Overview Of The Procedure

Overview of the Hair Transplant Procedure

All techniques performed at Beauty and Health Clinic for Hair Transplant is based on founding techniques of Follicular Unit Transplant (FUT) and Follicular Unit Extraction (FUE). The essence of these procedures is that the hair is transplanted into the balding area as individual follicular units (naturally occurring groups of 1-4 hairs), so that it will appear totally natural and be unnoticeable as a hair transplant.

The two techniques vary in the way the hair is picked (detached) from the donor area in the back of the scalp.

Follicular Unit Transplant

In Follicular Unit Transplant a thin strip of hair is taken from the back and/or sides of the scalp and the area where the strip was taken from is stitched closed. The hair from above the cut covers the area so that it is not noticeable. The donor strip is placed under a sequence of special dissecting microscopes where the individual follicular units, of one to four hairs each, are prudently dissected into tiny grafts. These grafts are kept in a special holding solution and keep cold while awaiting placement.

The recipient sites are made in the bald or thinning areas of the scalp using a fine-needle size instrument. Once the recipient sites are made, the follicular unit grafts are prudently inserted into the scalp. The 1-hair grafts are placed at the front hairline, the 2’s immediately behind them and the larger 3- and 4-hair units are placed in the central, forelock area. The recipient site sizes are matched to the different size follicular unit grafts to ease healing and maximize the growth of the transplanted follicles.

Follicular Unit Extraction

In Follicular Unit Extraction (FUE) a relatively large area in the back and sides of the scalp is shaved to approximately 1-mm in length. Instead of removing a single strip, as in FUT, a tiny circular incision is made around each follicular unit. The follicular units are then extracted, one-by-one, directly from the scalp. These grafts are stored in a special holding solution and refrigerated while awaiting placement in the bald or thinning scalp (the recipient area). The tiny wounds are left open to heal on their own.

As in Strip method, recipient sites are made in the bald or thinning areas of the scalp using a fine-needle size instrument. The follicular unit grafts are then placed into these sites. While in FUE The follicular units are removed directly from the back and sides of the scalp using a small, circular cutting instrument.

All of our hair Transplant surgeries are performed under local anesthesia. Hair transplant sessions that use thousands of follicular unit grafts may take a 6 to 7 hours; however, the time goes by quickly. During the procedure, patients rest comfortably and can watch TV or a movie, take a nap, or chat with the staff.

The perceptions that people may have of hair transplant surgeries, where patients leave the office with their heads wrapped in bandages and have significant bleeding and pain, are from experience with the outdated, plug techniques. In modern follicular unit hair transplants, patients leave the office with only a hat and headband and are able to shower and shampoo their hair the day after the hair transplant surgery.

Before Hair Transplant Surgery

Earlier to your hair Transplant surgery, we demand routine blood tests including screening tests for HIV and Hepatitis. You should avoid alcohol, aspirin and other anti-inflammatory medications before your hair transplant surgery, as these may increase bleeding. Of course, if by chance you smoke, this should be stopped as well. The morning of your procedure, all you need to do is shower and must use Baboo shampoo, wear loose fitting clothes and eat breakfast without caffeinated drinks.

The Hair Transplant Procedure

The hair transplant is commonly an all-day procedure completed under local anesthesia and light oral sedation. After your scalp is anesthetized, the doctor removes the donor hair via a long, thin strip or through tiny round incisions. The strip is placed under microscopes for further dissection into individual follicular units of 1-4 hairs each. After all the hair is harvested, tiny recipient sites are made in balding areas of the scalp. The follicular unit grafts are then placed into these sites using very fine instruments. Once all the grafts are placed, the scalp is cleaned, a tennis-band dressing is applied and the patient is set to go home.

 

After Hair Transplant Surgery

Hair transplant surgery using either FUT or FUE, the procedure is noticeable for about a week to ten days after the procedure. Some patients cover the area with their existing hair and others choose to wear a hat when they are in public. Patients can restart normal activities the second day following their hair Transplant surgery, although there are some restrictions on certain exercises (with FUT) and smoking and drinking with either procedure. New hair growth starts to appear 2 to 3 months after the hair transplant and the hair restoration is usually fully grown out in about a year.

 

The Hair Transplant Procedure

When you reach for your hair transplant, the staff begins by going over the activities for the day. The surgical consent form that had been sent to you is reviewed and other paperwork is completed. The physician reviews the objects that have been recognized and answers any questions that you still might have. He will sensibly re-draw the hairline that was marked and photographed during your consultation and will add other markings to further explain the amount of the procedure. You will have a chance to study and discuss them before proceeding. The physician will then take high quality photographs that become part of your permanent medical record.

Sedatives, generally oral valium, are given to relax you before the start of the hair transplant procedure, but you can remain fully attentive if you like. You will be offered a movie selection and cable T.V. Most patients select to listen to music, see a movie (or two), or just chat with the doctor and staff. The graft dissection will be performed in the same room as your hair transplant surgery so that we can explain what we are doing and answer any questions that you may have.

The span of your hair transplant procedure will depend upon how may follicular unit grafts are transplanted. Small sessions of less than 1500 grafts can be finished by noon, but larger sessions, of 2,500 or more, generally take a full day.

We do our very technical job in a friendly, relaxed atmosphere, so that your experience is pleasant and so that the time goes by speedily. You will be able to take a series of pauses, to the restroom, to eat, or to just move around and stretch. Many of our patients tell us that all the attention and treating they received throughout the hair loss surgery made the experience truly enjoyable.

We take great protections to protect both our patients and ourselves from blood-born agents during the hair restoration procedure. Our patients and staff are routinely tested for HIV and hepatitis for everyone’s safety and security. All instruments are either sterilized in an autoclave or are disposable.

Local Anesthesia
After sedatives are given orally, we use a combination of the local anesthetic Lidocaine (Xylocaine), the anesthetic is administered only around the boundary of the scalp (called a ring block) to make the entire scalp numb. Once the scalp is numb, the rest of the hair restoration surgery is painless. If more anesthesia is required, usually around 5-6 hours into the procedure, it will be given before the initial medication wears off.

Since the scalp is very vascular, there is a commonly held belief that a permanent hair transplant is a bleeding procedure. In our hands, this is not the case. We have advanced techniques that both minimize bleeding and minimize the amount of medications that are needed.

 

Stereo-Microscopic Dissection
In Follicular Unit Transplantation, the individual follicular units (each containing from 1 to 4 hairs) are precisely dissected from the donor strip in their naturally occurring groups under firm stereo-microscopic control. The grafts are neat of extra tissue and the dominant skin between the units is waste. The follicular unit grafts are then sorted into groups containing either 1-, 2-, 3- or 4-hairs and kept.

Creating the Recipient Sites
Recipient sites are made by the hair transplant surgeon using a fine tool the size of a 20- 19- or 18-gauge hypodermic needle. For most procedures, we use lateral (perpendicular slits) for the recipient sites although vertical sites will be used when suitable in exact circumstances. The creation of the recipient sites determines much of the aesthetic look of the transplant – it sets the angle at which the new hair grows and determines the distribution and density of the grafts. Recipient site creation is a critical aspect of hair restoration surgery that requires considerable experience and surgical skill and a keen aesthetic sense.

Graft Insertion
once all of the recipient sites are made, the surgical team begins to place the follicular unit grafts into these pre-made sites. One-hair follicular units are used in the front hair line to give a soft, natural appearance and 3- and 4-hair grafts are used in the central forelock area to achieve maximum fullness. Placing is the most time-consuming part of the hair loss surgery. Graft placement is an exacting process and during this period you will be asked to keep your head comparatively still. Watching movies, TV or sleeping, will make the time go by quickly and, of course, you make take breaks as needed to go to the restroom, stretch or eat.

At the End of the Procedure
when placing is completed, the position of all of the grafts will be double-checked. The post-op instructions will be explained and a printed copy will be given to you to take home. This will include the doctor’s cell phone number.

 

After Hair Transplant Surgery

The night of your hair transplant surgery, and for the next few nights, you are encouraged to sleep with your head raised on pillows. Medication is given for sleep and pain (if needed). Antibiotics are generally not required. The morning after your hair transplant surgery, you will remove the headband. We’ll call you the next day to make sure that everything is OK. You won’t need to come into the office at this time, but are welcome to do so.

For the remainder of the week, you should shower twice a day. When showering, you will be instructed to gently clean the transplanted area with a special shampoo. The follicular unit grafts are made to fit neatly into the recipient sites and will not be removed in the shower, if you follow the instructions given to you. After your first shower, no further dressings are required.

Although you must be very gentle for the first week after hair loss surgery, normal shampooing, scrubbing and hair care can be recommenced after ten days since, by this time, the grafts are firmly in place. You can also have a haircut at this point. You are able to dye your hair, if you choose, four weeks after the hair transplant.

You should evade alcohol for three days following your hair replacement procedure and refrain from smoking for two weeks. When in strong sunlight, you should wear a hat.

Generally patients can continue normal daily routine almost immediately. Limited exercise can be started in the first week. You should avoid tireless exercise for several weeks following hair restoration surgery, depending upon the type of donor incision and the tolerance of your scalp.

Recipient Sites

At Beauty and Health Clinic, the recipient sites in all of our hair transplant procedures are made using lateral slits (also called coronal or horizontal slits). Lateral slits have the advantage of positioning the hair within the follicular unit to tie the way it grows in nature. They give the hair transplant surgeon the highest degree of control over the direction and angle in which the transplanted hairs will ultimately grow.

Hair Transplant – Recipient Sites

The density of recipient sites regulates how close together the follicular grafts are sited. The spacing of recipient sites depends upon a number of factors. These include:

  1. desired graft density for the hair transplant surgery
  2. location on the scalp (grafts are generally placed closer together towards the front of the scalp and father apart towards the crown)
  3. size of area to be covered with grafts
  4. total donor supply
  5. ability to safely harvest a specific number of grafts in one hair transplant session
  6. size of the individual follicular units (smaller follicular units can be placed into smaller recipient sites and smaller recipient sites can be placed closer together)
  7. popping and other local factors that limit the very close placement of grafts during the hair restoration procedure
  8. the ability of the scalp to support a specific graft density (sun damage, smoking, and long standing baldness are factors that limit the close placement of grafts)

Donor Area

Minimizing the scar from the donor incision is an acute part of a successful hair transplant surgery. A fine donor scar lets a person to keep his/her hair relatively short after the hair restoration (if one wants to do so) and increases the amount of hair that can be harvested (removed) in subsequent hair transplant procedures.

A number of techniques have been developed to minimize donor scarring when using a strip excision during Follicular unit transplant. These include the use of tumescent anesthesia, undermining, absorbable sutures, buried sutures, staples, and trichophytic closures. The technique of FUE, where follicular units are removed directly from the scalp without a linear incision, is covered in another section.

Size of the Donor Strip

Although the length of the donor incision is determined primarily by the number of follicular unit grafts required for the hair transplant surgery, the width (height) of the donor incision depends upon the patient’s scalp leniency. This is a genetic characteristic of the patient’s scalp that must be carefully measured by the hair transplant surgeon during the early evaluation. With good scalp leniency, a wider strip may be picked from the donor area without the risk of scarring, although patients with very loose scalps may be at bigger risk of a wide scar. If the scalp is too tight, taking a normal size strip may be impossible.

Most patients have 90-100 follicular units per cm2 in their donor area. Therefore, in a hair transplant of 2,000 follicular unit grafts, a donor strip that was 1cm wide would need to be slightly over 20 cm long to yield the appropriate number of grafts.

 Removing the Donor Strip

Tumescent Anesthesia

A major progress in the abstraction of the donor strip is the use of tumescent anesthesia. Tumesce simply means to magnify by injecting fluid into the tissues. In this technique, very thinned concentrations of anesthetic fluid are injected into the fat layer of the donor region of the scalp. This serves a number of purposes, the first is to decrease bleeding from the pressure of the fluid on small blood vessels (capillaries), the second is to firm the skin so that the incision can be more easily controlled and third, to increase the distance between the follicles and the deeper tissues of the scalp. This helps the surgeon keep the incision superficial so that the larger nerves and blood vessels in the scalp are not injured and so that the fascia is not cut. The front is a layer of fibrous tissue that lies just below the fat layer that gives support to the scalp. If this layer is cut, the risk of having a stretched scar is significantly increased.

Donor Closure

Absorbable Sutures

Monocryl is a synthetic absorbable stitch with very low tissue reactivity. It is absorbed by hydrolysis (dissolved by the water in tissues rather than by an inflammatory response) so that there is minimal hurt to follicles. The advantage of this closure is patient comfort, the convenience of not having to be removed and the complete control of the wound edges. However, in spite of these benefits, we now prefer to use staples in the majority of our cases due to the ability of stapled closures to best preserve the patient’s donor hair supply.

Trichophytic “Tricho” Closure

In a trichophytic closure, the surgeon makes the early incision parallel to the hair follicles and then trims away 1 to 3-mm of tissue of either the upper or lower wound edge (or both), so that the top of the hair follicles at that wound edge are removed. During the “tricho” closure, the trimmed wound edge is dragged towards the opposite edge so that the bottom parts of the cut hairs are pointing slightly towards the incision (rather than parallel to each other). The goal is that these hairs will eventually grow through the incision and thus decrease the visibility of the scar.

Graft Numbers

The chart following the Norwood Classification, gives overall guidelines for the number of follicular unit grafts needed in the first hair transplant procedure.

 


Advantages of Large Hair Transplant Sessions

There are a number of surgical benefits in accomplishment a large, first hair transplant procedure. In a virgin scalp the elasticity of the skin is intact, so that grafts can be placed more easily and will stay more securely in place. Another characteristic of a virgin scalp is an intact blood supply. This allows hair grafts to be placed close together without compromising their survival after the surgical hair restoration procedure.

Besides these technical matters, there are social motives for performing the restoration quickly. Multiple, small hair transplant sessions, spread over an extended period, keeps the patient focused on the very problem he wanted to spot-on. The quicker the restoration is completed, the quicker the hair transplant patient can focus on other,

Finally, in all hair transplant surgeries there may be some associated flaking (telogen effluvium) in the recipient area. The hair that is at greatest risk of being shed is the hair that has started to reduce (a change in hair shaft diameter that can best be appreciated with a densitometer). Shrank hair is at the end of its life span, so when it is shed, it may not return. In areas where there is a high degree of miniaturization, the shedding may be cosmetically significant. Unless a substantial amount of hair is transplanted in these situations, there may be little benefit from hair restoration surgery.

 Hair Transplant Repair

A significant number of hair transplant surgeries performed at Beauty and Health Clinic are used to correct the appearance of poorly performed hair transplants, old plug-procedures, scalp reductions and flaps that were performed at other institutions. Although a “bad hair transplant” can significantly affect a person’s quality of life, recent advances can often improve the cosmetic appearance of those who have had even the worst hair restoration procedures.

 

 

 

 

Hair Transplant Glossary

Androgenetic Alopecia (Male Pattern Baldness)
The most common type of hair loss in men. It is caused by the genetic vulnerability of hair follicles to the hormone DHT.

Auto graft
a graft taken from one part of the body and moved to another. In a hair transplant, the follicular unit grafts are allografts.

Camouflage
Camouflage in hair Transplant repair involves the placement of small grafts (micro-grafts or follicular units) in front of larger ones to make them look more natural.

Club Hair (Telogen hair)
A hair that has stopped growing. One that is in the telogen (resting) phase of the hair cycle. It is affixed to the skin with its “club-like” root, but will eventually be pushed out and replaced by a new growing hair.

Dermal Papilla
The dermal papilla is situated at the base of the hair follicle. The dermal papilla is composed of fibroblasts, blood vessels and nerves. This structure is extremely important in the regulation of hair growth and is a key element in hair cloning, as the cells that make up the dermal papilla (fibroblasts) can be multiplied.

Dissection
To separate tissue so that the inner structure can be examined and its purpose and relationship of its components distinguished. In follicular unit hair transplantation, it refers to the isolation of follicular unit grafts from a donor strip using a stereo-microscope.

Donor Site (Area)
The area of the scalp (generally the back and sides) where hair-bearing skin is detached during a surgical hair restoration procedure. For hair transplants to be effective, the hair in this area must be permanent.

Finasteride
The generic form of the brand name drugs Propecia and Proscar. Propecia is the 1mg tablet of finasteride used for the treatment of hair loss. Finasteride works to stop hair loss by blocking the creation of dihydrotestosterone (DHT) by inhibiting the enzyme 5 alpha-reductase. Proscar is manufactured by Merck and is FDA approved for the treatment of benign prostate enlargement.

Follicle
The structure in the scalp that produces a hair.

Follicular Unit
Hair follicles that grow together naturally as a group. They share the same blood supply, nerves and muscle.

Follicular Unit Graft
A graft that is comprised of a single, intact follicular unit of 1-4 hairs. It is the only type of graft that is used in follicular unit hair transplant surgeries.

Follicular Unit Extraction (FUE)
A procedure where single follicular units are removed directly from the donor area. Because this hair transplant surgery often does not produce completely intact follicular units, this procedure may not be considered follicular unit transplantation in the harshest sense.

Follicular Unit Transplantation (FUT)
A technique of hair transplant surgery where hair is transplanted entirely in its naturally occurring, individual follicular units. Single strip harvesting and stereo-microscopic dissection are required in the standard definition of this hair transplant surgery. More recently, follicular unit extraction techniques are also considered a subset of this procedure.

Follicular Unit Hair Transplantation (FUHT)
FUHT is just the more wordy version of FUT. It describes the same procedure.

Hair Shaft
The dead portion of the hair that overhangs from the surface of the skin. It is made primarily of the protein keratin.

Lateral Slits (Coronal Slits, Horizontal Slits)
A specific coordination of recipient sites made so that the length of the slit lies parallel to the hairline. This hair transplant technique is felt to offer better coverage than other recipient site orientations, as the hair from the grafts placed in lateral slits tend to fan out over the scalp.

Micro-graft
Technically, a 1-2 hair graft. It does not necessarily need to be a follicular unit, but may be two 1-hair units or part of a 3-hair unit etc. The term micro-graft is used more generally in hair transplant surgery as any small graft.

Mini-graft
technically, a 3-6 hair graft derived from either a single follicular unit, multiple follicular units, or multiple, partial follicular units. In practice, hair transplant surgeons often call grafts containing up to 10 or more hairs mini-grafts.

Mini-Micrografting
A method of hair transplant surgery which uses grafts containing 1-6 hairs, in groups that do not necessarily correspond to the naturally occurring follicular units. In this type of hair transplant procedure, the micro-grafts are generally placed at the frontal hairline and the minigrafts behind them (for density). Mini-micrografting procedures, although technically easier to perform, do not look as natural as follicular unit transplantation.

Post Hair Transplant Effluvium
Also referred to as shock loss, is shedding of some of the patient’s existing hair in the area of the transplanted hair following a hair transplant procedure. The term does not refer to the shedding of the transplanted hair – which is almost universal. The shedding generally begins a few weeks after the hair transplant and can persist for three or four months.

Recipient Area
The region on the balding scalp that hair is transplanted into during a hair restoration procedure.

Recipient Site
A tiny hole or slit made in the recipient area by a needle or other sharp instrument to accommodate a graft during a hair transplantation procedure.

Sebum
An oily emission manufactured by tiny sebaceous glands that open into the hair follicles and that serves to keep the hair lubricated and shiny.

Slit-graft (Linear graft)
A rectangular shaped graft generated by cutting a long strip into thin sections. This type of graft produced an unnatural look due to its large size and geometric shape. It is no longer used by most hair transplant surgeons.

Stereo-microscope
A stereo-microscope is a special microscope that produces depth of field and has illumination powerful enough to make a thin piece of donor tissue relatively transparent. The depth of filed is produced by two separate visual paths with two sets of lenses to provide slightly different viewing angles to the left and right eyes.

Stereo-microscopic Dissection
A technique used to segregate follicular units from the surrounding tissue in a donor strip.

Low-Level Laser Therapy

This technique is designed around a scientific concept known as photo bio-therapy. This involves the use of laser lights to stimulate cell growth. As with drug treatments, patients who seem to respond to this form of therapy have areas of thinning, rather than areas of the scalp that are completely bald. Laser therapy for hair loss can be administered in a doctor’s office and is also available in a smaller home version.

 

 

Camouflage Techniques

Using cosmetics is a common way of hiding ones hair loss and is often used by persons who are just starting to thin, especially in the crown. A number of over the counter products are now available that can make the hair look thicker. They come primarily in powders, sprays and creams. The main limitation of all of these products is that unless the person has a significant amount of hair to hold the cosmetics in place, it doesn’t look natural.

 

Hair Transplant Costs & Consultation Fees

Consultation Fees

Free of cost.

Hair Transplant Costs

The hair transplant surgery cost for a procedure in our Islamabad hair surgery center varies, depending on the number and type of follicular unit grafts that are transplanted in your procedure. The following section includes current price information for a hair transplant procedure.

Follicular Unit Transplantation (FUT)
The cost of a procedure using Follicular Unit Hair Transplantation using strip harvesting is  40 Rupees  per graft.

Follicular Unit Extraction (FUE)
The cost of a procedure using Follicular Unit Extraction is 100 per graft.

Other Information

Deposit

A 25% deposit is required to schedule a hair transplant surgery. The deposit is applied to the price of the session. This deposit is refundable up to ten (10) business days prior to your procedure.