Hair transplantation is a surgical technique that involves moving individual hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. However, it is also used to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.
Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques transplant these naturally occurring 1–4 hair "follicular units" in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This hair transplant procedure is called Follicular Unit Transplantation (FUT). Donor hair can be harvested in two very different ways;
1. Strip Harvesting - a strip of scalp is removed under local anesthesia, the wound is then sutured back together and this piece of scalp tissue is then cut in to small pieces of tissue called grafts which are then transplanted back in to the thinning area of the patients head. This method will leave a linear scar in the donor area, which should be covered by a patients hair (if long). The recovery period is around 2 weeks and will require the stitches to be removed by medical personnel.
2. Follicular Unit Extraction or FUE Harvesting - individual follicles of hair are removed under local anesthesia; this micro removal uses tiny punches of between 0.6mm and 1.25mm in diameter. Each follicle is then reinserted back in to the scalp in the thinning area using a micro blade. Because this is single follicles and no large amount of tissue is removed there is no visible scars or post-surgery pain, with no stitches to be removed. Recovery from FUE is within 7 days.

Procedure

Step-1 : Harvesting of Strip :

The hairs in the Donor site from back and side from which we harvest the Strip are normally trimmed short after deciding how big strip is required. The area is cleaned with antiseptics and the skin in numbed by local Anesthetic. After harvesting the strip with single blade knife with least possible damage to the hair under magnification, the gap is closed by only one continuous stitch. The stitch line and the subsequent very thin linear mark will remain covered and hidden by the long hair on the top of the suture line, even when you leave the clinic after surgery. No bandage is given when you leave the clinic.

Step-2 : Cutting of Strip into Follicular Units :

By using high magnification and digital magnification the strip is first slivered into rows of single follicular unit thickness. The slivers are further cut into Follicular Unit Grafts (FUG) by a well-trained team of technicians. They are carefully preserved into cold normal saline until finally implanted in the patients' body.

Step-3 : Implantation of Graft to Recipient Area :

The meticulously prepared grafts of Follicular Units are implanted with the special device called implanter taking care of direction, depth, density and naturalness. The procedure is virtually pain free due to numbing of the skin with thinnest possible needle. Use of implanter avoids the handling of stem cell area of the follicles so the damage to follicles are minimized and the growth rate is maximized.

Entire procedure experience is made pleasant and pain free. You can talk to staff, or us because you are never made sleepy or unconscious. You can, read, listen to music, watch TV, have break for lunch, juice or toilet or can take a nap if you have to get over the Jet lag! At the end of the procedure you can put on your cap and walk back home

Surgery

Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia, which typically last about six hours. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested.
In the usual follicular unit procedure, the surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. The excised strip is about 1–1.5 x 15–30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts from the strip. Working with binocular Stereo-microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting. The latest method of closure is called 'Trichophytic closure' which results in much finer scars at the donor area.
FUE harvesting negates the need for large areas of scalp tissue to be harvested and can give very natural results with little or no scarring.
The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The assistants generally do the final part of the procedure, inserting the individual grafts in place.

Modern techniques

There are several different techniques available for the harvesting of hair follicles, each with their own advantages and disadvantages. Regardless of which donor harvesting technique is employed, proper extraction of the hair follicle is paramount to ensure the viability of the transplanted hair and avoid transection, the cutting of the hair shaft from the hair follicle. Hair follicles grow at a slight angle to the skin's surface, which means that regardless of technique transplant tissue must be removed with a corresponding angle and not perpendicular to the surface.
There are two main ways in which donor grafts are extracted today: strip excision harvesting and follicular unit extraction.
Strip harvesting is the most common technique for removing hair and follicles from a donor site, most commonly the area at the back and sides of the scalp. A single-, double-, or triple-bladed scalpel is used to remove strips of hair-bearing tissue from the donor site. Each incision is planned so that intact hair follicles are removed. Once removed, the strip is dissected into follicular units, which are small, naturally formed groupings of hair follicles.
Follicular Unit Extraction (FUE) takes place in a single long session or multiple small sessions. FUE is considered to be more time consuming, depending on the operator's skill, and there are restrictions on patient candidacy. The advantages of this technique over the conventional strip harvest are that it does not leave a linear scar, and the procedure produces little or no postoperative pain and discomfort. There are some disadvantages such as increased surgical times and higher cost to the patient . Clients are selected for FUE based on a fox test . There is however some debate about the usefulness of this in screening clients for FUE.

Side effects

Hair thinning, known as "shock loss", is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day.
Other side effects include swelling of areas such as the scalp and forehead. If this becomes uncomfortable, medication may ease the swelling. Additionally, the patient must be careful if his scalp starts itching, as scratching will make it worse and cause scabs to form. A moisturizer or massage shampoo may be used in order to relieve the itching.
Several years after the surgery, more hair loss can occur, with the transplanted patches staying in place. This results in odd patches of hair, unless they are removed, or unless more hair is transplanted

The Truth About Hair Loss

Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff, and even excessive hat-wearing. All of these theories have been disproved. It's also untrue that hair loss can be determined by looking at your maternal grandfather, or that 40-year-old men who haven't lost their hair will never lose it.

The Best Candidates for Hair Replacement

Hair replacement surgery can enhance your appearance and your self-confidence, but the results won't necessarily match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.
It's important to understand that all hair replacement techniques use your existing hair. The goal of surgery is to find the most efficient uses for existing hair.
Hair replacement candidates must have healthy hair growth at the back and sides of the head to serve as donor areas. Donor areas are the places on the head from which grafts and flaps are taken. Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result. There are a number of techniques used in hair replacement surgery. Sometimes, two or more techniques are used to achieve the best results.
Transplant techniques, such as punch grafts, mini-grafts, micro-grafts, slit grafts, and strip grafts are generally performed on patients who desire a more modest change in hair fullness. Flaps, tissue-expansion and scalp-reduction are procedures that are usually more appropriate for patients who desire a more dramatic change.
Remember, there are limits to what can be accomplished. An individual with very little hair might not be advised to undergo hair replacement surgery.

Hair Loss in Women

Some doctors estimate that one in five women will experience some degree of hair loss usually caused by aging, illness, or hormonal changes after menopause. Women tend to experience a subtle thinning all over the scalp rather than losing hair in patches as is common in men. To correct the problem, some women choose to wear a wig or hair extensions. Others have had some success using a topical prescriptive drug. The effectiveness of such drugs varies in some patients and simply prevents further hair loss without stimulating any appreciable new growth. Hair replacement surgery may be the answer for those who feel uncomfortable with either of these options.
Because mini-grafts are usually the surgical treatment of choice for filling-in thinning areas, good candidates for this procedure should have dense hair growth at the back of the head. Mini-grafts are harvested from this dense area and replanted in thinning areas to create a fuller look. Occasionally flap and tissue expansion procedures may be used if the individual is judged to be a good candidate.
If you're considering a hair replacement procedure, it's important to understand that you will never have the coverage you had prior to your hair loss, but surgery may camouflage the thin areas and give you more fullness.

After Your Surgery

How you feel after surgery depends on the extent and complexity of the procedure. Any aching, excessive tightness, or throbbing can be controlled with pain medication prescribed by your physician.
If bandages are used, they will usually be removed one day later. You may gently wash your hair within two days following surgery. Any stitches will be removed in a week to 10 days. Be sure to discuss the possibility of swelling, bruising, and drainage with your surgeon.
Because strenuous activity increases blood flow to the scalp and may cause your transplants or incisions to bleed, you may be instructed to avoid vigorous exercise and contact sports for at least three weeks. Some doctors also advise that sexual activity be avoided for at least 10 days after surgery.
To make sure that your incisions are healing properly, your doctor will probably want to see you several times during the first month after surgery. It's important that you carefully follow any advice you receive at these follow-up visits.

Getting Back to Normal

How soon you resume your normal routine depends on the length, complexity and type of surgery you've had. You may feel well enough to go back to work and resume normal, light activity after several days.
Many patients who have had transplants (plugs or other grafts) are dismayed to find that their "new" hair falls out within six weeks after surgery. Remember, this condition is normal and almost always temporary. After hair falls out, it will take another five to six weeks before hair growth resumes. You can expect about a half-inch of growth per month.

Hair Replacement Surgery Cost

The cost of hair replacement surgery can vary widely depending on the procedure and size of the area to be replaced. The end cost can be anywhere from $1,200 to $10,000. There are also additional costs later on; however, it is possible to produce undetectable results in what looks like a natural head of hair.

Consultation
- An initial consultation is important to decide exactly what needs to be done and to get a cost estimate. The consultation itself is usually free of charge.
Grafts
- The number of grafts done for the hair replacement surgery will determine how much hair is transplanted. Each graft will cost $3 to $9. It is possible to need 1,000 or more grafts.
Less Common Procedures
- There are procedures done to increase the appearance of hair replacement. They include scalp reductions, lifts, rotations, extensions and flaps. The cost for these procedures can be just as much as hair replacement.
Long-Term Maintenance
- A hair replacement procedure will need upkeep every 5 to 6 weeks. Larger areas also need to be replaced approximately once a year, so the upkeep can run another $2,000 annually.
Considerations
- Hair replacement surgery can improve self-esteem, which is hard to put a price on. Also, many of those suffering from hair loss are already spending more than the cost of the surgery on temporary options.