Hair Transplant

Overview

A hair transplant moves hair follicles from one part of your scalp, where hair grows well, to areas where it has thinned or gone. The hair that is moved is your own, so it keeps the colour and texture it had before. Nothing artificial is implanted.

The hair is moved as grafts. A graft is a small group of one to four hairs that grow together naturally from the same spot, called a follicular unit. The area the surgeon takes them from is the donor area, usually the back and sides of the head. Hair there tends to resist the hormone (DHT, a by-product of testosterone) that shrinks follicles in pattern baldness, which is why it usually keeps growing after it is moved.

The procedure is done under local anaesthetic, so you are awake. Most people go home or back to their hotel the same evening. Turkey is a common destination for hair transplants, and patients also travel to Thailand, Mexico, India and Malaysia for them.

Who needs it

This is a cosmetic procedure. Nobody needs it for their health, and a careful surgeon will spend time on whether it makes sense for you before talking about numbers of grafts.

You are more likely to be a suitable candidate if:

• You have male or female pattern hair loss that has been fairly stable for a while.
• Your donor area is dense enough to give grafts without looking thin afterwards.
• Your expectations match what your donor hair can realistically cover.
• You are in good general health, with blood pressure and blood sugar under control.

A surgeon may advise waiting or against surgery if you are young and still losing hair quickly, because a hairline placed now may look out of place once more hair is lost behind it. Hair loss caused by illness, stress, iron deficiency or thyroid problems usually needs treating at its cause instead. Alopecia areata (patchy loss caused by the immune system) and diffuse thinning across the whole scalp are often poor reasons for a transplant.

Your donor supply is limited. Every follicle taken from the back of the head is gone from there for good, so planning matters, especially if you might want a second session years later.

How it is done

The main difference between techniques is how the grafts are taken out and how they are put in.

FUE (follicular unit extraction)

The surgeon removes grafts one by one from the donor area using a small round punch, usually under 1 mm across. The donor area is normally shaved short first. It leaves many tiny dot scars that are usually hidden by hair once it grows. FUE is the most common technique today.

FUT (follicular unit transplantation), also called the strip method

The surgeon removes a thin strip of scalp from the back of the head and closes the wound with stitches. A team then divides the strip into individual grafts under a microscope. FUT leaves a fine line scar, which shows only if you keep your hair very short. It can be a reasonable choice for people who need many grafts or who do not want the back of their head shaved.

DHI (direct hair implantation)

DHI is a variation of FUE. The grafts are taken in the same way, but they are placed with a pen-shaped implanter that opens the skin and inserts the graft in one movement, without opening the channels first. Some surgeons prefer it for hairlines and dense packing. It is usually slower and often costs more. No method suits everyone, and the skill of the team matters more than the name of the technique.

On the day

Expect a long day, often six to eight hours depending on the number of grafts. The surgeon draws the planned hairline with you first. You are given local anaesthetic injections in the donor and recipient areas, which sting for a short time. After the grafts are taken, they are kept in a cooled solution while the recipient sites are prepared. You can usually eat, rest and use the toilet during breaks.

Ask clearly who does each part. In some clinics a surgeon does the whole procedure. In others, technicians do much of the extraction and placement, and the rules about this differ between countries.

Recovery and how long you stay

Hair transplant is usually day care, so you leave the clinic the same day with a bandage around the donor area and instructions for sleeping with your head raised. Most people stay 3 to 5 days in the destination in total: a consultation and blood tests on arrival, the procedure, a check the next day, and often a first wash done by the clinic on day two or three.

What usually happens over the following weeks and months:

• First week: swelling of the forehead, sometimes around the eyes, peaks around day two to four and then settles. Small scabs form around each graft.
• Days 10 to 14: the scabs fall away with gentle washing. Any stitches after FUT come out around this time.
• Weeks 2 to 8: most of the transplanted hairs shed. This is expected. The follicles stay in the skin and rest before growing again. Some nearby native hair can shed too (called shock loss) and usually returns.
• Months 3 to 4: fine new hairs start to appear.
• Months 6 to 9: the hair thickens and the change becomes easier to see.
• Months 12 to 18: surgeons usually judge the result at about a year, and the crown can take longer.

Surgeons generally ask you to avoid alcohol for a few days, smoking for at least a couple of weeks around surgery (nicotine reduces blood flow to the grafts), heavy exercise for about two weeks, and swimming and direct sun on the scalp for some weeks. Risks include infection, bleeding, numbness of the scalp, folliculitis (small inflamed spots around hair follicles), poor graft growth and a donor area that looks thin if too many grafts are taken.

Flying soon after any surgery raises the risk of blood clots in the legs, so the surgeon decides when you fly. MediCurage can ask clinics in different countries to quote for the same graft estimate so you compare like with like, and books your room within easy reach of the clinic because you go back for the wash and checks.

Questions to ask your surgeon

Take these to your online consultation:

1. How many grafts do you think I need, and how much donor hair would that leave for the future?
2. Do you recommend FUE, FUT or DHI for me, and why?
3. Which parts of the procedure will you do yourself, and which will technicians do?
4. Will my donor area be shaved, and will the recipient area be shaved too?
5. Where would you place my hairline, given how my hair loss may progress?
6. Should I take any medicine to protect the hair I still have?
7. How are grafts counted in your quote, and what happens if fewer are taken than planned?
8. How will you follow my growth after I go home, and how often should I send photos?

Keep a set of dated photos from before the procedure. Comparing them with photos at six and twelve months is the clearest way for you and your surgeon to see how the grafts are growing.