Hair Transplant Surgery – Androgenetic Alopecia

Introduction to hair transplant surgery and androgenetic alopecia

It is well known that androgenetic alopecia (also known as Pattern Hair Loss) affects men and women, but few people talk about it. In a society governed by increasingly demanding beauty canons, it is advisable to approach the problem with the highest scientific rigor and seek solutions in expert hands so as not compromising the patient’s integral health.

Alopecia or baldness is one of the most common worries of a mid-aged man, maybe due to social standards or self-esteem. Although the hair is treated with the utmost care, the chances of losing hair volume increase as the years go by. In the great majority of cases it is due to androgenetic causes, it is linked to hereditary factors and hormonal causes related to testosterone. Other less frequent causes are local diseases of the scalp, such as alopecia areata, fungi, seborrhea, nutritional disorders, stress, chemotherapy, and others.

Medical management is the first step to fight this problem and two are the drugs most commonly used: Minoxidil 1-5% as topical treatment 1-2 times per day and Finasteride 0,5-1mg/day as systemic treatment (the second one only effective in men patients). When the hair loss is advanced already, hair transplantation is the next line of treatment.

Hair transplantation is a surgical procedure that implies the removal of a strip of skin covered with permanent hair from the occipital zone of the head to subsequently divide it and create micrograft and mini-grafts. These micrograft and mini-grafts are then implanted meticulously in the area of the scalp that presents baldness or reduction in density (receptor area).

Depending on the degree of baldness of the frontal or crown area, one to three interventions may be necessary, involving several hundred grafts to achieve the desired density. Within a period of 24 hours, small crusts form in each graft, which come off in the next seven to ten days. Usually, the grafted hair begins to grow again 12 weeks after the intervention and continues to grow throughout life.

Before opting for this alternative, it is very important that you know the pros and cons of this hair treatment, and thus be able to make the best decision:

Advantages of the Hair Transplant

• Significantly improves the appearance.
• You use your own hair, you are your own donor. There is no risk of rejection.
• The process is relatively quick and is performed under local anesthesia.
• The recovery after the procedure is fast, and after proper care, this is not so annoying (depending on the technique used).
• Long-term care is not necessary since the transplanted hair are permanent.
• Most people in good health can be candidates for a hair graft.

Disadvantages of the Hair Transplant

As any intervention, hair transplant may have side effects or risks:

• Although the procedure combats baldness and improves the appearance, it might require several long sessions of hair micrograft to see lasting and satisfying results.
• There is risk of infection.
• People with very thin and diffuse hair are not good candidates.
• Hair grafting can only be an effective treatment for people with well-located areas of baldness.
• There may be swelling and bleeding on the scalp.
• Symptoms such as numbness, inflammation, and others, might be experienced, but they should disappear within a few days.

About the Hair Transplant Surgery

It is a very laborious process (you have to implant the hair follicles one by one) and could be a long surgery depending on the number of units grafted, it usually takes 3-5 hours.

The surface to be covered with a hair transplant will depend on two factors: the patient’s ‘reserve’ of hair in the nape area and the total area of alopecia. In general, when the alopecia is not very advanced, almost all of the hair areas can be covered satisfactorily.

The transplanted hair is absolutely natural, from the patient himself. The reason for acquiring it from the area of the neck is that in that region the hair is genetically resistant to the process of alopecia so that transplanted hair will never be lost. However, it is important that the patient combines the hair transplant with an adequate medical treatment of their alopecia (minoxidil or antiandrogens) to avoid hair loss of the area that is not transplanted.

What is transplanted are follicular units, which include both the hair follicle and the follicular root. The latter is the important structure in a hair transplant, since it is the ‘factory’ of the hair follicle is the one that will continuously produce hair follicles in the same way as it would have done in the neck area.

Many patients think that hair transplantation is an exclusive therapeutic tool for men, but it is not so. In fact, doctors are currently transplanting both men and women. The cosmetic result is optimal in both, but it is very important to select patients appropriately.

Not everyone can have a hair transplant. The most important selection criterion is that the patient has a good donor area (must have an adequate ‘reserve’ of hairs from which to extract). In addition, it is important that the patient perform an adequate medical treatment to preserve the rest of the hair that have not been transplanted.

Currently, two techniques are used: the so-called FUE (Follicular Unit Extraction) and FUS (Follicle Unit Strip), it differs in the way of obtaining the micrograft or follicular units from the donor area.

FUE Hair Transplant Technique

It consists of an ambulatory surgical procedure, with local anesthesia, without forceps or scalpel. It is defined by the extraction of the follicular units individually, without the need to remove a strip from the scalp. It is a minimally invasive procedure that minimizes scarring, as it does not require suturing. In just 48 hours the intervened area begins to recover and in a few days the patient appreciates the changes.

The recovery of the intervened area begins almost immediately, with minimal restrictions and significant advances. The process of regeneration is progressive and depends on the metabolism of each patient. The results begin to be visible after a period of 3 months and it could take up to 1 year to appreciate the full results.

FUS Hair Transplant Technique

A strip of scalp is removed from the donor area, usually from the occipital zone, then the surgeon proceeds with the separation of the follicular units. In both methods the placement of the micro-implants in the bald or recipient area, is similar. The donor area is a single elliptical strip, about 1-1,5cm wide, and scarring can be avoided with proper surgical excision and suturing techniques. In both techniques, the scars in the receiving area are imperceptible.

Postoperative Care in hair transplant patients

The surgeon will advise on antibiotic therapy and analgesics following the procedure. Smoking and alcohol are to be avoided. Exercises involving head and neck should not be performed for at least 2 weeks after surgery. An antiseptic shampoo will be used for at least 1 week (but not in the first 48h). Finasteride may be started immediately, but minoxidil should be started a week after surgery, when the scabs fall off.

The majority of hairs transplanted will fall off in 2-4 weeks due to what is known as “telogen effluvium”, in this specific case caused by the stress sustained during surgery. Growth begins in the 4^th month and optimal results will be seen in 9-12 months.

Work and normal life can be resumed from the day following surgery.

Some swelling around the eyes might appear between the 3^rd and 5^th day after surgery and can be managed by sleeping in a more appropriate position and by applying icepacks.

Advices for prospective hair transplant surgery patients

As always proper training, knowledge and equipment are fundamental. The scalp is a heavily bleeding area of the body and the surgeon must be comfortable with the procedure. Dissection of the donor area requires skills that might not be taught while completing a residency training so specific in-theater training is required. Moreover, hair transplantation requires team work which becomes even more fundamental when the number of units grafted is high as the assistants are the ones to cut the grafts (dissecting them) and place them in the recipient area.

Synthetic hair implantation should never be accepted due to possible reactions (foreign body rejection, chronic infections). It is not an approved procedure in the USA as well as most EU countries.

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