- Men who have been losing their hair due to male pattern baldness (MPB) for more than five years or who have progressed to a Norwood class 3 or above.
- Men who have been balding for many years and who's pattern has stabilized and are interested in just adding some hair to provide a more youthful appearance.
- Men and women who have lost hair due to trauma or burns
- Men and women who have lost hair due to other cosmetic procedures such as face-lifts (often the side-burns, along the incision sites).
- Women who have suffered hair loss due to mechanical or traction Alopecia (non hormonal)
- Women who have a distinct pattern of baldness, similar to that of male pattern baldness. This includes, hairline recession, vertex thinning, and a donor area that is not affected by androgenetic Alopecia.
- Women with alopecia marginalis, a condition that looks very similar to traction alopecia.
MEDICAL THERAPYMedical therapy is often used in conjunction with hair restoration surgery.
- Punch Harvesting -- This technique was used most commonly for harvesting donor follicles until the late 1980s or early 1990s. With the punch harvesting technique, a small hand engine is used (which spins approximately 10,000-15,000 revolutions per minute) with a 2- to 6-mm punch. Defects created from harvesting may be left to heal by secondary intention or may be closed using sutures or skin staples. Healing by secondary intention has been abandoned, largely because of results that are cosmetically inferior.
- Excision -- The donor site is excised as an elongated fusiform ellipse of full-thickness scalp using a scalpel blade size 10 or 15, taking care not to damage hair follicles at the edge of the donor tissue. The resultant defect is closed using suture or skin staples, and the scar is minimal. Then, donor tissue is dissected carefully into the desired number of grafts, which can vary in size.
- Strip harvesting -- A scalpel containing 2 or more size 15 blades mounted in parallel is used to cut strips of donor tissue. This facilitates the division of donor scalp into minigrafts and micrografts. Several multibladed scalpel handles currently are available that can accommodate as many as 6 or more No. 15 blades, which most commonly are spaced 1.5-2.5 mm apart. This technique may carry a higher risk of follicle transection than excision.
Recipient Site PreparationSeveral techniques are used for preparing recipient sites (where grafts are to be placed). They include:
- Single hair and slit grafting (micrografting) is most often used to recreate the frontal hairline.
- Dilation (modified slit grafting) -- Micrografting (grafts containing 1-2 hair follicles) or minigrafting can be performed using dilation. Micrografting most often is used to recreate the frontal hairline. This method has not become popular as it is typically slower than slit grafting and may result in compression of the grafts, especially when more than one hair follicle is grafted.
- Punch grafting -- a defect is created at the recipient site using a 1-4 mm diameter punch into which the graft may be inserted. The larger the size of the graft, the more likely it is to have what is termed a "doll's hair" or "cornrow" appearance.
- Laser-assisted grafting -- Carbon dioxide laser has been used to create recipient sites. Significant delay in the growth of the transplanted hairs usually occurs after laser-assisted transplantation.
- Antibiotic use -- Significant controversy remains regarding the use of prophylactic antibiotics in hair transplant surgery. The most appropriate time to administer prophylactic oral antibiotics (as single dose) is 1 hour preoperatively. Some surgeons use oral antibiotics for 3-5 days postoperatively to reduce risk of infection. For most patients, first-generation cephalosporin is used, unless a history of cephalosporin allergy exists and then azithromycin or ciprofloxacin may be substituted. Some surgeons also use topical antibiotics during the postoperative period to reduce risk of wound infection, although no benefit has been established yet.
- Corticosteroids -- Many surgeons administer oral or intramuscular corticosteroids to reduce postoperative swelling, although few data are available supporting this practice.
- Pain medications -- Some patients require oral narcotics for the first few days after hair transplantation. Usually, Tylenol with codeine, Percocet, or Lortab 5 is sufficient to alleviate most postoperative discomfort.
- Scarring at donor site
- Scarring at recipient sites
- Dyspigmentation at recipient sites
- Cobblestone appearance at recipient sites
- Failure of graft
- Cyst formation
- Poor results -- too large plugs used, doll's hair or corn-row appearance, poorly planned hairline, etc.
Hair Transplant Surgery Process: Photo Journal -- shows photos taken along the process, very nicely done.
Revised April 6, 2008
Hair Replacement Surgery, Hair Transplantation; Jorge l de la Torre MD, Gary D Monheith MD, John D Kayal MD; eMedicine Article, June 6, 2006
Surgical Hair Restoration -- American Hair Loss Association
Hair Replacement Surgery, Hair Transplantation in Women; Mark E Krugman MD and others; eMedicine Article, August 20, 2005
Hair Graft Transplantation for Baldness; Jeffrey S Epstein MD and others; eMedicine Article, October 17, 2005
Bernstein Medical Center for Hair Restoration Web-site (very nice with lots of information) and Blog