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John Bell Croyden Centre
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27 YEARS
AT JOHN BELL & CROYDEN
50 - 54 WIGMORE STREET
LONDON
W1U 2AU

CALL US: 020 7224 4640

solutions@the-hair-clinic.co.uk

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Trichology

Transplant

Hair Transplants

Hair Transplants

Hair transplantation is a surgical technique that removes hair follicles from one part of the body, called the donor site, to a bald or balding part of the body known as the recipient site. The technique is primarily used to treat male pattern baldness. In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding are transplanted to the bald scalp. Hair transplantation can also be used to restore eyelashes, eyebrows, beard hair, chest hair, 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 groupings of 1 to 4 hairs, current techniques harvest and transplant hair follicular units in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking original hair orientation. This hair transplant procedure is called follicular unit transplantation. Donor hair can be harvested in two different ways: strip harvesting, and follicular unit extraction.

Pre-operative assessment and planning

At an initial consultation, the surgeon analyzes the patients scalp, discusses their preferences and expectations, and advises them on the best approach and what results might reasonably be expected.

Pre-operative folliscopy will help to know the actual existing density of hair, so that postoperative results of newly transplanted hair grafts can be accurately assessed. Some patients may benefit with preoperative topical minoxidil application and vitamins.

For several days prior to surgery the patient refrains from using any medicines which might result in intraoperative bleeding and resultant poor grafting. Alcohol and smoking can contribute to poor graft survival. Post operative antibiotics are commonly prescribed to prevent wound or graft infections.

Harvesting methods

Transplant operations are performed on an outpatient basis, with mild sedation and injected local anesthesia. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested.

There are several different techniques for harvesting hair follicles, each with their own advantages and disadvantages. Regardless of the harvesting technique, 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 skins surface, so transplanted tissue must be removed at a corresponding angle.

There are two main ways in which donor grafts are extracted today. Strip excision harvesting, and follicular unit extraction.

Strip harvesting

Strip harvesting is the most common technique for removing hair and follicles from a donor site. The surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. 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. 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, which are small, naturally formed groupings of hair follicles, 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.

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 technicians generally do the final part of the procedure, inserting the individual grafts in place.

Strip harvesting will leave a thin linear scar in the donor area, which is typically covered by a patients hair even at relatively short lengths. The recovery period is around two weeks and will require the stitches or staples to be removed by medical personnel or sub cuticular suturing can be done.

Follicular unit extraction

With Follicular Unit Extraction harvesting, individual follicular units containing 1 to 4 hairs are removed under local anesthesia; this micro removal typically uses tiny punches of between 0.6mm and 1.0mm in diameter. 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 technicians generally do the final part of the procedure, inserting the individual grafts in place.

Follicular Unit Extraction takes place in a single long session or multiple small sessions. The Follicular Unit Extraction procedure is more time consuming than strip surgery. An Follicular Unit Extraction surgery time varies according to the surgeons experience, speed in harvesting and patient characteristics.

The procedue can take anywhere from a couple hours to extract 200 grafts for a scar correction to a surgery over two consecutive days for a megasession of 2,500 to 3,000 grafts. With the Follicular Unit Extraction Hair Transplant procedure there are restrictions on patient candidacy. Clients are selected for Follicular Unit Extraction based on a fox test, though there is some debate about the usefulness of this in screening clients for Follicular Unit Extraction.

Follicular Unit Extraction can give very natural results. The advantage over strip harvesting is that Follicular Unit Extraction harvesting negates the need for large areas of scalp tissue to be harvested, so there is no linear incision on the back of the head and it does not leave a linear scar.

Because individual follicles are removed, only small, punctate scars remain which are virtually not visible and any post surgical pain and discomfort is minimized. As no suture removal is required, recovery from Micro Grafting Follicular Unit Extraction is less than seven days.

Disadvantages include increased surgical times and higher cost to the patient. It is challenging for new surgeons because the procedure is physically demanding and the learning curve to acquire the skills necessary is lengthy and difficult. Some surgeons note that Follicular Unit Extraction can lead to a lower ratio of successfully transplanted follicles as compared to strip harvesting.

Follicular unit transplant

Follicular unit transplant is the traditional hair transplant method which involves extracting a linear strip of hair bearing skin from the back or the side of the scalp. The strip is then dissected to separate individual grafts.

Types of hair transplant surgery

There are a number of applications for hair transplant surgery, including:

  • Androgenetic alopecia.
  • Eyebrow transplant.
  • Frontal hair line lowering or reconstruction.

If donor hair numbers from the back of the head are insufficient, it is possible to perform Body Hair Transplantation on appropriate candidates who have available donor hair on the chest, back, shoulders, torso and or legs. Body hair transplant surgery can only be performed by the Follicular Unit Extraction harvesting method and, so, requires the skills of an experienced Follicular Unit Extraction surgeon. However, there are several factors for a potential Body Hair Transplantation candidate to consider prior to surgery. These include understanding the natural difference in textural characteristics between body hair and scalp hair, growth rates, and having realistic expectations about the results of Body Hair Transplantation surgery.

Post operative care

Advances in wound care allow for semi permeable dressing, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have the patient shampoo the day after surgery. Shampooing is important to prevent scabs from forming around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first seven to ten days post operation.

During the first ten days, some of the transplanted hairs, inevitably traumatized by their relocation, may fall out. This is referred to as a shock loss. After two to three months new hair will begin to grow from the moved follicles. The patients hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to slow such loss, while others plan a subsequent transplant procedure to deal with this eventuality.


Other Articles on Hair Replacement and Trichology

Hair loss in women

Androgenetic alopecia, is a type of hair loss that is commonly referred to as male or female pattern baldness. This condition was not really understood until the last few decades. For many years, scientists believed that androgenetic alopecia was caused by the predominance of the male sex hormone, testosterone, which women also have in trace amounts under normal conditions. But while testosterone is at the centre of the balding process, dihydrotestosterone, more commonly referred to as DHT, is now thought to be the main reason for hair loss in women.

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Hair Transplants: Potentially a Life Saving Procedure

There are many more bald celebrities these days, of that there is no doubt! Some of them may not even suffer from any form of hair loss, they simply prefer the bald look or it suits their public image more. One thing that is virtually unheard of though is a celebrity who is happy to put up with thinning hair. Bald yes, thinning no!

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Follicular Unit Transplantation (FUT) : In depth

Hair transplantation has become a minimally invasive surgical procedure that moves individual hair follicles from one part of the body that is called the donor site to a bald or balding part of the body that is known as the recipient site. This procedure is commonly used to treat male pattern baldness. The Follicular Unit Extraction involves the taking of grafts that contain hair follicles that are genetically resistant to balding. The donor area is often the rear or sides of the head and these grafts are then transplanted to the bald recipient part of the scalp. This amazing procedure can also used to restore eyelashes, eyebrows, beard hair, chest hair, pubic hair and to fill in scars that were caused by accidents or surgery such as face lifts and previous hair transplants. Follicular Unit Extraction and transplantation differs from skin grafting in that the 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.

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Hair Transplants for Women

Hair restoration surgery is considered a pretty good option for nearly 90% of men who are suffering from thinning hair or baldness, but what about women? When one thinks about a person losing their hair, a man usually springs to mind. If a women is seen with little or no hair, the assumption is that she has had chemotherapy, but women can lose their hair the same as men but unfortunately women generally do not make good candidates for hair transplant procedures.

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Wayne Rooney casually tweeted recently that he'd had a hair transplant. He had claimed that it was because he was going bald at the age of twenty five, which was clearly too early in his opinion.

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Why Have a Hair Transplant

We've all heard time and time again about how desirable and distinguished a man looks when his hair has gone. We also seem to be reminded on a daily basis that bald men have superior pulling power than men with a full head of hair, but is this true or just a myth put out there by bald people or others just attempting to be politically correct?

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Further Information

If you would like to know more or are interested in a quote we would be happy to help. Phone us on 020 7224 4640, email us at solutions@the-hair-clinic.co.uk or fill in our enquiry form and we will be in touch as soon as possible.