Hair transplant

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Baldness treatment

Definitions, objectives and principles

Baldness is the most resented condition, in both men and women. It’s a very difficult and challenging condition to live with, but is now easily treatable via surgery. Recent innovations like micrografting, have greatly transformed this procedure, thereby reducing its enormity, and making it a virtually scar-free procedure. However, it’s not a case of “one size fits all”.  Different approaches and techniques apply to different situations. The following techniques or combinations thereof, are applicable on a case-by-case basis:

  •  Micrografting

  •  Scalp Flap surgery

  •  Tonsure reduction

  •  Scalp Lifting

When necessary, any or all of these techniques can be combined in a single patient, so as to achieve the desired result. Each case is unique, and will of course be analyzed for factors like scalp flexibility, hair quality, and personal preferences. Based on all these, along with the patient’s age and the scalability of baldness, the surgeon will be able to device a suitable approach.
Most transplants involve grafting from the crown of the hair, as it is the area least likely to be affected by hair loss or baldness. Hair is usually grafted from the crown on to other areas, like the hairline, tonsure area etc., by one of the methods listed above, in order to combat with baldness issues.

Before surgery

The surgeon conducts the pre-surgical evaluation and recommends the techniques to be used. The patient must stop taking any medication containing aspirin, 10 days prior to surgery.

Anesthesia

Most procedures are carried out under local anesthesia. In some special situations, the anesthetist may recommend general anesthesia, during the pre-surgical consultation.

Procedure

This procedure can be performed as an ambulatory one – meaning a day surgery with a same-day discharge, after some hours of monitoring.  However, in some special cases, a short hospitalization may be required. In those cases, the patient is usually admitted the previous afternoon or evening, and will be discharged on the following day.


As explained earlier, the surgeon adopts the best technique(s), to achieve the best possible result in a given case.

Micrografts

In this procedure, the scalp in the crown area is removed in strips of 8-10 cm long and 1-2 cm wide. Each strip is in turn divided into smaller fragments, each containing 1-3 (micrografts), or 4-8 (minigrafts) strands of hair. In the recipient (balding) area, multiple incisions are made, so as to hold these grafts.
Post-surgery, a small scab may form on each implant, but this will fall off, after about 2 weeks. This may cause some hair loss, but there will be regrowth before the 3rd month.  Repeated sessions may be needed on the same recipient site, in order to achieve the desired density of hair. The operation is very minor and is performed under local anesthesia.

Scalp flaps

In this procedure, strips of scalp, about 15-18 cm long and 3 cm wide, are removed from the donor area, along with the pedicle, and grafted onto the recipient area. The pedicle is necessary for the vascularization of the recipient area, and is therefore retained during removal. This is the only procedure that allows for a high density of hair to be transplanted to the frontal region of the head, in a single sitting. However, the flap technique carries some risks, which will be explained in detail by the surgeon during consultation. Scalp flaps is performed under local anesthesia, but it may require a few days of recovery time, before returning to active work.

Tonsure (bald patch) reduction

In this procedure, the surgeon removes a portion of the bald area, and sutures it back by stretching the scalp over, and suturing back, thus reducing the bald patch. Usually a patch of about 10 - 12 cm long, and 3-4 cm wide can be reduced using this technique. This procedure uses the elasticity of the scalp and is therefore more effective in patients with a fairly resilient scalp. The procedure is performed under local anesthesia and the patient can return to normal activities in no time. Repeat surgeries can be performed twice or thrice, with a few months gap in between them.

Scalp lifting

This procedure combines the dual operations of scalp reduction and scalp flapping of large regions, so as to cover large frontal regions of baldness.
This procedure allows for large areas of baldness to be fixed in just two operations. It is performed under general anesthesia, and requires a recovery time of 8 to 10 days, before one can resume one’s normal activities.

Recovery

Recovery duration of 8-10 days is required, during which the patient must refrain from professional work and activities. In case of micrografts, a small scab may form on each graft, and this falls off between 8 to 10 days. The transplanted hair falls along with the scab crust, but will regrow between the second and third months. The hair will grow at the rate of 1 cm per month. In case of tonsure reductions and scalp flaps, there is no hair fall. In these cases, the sutures are removed after 8 days. The patient is allowed to use shampoo after 48 hours in most cases. Sports and heavy activities can only be resumed after 4 weeks. The patient may experience some headache, which lasts a few days. There may also be some edema (swelling) and ecchymosis (bruises) the magnitude and duration of which, vary greatly from one individual to another.

Results

Micrograft results will only be visible for assessment after 3 – 6 months.  Multiple sittings or operations may be required to fully assess the desired result including the required density of hair. In all other techniques, the end results are immediately visible.

Possible complications

The correction of baldness, although carried out mainly for cosmetic reasons, is nonetheless a surgery, and therefore implies the same risks associated with any other surgical procedure. In hair transplant surgery requiring general anesthesia, the anesthetist will be able to provide detailed information to the patient regarding the risks associated with it. The risks of course are very minimal, given the fact that a fully qualified anesthetist, working in a surgical context, is present during the consultations as well as the surgery.

In the past twenty years, the science of anesthetics has advanced considerably, thus minimizing any possible risks associated with it. When performed on an otherwise healthy individual, the risks are almost non-existent. As for other kinds of risks and complications resulting from this procedure, they do occur in some cases, albeit very rarely.

Hair loss

Hair loss may occur in the periphery of the grafted area, 2 - 3 weeks after surgery. This is, however, temporary.

Hematoma

Bruising or hematoma may occur. The bruises are mostly benign and harmless, but if too large, they can be rectified during recovery period.

Infection

Although rare, infections may occur during a scalp operation, with micro abscesses developing on the sutures. These are however, easily treatable.  

Abnormal healing

This is very rare indeed in case of transplant patients.

Epidermal cyst

These are cysts that may appear on the hair transplant area, and can be easily treated and eliminated.  They are easy to remove and do not in any way, compromise the quality of the final result.

Temporary alopecia

Some patch hair loss may occur on the scalp flap. It is a minor ailment and may occur up to the 3rd week of recovery. After regrowth, the hair will look normal.

Skin necrosis

This is sometimes observed in flap techniques, and is usually limited and localized. This complication can be avoided by adapting correct techniques and the right approach.

Conclusion

Treatment of baldness is now a very advanced technique; via micrografts or other techniques provide therapeutic strategy and solutions for the hair loss problems in both men and women.

 

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Docteur Dany GZAÏEL - Cosmetic & Aesthetic Surgery

Doctor Dany GZAÏEL - Cosmetic & Aesthetic Surgery 

18, Rue de Magdebourg
 75116  PARIS - FRANCE
Tél : +33 1 45 05 26 16

Fax : +33 1 46 21 85 42-docteurgzaiel@free.fr