Follicular Hair Extraction (Excision)

Once the follicular unit is dead, no new hairs can be grown despite of treatment. Here lies the importance of hair transplant surgeries. Hair transplant can only be performed by harvesting dihydrosterone (DHT) resistant hair from the back of your own scalp, and then transplanting it into the balding areas.

In general, it is believed that hair transplanted from one person to another will be rejected unless anti-rejection medications are taken for life. The risk of taking these medications far out weigh the benefits attained from the transplant.

Typically, men experiencing male pattern baldness will remain with a permanent wreath of hair surrounding the sides and the back of their head, this is where hair is harvested from for transplantation.

The donated hair follicles, surrounding tissue and skin are called grafts . Each graft contains one or more hair follicles with accompanying hair, tissue, and skin.

It is important to remember that no two heads are alike, and each procedure should be looked at on an individual basis. Hair density is the number of hair follicles per squared centimeter of scalp.

Hair grows in several different directions from the scalp forward at the top and front, down or away from the middle and the sides of the head, and back or down in the rear.

It is important to remember that a natural hairline will vary from person to person. When a doctor chooses the recipient sites for hairline placement, several things should be taken into account – the shape of the face, the age of the patient, and the prognoses of future hair loss.

Understanding Hair Transplants

Where are my donor sites?

Male pattern baldness and female pattern baldness are terms that include the word pattern. That’s because there is a pattern to the baldness. The sides and back of the scalp are far less affected by the action of DHT upon their hair follicles. These areas are the donor sites.

More grafts of hair can be transplanted when your density is high and the scalp laxity is high.

Coarse hair is bulkier and can therefore be transplanted using fewer hairs per graft since it gives more coverage of the scalp. Fine hair has less bulb and can give a very natural look but less coverage than coarser hair. Wavy and curly hair lends itself to good visual results in transplantation because a single wavy or curly hair curls on itself and can therefore cover more scalp area than can a straight hair.

When designing your procedure, your doctor must keep in mind your future hair loss pattern and the rate of that potential hair loss. The design of your restored hairline is crucial. Natural front hairlines vary in shape and density from person to person.

The front and top of your head will receive transplanted hair first needed because these are the areas that frame your face and make the most impact on your appearance. The crown is usually the last area to receive hair (in later procedures), unless it’s your only balding area.

Am I a Candidate?

For the right candidate hair restoration surgery can significantly improve your appearance and general sense well being, however, not everyone is a good candidate for the surgery and those who are must have realistic expectations before undergoing a hair transplant procedure.

It is also important to note that surgery should always be your last resort after all attempts to stop the progression of your hair loss have been exhausted.

The best candidates for hair restoration surgery are:

Men who have been losing their hair due to male pattern baldness for more than five years or who have progressed to a Norwood class 3 or above.

Men with realistic expectations and who understand that their hair loss might continue to progress even if they are taking prescription medication to stop the progression.

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

Preparing for Surgery

You will receive specific instructions form your surgeon on how to prepare for your hair transplant surgery. It is imperative that you follow these instructions to the letter to help insure that your surgery is uneventful and without complications.

The guidelines provided will include information on drinking, smoking, and avoiding certain vitamins and medications. If you smoke it is extremely important to STOP at least two weeks prior to surgery and for a least one month after your procedure. Smoking inhibits blood flow to the skin and can interfere with healing and the final outcome of your hair transplant.

What is the procedure of doing hair transplant by Follicular unit extraction (FUE) technique?
Follicular unit extraction (FUE) is a modern method of doing hair transplant in which individual follicular units are directly harvested from the donor area with the help of specialized punches of sizes less than 1mm. After harvesting the donor area is given a small dressing to cover it and avoid bleeding. Here as compared to the strip method, no linear scar is formed and no sutures are required. The acquired follicular units are then carefully inserted in the bald area with help of microscope. The surgery is done under local anaesthesia and the patient is awake throughout the surgery. The entire surgery is absolutely painless after the anaesthesia is given.

Pre transplant instructions for the patient:

1. Surgery dates are confirmed by the patient.
2. All blood investigations are to be done 1 week before the surgery and to inform the doctor about the reports well in advance.
3. Avoid multivitamins and NSAID’s seven days prior to surgery.
4. Pre existing illness medications like blood pressure and diabetes to be continued till the day of surgery.
5. It is recommended to abstain from smoking for about 3 weeks before surgery. Smoking causes vasoconstriction of blood vessels and decrease blood flow to the scalp. Also carbon monoxide in smoke decreases the oxygen carrying capacity of blood. These factors may contribute to poor hair growth.
6. Avoid alcohol intake atleast 5 days prior to surgery.
7. Application of hair tonics and minoxidil to be stopped seven days prior to surgery.
8. Avoid wearing a t-shirt for the surgery and wear a shirt instead.
9. You can bring a collection of your favourite songs or movie in a pen drive to be played during the surgery.
10. Have good sleep of about 8 hrs prior night.
11. Wash your head thoroughly with shampoo on the day of surgery
12. Have your breakfast on the day of surgery and report to the clinic on the specified time.

Procedure-Surgery day:

On the day of the hair transplant surgery the patient comes to our clinic. The plan is reviewed and photographs are taken. Lines will then be drawn to demark the area that will receive the hair. More pictures are taken. The risks and benefits of the procedure are discussed in detail again and the patient is given a consent form to review and sign. The patient is then brought into the procedure room. The hair is trimmed with electric razor to a size of about 1 mm. After trimming the doctor will numb the area with a local anesthesia. With the help of specialised micro motor punches of size less than 1mm, individual follicular units will be harvested from the back area. Harvesting the follicular units will take about 2 to 3 hrs. Once harvesting is done a small dressing will be applied to the donor area to avoid bleeding and to give comfort while the patient keeps his head on the pillow for the next part of surgery.

After harvesting the specified number of grafts, the patient will be given a small meal. Next, the patient is reclined back into the chair and local anesthetic is applied to the bald or thinning area. After a few minutes the skin is numb at which time the hair transplant doctor painlessly creates hundreds or thousands of tiny sized slits in the area. All slits made by the doctor are under 1.mm in length and are made at the proper depth and angle to maximize results. The hair transplant patient feels no pain and is usually watching TV at this point while the grafts are placed one by one into the skin under magnification. At the end of the day it looks as if the patient has pimples on his head which represent the scabs of the new hair follicles. The patient goes home on the same day to have his meals and rest.

Post operative instructions for the patient-

1. You should NOT drive home alone after the surgery. You should arrange for a ride and should plan to take it easy for a couple of days
2. Sleep in an appropriate position to avoid rubbing of the recipient area.
3. Take all post operative medications including antibiotic and pain killers as prescribed by the doctor on time. have plenty of water.
4. Even though many doctors claim that you can return to work after a day or two, realistically you should plan on taking a least one week off from your job.
5. Take a mild shower after 48 hours of surgery and report to the doctor for removal of dressing and to inspect the condition of the inserted hair follicles.
6. Mild massage of the recipient area is to be done from 4th day of surgery to remove the scab. You can have normal bath from 7th day of surgery.
7. You may have swelling on your forehead and surrounding the eyes. Do not panic. Apply ice and cold pack. The swelling will subside and will not cause any harm to eyes.
8. You can start exercising, swimming and jogging after 10 days of surgery if you wish to.
9. Lack of sensitivity in the area of implant or donor area can be there for few days, weeks or months, but will not interfere with one’s day to day activity.

Overall Follicular Unit Extraction (FUE) is a very safe surgery done under local anesthesia. It requires about 6 to 8 hours to be completed. There is no downtime required and the patient can go to his office the very next day. The hairs start growing for about 3 to 4 weeks and then shed off. Once again the hairs re-grow and the best results are seen after 10 to 12 months post surgery.