Basics of Hair Transplantation

The Basics of Hair Transplantation
A declining hairline imitates age. The commonest form of hair loss is determined by our genes & male hormones & hence called Androgenetic alopecia or male pattern alopecia. This can affect both males & females. Apart from the hormones, hair flaking can be because of improper excess combing, disease/deficiency or psychological problem.

Hair transplant surgery can be carried out by various methods. The goal of hair transplant surgery is to restore a natural undetectable hair line as well hair style to the face, giving a sense of fullness & well-being to the patient.

The up-to-date techniques for reinstating hair are use of follicular, micro , mini and slit grafts, scalp reduction, slit grafts, scalp reduction, strip graft and flap procedure. Use of one or combinations of these techniques gives desirable and satisfactory result in suitable cases.

Follicular or single hair transplant surgery is also more and more common in use these days. They also give natural result. The benefit being that this can be achieved under local anesthesia on a day care basis and patient does not need hospitalization for this. The downside is that to get the desired density multiple sessions are to be performed.

Before using any procedure or taking any pills, it is very important to diagnose the cause of hair loss. This can be done with following investigations:

One is a simple method called trichogram, which involves examination of hair roots under microscope & other is by routine blood testing. There is a wide range of products available in the market but it is only after investigation, proper medicine can be prescribed by a doctor. In females, if the hormone levels are found to be raised, anti-androgens can be prescribed.


At an early stage, hair loss can be tackled by just medical therapy, but once the hair line starts to recede the only option left is Hair transplantation. The concept of “donor dominance” forms the corner stone of a successful Hair transplantation. This means that the hair on the back of the scalp (occiput) does not fall off, as they are devoid of the receptors on which hormones (testosterone) acts. These hair are thus grafted over the frontal region.

The Procedure


Hair follicles from the back of the scalp in the form a strip, measuring about 12 cm is taken & then dissected in to multiple small grafts i.e. Single, Micro (1-2 hair) or Mini grafts (3-4 hair) according to the need of the patient.

These are then grafted over the frontal region after making a frontal hairline. The number of the hair grafted depends upon the density of the back (occiput).From an average 12 -13 cm long strip, approximately 1200 hair can be taken out. Surgery is done under local anesthesia. First the bald area is divided in to “transition zone”& “defined zones” following which 1, 2, 3 hair follicular units are selectively & separately grafted to give a natural look with an acceptable density.

These grafted hair retain the property of the back hair & thus grow thick & long.

Hormones have no affect on them & they do not become fine.

Hair transplant surgery has also been under taken to correct alopecia of diverse etiology. Surgical restoration ofeyebrow, moustache destroyed by accident or burns have been performed with varying degree of success.

Unluckily, procedures like punch grafting, which are more familiar to the patients, should not be carried out in practice as they lead to “Doll hair appearance”.

The secret of effective hair transplant surgery not only lies in the procedure but also on the art & aesthetic with essence of hair styling.

Single Hair Transplant surgery is the gold standard for creating a natural hairline, which gives patients a natural look. We use “follicular unit” micro graft for frontal hairline to give a natural look & thus avoid scaring.

Management Of the Donar Area:
The donor area  i.e. from where the hair is taken, is stitched by continues sutures, which is removed after 10 days.

A dressing is done, which is removed after one night. Patient would be advised a course of antibiotics. After 5 days patient is advised to shampoo their hair. A list of instructions would be given to the patient following the surgery. Patient is strictly advised not to take alcohol or smoke for next 5 days following the surgery. There are no stringent restrictions & patient can even attend his or her office the very next day.


Hair line improvement is done for those patient who has already undergone one sitting of hair transplantation & wants a more fuller or denser look or those who is the initial stages of hair loss.


Management of hair loss with Tissue Expansion:
Tissue expansion is another technique of restoring hair which is though expensive, gives best result amongst all techniques in a suitable case. It involves two stage surgery 6 weeks apart. In first stage a balloon like device called tissue expander is inserted under the hair bearing area of scalp. This balloon is gradually inflated in a period of 6 weeks to expand hair bearing area of scalp .in second stage surgery this expanded hair bearing scalp is replaced over the bald area. This technique gives the best density and most pleasing result amongst all the techniques available today.


Female Hair Loss:
Female pattern of baldness usually begins at about the age of 30, becomes more noticeable at the age of 40, & even more after menopause. They usually show overall thinning of hair over the top of the head, but hairline is maintained. Females may also show male pattern of baldness. With correct diagnosis & investigation it can be arrested medically; & if not, even females can go for hair transplantation.


Possible Complications:

The incidence of complications is low, and when they do occur are relative minor.

The scalp is rich with blood vessels and therefore excessive bleeding is possible. It can usually be brought under control with pressure and, if necessary, with sutures. Infection is rare and can be controlled with antibiotics. Problematic scarring is also rare but may occur and depends largely on the patient’s predisposition to keloid formation.

Grafts that refuse to take are an unusual occurrence. More often than not the cause of graft failure is that the grafts are pulled out accidentally or are lost due to scalp injury. An unsatisfactory hairline may be adjusted by inserting more grafts or by removing them.

Hair loss of non transplanted hair may occur in the recipient area. This is commonly noted in an area of marked thinning. The hair that is lost is hair that is genetically predestined to fall out but the transplant tends to accelerate the attrition rate.

In grown hairs or pebbled graft sites may occur. Usually extraction with a needle and time will rectify this situation.

Swelling of the forehead occurs most commonly when larger sections of the front portion of the scalp are transplanted. When the swelling extends to the eyelids black eyes may results. In the 2% of cases that this occurs it is resolved with in 4 to 8 days after procedure.

Other problems may include allergic reactions to the anesthetic, pigmentary differences between grafts and recipient areas. And other equally rare complications all easily managed and corrected by the attending surgeon.