must never compromise quality with price.
Q. What is your message to the patients who aspire for a Hair transplant surgery?
Recent advances in technology have made hair replacement surgery a viable option for many people but we must utilize this technique prudently. One must avoid shabby clinics and centres with un-qualified people who lure the patients by offering huge discounts just to grab more patients. See, there is a very thin line between designing an aesthetically natural hair line and devastating the hair-restoration procedure altogether. When performing hair transplantation, an expert advice, proper patient evaluation and execution of a comprehensive treatment plan can produce safe, reliable, and satisfactory outcomes.
Dr Mir Shahnawaz (MBBS, MD) is Dermatologist, Laser Expert & Hair transplant Surgeon; Director & Founder - DERMIS CLINIC, Bemina, Srinagar (J&K). He can be reached at firstname.lastname@example.org